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Screening for Depression in the General Population with the Center for Epidemiologic Studies Depression (CES-D): A Systematic Review with Meta-Analysis

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  • Gemma Vilagut
  • Carlos G Forero
  • Gabriela Barbaglia
  • Jordi Alonso

Abstract

Objective: We aimed to collect and meta-analyse the existing evidence regarding the performance of the Center for Epidemiologic Studies Depression (CES-D) for detecting depression in general population and primary care settings. Method: Systematic literature search in PubMed and PsychINFO. Eligible studies were: a) validation studies of screening questionnaires with information on the accuracy of the CES-D; b) samples from general populations or primary care settings; c) standardized diagnostic interviews following standard classification systems used as gold standard; and d) English or Spanish language of publication. Pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratio were estimated for several cut-off points using bivariate mixed effects models for each threshold. The summary receiver operating characteristic curve was estimated with Rutter and Gatsonis mixed effects models; area under the curve was calculated. Quality of the studies was assessed with the QUADAS tool. Causes of heterogeneity were evaluated with the Rutter and Gatsonis mixed effects model including each covariate at a time. Results: 28 studies (10,617 participants) met eligibility criteria. The median prevalence of Major Depression was 8.8% (IQ range from 3.8% to 12.6%). The overall area under the curve was 0.87. At the cut-off 16, sensitivity was 0.87 (95% CI: 0.82–0.92), specificity 0.70 (95% CI: 0.65–0.75), and DOR 16.2 (95% CI: 10.49–25.10). Better trade-offs between sensitivity and specificity were observed (Sensitivity = 0.83, Specificity = 0.78, diagnostic odds ratio = 16.64) for cut-off 20. None of the variables assessed as possible sources of heterogeneity was found to be statistically significant. Conclusion: The CES-D has acceptable screening accuracy in the general population or primary care settings, but it should not be used as an isolated diagnostic measure of depression. Depending on the test objectives, the cut-off 20 may be more adequate than the value of 16, which is typically recommended.

Suggested Citation

  • Gemma Vilagut & Carlos G Forero & Gabriela Barbaglia & Jordi Alonso, 2016. "Screening for Depression in the General Population with the Center for Epidemiologic Studies Depression (CES-D): A Systematic Review with Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-17, May.
    • Handle: RePEc:plo:pone00:0155431
    DOI: 10.1371/journal.pone.0155431
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    3. Conal Twomey & Gary O’Reilly, 2018. "The association of ‘self-monitoring’ with depression in help-seeking Facebook users," International Journal of Social Psychiatry, , vol. 64(5), pages 482-487, August.
    4. Johanna W de Joode & Susan EM van Dijk & Florine S Walburg & Judith E Bosmans & Harm WJ van Marwijk & Michiel R de Boer & Maurits W van Tulder & Marcel C Adriaanse, 2019. "Diagnostic accuracy of depression questionnaires in adult patients with diabetes: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-16, June.
    5. Johannes Beller, 2022. "Age-period-cohort analysis of depression trends: are depressive symptoms increasing across generations in Germany?," European Journal of Ageing, Springer, vol. 19(4), pages 1493-1505, December.
    6. Giulietti, Corrado & Vlassopoulos, Michael & Zenou, Yves, 2022. "Peers, gender, and long-term depression," European Economic Review, Elsevier, vol. 144(C).
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    8. Xiaxia Sun & Jingjing Ge & Hongdao Meng & Zhiguo Chen & Danping Liu, 2019. "The Influence of Social Support and Care Burden on Depression among Caregivers of Patients with Severe Mental Illness in Rural Areas of Sichuan, China," IJERPH, MDPI, vol. 16(11), pages 1-12, June.
    9. Shen, Zheng & Fang, Xiangming & Zheng, Xiaodong, 2022. "The impact of women's off-farm employment on depressive symptoms: Evidence from rural China," Social Science & Medicine, Elsevier, vol. 311(C).
    10. David M. Cutler & Noémie Sportiche, 2022. "Economic Crises and Mental Health: Effects of the Great Recession on Older Americans," NBER Working Papers 29817, National Bureau of Economic Research, Inc.
    11. Li, Yanan & Sunder, Naveen, 2021. "What doesn’t kill her, will make her depressed," Economics & Human Biology, Elsevier, vol. 43(C).
    12. Yijing Chen & Claudia Rafful & Mercedes Mercado & Lindsey Carte & Sonia Morales-Miranda & Judeline Cheristil & Teresita Rocha-Jiménez, 2022. "Hoping for a Better Future during COVID-19: How Migration Plans Are Protective of Depressive Symptoms for Haitian Migrants Living in Chile," IJERPH, MDPI, vol. 19(16), pages 1-15, August.
    13. Jorge Arias-de la Torre & Gemma Vilagut & Antoni Serrano-Blanco & Vicente Martín & Antonio José Molina & Jose M Valderas & Jordi Alonso, 2020. "Accuracy of Self-Reported Items for the Screening of Depression in the General Population," IJERPH, MDPI, vol. 17(21), pages 1-10, October.
    14. Azad R. Bhuiyan & Marinelle Payton & Amal K. Mitra & Sophia S. Leggett & Jihua Xu & Paul B. Tchounwou & Frank Smart, 2021. "Progression of Metabolic Syndrome Components along with Depression Symptoms and High Sensitivity C-Reactive Protein: The Bogalusa Heart Study," IJERPH, MDPI, vol. 18(9), pages 1-14, May.
    15. Xue Yang & Rui She & Mason MC Lau & Joseph TF Lau, 2020. "Anticipated socio-political developments and related personal responses as structural determinants of mental health problems: A population-based study," International Journal of Social Psychiatry, , vol. 66(1), pages 58-66, February.
    16. Jia-In Lee & Yu-Ping Chang & Ching-Shu Tsai & Cheng-Fang Yen, 2022. "Internalized Sexual Stigma among Lesbian, Gay, and Bisexual Individuals in Taiwan: Its Related Factors and Association with Mental Health Problems," IJERPH, MDPI, vol. 19(4), pages 1-13, February.
    17. Phan Sok & Mary V. Seeman & Rosane Nisenbaum & James Watson & Sean B. Rourke & on behalf of the PSHP Team, 2021. "Four-Year Trajectories of Health-Related Quality of Life in People Living with HIV: Impact of Unmet Basic Needs across Age Groups in Positive Spaces, Healthy Places," IJERPH, MDPI, vol. 18(22), pages 1-16, November.
    18. Platt, Jonathan M. & Bates, Lisa M. & Jager, Justin & McLaughlin, Katie A. & Keyes, Katherine M., 2020. "Changes in the depression gender gap from 1992 to 2014: Cohort effects and mediation by gendered social position," Social Science & Medicine, Elsevier, vol. 258(C).
    19. Eileen Heumann & Jannis Trümmler & Christiane Stock & Stefanie M. Helmer & Heide Busse & Sarah Negash & Claudia R. Pischke, 2023. "Study Conditions and University Students’ Mental Health during the Pandemic: Results of the COVID-19 German Student Well-Being Study (C19 GSWS)," IJERPH, MDPI, vol. 20(7), pages 1-15, March.
    20. Benjamin Kaveladze & Allison Diamond Altman & Meike Niederhausen & Jennifer M Loftis & Alan R Teo, 2022. "Social relationship quality, depression and inflammation: A cross-cultural longitudinal study in the United States and Tokyo, Japan," International Journal of Social Psychiatry, , vol. 68(2), pages 253-263, March.
    21. Snell-Rood, Claire & Carpenter-Song, Elizabeth, 2018. "Depression in a depressed area: Deservingness, mental illness, and treatment in the contemporary rural U.S," Social Science & Medicine, Elsevier, vol. 219(C), pages 78-86.
    22. Shen-Ju Tsai & Yu-Han Hsiao & Miao-Yu Liao & Meng-Chih Lee, 2022. "The Influence of Depressive Mood on Mortality in Elderly with Different Health Status: Evidence from the Taiwan Longitudinal Study on Aging (TLSA)," IJERPH, MDPI, vol. 19(11), pages 1-11, June.
    23. Byung-Sun Park & Keungeun Lee & Changhwan Shin & Kwonho Choi & Sung-Woo Bae, 2022. "Longitudinal Measurement Invariance of the Korean Version of the CES-D-11 Scale," SAGE Open, , vol. 12(3), pages 21582440221, August.
    24. Luana Caroline de Assunção Cortez Corrêa & Cristiano dos Santos Gomes & Saionara Maria Aires da Camara & Juliana Fernandes de Souza Barbosa & Ingrid Guerra Azevedo & Afshin Vafaei & Ricardo Oliveira G, 2023. "Gender-Specific Associations between Late-Life Disability and Socioeconomic Status: Findings from the International Mobility and Aging Study (IMIAS)," IJERPH, MDPI, vol. 20(4), pages 1-11, February.

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