title: 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.
abstract: 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.
authors.affiliation: Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York 11201, United States.
authors.forename: Sydney
authors.initials: S
authors.lastname: Chiu
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.forename: Jackson
authors.initials: J
authors.lastname: Gustave
authors.forename: Roy
authors.initials: R
authors.lastname: Lee
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: Linda
authors.initials: L
authors.lastname: Rizzotto
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
mesh_terms: 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