Center for Epidemiologic Studies Depression Scale (CES-D)
Depressive symptoms are determined in each wave
Contact: Hannie Comijs
Depression is among the most prevalent psychiatric disorders in late-life, but the prevalence appears to shift from a decrease in depressive disorders fulfilling rigorous diagnostic criteria to an increasing prevalence of clinically relevant depressive syndromes (also: sub threshold disorders, here: minor depression), which are associated with declines in well-being and physical performance, health care utilization and mortality.
Measurement instrument in LASA
Within the LASA depressive symptoms are measured with the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977). The CES-D is a self-report scale designed to measure depressive symptoms in the general population. The items were chosen to represent depressive symptoms, common in the community. The development of the scale has been described in detail elsewhere (Radloff et al 1977, 1986; Beekman et al. 1994; 1997). Since its introduction it has been used extensively: at all ages, in more than 15 languages, in both healthy and illness populations and in different health care settings.
The scale consists of 20 items covering depressive symptomatology experienced in the past week. Each answer is rated on a 4-point scale ranging from 0 'rarely or never' to 3 'mostly or always'. The total score of the 20 items ranges from 0 to 60, higher scores indicating more depressive symptoms. The values were reversed for the positive affect items (item 4, 8, 12 and 16). The CES-D has good psychometric properties in elderly samples (Himmelfarb and Murrell 1983, Radloff et al 1986, Hertzog et al 1990).
The psychometric properties of the Dutch translation were tested in three groups of older persons prior to its use in LASA. Results were favorable and have been described in detail elsewhere (Beekman et al 1994; 1997). The factor structure of the Dutch translation of the CES-D as used in the baseline measurement of the LASA study was similar to the factor structure of the original CES-D and to several other translated versions: depressed affect (item: 3, 6, 9, 10, 14, 17, 18), positive affect (item: 4, 8,12, 16), somatic and retarded activity (item: 1, 2, 5, 7, 11, 13, 20) and an interpersonal factor (item 15, 19) (Beekman et al 1994, 1997).
In most studies a score of ³ 16 is used as a cut-off point to identify subjects with clinically relevant levels of depressive symptomatology (Berkman et al. 1986). Using this cut-off, the criterion validity for major depression was very satisfactory (sensitivity 100% and specificity 88%; Beekman et al., 1997).
The CES-D is a self-report symptom rating scale. It has been administered in different ways (face-to-face interview (main interview), telephone interview, self administration). In LASA the effect of different modes of administration were studied. Self-administered CES-D scales were found to yield systematically higher scores than when the scale was administered in a face-to-face interview. This mode effect, including a method to adjust for the mode effect, has been described in a separate paper (Geerlings et al 1999).
LASAB025 / LASAC025 / LASAD025 / LASAE025 / LAS2B025 / LASAF025 / LASAG025 / LASAH025
(main interview, in English/in Dutch)
Previous use in LASA
- as a dichotomous variable using the generally accepted cut-off for clinically relevant depressive symptoms: CES-D ≥ 16.
- as a continuous variable measuring increasing levels of depressive symptoms.
Within LASA, numerous papers have been written using the CES-D: on the prevalence and risk factors for minor and major depression, on different symptoms profiles in specific risk groups, on the natural course of depression, on the association with different aspects of physical health (iatrogenic depression, pain, cognitive decline, cardiovascular diseases and mortality), on gender differences, on religion, on the co morbidity with anxiety disorders and about health care utilization.
Beekman ATF, van Limbeek J, Deeg DJH, Wouters L, van Tilburg W (1994). Een screenings-instrument voor depressie bij ouderen in de algemene bevolking: de bruikbaarheid van de Center for Epidemiologic Studies Depression Scale (CES-D). Tijdschr Gerontol Geriatrie, 25, 95-103.
Beekman ATF, Deeg DJH, van Limbeek J, et al. 1997. Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community based sample of older adults in the Netherlands. Psychol. Med. 27, 231-235.
Berkman LF, Berkman CS, Kasl SV, et al. (1986) Depressive symptoms in relation to physical health and functioning in the elderly. Am. J. Epidem. 124, 372-388.
de Beurs E, Comijs HC, Twisk JWR, Sonnenberg C, Beekman ATF, & Deeg DJH. Stability and change in symptoms of depression, anxiety, and general negative affect in late life: modelling of vulnerability profiles. Journal of Affective Disorders, 2005, 84: 53-62.
Bierman EJ, Comijs HC, Jonker C, & Beekman AT. Symptoms of Anxiety and Depression in the Course of Cognitive Decline. Dem Geriatr Cogn Disord. 2007, 10, 24(3):213-219
Bierman EJM, Comijs HC, van Leeuwen JEP, Jonker C, & Beekman ATF. Anxiety has a different effect on cognition than depression in later life. Am J Geriatr Psychiatry, 2005, 13(8): 686-693.
Braam AW, Hein E, Deeg DJ, Twisk JW, Beekman AT, Van Tilburg W. Religious involvement and 6-year course of depressive symptoms in older Dutch citizens: results from the Longitudinal Aging Study Amsterdam. J Aging Health. 2004;16(4):467-89.
Braam AW, Beekman AT, Knipscheer CP, Deeg DJ, van den Eeden P, van Tilburg W. Religious denomination and depression in older Dutch citizens: patterns and models. J Aging Health. 1998 Nov;10(4):483-503.
Bremmer MA, Beekman AT, Deeg DJ, Penninx BW, Dik MG, Hack CE, Hoogendijk WJ. Inflammatory markers in late-life depression: results from a population-based study. J Affect Disord. 2008 Mar;106(3):249-55.
Bremmer MA, Hoogendijk WJ, Deeg DJ, Schoevers RA, Schalk BW, Beekman AT. Depression in older age is a risk factor for first ischemic cardiac events. Am J Geriatr Psychiatry. 2006,14(6):523-30.
Comijs HC, Beekman ATF, Smit F, van Tilburg T, & Deeg DJH. The association between recent life events and depressive symptoms in older persons and the interaction with early events. J Affect Disord. 2007, 103(1-3):243-246.
Comijs HC, van Tilburg T, Geerlings SW, Jonker C, Deeg DJH, van Tilburg W, & Beekman ATF. Do severity and duration of depressive symptoms predict cognitive decline older persons? Results of the Longitudinal Aging Study Amsterdam. Aging Clin Exp Res, 2004, 16 (3): 226-232.
Geerlings SW, Beekman ATF, Deeg DJH, Smit JH, van Tilburg W (1999) The Center for Epidemiologic Studies Depression scale (CESD-D) in a mixed mode, repeated measures design: age and sex differences. Int J Meth Psychiatr Res 8, 102-109.
Hertzog C, van Alstine J, Usala PD, Hultsch DF, Dixon, R. (1990) Measurement properties of the center for epidemiological studies depression scale (CES-D) in older populations. Psychol. Assess. 2, 64-72.
Himmelfarb S and Murrell SA (1983) Reliability and validity of five mental health scales in older persons. J. Gerontol. 38, 333-339.
Hoogendijk WJ, Lips P, Dik MG, Deeg DJ, Beekman AT, Penninx BW. Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry. 2008 65(5):508-12.
Janssen J, Beekman AT, Comijs HC, Deeg DJ, & Heeren TJ. Late-life depression: the differences between early- and late-onset illness in a community-based sample. Int J Geriatr Psychiatry. 2006, 21(1):86-93.
Radloff LS. 1977. The CES-D Scale: A self-report depression scale for research in the general population. Appl. Psychol. Meas. 3, 385-401.
Radloff LS and Teri. L, (1986) Use of the CES-D with older adults. Clin. Gerontol. 5, 119-36.
Sonnenberg CM, Beekman AT, Deeg DJ, van Tilburg W. Sex differences in late-life depression. Acta Psychiatr Scand. 2000 101(4):286-92.
Steunenberg B, Beekman AT, Deeg DJ, Kerkhof AJ. Personality and the onset of depression in late life. J Affect Disord. 2006, 92(2-3):243-51.
Steunenberg B, Beekman AT, Deeg DJ, Bremmer MA, Kerkhof AJ. Mastery and neuroticism predict recovery of depression in later life. Am J Geriatr Psychiatry. 2007, 15(3):234-42.