title: Validating the Center for Epidemiological Studies Depression Scale for Children in Rwanda.
abstract: OBJECTIVE
  We assessed the validity of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) as a screen for depression in Rwandan children and adolescents. Although the CES-DC is widely used for depression screening in high-income countries, its validity in low-income and culturally diverse settings, including sub-Saharan Africa, is unknown.
  
  
  METHODS
  The CES-DC was selected based on alignment with local expressions of depression-like problems in Rwandan children and adolescents. To examine criterion validity, we compared CES-DC scores to depression diagnoses on a structured diagnostic interview, the Mini International Neuropsychiatric Interview for Children (MINI KID), in a sample of 367 Rwandan children and adolescents aged 10 through 17 years. Caregiver and child or adolescent self-reports endorsing the presence of local depression-like problems agahinda kenshi (persistent sorrow) and kwiheba (severe hopelessness) were also examined for agreement with MINI KID diagnosis.
  
  
  RESULTS
  The CES-DC exhibited good internal reliability (α = .86) and test-retest reliability (r = .85). The area under the receiver operating characteristic curve for the CES-DC was 0.825 when compared to MINI KID diagnoses, indicating a strong ability to distinguish between depressed and nondepressed children and adolescents in Rwanda. A cut point of≥30 corresponded with a sensitivity of 81.9% and a specificity of 71.9% in this referred sample. MINI KID diagnosis was well aligned with local expressions of depression-like problems.
  
  
  CONCLUSIONS
  The CES-DC demonstrates good psychometric properties for clinical screening and evaluation in Rwanda, and should be considered for use in this and other low-resource settings. Population samples are needed to determine a generalizable cut point in nonreferred samples.
authors.affiliation: Research Program on Children and Global Adversity, François-Xavier Bagnoud (FXB) Center for Health and Human Rights, Harvard School of Public Health, 651 Huntington Avenue, Boston, MA 02115, USA. Theresa_Betancourt@harvard.edu
authors.forename: Theresa
authors.initials: T
authors.lastname: Betancourt
authors.forename: Pamela
authors.initials: P
authors.lastname: Scorza
authors.forename: Sarah
authors.initials: S
authors.lastname: Meyers-Ohki
authors.forename: Christina
authors.initials: C
authors.lastname: Mushashi
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Kayiteshonga
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
authors.forename: Sara
authors.initials: S
authors.lastname: Stulac
authors.forename: William R
authors.initials: WR
authors.lastname: Beardslee
mesh_terms: D000293:Adolescent; D001526:Behavioral Symptoms / Q000175:diagnosis*; D002648:Child; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012372:ROC Curve; D015203:Reproducibility of Results; D012432:Rwanda / Q000453:epidemiology; D014177:Translations