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.
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.
Thomas
J L
JL
Louisiana State University, USA.
Jones
G N
GN
Scarinci
I C
IC
Mehan
D J
DJ
Brantley
P J
PJ
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