Screening for Depression among Community-dwelling Elders: Usefulness of the Center for Epidemiologic Studies Depression Scale

Abstract

Context:Though common, depressive disorders often remain undetected in late life.Aim:To examine the usefulness of Center for Epidemiologic Studies Depression (CES-D) for identifying depression among older people.Settings and Design:Community resident older people (aged 65 years or more), were evaluated by clinicians trained in psychiatry, as part of a cross-sectional study of late-life depression. Assessments were done in the community.Methods and Material:The participants were assigned ICD-10 diagnoses and assessed using Montgomery-Asberg Depression Rating Scale (MADRS) and CES-D. A short version of CES-D with 10 items, translated to the local language Malayalam, was used.Statistical Analysis:The sensitivity and specificity of CES-D was evaluated against ICD-10 clinical diagnosis of depression. The correlation of CES-D and MADRS was assessed using Pearson correlation coefficient.Results:220 consenting adults from 3 wards of the Panchayath were assessed. On analysis of the Receiver Operating Characteristic (ROC) curve of CES-D scores in relation to clinical diagnosis, the large Area Under Curve (AUC) showed efficient screening and a cut off score of 4 in CES-D had a sensitivity of 97.7% and a specificity of 79.1% for depression. There was also good correlation between the MADRS and CES-D scores (0.838).Conclusion:CES-D is a short simple scale which can be used by health care professionals for detecting depression in older people in primary care settings.

Maternal depressive symptoms are negatively associated with child growth and development: Evidence from rural India

“…These associations attenuated in the full model after adjusting for child, maternal, and household factors and only remained statistically significant for fine motor development (β = −1.8 for low MDS and −3.9 for high MDS). Child development results are generally robust to an analysis that discretizes the CES‐D individual questions and then adopts a cut‐off of 4 as used in a previous study (Kumar et al, ). However, this treatment of the data fails to capture the negative relation between MDS and child growth observed at the highest decile of depressive symptoms (Tables S3 and S4).…”

“…MDSs were measured using the Center for Epidemiologic Studies Short Depression Scale (CES‐D‐10), an adaptation of the 20‐question scale in common use (Radloff, ). The shortened set of questions has been validated in various settings (Irwin, Artin, & Oxman, ; Zhang et al, ), including India (Kumar, Nakulan, Thoppil, Parassery, & Kunnukattil, ). The CES‐D‐10 scale includes a 10‐item checklist that measures symptoms of depression experienced over the past week, including feelings of bother, distraction, hopelessness, restlessness, and sleep disturbance.…”

“…Each item can be scored on a scale of 0–3, yielding a range for the possible summary score from 0 to 30, with higher scores indicating increased severity of depressive symptoms. Some studies reduce 0–3 responses to yes/no dichotomies yielding a possible total score of 0–10 (Irwin et al, ; Kumar et al, ). We conduct analysis on the full score, but all reported results are robust to such a score truncation.…”

“…Many of the previous studies collapse the CES‐D‐10 scores into a binary indicator with a local cut‐off that represents a likely diagnosis of depression (Irwin et al, ; Kumar et al, ). However, for our purpose of understanding depressive symptoms as a risk factor, we instead examined the association between MDS and child development in a flexible manner.…”

“…Therefore, we decided to adopt a flexible specification with three cut‐offs to capture this heterogeneity in the relation between MDS and child development: low (first five deciles, score ≤ 8), medium (next four deciles, score 9–14), and high (highest decile, score ≥ 15). We also conducted sensitivity analysis, applying the same method to collapse the CES‐D‐10 scores into a binary indicator with a local cut‐off of ≥4 (Kumar et al, ), which is roughly at the lowest quartile in our sample. This cut‐off includes mild, moderate, and severe depression under other criteria for diagnosis reported in that study, although cut‐offs for moderate and severe depression were not reported.…”