Description:
The Center for Epidemiological Studies-Depression
Scale (CES-D) is a 20-item instrument that can be self-administered
or administered with minimal involvement by an interviewer.
The instrument was developed by the National Institute of
Mental Health to detect major or clinical depression in the
general (nonpsychiatric) adult population (i.e., persons older
than 18), specifically the frequency and duration of cognitive,
affective, and behavioral depressive symptoms (within the
past week).
Uses of Information: The CES-D is used for initial screening
of symptoms related to depression or psychological distress.
However, because the CES-D does not assess the full-range
of depression symptoms (for example, it does not assess suicidality)
and because it assesses the occurrence of the symptoms during
the past week, users are cautioned against relying on the
CES-D exclusively. It has also been used extensively for research
purposes to investigate levels of depression among the nonpsychiatric
population.
Reliability: (1) Internal consistency reliability (Cronbach’s
alpha) ranged from .84 to .90 in field studies. (2) Test-retest
reliability: Ranges from .51 to .67 in 2- to 8-week intervals
and .41 to .54 in 3-to 12-month intervals.
Validity: (1) Concurrent validity:
studies have examined the degree to which CES-D scores are
in agreement with other measures of depression. These studies
found CES-D to have correlations ranging from .50s to .80s
with the Hamilton rating scale, .30s to .80s with the Raskin
rating scale, .40s to .50s with the Lubin Depression Adjective
Checklist, .60s and .20s, respectively, with the Bradburn
Affect Balance Scale’s Negative Affect and Positive
Affect Scales, .50s with the Langner scale and .43 with the
Cantril life satisfaction ladder. Discriminant validity tests
found CES-D to be less successful in differentiating between
depression and other types of emotional responses, such as
anger, fear, and boredom.
Method of Scoring: Respondents indicate the frequency or
duration of time (in the past week) during which they have
experienced certain feelings/situations. They circle a number
between 0 and 3; 0 indicates that the situation occurred “rarely
or none of the time” (less than 1 day), 1 indicates
“some or a little of the time” (1 to 2 days),
2 indicates “occasionally or a moderate amount of time”
(3 to 4 days), and 3 indicates “most or all of the time”
(5 to 7 days). After adjusting the scores for the four positive-feature
items, the item scores are summed to obtain the total scale
score.
Interpretability: The possible range of total scores is from
0 to 60, with higher scores indicating greater distress. Radloff,
the author of the scale, suggests that that a total score
of 16 be used as the cutoff to indicate “case”
depression. However, other studies have suggested that scores
of 0 to 15.5 be interpreted to indicate that an individual
is “not depressed”, 16 to 20.5 to indicate “mild
depression”, 21 to 30.5 to indicate “moderate
depression”, and 31 or higher to indicate “severe
depression”. It is suggested that the scale be used
only as an indicator of symptoms relating to depression, not
as a means to clinically diagnose depression. Therefore, higher
scores on the CES-D scale may indicate a need for further
clinical tests/screenings. However, because of the CES-D’s
limitations, a low score does not necessarily indicate the
absence of clinical depression.
Training Support: None described.
Adaptations/Special Instructions for Individuals with Disabilities:
None described.
Report Preparation Support: None described. References:
Devins, Gerald M. and Carolee M. Orme. “Center for
Epidemiologic Studies Depression Scale.” In Test Critiques,
edited by D.J. Keyser and R.C. Sweetland. Kansas City, MO:
Test Corporation of America, 1985.
Radloff, L.S. “The CES-D Scale: A Self-Report Depression
Scale for Research in the General Population.” Applied
Psychological Measurement, vol. 1, 1977, pp. 385-401.
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