Center for Epidemiological Studies Depression Scale

What it measures?

• The Center for Epidemiological Studies Depression Scale (CESD-R) is a self-report questionnaire designed to measure depressive symptoms in the general population. It aims to identify the frequency and severity of depressive symptoms experienced over the past week (i.e. restless sleep, poor appetite, and loneliness).  
• The CESD-R has been employed with the general population and diverse samples to assess depressive symptoms (e.g. people experiencing specific chronic illnesses).

Who is it for?

* Adults aged 18 years + * The CESD-R can also be used with adolescents, with a systematic review supporting a four-factor structure when employed with tis age group (Blodgett et al., 2024)

Instrument Quality

• The psychometric properties of CES-D Scale (including test-retest reliability, internal consistency, factorial validity, convergent validity, and construct validity) have demonstrated adequacy across multiple studies (i.e. Hann et al., 1999; Orme et al., 1986; Radloff, 1977).

Structure

• 20-items covering six major dimensions of depression, including: depressed mood, feelings of guilt and worthlessness, psychomotor retardation, feelings of helplessness and hopelessness, sleep disturbance, and loss of appetite.
• Respondents are asked how often (0 = “rarely or none of the time”; 3 = “most or almost all the time”) they felt or behaved in line with each statement (e.g. “I had trouble keeping my mind on what I was doing”) during the past week.

Scoring instructions

• Sum all items to derive the full-scale score.

Score Interpretation

What higher scores mean?

• Higher scores indicate a higher risk of clinical depression being present. The total score ranges from 0 to 60, with more elevated scores indicating more profound depressive symptoms. Typically, individuals scoring 16 or higher are considered to be at risk for Major Depression; however meta-analytic research analysing 28 individual studies (N = 10,617) found that a cutoff score of 20 may be more appropriate (Vilagut et al., 2016). At the cut-off score 16, sensitivity was 0.87 (95% CI: 0.82–0.92), specificity 0.70 (95% CI: 0.65–0.75); At a cutoff score of 20, sensitivity = 0.83, specificity = 0.78 (95% CI: 0.75–0.89); Haringsma and colleagues (2004) reported that the optimal cut-off score for identifying Major Depressive Disorder in older adults was 25, (sensitivity 85%, specificity 64%, and positive predicted value of 63%). For identifying clinically relevant depressive symptoms in the using sample, the optimal cut-off was 22 (sensitivity 84%, specificity 60%, and positive predicted value 77%). According to the official website for the CESD-R, the following information can be used to further categorise symptom severity: Criteria for Major Depressive Episode: Persistent lack of interest or depressed mood almost every day for the last two weeks, along with symptoms from at least four additional DSM categories, also present nearly every day during this period. Likely Major Depressive Episode: A nearly daily loss of interest or low mood for the last two weeks, accompanied by symptoms from three other DSM categories, either occurring nearly every day for two weeks or for 5-7 days in the past week. Potential Major Depressive Episode: A near-daily experience of anhedonia or depressed mood over the last two weeks, along with symptoms from two additional DSM symptom groups, either present nearly every day for two weeks or for 5-7 days within the past week. Subthreshold Depression Symptoms: Individuals with a score of 16 or higher on a CESD-like scale but who don’t meet the criteria listed above. Not Clinically Significant: Individuals scoring below 16 on a CESD-style measure across all 20 items.

Identifying risk

A patient may be at risk if they endorse any of the following ‘red flag’ items. Further risk assessment should be undertaken.

Instrument developers

• Radloff, L. S. (1977). The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306

Refrences

* Blodgett, J. M., Lachance, C. C., Stubbs, B., Co, M., Wu, Y. T., Prina, M., ... & Cosco, T. D. (2021). A systematic review of the latent structure of the Center for Epidemiologic Studies Depression Scale (CES-D) amongst adolescents. BMC psychiatry, 21, 1-8. * Haringsma, R., Engels, G. I., Beekman, A. T. F., & Spinhoven, Ph. (2004). The criterion validity of the Center for Epidemiological Studies Depression Scale(CES-D) in a sample of self-referred elders with depressive symptomatology. International Journal of Geriatric Psychiatry, 19(6), 558–563. https://doi.org/10.1002/gps.1130 * Radloff, L. S. (1977). The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306 * Vilagut, G., Forero, C. G., Barbaglia, G., & Alonso, J. (2016). Screening for Depression in the General Population with the Center for Epidemiologic Studies Depression (CES-D): A Systematic Review with Meta-Analysis. PLOS ONE, 11(5), e0155431. https://doi.org/10.1371/journal.pone.0155431