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Center for Epidemiologic Studies-Depression Scale (CES-D)
The instrument is freely available here:
NeuroRehab Supplemental - Highly Recommended:
Recommendations for Use: Indicated for studies requiring a measure of psychological status.
Supplemental - Highly Recommended: Sport-Related Concussion (SRC) Acute (time of injury until 72 hours)
Supplemental: Mitochondrial Disease (Mito), Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS), Multiple Sclerosis (MS), Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post concussion), Stroke, and Traumatic Brain Injury (TBI)
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
Purpose: The Center for Epidemiologic Studies Depression Rating Scale (CES-D) is a widely used screening scale for depression and employed in stroke and cardiovascular health studies. It measures depressive feelings and behaviors occurring in the past week of a patient's life.
Overview: The CES-D consists of 20 items, which make up six scales reflecting depressive symptomatology: depressed mood, feelings of guilt and worthlessness, feelings of helplessness and hopelessness, psychomotor retardation, loss of appetite, and sleep disturbance.
Time: Evaluation is approximately 5 minutes
Comments/Special Instructions
NeuroRehab Specific: Applicable to the following populations: stroke, multiple sclerosis, mild TBI.
Scoring and Psychometric Properties
Each item is scored on a 4-point scale ranging from 0 (rarely/none of the time) to 3 (most/all of the time). Scores for items 4, 8, 12, and 16 are reversed before summing all items to yield a total score, which can range from 0–60. Higher scores indicate more depressive symptoms.
Psychometric Properties: The measure is reliable for assessing number, types and duration of depressive symptoms across racial, gender, and age categories, has been reported to have high internal consistency, and has been extensively validated.
Strengths and Weaknesses: The CES-D is not intended as a clinical diagnostic tool and interpretations of individual scores should not be made. Group means should only be used to reference other groups. The internal reliability and consistency is good for all groups tested (Race, age, education).
Other Important Notes: The CES-D can be self or interviewer-administered. The CES-D was developed for use in studies of the epidemiology of depressive symptomatology in the general population. Items were selected from previously validated scales and cover the major components of depressive symptomatology. The scale is not intended for a clinical diagnosis of depression.
Sport-Related Concussion Specific:
Advantages: Widely used screen for depressive symptoms.  It is not a diagnostic instrument.  Some of the depressive symptoms will overlap with post-concussion symptoms. It is self-administered and very brief screen.
Age Range: can be used in adults, as well as children and adolescents (6–17). Less reliable in the younger children.
Stroke References:
Haley WE, Roth DL, Kissela B, Perkins M, Howard, G.. Quality of life after stroke: a prospective longitudinal study. Qual Life Res. 2011; 20: 799-806.
Kim J, Park E. The Factor Structure of the Center for Epidemiologic Studies Depression Scale in Stroke Patients. Top Stroke Rehabil. 2012;19(2):54-62.
Parikh RM, Eden DT, Price TR, Robinson RG. The sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale in screening for post-stroke depression. Int J Psychiatry Med. 1988;18(2):169-181.
Ramasubbu R, Robinson RG, Flint AJ, Kosier T, Price TR. Functional impairment associated with acute poststroke depression: the Stroke Data Bank Study. J Neuropsychiatry Clin Neurosci. 1998;10(1):26-33.
Shinar D, Gross CR, Price TR, Banko M, Bolduc PL, Robinson RG. Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiologic Studies Depression Scale. Stroke. 1986;17(2):241-245.
Steffens DC, Krishnan KR, Crump C, Burke GL. Cerebrovascular disease and evolution of depressive symptoms in the cardiovascular health study. Stroke. 2002;33(6):1636-1644.
TBI References:
Radloff, LS. The CES-D Scale: A self-report depression scale for research in the general population. App Psychol Meas. 1977;1(3):385-401.
Spanish Language References:
McCabe BE, Vermeesch AL, Hall RF, Peragallo NP, Mitrani VB. Acculturation and the Center For Epidemiological Studies-Depression Scale for Hispanic women. Nurs Res. 2011;60(4):270-275.
Ruiz-Grosso P, Loret de Mola C, Vega-Dienstmaier JM, Arevalo JM, Chavez K,Vilela A, Lazo M, Huapaya J. Validation of the Spanish Center for epidemiological Studies Depression and Zung Self-Rating Depression Scales: a comparative validation study. PLoS One. 2012;7(10):e45413.
ME/CFS References:
Hill NF, Tiersky LA, Scavalla VR, Lavietes M, Natelson BH. Natural History of Severe Chronic Fatigue Syndrome. Arch Phys Med Rehabil. 1999;80:1090-1094.
NeuroRehab References:
Greeke EE, Chua AS, Healy BC, Rintell DJ, Chitnis T, Glanz BI. Depression and fatigue in patients with multiple sclerosis. J Neurol Sci. 2017 Sep 15;380:236-241.
Kennedy JE, Reid MW, Lu LH, Cooper DB. Validity of the CES-D for depression screening in military service members with a history of mild traumatic brain injury. Brain Inj. 2019;33(7):932-940.
Document last updated January 2022