title: Challenges in assessing depressive symptoms in Fiji: A psychometric evaluation of the CES-D.
abstract: OBJECTIVE
  The CES-D is a commonly used self-report assessment for depressive symptomatology. However, its psychometric properties have not been evaluated in Fiji. This study aims to evaluate the reliability and validity of English language and Fijian vernacular versions in ethnic Fijian adolescent schoolgirls.
  
  
  METHODS
  As part of the HEALTHY Fiji study, ethnic Fijian female adolescents (N = 523) completed the CES-D. Participants selected to respond in English or the local vernacular. Reliability (internal consistency, item-total score correlation, and test-retest estimates), validity (associations with other proxies for depression) and factor structure were assessed. Evaluations considered differences between language versions.
  
  
  RESULTS
  In this sample, the CES-D had a Cronbach's α of 0.81 and item-total score correlation coefficients ranged between 0.2 and 0.63. One week test-retest reliability (ICC(2)) was 0.57. CES-D scores were higher among individuals who endorsed feelings of depression and suicidality compared to those who did not. ROC analyses of the CES-D versus binary depression and suicidality variables produced AUCs around 0.70 and did not support a discrete cut-off for significant disturbance. Findings were similar across the two language groups.
  
  
  CONCLUSIONS
  The CES-D has acceptable reliability and validity among ethnic Fijian female adolescents in English and in the Fijian vernacular language. Findings support its utility as a dimensional measure for depressive symptomatology in this study population. Further examination of its clinical utility for case finding for depression in Fijian school-based and community populations is warranted.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA aopoline@hsph.harvard.edu.
authors.forename: April
authors.initials: A
authors.lastname: Opoliner
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Boston,MA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Blacker
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA McLean Hospital, Belmont, MA, USA.
authors.forename: Garrett
authors.initials: G
authors.lastname: Fitzmaurice
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston,MA, USA Department of Global Health and Social Medicine, Harvard Medical School.
authors.forename: Anne
authors.initials: A
authors.lastname: Becker
mesh_terms: D000293:Adolescent; D003863:Depression / Q000175:diagnosis*; D005260:Female; D005367:Fiji; D006801:Humans; D011594:Psychometrics; D057566:Self Report; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult
keywords: CES-D; Fiji; cross-cultural; reliability; validity