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Criterion Validity of the 10-Item Center for Epidemiological Studies Depression Scale (CES-D)

Michael Irwin, MD; Kamal Haydari Artin, MD; Michael N. Oxman, MD

Arch Intern Med. 1999;159:1701-1704.

Background  The Center for Epidemiological Studies Depression Scale (CES-D) has been widely used in studies of late-life depression. While the CES-D is convenient to use in most settings, it can present problems for elderly respondents who may find the response format confusing, the questions emotionally stressful, and the time to complete burdensome. A briefer 10-item version has been proposed, but there are few data on its properties as a screening instrument.

Methods  The 10-item CES-D was administered in 2 studies. In study 1, a stratified sample of middle-aged depressed patients (n=40) and comparison controls (n=43) were administered the CES-D to determine an optimal cutoff score. In study 2, the accuracy of the CES-D optimal cutoff score was tested in a sample of adults older than 60 years (n=68). Major depression diagnoses were derived from the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, with consensus diagnoses usingDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Results  Reliability statistics with the 10-item CES-D were found to be comparable to those reported for the original CES-D. Using an optimal cutoff score of 4 in study 1, the sensitivity of the 10-item CES-D was 97%; specificity, 84%; and positive predictive value, 85%. In the study 2 sample of older adults, the sensitivity of the CES-D was 100%; specificity, 93%; and positive predictive value, 38%.

Conclusion  The 10-item CES-D has excellent properties for use as a screening instrument for the identification of major depression in older adults.

From the Departments of Psychiatry, School of Medicine (Drs Irwin and Artin), and Departments of Medicine, Infectious Diseases Section (Dr Oxman), University of California at San Diego and the Veterans Affairs Healthcare System.

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