title: Comparison of the CES-D and PHQ-9 depression scales in people with type 2 diabetes in Tehran, Iran.
abstract: BACKGROUND
  The quality of life in patients with various chronic disorders, including diabetes has been directly affected by depression. Depression makes patients less likely to manage their self-care regimens. Accurate assessment of depression in diabetic populations is important to the treatment of depression in this group and may improve diabetes management. To our best knowledge, there are few studies that have looked for utilizing questionnaires in screening for depression among patients with diabetes in Iran. Therefore the aim of this study was to assess the efficacy and accuracy of the Center for Epidemiological Studies Depression (CES-D) scale and the Patient Health Questionnaire-9 (PHQ-9), in comparison with clinical interview in people with type 2 diabetes.
  
  
  METHODS
  Outpatients who attended diabetes clinics at IEM were recruited on a consecutive basis between February 2009 and July 2009. Inclusion criteria included patients with type 2 diabetes who could fluently read and speak Persian, had no severe diabetes complications and no history of psychological disorders. The history of psychological disorders was ascertained through patients' medical files, taking history of any medications in this regard. The study design was explained to all patients and informed consent was obtained. Volunteer patients completed the Persian version of the questionnaires (CES-D and PHQ-9) and a psychiatrist interviewed them based on Structured Clinical Interview (SCID) for DSM-IV criteria.
  
  
  RESULTS
  Of the 185 patients, 43.2% were diagnosed as having Major Depressive Disorder (MDD) based on the clinical interview, 47.6% with PHQ-9 and 61.62% with CES-D. The Area Under the Curve (AUC) for the total score of PHQ-9 was 0.829 ± 0.30. A cut-off score for PHQ-9 of ≥ 13 provided an optimal balance between sensitivity (73.80%) and specificity (76.20%). For CES-D the AUC for the total score was 0.861 ± 0.029. Optimal balance between sensitivity (78.80%) and specificity (77.1%) was provided at cut-off score of ≥ 23.
  
  
  CONCLUSIONS
  It could be concluded that the PHQ-9 and CES-D perform well as screening instruments, but in diagnosing major depressive disorder, a formal diagnostic process following the PHQ-9 and also the CES-D remains essential.
authors.affiliation: Endocrine Research Center (Firoozgar), Institute of Endocrinology and Metabolism, Tehran University of Medical Sciences, Iran. m-khamseh@tums.ac.ir
authors.forename: Mohammad E
authors.initials: ME
authors.lastname: Khamseh
authors.forename: Hamid R
authors.initials: HR
authors.lastname: Baradaran
authors.forename: Anna
authors.initials: A
authors.lastname: Javanbakht
authors.forename: Maryam
authors.initials: M
authors.lastname: Mirghorbani
authors.forename: Zahra
authors.initials: Z
authors.lastname: Yadollahi
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Malek
mesh_terms: D019540:Area Under Curve; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006304:Health Status; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D011788:Quality of Life; D012648:Self Care; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires