Measuring depression with CES-D in Chinese patients with type 2 diabetes: the validity and its comparison to PHQ-9.
BACKGROUND
The validity of the 20-item Center for Epidemiological Studies Depression (CES-D) scale for depression screening in Hong Kong Chinese patients with type 2 diabetes remains unknown. We aimed to validate CES-D, compare its psychometric properties with the 9-item Patient Health Questionnaire (PHQ-9), and explore whether one of the two is more suitable for depression screening in Chinese patients with type 2 diabetes.


METHODS
Between June 2010 and July 2011, 545 consecutive Chinese patients with type 2 diabetes who underwent structured comprehensive assessments completed the CES-D and PHQ-9. Forty patients were retested within 2-4 weeks by telephone interview and 97 patients were randomly selected to undergo the Mini International Neuropsychiatric Interview (MINI) by psychiatrists for clinical diagnosis of depression.


RESULTS
The internal consistency (Cronbach's α) of CES-D was 0.85, with a test-retest correlation coefficient of 0.64. The area under the curve for CES-D compared to the clinical diagnosis of major depression was 0.85. A cut-off score of ≥21 for CES-D provided the optimal balance between sensitivity (78.3 %) and specificity (74.3 %) and identified 17.8 % (n = 97) of patients with depression. CES-D and PHQ-9 showed moderate agreement in depression screening (Cohen's Kappa: 0.45). Compared to non-depressed patients, those who screened positive by PHQ-9 had a higher HbA1c whereas the glycemic differences were not significant when using CES-D.


CONCLUSIONS
The CES-D is a valid screening tool for depression in Chinese type 2 diabetic patients although the PHQ-9 was more discriminative in identifying those with suboptimal glycemic control.
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. jennyzhang@adf.org.hk.|Asia Diabetes Foundation, The Chinese University of Hong Kong, Hong Kong SAR, China. jennyzhang@adf.org.hk.
Yuying
Y
Zhang
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. pigpig350@gmail.com.
Rose Z W
RZ
Ting
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China. lhb352@ha.org.hk.
Marco H B
MH
Lam
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China. joycelam@cuhk.edu.hk.
Siu-Ping
SP
Lam
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. roseanne.yeung@gmail.com.|Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China. roseanne.yeung@gmail.com.|Asia Diabetes Foundation, The Chinese University of Hong Kong, Hong Kong SAR, China. roseanne.yeung@gmail.com.
Roseanne O
RO
Yeung
Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China. nan.fang08@gmail.com.
Hairong
H
Nan
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. risaozaki@cuhk.edu.hk.|Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China. risaozaki@cuhk.edu.hk.
Risa
R
Ozaki
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. andrealuk@cuhk.edu.hk.|Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China. andrealuk@cuhk.edu.hk.|Asia Diabetes Foundation, The Chinese University of Hong Kong, Hong Kong SAR, China. andrealuk@cuhk.edu.hk.
Andrea O Y
AO
Luk
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. alicekong@cuhk.edu.hk.|Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China. alicekong@cuhk.edu.hk.|Asia Diabetes Foundation, The Chinese University of Hong Kong, Hong Kong SAR, China. alicekong@cuhk.edu.hk.
Alice P S
AP
Kong
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China. ykwing@cuhk.edu.hk.
Yun-Kwok
YK
Wing
The Association for the Improvement of Mental Health Programmes, Geneva, Switzerland. sartorius@normansartorius.com.
Norman
N
Sartorius
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. jchan@cuhk.edu.hk.|Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China. jchan@cuhk.edu.hk.|Asia Diabetes Foundation, The Chinese University of Hong Kong, Hong Kong SAR, China. jchan@cuhk.edu.hk.
Juliana C N
JC
Chan
D000328:Adult; D000368:Aged; D044466:Asian People / Q000523:psychology*; D002681:China; D003863:Depression / Q000150:complications* / Q000175:diagnosis*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results