title: The utility of the CES-D as a depression screening measure among low-income women attending primary care clinics. The Center for Epidemiologic Studies-Depression.
abstract: OBJECTIVE
  Depressive disorders are among the most common medical disorders seen in primary care practice. The Center for Epidemiologic Studies-Depression (CES-D) scale is one of the measures commonly suggested for detecting depression in these clinics. However, to our knowledge, there have been no previous studies examining the validity of the CES-D among low-income women attending primary care clinics.
  
  
  METHODS
  Low-income women attending public primary care clinics (n = 179, ages 20-77) completed the CES-D and the Diagnostic Interview Schedule for the DSM-IV (DIS-IV).
  
  
  RESULTS
  The results supported the validity of the CES-D. The standard cut-score of 16 and above yielded a sensitivity of .95 and specificity of .70 in predicting Major Depressive Disorder (MDD). However, over two-thirds of those who screened positive did not meet criteria for MDD (positive predictive value = .28). The standard cut-score appears valid, but inefficient for depression screening in this population. An elevated cut-score of 34 yielded a higher specificity (.95) and over 50 percent of the patients who screened positive had a MDD (positive predictive value = .53), but at great cost to sensitivity (.45).
  
  
  CONCLUSIONS
  Results indicated that the CES-D appears to be as valid for low-income, minority women as for any other demographic group examined in the literature. Despite similar validity, the CES-D appears to be inadequate for routine screening in this population. The positive predictive value remains very low no matter which cut-scores are used. The costs of the false positive rates could be prohibitive, especially in similar public primary care settings.
authors.affiliation: Louisiana State University, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Thomas
authors.forename: G N
authors.initials: GN
authors.lastname: Jones
authors.forename: I C
authors.initials: IC
authors.lastname: Scarinci
authors.forename: D J
authors.initials: DJ
authors.lastname: Mehan
authors.forename: P J
authors.initials: PJ
authors.lastname: Brantley
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires