title: Assessment of depression in rheumatoid arthritis: a modified version of the center for epidemiologic studies depression scale.
abstract: OBJECTIVE
  The Center for Epidemiologic Studies Depression Scale (CES-D) is an instrument commonly used to assess depressive symptoms. Although the psychometric properties of the instrument are well established, the instrument's ability to identify confirmed cases of major depression has been unclear. The purpose of this study was to evaluate the ability of cutoff scores from both a full scale and a modified CES-D to detect major depression in people with rheumatoid arthritis (RA).
  
  
  METHODS
  Data were analyzed from 457 persons with RA, including 91 who met criteria for major depression.
  
  
  RESULTS
  Results indicated that, in general, a full scale cutoff score of 19 was the most efficient in identifying cases of major depression; the cutoff score of 19 outperformed a variety of other cutoff scores from the modified scale. Even the most efficient cutoff scores, however, demonstrated problems in accurately identifying people with depression.
  
  
  CONCLUSIONS
  The CES-D, while potentially useful as a screening tool, should not be used to identify cases of major depression.
authors.affiliation: Harry S Truman Memorial Veterans' Hospital and University of Missouri School of Medicine, Columbia, MO 65201, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Martens
authors.forename: Jerry C
authors.initials: JC
authors.lastname: Parker
authors.forename: Karen L
authors.initials: KL
authors.lastname: Smarr
authors.forename: James E
authors.initials: JE
authors.lastname: Hewett
authors.forename: James R
authors.initials: JR
authors.lastname: Slaughter
authors.forename: Sara E
authors.initials: SE
authors.lastname: Walker
mesh_terms: D001172:Arthritis, Rheumatoid / Q000523:psychology*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity