The Center for Epidemiologic Studies Depression Scale in older Chinese: thresholds for long and short forms.
OBJECTIVE
No study has examined the diagnostic validity of the Center for Epidemiologic Studies Depression Scale (CES-D) in the Chinese elderly. This study aims to determine appropriate cutoffs for the 20- (CESD-20) as well as a ten-item (CESD-10) version of the instrument. Data were also provided, based on simulated scoring, for the diagnostic performance of the scales when using dichotomous instead of 4-point rating scales.


METHODS
Three hundred and ninety eight persons aged 60 +referred for psychiatric assessment by a physician were administered the CES-D as well as given an independent psychiatric assessment. A spectrum of depression diagnosis as the criterion was used to assess the diagnostic validity of the CES-D.


RESULTS
The ten and the 20-item version of the CES-D, regardless of scoring method, produced essentially identical performance indices. The optimal thresholds were 12 and 22 for CESD-10 and CESD-20 respectively, and based on these thresholds, sensitivity, specificity, positive predictive value and negative predictive value were 0.76, 0.55, 0.57 and 0.74 for CESD-10, and 0.75, 0.51, 0.55 and 0.72 for CESD-20. With both ends of the rating scale collapsed to create dichotomous items, the optimal thresholds became 4 for CESD-10 and 7 for CESD-20, and the corresponding performance indices were 0.67, 0.58, 0.56 and 0.69 for CESD-10, and 0.70, 0.58, 0.57 and 0.70 for CESD-20.


CONCLUSIONS
The ten-item version can be used in lieu of the 20-item version, and a dichotomous response format would probably work as well as the original four-point format, in order to simplify administration for elderly persons.
Cheng
Sheung-Tak
ST
Department of Applied Social Studies, City University of Hong Kong. tak.cheng@cityu.edu.hk
Chan
Alfred C M
AC
D000368:Aged; D044466:Asian People / Q000523:psychology*; D003431:Cross-Cultural Comparison; D003863:Depression / Q000175:diagnosis* / Q000208:ethnology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012680:Sensitivity and Specificity