title: Reliability and validity of the center for epidemiologic studies-depression scale in screening for depression among HIV-infected and -uninfected pregnant women attending antenatal services in northern Uganda: a cross-sectional study.
abstract: BACKGROUND
  There are limited data on the prevalence and approaches to screening for depression among pregnant women living in resource poor settings with high HIV burden.
  
  
  METHODS
  We studied the reliability and accuracy of the Center for Epidemiologic Studies Depression (CES-D) scale in 123 (36 HIV-infected and 87 -uninfected) pregnant women receiving antenatal care at Gulu Regional Referral Hospital, Uganda. CES-D scores were compared to results from the psychiatrist-administered Mini-International Neuropsychiatric Interview (MINI) for current major depressive disorder (MDD), a "gold standard" for assessing depression. We employed measures of internal consistency (Cronbach's alpha), and criterion validity [Area Under the Receiver Operating Characteristic Curve (AUROC), sensitivity (Se), specificity (Sp), and positive predictive value (PPV)] to evaluate the reliability and validity of the CES-D scale.
  
  
  RESULTS
  35.8% of respondents were currently experiencing an MDD, as defined from outputs of the MINI-depression module. The CES-D had high internal consistency (Cronbach's alpha = 0.92) and good discriminatory ability in detecting MINI-defined current MDDs (AUROC = 0.82). The optimum CES-D cutoff score for the identification of probable MDD was between 16 and 17. A CES-D cutoff score of 17, corresponding to Se, Sp, and PPV values of 72.7%, 78.5%, and 76.5%, is proposed for adoption in this population and performs well for HIV-infected and -uninfected women. After adjusting for baseline differences between the HIV subgroups (maternal age and marital status), HIV-infected pregnant women scored 6.2 points higher on the CES-D than HIV-uninfected women (p = 0.032).
  
  
  CONCLUSIONS
  The CES-D is a suitable instrument for screening for probable major depression among pregnant women of mixed HIV status attending antenatal services in northern Uganda.
authors.forename: Barnabas K
authors.initials: BK
authors.lastname: Natamba
authors.forename: Jane
authors.initials: J
authors.lastname: Achan
authors.forename: Angela
authors.initials: A
authors.lastname: Arbach
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Oyok
authors.forename: Shibani
authors.initials: S
authors.lastname: Ghosh
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mehta
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stoltzfus
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Griffiths
authors.forename: Sera L
authors.initials: SL
authors.lastname: Young
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D007406:Interview, Psychological / Q000379:methods / Q000592:standards; D008403:Mass Screening / Q000592:standards*; D009483:Neuropsychological Tests / Q000592:standards / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D011295:Prenatal Care / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000592:standards* / Q000706:statistics & numerical data; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult