title: Screening value of the Center for epidemiologic studies - depression scale among people living with HIV/AIDS in Ho Chi Minh City, Vietnam: a validation study.
abstract: BACKGROUND
  Depression is believed to be under-diagnosed and under-treated in people living with HIV/AIDS (PLHIV). Early screening and referral to mental health services for treatment has been shown to enhance HIV patients' health during the course of HIV treatment. A lack of psychiatric specialist services for PLHIV at outpatient clinics (OPC) in Vietnam leads to insufficient identification of depression. However, alternative approaches are available such as the use of screening scales. This study investigated the psychometric properties of the Center for Epidemiologic Studies - Depression scale (CES-D) in Vietnamese HIV positive outpatients.
  
  
  METHODS
  A cross-sectional survey of 400 HIV positive outpatients was conducted in Ho Chi Minh City, Vietnam. Participants completed a self-reported questionnaire that included the CES-D. Participants were also interviewed independently by a psychiatrist who assessed for symptoms of major depressive disorder. CES-D reliability was measured by Cronbach's alpha. Criterion validity was evaluated by ROC analysis, Kappa index and the percentage of agreement between the CES-D and psychiatrists' interview. Construct validity was investigated by confirmatory factor analysis.
  
  
  RESULTS
  The reliability for the whole scale was good (Cronbach α = 0.81). The four sub-scales of the CES-D had lower levels of internal consistency with Cronbach alpha of 0.71, 0.73, 0.71 and 0.58 for somatic complaints, depressive affect, positive affect and interpersonal problems respectively. CES-D has adequate construct validity with CFI = 0.926, IFI = 0.927, GFI = 0.930 and RMSEA = 0.045 (90% CI = 0.037-0.053) in the final four-factor model. Area under curve was 0.88 indicating good criterion validity. At the cutoff of 16, the sensitivity and specificity were 79.8% and 83.0% respectively while the percentage of agreement between the CES-D and psychiatrists' interview was 82.0% with Kappa index at 0.60.
  
  
  CONCLUSIONS
  The CES-D was shown to be acceptable, reliable and valid for screening symptoms of depression in Vietnamese HIV outpatient clinic settings where mental health specialists are not always available. Routine use of the CES-D at HIV outpatient clinics, in combination with the availability of free-for-all national mental health services, is likely to be beneficial in improving the lives of PLHIV in Vietnam who have depression.
authors.affiliation: Faculty of Public Health, Ho Chi Minh City University of Medicine and Pharmacy, 159 Hung Phu Street, District 8, Ho Chi Minh City, Vietnam. ThaiThanhTruc@fphhcm.edu.vn.|Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, Sydney, 2141, Australia. ThaiThanhTruc@fphhcm.edu.vn.
authors.forename: Truc Thanh
authors.initials: TT
authors.lastname: Thai
authors.affiliation: Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, Sydney, 2141, Australia.
authors.forename: Mairwen K
authors.initials: MK
authors.lastname: Jones
authors.affiliation: School of Psychological Sciences, Australian College of Applied Psychology, Level 6, 11 York Street, Sydney, 2000, Australia.
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Harris
authors.affiliation: Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, Sydney, 2141, Australia.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Heard
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014744:Vietnam / Q000453:epidemiology
keywords: CES-D; Depression; HIV outpatient; Validation