What is the Center for Epidemiologic Studies Depression Scale (CES-D)?

The CES-D is a 20-item self-report scale designed to measure depressive symptomatology in the general population. Originally developed for epidemiologic research, it has become one of the most widely used depression screening instruments worldwide. The CES-D focuses on the affective component of depression and is particularly valuable for community-based studies and primary care screening.

Who developed the CES-D and when?

Developed by Dr. Lenore Radloff in 1977 at the Center for Epidemiologic Studies, National Institute of Mental Health (NIMH). Dr. Radloff specifically designed the scale to be used in community surveys and epidemiologic studies to measure the current level of depressive symptomatology, with emphasis on the affective component.

What are the four subscales of the CES-D?

1. Depressed Affect (7 items):

• Feeling bothered by things that usually don't bother you
• Feeling sad, blue, or depressed
• Feeling lonely or like crying
• Feeling like people were unfriendly or disliked you
• Having trouble shaking off the blues

2. Positive Affect (4 items - reverse scored):

• Feeling just as good as other people
• Feeling hopeful about the future
• Feeling happy
• Enjoying life

3. Somatic and Retarded Activity (7 items):

• Poor appetite
• Sleep disturbance
• Trouble concentrating
• Everything being an effort
• Feeling restless
• Inability to get going

4. Interpersonal (2 items):

• Feeling that people dislike you
• People being unfriendly

How is the CES-D scored and interpreted?

Total scores range from 0-60 based on frequency of symptoms in the past week:

• 0 points: Rarely or none of the time (less than 1 day)
• 1 point: Some or a little of the time (1-2 days)
• 2 points: Occasionally or moderate amount of time (3-4 days)
• 3 points: Most or all of the time (5-7 days)

Interpretation Guidelines:

• 0-15: Minimal or no depression
• 16-26: Mild to moderate depression (clinical attention recommended)
• 27-60: Major depression likely (immediate clinical attention)

Clinical Cutoff Points:

• ≥16: Commonly used cutoff for possible depression (80% sensitivity)
• ≥27: Suggests major depression
• ≥30: High probability of major depressive episode

Unique Features and Advantages

• Population-based: Designed for general population screening, not just clinical samples
• Culturally adaptable: Validated across diverse ethnic and cultural groups
• Age-appropriate versions: Available for adolescents and elderly populations
• Brief and accessible: Simple language and quick administration
• Epidemiologic utility: Excellent for large-scale community studies
• Longitudinal tracking: Sensitive to changes over time

Research Applications and Validation

The CES-D has been extensively used in:

• Large-scale epidemiologic studies (e.g., National Health and Nutrition Examination Survey)
• Primary care depression screening
• Community mental health assessments
• Treatment outcome studies
• Cross-cultural depression research
• Aging and geriatric studies
• Maternal and perinatal depression screening

Populations and Special Considerations

The CES-D has been validated in:

• General adult population (primary validation group)
• Elderly adults (cutoff may be higher: ≥20)
• Adolescents and young adults
• Diverse ethnic and racial groups
• Medical populations (though HADS may be preferred)
• Postpartum women (Edinburgh scale may be preferred)