Validation of the Center for Epidemiologic Studies Depression Scale in screening for major depressive disorder among retired firefighters exposed to the World Trade Center disaster.
BACKGROUND
We evaluated the performance of a modified Center of Epidemiologic Studies Depression Scale (CES-D-m), which captured symptoms in the past month, in comparison to the Diagnostic Interview Schedule (DIS) in identification of major depressive disorder (MDD) in World Trade Center (WTC)-exposed retired Fire Department, City of New York (FDNY) firefighters.


METHODS
From 12/2005 to 7/2007, FDNY enrolled retired firefighters in its Medical Monitoring and Treatment Program. All participants completed the CES-D-m and the DIS on the same day. Sensitivity, specificity, receiver operating characteristic (ROC) curves, and Youden's index were used to assess properties of the CES-D-m. Multivariate logistic regression analyses were also used.


RESULTS
7% of 1915 retired male firefighters were diagnosed with MDD using the DIS. Using the most common CES-D cutoff score of 16, the prevalence of elevated risk was 36%, which declined to 23% using a cutoff score of 22, as determined by Youden's index. At 22, CES-D-m sensitivity was 0.84, specificity was 0.82, and the area under the ROC curve was 0.89 relative to DIS MDD diagnosis.


CONCLUSIONS
Participants were more likely than non-participants to live in the New York City area.


CONCLUSIONS
This is the first study of WTC rescue/recovery workers to assess the performance of a one-month version of the CES-D. The CES-D-m performed well in identifying those at elevated risk. Since diagnostic follow-up is time consuming and costly, it is important to correctly distinguish those at elevated risk using a screening tool that has been validated in the population under study.
Chiu
Sydney
S
Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York 11201, United States.
Webber
Mayris P
MP
Zeig-Owens
Rachel
R
Gustave
Jackson
J
Lee
Roy
R
Kelly
Kerry J
KJ
Rizzotto
Linda
L
Prezant
David J
DJ
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D005390:Fires; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009519:New York City; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012179:Retirement; D047851:September 11 Terrorist Attacks; D014505:Urban Population / Q000706:statistics & numerical data