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Validity of Center for Epidemiologic Studies Depression (CES-D) scale in a sample of Iraq and Afghanistan Veterans.

Quiñones AR, Thielke SM, Clark ME, Phillips KM, Elnitsky C, Andresen EM - SAGE Open Med (2016)

Bottom Line: Optimal depression screening necessitates measurement tools that are valid across varied populations and in the presence of comorbidities.Participants (N = 359) recruited from two Department of Veterans Affairs hospitals completed a clinical interview, structured diagnostic interview, and self-reported measures.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%).

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, Oregon Health & Science University, Portland, OR, USA; Portland VA Medical Center, Portland, OR, USA.

ABSTRACT

Objectives: 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.

No MeSH data available.


Related in: MedlinePlus

Receiver Operating Characteristic (ROC) curves for MINI-MDD and CES-D for Veterans with (n = 95) and without (n=264) PTSD.
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fig2-2050312116643906: Receiver Operating Characteristic (ROC) curves for MINI-MDD and CES-D for Veterans with (n = 95) and without (n=264) PTSD.

Mentions: The stratified analyses by Veterans with and without PTSD showed differences in the performance of the CES-D against the MINI-MDD. We examined both CES-D scales at the higher cut points because of the comparable test properties and higher specificities demonstrated by the CESD-20 at the 18+ cut point and the CESD-10 at the 10+ cut point. Both scales were more accurate in identifying MDD for Veterans without PTSD (for CESD-20: sensitivity 81%, specificity 80%, area under ROC curve 90%; for CESD-10: sensitivity 81%, specificity 77%, area under ROC curve 89%) (Table 3; bottom of Figure 2). For Veterans with PTSD, however, the specificity was quite low for both the CESD-20 (sensitivity 98%, 13% specificity, area under ROC curve 75%) and CESD-10 (sensitivity 98%, specificity 16%, area under ROC curve 73%) (Top of Figure 2; Table 4).


Validity of Center for Epidemiologic Studies Depression (CES-D) scale in a sample of Iraq and Afghanistan Veterans.

Quiñones AR, Thielke SM, Clark ME, Phillips KM, Elnitsky C, Andresen EM - SAGE Open Med (2016)

Receiver Operating Characteristic (ROC) curves for MINI-MDD and CES-D for Veterans with (n = 95) and without (n=264) PTSD.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4834469&req=5

fig2-2050312116643906: Receiver Operating Characteristic (ROC) curves for MINI-MDD and CES-D for Veterans with (n = 95) and without (n=264) PTSD.
Mentions: The stratified analyses by Veterans with and without PTSD showed differences in the performance of the CES-D against the MINI-MDD. We examined both CES-D scales at the higher cut points because of the comparable test properties and higher specificities demonstrated by the CESD-20 at the 18+ cut point and the CESD-10 at the 10+ cut point. Both scales were more accurate in identifying MDD for Veterans without PTSD (for CESD-20: sensitivity 81%, specificity 80%, area under ROC curve 90%; for CESD-10: sensitivity 81%, specificity 77%, area under ROC curve 89%) (Table 3; bottom of Figure 2). For Veterans with PTSD, however, the specificity was quite low for both the CESD-20 (sensitivity 98%, 13% specificity, area under ROC curve 75%) and CESD-10 (sensitivity 98%, specificity 16%, area under ROC curve 73%) (Top of Figure 2; Table 4).

Bottom Line: Optimal depression screening necessitates measurement tools that are valid across varied populations and in the presence of comorbidities.Participants (N = 359) recruited from two Department of Veterans Affairs hospitals completed a clinical interview, structured diagnostic interview, and self-reported measures.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%).

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, Oregon Health & Science University, Portland, OR, USA; Portland VA Medical Center, Portland, OR, USA.

ABSTRACT

Objectives: 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.

No MeSH data available.


Related in: MedlinePlus