Validation of the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) in Zulu, Xhosa and Afrikaans populations in South Africa

Abstract

BackgroundThe 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) is a depression screening tool that has been used in the South African National Income Dynamics Study (NIDS), a national household panel study. This screening tool has not yet been validated in South Africa. This study aimed to establish the reliability and validity of the CES-D-10 in Zulu, Xhosa and Afrikaans. The CES-D-10’s psychometric properties were also compared to the Patient Health Questionnaire (PHQ-9), a depression screening tool already validated in South Africa.MethodsStratified random samples of Xhosa, Afrikaans and Zulu-speaking participants aged 15 years or older (N = 944) were recruited from Cape Town Metro and Ethekwini districts. Face-to-face interviews included socio-demographic questions, the CES-D-10, Patient Health Questionnaire (PHQ-9), and WHO Disability Assessment Schedule 2.0 (WHODAS). Major depression was determined using the Mini International Neuropsychiatric Interview. All instruments were translated and back-translated to English. Construct validity was examined using exploratory factor analysis with varimax rotation. Receiver Operating Characteristics (ROC) curves were used to investigate the CES-D-10 and PHQ-9’s criterion validity, and compared using the DeLong method.ResultsOverall, 6.6, 18.0 and 6.9% of the Zulu, Afrikaans and Xhosa samples were diagnosed with depression, respectively. The CES-D-10 had acceptable internal consistency across samples (α = 0.69–0.89), and adequate concurrent validity, when compared to the PHQ-9 and WHODAS. The CES-D-10 area under the Receiver Operator Characteristic curve was good to excellent: 0.81 (95% CI 0.71–0.90) for Zulu, 0.93 (95% CI 0.90–0.96) for Afrikaans, and 0.94 (95% CI 0.89–0.99) for Xhosa. A cut-off of 12, 11 and 13 for Zulu, Afrikaans and Xhosa, respectively, generated the most balanced sensitivity, specificity and positive predictive value (Zulu: 71.4, 72.6% and 16.1%; Afrikaans: 84.6%, 84.0%, 53.7%; Xhosa: 81.0%, 95.0%, 54.8%). These were slightly higher than those generated for the PHQ-9. The CES-D-10 and PHQ-9 otherwise performed similarly across samples.ConclusionsThe CES-D-10 is a valid, reliable screening tool for depression in Zulu, Xhosa and coloured Afrikaans populations.

High prevalence of HIV and non‐communicable disease (NCD) risk factors in rural KwaZulu‐Natal, South Africa

“…While the WHO estimates that 42% of the South African population is hypertensive, 32% have elevated levels of LDL and 11% with elevated blood glucose levels 27, these data found the prevalence of HTN to be 33.3%, LDL 19.8% and elevated blood glucose 3.9%. While study limitations restrict direct comparison to national datasets, obesity, HTN and elevated LDL levels appear to present a significant disease burden in this community.…”

“…A short form Patient Health Questionnaire (PHQ‐9) score of ten or more was used as the standard cut‐off indicating major depressive symptoms 25. The PHQ‐9 has been previously validated for use among all ages of the South African population 26, 27, 28.…”

Psychometric properties of a short form of the Center for Epidemiologic Studies Depression (CES-D-10) scale for screening depressive symptoms in healthy community dwelling older adults

“…For example, minimum sample size requirements at least doubled when moving from one to two factors CFA [34]. A review of the literature of published CES-D-10 validation studies revealed that except for one study with over 16,000 participants [20], sample sizes for one factor solution varied from as low as 47 to 755 [11,18,19,21,35–39]. Also, two studies with sample sizes of 1013 and 742 reported a two factor solution [16,17].…”

“…While the published validity studies of the CES-D-10 illustrated acceptable factorial validity there were indications that the factorial structure has not been consistently determined. For example while studies among adults in Zulu, Xhosa and Afrikaans in South Africa [19] and the USA Hispanics population [20] concluded a one factor solution had the best model fit, studies in Canadian adolescents [21] and Singaporian elderly [16] resulted in a two-factor model and validation studies in older Chinese populations [17,18] reported two-factor and three-factor models of the CES-D-10 respectively. These contradictory findings may be due in part to the use of: i) individuals with different cultural background; ii) differences in study sample age ranges; iii) participant characteristics (e.g.…”

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“…It is based on measures self-reported by the participants and collected in every wave of the NIDS. The CES-D scale has been used in a wide set of longitudinal studies and is a validated measure for the poorer populations living in South Africa [6].…”