title: Using the CES-D in a two-phase survey for depressive disorders among nonreferred adolescents in Taipei: a stratum-specific likelihood ratio analysis.
abstract: BACKGROUND
  Efficient screening is important in two-phase surveys. We examined whether the Center for Epidemiologic Studies Depression Scale (CES-D) is an appropriate instrument for screening depressive disorders among adolescents in Taipei, an ethnic group whose depression is little known of.
  
  
  METHODS
  Among the 2440 students of a school in Taipei, aged 12 to 16 years who completed the CES-D and eating attitude test (EAT; response rate=98.5%), 178 were randomly selected from four subgroups defined by the 90th percentile of the two screening tools for face-to-face interview, using the Schedule for Affective Disorders and Schizophrenia for Children (K-SADS). Discriminatory validities of instruments for depressive disorders were estimated, and then a stratum-specific likelihood ratio (SSLR) analysis was conducted for instruments with sufficient validity.
  
  
  RESULTS
  The prevalence estimates of depressive disorders varied with different levels of impairment, with a value of 2.4% for major depressive disorder and 0.3% for dysthymic disorder if at least two impairment items were endorsed. The areas under the receiver operative characteristic (ROC) curves were consistently high (0.88-0.90) for major depressive disorder with or without impairment requirement, but low (0.49) for dysthymic disorder without impairment requirement. Three strata of CES-D scores (0-28, 29-48, and > or =49) were derived for major depressive disorder with (SSLR=0.63, 3.00, and 11.75) and without (SSLR=0.61, 5.09, and 10.42) impairment requirement.
  
  
  CONCLUSIONS
  The CES-D is useful in screening for major depressive disorder among nonreferred adolescents. Three strata are recommended for its practical application.
authors.affiliation: Institute of Epidemiology, College of Public Health, National Taiwan University, 1 Jen-Ai Road., Sec. 1, Taipei 100, Taiwan.
authors.forename: Hao-Jan
authors.initials: HJ
authors.lastname: Yang
authors.forename: Wei-Tsuen
authors.initials: WT
authors.lastname: Soong
authors.forename: Po-Hsiu
authors.initials: PH
authors.lastname: Kuo
authors.forename: Hsueh-Ling
authors.initials: HL
authors.lastname: Chang
authors.forename: Wei J
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D002391:Catchment Area, Health; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology