title: Validity of Center for Epidemiologic Studies Depression (CES-D) scale in a sample of Iraq and Afghanistan Veterans.
abstract: OBJECTIVE
  Optimal depression screening necessitates measurement tools that are valid across varied populations and in the presence of comorbidities.
  
  
  METHODS
  This study assessed the test properties of two versions of the Center for Epidemiologic Studies Depression scale against psychiatric diagnoses established by the Mini International Neuropsychiatric Interview among a clinical sample of US Veterans deployed during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Participants (N = 359) recruited from two Department of Veterans Affairs hospitals completed a clinical interview, structured diagnostic interview, and self-reported measures.
  
  
  RESULTS
  Based on diagnostic interview and the Diagnostic and Statistical Manual of Mental Disorders 4th Edition criteria, 29.5% of the sample met diagnostic criteria for major depressive disorder and 26.5% met diagnostic criteria for post-traumatic stress disorder. Both Center for Epidemiologic Studies Depression-20 and Center for Epidemiologic Studies Depression-10 scales performed well and almost identically against the Mini International Neuropsychiatric Interview-major depressive disorder in identifying Veterans with major depressive disorder (Center for Epidemiologic Studies Depression-20 area under the Receiver Operating Characteristic curve 91%; Center for Epidemiologic Studies Depression-10 area under the ROC curve 90%). Overall, higher cut points for the Center for Epidemiologic Studies Depression scales performed better in correctly identifying true positives and true negatives for major depressive disorder (Center for Epidemiologic Studies Depression-20 cut point 18+ sensitivity 92% specificity 72%; Center for Epidemiologic Studies Depression-10 cut point 10+ sensitivity 92% specificity 69%).
  
  
  CONCLUSIONS
  The specificity of the Center for Epidemiologic Studies Depression scales was poor among Veterans with co-occurring post-traumatic stress disorder (13% and 16%). Veterans with post-traumatic stress disorder who have a positive depression screen should have a more thorough assessment of mental health symptoms and comorbidities, rather than immediate diagnosis of and treatment for depression.
authors.affiliation: School of Public Health, Oregon Health & Science University, Portland, OR, USA; Portland VA Medical Center, Portland, OR, USA.
authors.forename: Ana R
authors.initials: AR
authors.lastname: Quiñones
authors.affiliation: Geriatric Research, Education, and Clinical Centers, Puget Sound VA Medical Center, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Thielke
authors.affiliation: Chronic Pain Rehabilitation Program, VA National Polytrauma Pain Workgroup, James A. Haley Veterans' Hospital, Tampa, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Clark
authors.affiliation: Cancer and Palliative Care Programs, James A. Haley Veterans' Hospital, Tampa, FL, USA.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Phillips
authors.affiliation: School of Nursing, University of North Carolina at Charlotte, Charlotte, NC, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Elnitsky
authors.affiliation: School of Public Health, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Andresen
keywords: Depression; Veterans; major depressive disorder; post-traumatic stress disorder; psychometrics