Centre of Epidemiology Studies Depression Scale (CES-D)

Centre of Epidemiology Studies Depression Scale (CES-D)

Lenore Sawyer Radloff originally developed the CES–D in 1977.  The scale was developed as a screener for the presence of depressive symptoms in adults (Radloff, 1977).  The CES–D consists of 20 items in a self-report format measuring depressive symptoms experienced in the past week on a 4-point Likert scale ranging from 0 (rarely or none of the time) to 3 (most or all of the time). Example items include “during the past week I was bother by things that don’t bother me” and “I thought my life had been a failure” (Radloff, 1977).  Scores can range from 0-60 and are calculated by adding numbers from each item, with reverse scores on question 4, 8, 12, and 16 (Radloff, 1977).  A score of over 16 on the CES–D indicates the individual may have depressive symptoms that could indicate a disorder may be present; therefore, further assessment should take place (Radloff, 1977).  The CES–D can also be used for the observing the decline or increase in depressive symptoms throughout an individual’s treatment (Radloff, 1977).  The CES–D was developed in the United States of America and has been tested in both African American and white American adults.  In addition, studies demonstrated the scales validity and applicability for individuals ranging from adolescence to old age and for different cultures including Chinese populations (Cheng & Chan, 2005).  Additionally, norms for the CES–D have been established in an Australian sample (Crawford, et al. 2011).

In regards to psychometric properties the CES–D was tested against other scales measuring depressive symptoms, including the Hamilton Clinician’s Rating Scale and the Raskin Rating Scale and showed moderate correlations of .44 to .54 (Radloff, 1977).  Radloff (1977) stated this convergent validity improved after treatments were administered for 4 weeks (0.69 to 0.75), however, there may be many factors involved in this correlational increase and individuals should be wary about this finding.  The tool had good internal consistency ranging from Cronbach’s alpha 0.85 to 0.90 and has an okay test-retest reliability with all correlations except one ranging from 0.45 to 0.70 (Radloff, 1977).

The factor structure for the CES–D was separated into four factors measuring depressed affect, positive affect, somatic and retarded activity, and interpersonal functioning (Radloff, 1977).  Recent research by Carleton et al. (2013) has suggested that a three-factor model of negative affect, anhedonia and somatic symptoms with 14-items produces a better model fit with current DSM criteria.  Additionally, Carlton et al. (2013) also criticises some of the original scales questions in regards to relevance and wording, (e.g. Question 17 – I had crying spells).  Furthermore, Eaton (2004) revised the scale of the CES–D that included question rewording and some self-harm indicators that were not included in the original scale.  For example, “I wanted to hurt myself” and “I wish I was dead” rated on the 5-point Likert scale ranging from 0 (not at all or less than 1 day) to 5 (nearly every day for 2 weeks).

The CES–D is a freely available tool to the public and can be accessed on the internet.  In addition, there is an online version for the CESD–R that can be accessed by the public as a self-administered measure and can give the individual advice on whether to follow up symptoms with a health care professional (The Centre for Epidemiological Studies Depression Scale Revised, n.d.).  It is important to note that the CESD–R was never created as a diagnostic tool; however, health professionals can use it as a quick and cost effective screener before administering further diagnostic measures (Radloff, 1977).  The CES–D could also be used in research for measuring depressive symptomology in participants, however it cannot be stated an individual has Major Depressive Disorder based on the results of the scale.  In conclusion, the CES–D and the CESD–R can be used to detect depressive symptoms in individuals from adolescence to old age and in a range of cultures, however it is important to note it may not be applicable for all cultures.  The tools are generally a reliable and valid measure for depressive symptomology, however, it is important the tools administered are for screening or monitoring purposes and used with additional assessments including clinical judgement when making a formal diagnosis (Radloff, 1977).

References

Carleton R. N, Thibodeau M. A., Teale M. J., Welch P. G., Abrams M. P. , Robinson T., Asmundson G. J. (2013). The center for epidemiologic studies depression scale: a review with a theoretical and empirical examination of item content and factor structure. PLoS One. doi: 10.1371/journal.pone.0058067.

CESD-R The Centre of Epidemiology Studies Depression Scale Revised. (n.d.). Retrieved from http://cesd-r.com/cesdr/.

Cheng S. T. & Chan, A. C. (2005). The Centre for Epidemiologic Studies Depression Scale in Older Chinese: Thresholds for long and short forms. International Journal of Geriatric Psychiatry20(5), 465–470. doi: 10.1002/gps.1314.

Crawford, J. R., Cayley, C., Lovibond, P. F., Wilson, P. H., & Hartley, C. (2011). Percentile norms and accompanying interval estimates from an Australian general adult population sample for self-report mood scales (BAI, BDI, CRSD, CES-D, DASS, DASS-21, STAI-X, STAI-Y, SRDS, and SRAS). Australian Psychologist46, 3–14. doi:10.1111/j.1742-9544 .2010.00003.x

Eaton W. W., Muntaner C., Smith C., Tien A., Ybarra M.  (2004). Center for Epidemiologic Studies Depression Scale: Review and revision (CESD and CESD-R). In Maruish M. E., (Eds.). The Use of Psychological Testing for Treatment Planning and Outcomes Assessment. (pp. 363-377). Mahwah, New Jersey: Lawrence Erlbaum.

Radloff L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement1 3, 85-401.

The Centre of Epidemiology Studies Depression Scale Revised (CESD-R). (n.d.) http://www.brandeis.edu/roybal/docs/CESD-R_Website_PDF.pdf.