Center for Epidemiological Studies-Depression Scale (CES-D) Print

Original Citation – Radloff LS. The CES-D Scale. A self-report depression scale for research in the general population. Appl Psychol Measures 1977; 1:385-401.

Contact Information – No information found.

Price & Availability – In the public domain. Available through multiple websites, conduct internet search.  Click here to view instrument.

Brief Description of Instrument – Short self-report scale designed to measure symptoms associated with depression, with emphasis on the affective component. Designed for use in studies of the relationships between depression and other variables across population subgroups.

Administration time – Less than 10 minutes.

Scale Format – 20 items, indicating the feelings during the past week. 4 response options per question: 1) rarely or none of the time - less than 1 day, 2) some or a little of the time - 1-2 days, 3) occasionally or a moderate amount of time 3-4 days, 4) most or all of the time - 5-7 days.

Administration Technique – Self- or interviewer-administered.

Scoring and Interpretation – Each response scored from 0-3 on scale of frequency of occurrence of the symptom. Possible range of scores is 0-60. Higher scores indicate more symptoms, weighted by frequency of occurrence during the past week.

Factors and Norms – Four factors: depressed affect, positive affect, somatic activity, interpersonal. Investigated through factor analysis. Authors emphasize all items are symptoms related to depression. Single total scale score is recommended rather than examining factors separately.

Test-retest Reliability – Completed in household sample with various intervals between administrations. Correlations were in the moderate range (0.45-0.70). For patient sample the interval was four weeks, r=0.53.

Internal Consistency – Cronbach's alpha for general population: 0.85; psychiatric patient sample: 0.90.

Construct Validity – Discrimination between psychiatric patients and general population samples. Also found to discriminate among levels of severity within patient group.

Criterion-Related Validity – Correlations with other valid self-report depression scales (Rockliff Depression Rating Scale, Raskin Depression Rating Scale, SCL-90, Lubin, Bradburn Negative Affect and Bradburn Balance), correlations with clinical ratings of severity of depression on the Hamilton Rating Scale and the Raskin on psychiatric patient sample. Other scales used include Langer and Cantrill Ladder for general pathology, Marlow-Crowne for social desirability.

Responsive to Change Over Time – Responsive to major life events viewed as negative for population sample. Scale also demonstrated to be responsive to improvement after treatment for patient sample.

Content & Face Validity – CES-D items were selected from a pool of items from previously validated depression scales (such as the Beck Depression Inventory) to include the major components of depressive symptomatology as identified by clinical judgment, frequency of use in other questionnaires for depression and factor analytic studies.

Strengths – Demonstrated reliability and validity, short scale at 20 items.

Limitations – Not a clinical diagnostic tool, not meant for interpretations of single scores. Measures level of symptoms, not actual illness. No cut-off scores.

Updates – Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol. 1977 Sep;106(3):203-14.

Published APN Studies using instrument –- Allen K, Hazelett S, Jarjoura D, Hua K, Wright K, Weinhardt J, Kropp D.  A randomized trial testing the superiority of a postdischarge care management model for stroke survivors.  J Stroke Cerebrovasc Dis. 2009 Nov-Dec;18(6):443-52.  View in PubMed
Badger, T.A., Gagan, M.J., McNiece, C. Community analysis for healthy planning with vulnerable populations. Clinical Nurse Specialist, 2001, 15(3); 95-102. View in PubMed
Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, Hull JG, Li Z, Tosteson TD, Byock IR, Ahles TA.  Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial.  JAMA. 2009 Aug 19;302(7):741-9. FREE full-text available
McCorkle R, Siefert ML, Dowd MF, Robinson JP, Pickett M. Effects of advanced practice nursing on patient and spouse depressive symptoms, sexual function, and marital interaction after radical prostatectomy. Urol Nurs. 2007 Feb;27(1):65-77; discussion 78-80. View in PubMed
McCorkle R. Strumpf NE. Nuamah IF. Adler DC. Cooley ME. Jepson C. Lusk EJ. Torosian M. A specialized home care intervention improves survival among older post-surgical cancer patients. Journal of the American Geriatrics Society. 2000 Dec; 48(12): 1707-13. View in PubMed
Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999 Feb 17;281(7):613-20. FREE full-text available

Related Methods Articles (Not Reviewed) – Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994 Mar-Apr;10(2):77-84.
Cumulative Index to Nursing & Allied Health Literature – Center for Epidemiological Studies Depression Scale (CES-D Scale) Summary. Accession Number 1995019418
Stommel M, Given BA, Given CW, Kalaian HA, Schulz R, McCorkle R. Gender bias in the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D). Psychiatry Res. 1993 Dec;49(3):239-50.