Screening value of the Center for epidemiologic studies – depression scale among people living with HIV/AIDS in Ho Chi Minh City, Vietnam: a validation study

Abstract

BackgroundDepression is believed to be under-diagnosed and under-treated in people living with HIV/AIDS (PLHIV). Early screening and referral to mental health services for treatment has been shown to enhance HIV patients’ health during the course of HIV treatment. A lack of psychiatric specialist services for PLHIV at outpatient clinics (OPC) in Vietnam leads to insufficient identification of depression. However, alternative approaches are available such as the use of screening scales. This study investigated the psychometric properties of the Center for Epidemiologic Studies – Depression scale (CES-D) in Vietnamese HIV positive outpatients.MethodsA cross-sectional survey of 400 HIV positive outpatients was conducted in Ho Chi Minh City, Vietnam. Participants completed a self-reported questionnaire that included the CES-D. Participants were also interviewed independently by a psychiatrist who assessed for symptoms of major depressive disorder. CES-D reliability was measured by Cronbach’s alpha. Criterion validity was evaluated by ROC analysis, Kappa index and the percentage of agreement between the CES-D and psychiatrists’ interview. Construct validity was investigated by confirmatory factor analysis.ResultsThe reliability for the whole scale was good (Cronbach α = 0.81). The four sub-scales of the CES-D had lower levels of internal consistency with Cronbach alpha of 0.71, 0.73, 0.71 and 0.58 for somatic complaints, depressive affect, positive affect and interpersonal problems respectively. CES-D has adequate construct validity with CFI = 0.926, IFI = 0.927, GFI = 0.930 and RMSEA = 0.045 (90 % CI = 0.037–0.053) in the final four-factor model. Area under curve was 0.88 indicating good criterion validity. At the cutoff of 16, the sensitivity and specificity were 79.8 % and 83.0 % respectively while the percentage of agreement between the CES-D and psychiatrists’ interview was 82.0 % with Kappa index at 0.60.ConclusionsThe CES-D was shown to be acceptable, reliable and valid for screening symptoms of depression in Vietnamese HIV outpatient clinic settings where mental health specialists are not always available. Routine use of the CES-D at HIV outpatient clinics, in combination with the availability of free-for-all national mental health services, is likely to be beneficial in improving the lives of PLHIV in Vietnam who have depression.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0860-3) contains supplementary material, which is available to authorized users.

Social Support as a Key Protective Factor against Depression in HIV-Infected Patients: Report from large HIV clinics in Hanoi, Vietnam

“…The prevalence of depression found in this study (26.2%) was relatively lower than that in previous studies targeting Vietnam’s HIV population, and using the same cut-off score for CES-D (36.5–78.0%) 6 , 18 , 19 . However, the prevalence in the present study was near that reported for Vietnam’s general population (24.3%) 49 .…”

“…CES-D is a widely used self-reporting scale for measuring depressive symptoms that participants experience 34 , 35 . There is strong evidence for both its reliability and validation in Vietnam’s HIV population, with Cronbach’s alpha of 0.81, and sensitivity and specificity of 79.8% and 83.0%, respectively, at the cut-off score of 16 19 .…”

“…We used the Vietnamese version of CES-D, which was already available, and in this study defined a CES-D score of ≥16 as indicating depression. This cut-off score has been proven optimal for assessing depression in Vietnam’s HIV population 19 .…”

“…The study was approved by the Human Research Ethics Committee of the National Center for Global Health and Medicine (reference: NCGM-G-001845-00), BMH (reference: 19 /BM-HDDD), and NHTD (reference: 12 /HDDD-NDTU). We performed this study in accordance with the Japan Ethical Guidelines for Medical and Health Research Involving Human Subjects issued by Japan Ministry of Health, Labor and Welfare, in Dec 2014.…”

“…However, few studies have addressed this issue in Vietnam 6 , 17 – 20 . These studies have had several limitations, such as relatively small sample size 18 , 19 , focusing on only a subgroup of the HIV population (e.g., males or sex workers) 18 , 20 , and using poorly validated instruments 17 .…”