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The aim of this study is to assess the association between smartphone usage and depression in each gender of senior high school students. A cross-sectional study with self-administered questionnaires for 295 high school students, aged 15-19 was conducted in Japan. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Female adolescents used smartphones more hours a day than males. Students who used the smartphones for three hours a day accounted for 44.3% of female students and 22.5% of male students. Female students spent longer hours on online chat, social networking sites (SNS), and Internet browsing. The longer hours they spent for online chat (Odds ratio (OR): 1.74; 95% confidence interval (CI): 1.18-2.56), and SNS (OR: 1.41, 95% CI: 1.04-1.92) were associated with depression. On the other hand, male students spent more hours playing games than female students, and their smartphone use was not correlated with depression. There were gender differences in smartphone usage: female students spent more time on social contacts, whereas males were more likely to use them for entertainment. Therefore, if female students overuse online communication, they may be at a higher risk for depression.

Breakfast consumption has been suggested to influence mood, but prospective evidence on this issue is limited. We prospectively investigated the association between the frequency of breakfast consumption and the risk of depressive symptoms in Japanese employees. Participants were 716 employees aged 19–68 years who were free from depressive symptoms and mental disorders at baseline and who attended the 3-year follow-up survey. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. The frequency of breakfast consumption was categorized into “daily”, “5–6 times/week”, “3–4 times/week”, “1–2 times/week”, or “≤1 times/week”. Logistic regression was used to estimate odds ratios of depressive symptoms according to breakfast consumption adjusted for dietary and lifestyle factors. Participants who consumed breakfast ≤1 times/week had an increased risk of depressive symptoms compared to those who ate breakfast every day, even after adjusting for other dietary factors (multivariable-adjusted odds ratio 2.92; 95% confidence interval, 1.37–6.22) The risk of depressive symptoms tended to increase with decreasing frequency of breakfast consumption (P for trend = 0.02). The omission of breakfast is related to increased risk of depressive symptoms among Japanese employees, independently of other dietary and non-dietary factors.

This study analyzes the performance of the Center for Epidemiologic Studies Depression Scale (CES-D) to screen for major depressive disorder (MDD) in adults. We divided adults into three groups such as community-indwelling adults, patients with chronic diseases, and psychiatric patients. Electronic searches were performed on the MEDLINE, EMBASE, CINAHL, and PsycINFO database using the following keywords: depression, depressive disorder, major, and CES-D scale. The Quality Assessment of Diagnostic Accuracy Studies-2 was applied to assess the risk of bias in diagnostic studies. We reviewed 33 studies, including 18,271 adults that met the selection criteria. In meta-analysis, the pooled sensitivity was 0.86 on community-indwelling adults, 0.85 on patients with chronic diseases and 0.85 on psychiatric patients. The pooled specificity was 0.74, 0.84, and 0.88, respectively, and the summary receiver-operating characteristic curves were 0.88, 0.91, and 0.93, respectively. The RE correlation was a negative value (-0.394) only in patients with chronic diseases, showing no heterogeneity between studies. The CES-D, which has shown high diagnostic accuracy in adults, can be recommended for use as a first-stage screener for MDD. As a result, the early application of the CES-D can lead to disease prevention in adults at risk for depression.

Background We examined cross-sectional associations between depression and both inflammatory markers and fractional exhaled nitric oxide (FeNO). Methods This cross-sectional study is a secondary analysis of the data of the Iwaki Health Promotion Project 2016 (1,148 subjects). We analyzed the subjects' characteristics and laboratory data including plasma interleukin (IL)-6, high-sensitivity C-reactive protein (hs-CRP), and FeNO. The subjects with Center for Epidemiologic Studies Depression Scale scores ≥16 were assigned to the depression group. We performed a multivariate logistic regression analysis to determine whether inflammatory markers and FeNO were associated with depression. Results We assessed 1,099 subjects (430 males, 669 females). The depression group was 237 subjects (21.5%) [84 males (19.5%), 153 females (22.9%)]. The non-depression group was 862 subjects (346 males and 516 females). There were no significant differences in IL-6, hs-CRP, or FeNO between both groups. However, the multivariate logistic regression analysis indicated that lower FeNO was significantly associated with depression in males after adjusting for possible confounding factors (age, BMI, comorbidities, high-sensitivity troponin T, FEV1%, asthma, antidepressant use, smoker and alcohol drinker) (per 1 bpm increase, OR: 0.982; 95%CI: 0.967–0.998; p = 0.032). Conclusion Our findings indicate that lower FeNO may be associated with depression in males.

Depression and cognitive complaints are common after stroke; these issues have been studied in older populations, but not in the young. Two hundred and seventy four eligible stroke and TIA patients consented to participate and complete the Center for Epidemiologic Studies Depression Scale, and National Institute of Neurological Disorders and Stroke - Canadian Stroke Network 30-min neuropsychological battery; 57 (21%) were ≤ 50 years of age. Younger patients reported greater symptoms of depression and less executive dysfunction than older patients. This study highlights age differences in post-stroke depression symptoms and cognitive impairment, and emphasizes the need for screening across ages.

To examine the underlying substructure of DSM-5 PTSD in an adolescent sample, this study used a confirmatory factor analysis alternative model approach to assess 813 adolescents two and a half years after the Ya’an earthquake. Participants completed the PTSD Checklist for DSM-5, the Center for Epidemiologic Studies Depression Scale for Children, and the Screen for Child Anxiety Related Emotional Disorders. The results found that the seven-factor hybrid PTSD model entailing intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal had significantly better fit indices than other alternative models. Depression and anxiety displayed high correlations with the seven-factor model. The findings suggested that the seven-factor model was more applicable to adolescents following the earthquake, and may carry important implications for further clinical practice and research on posttraumatic stress symptomatology.

It is well known that some lifestyle factors are related to depression, but their cumulative contribution to the depression remains unclear. This study aimed to assess the importance of multiple lifestyle factors in contributing to depressive symptoms among Chinese college students. Between September and December in 2012, we conducted a cross-sectional study among 1907 Chinese college students from Guangzhou, Southern China. College students completed self-administered questionnaires and reported their lifestyle factors including sleep quality and duration, Internet use, smoking, drinking, exercise, outdoor activity or sunlight exposure, and eating breakfast. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D), and mild-to-moderate depressive symptoms were defined as the CES-D score ≥16. Among all the students, 29.7% reported mild-to-moderate depressive symptoms. Higher quality and longer duration of sleep, more exercises, more outdoor activities or sunlight exposures, and eating breakfast daily were associated with a lower CES-D score, which could explain 11.3% of variance of the CES-D score, after adjusting for socio-demographics, family history, interpersonal relationship, and academic characteristics using hierarchical multivariable linear regression. These associations were comparable between males and females. The protective role of healthy lifestyles should be considered in intervention programs for improving mental health among college students.

With the increase in the popularity of the Internet, more and more of its users are becoming addicted to it. Special focus in this study is placed on adolescents and emerging adults who constitute the largest number of users in Poland. The participants in the study were 718 individuals aged 12 to 30 (M = 17.57, SD = 3.63). There were two groups: 390 adolescents (aged 12–17 years, M = 14.71 years, SD = 0.99; 192 females) and 328 emerging adults (aged 18–30 years, M = 20.96 years, SD = 2.54; 197 females). The respondents completed: the Polish versions of Young's Internet Addiction Test (IAT), the Center for Epidemiologic Studies Depression Scale (CES-D), the IPIP-BFM-20 questionnaire measuring the Big Five, and the Future Time Perspective Questionnaire. The results showed that depression had the highest predictive power for IA. Personality traits were related to Internet addiction. In both groups, conscientiousness and agreeableness had negative contribution to Internet addiction. In the group of adolescents extraversion was a positive predictor of IA, whereas in emerging adults intellect was a negative predictor of IA. FTP long and FTP goals were predictors of IA in the group of emerging adults.

The aim of this study is to examine the mediating role of family function on the association between mother's education and their offspring's depression in college (M age = 19.19, SD = 1.60). A sample of 1177 student respondents was systematically sampled from 12 universities that include both generalist universities and specialist institutions in Beijing. The Family Assessment Device (FAD) and Center for Epidemiologic Studies Depression Scale (CES-D) were used to measure family function and students’ depression level, respectively. Multiple regression analysis indicated that mother's education was positively associated with college students’ depression and negatively associated with general family function. Mediation analysis indicated that mother's education significantly influenced students’ depression but the effect was not statistically significant when taking family function into account. General family function mediates the association between mother's education and depression of college students.

Most inhabitants of Tohoku district suffer from chronic fatigue after the 2011 Great East Japan Earthquake. Chronic fatigue following disasters may lead to serious illness, even death. Posttraumatic growth appears to counteract fatigue. We predicted that the chronic fatigue would be inversely related to the posttraumatic growth factor “relating to others,” as represented by mutual helping and a strong sense of connection with humanity. Young 59 healthy volunteers, residing in Miyagi prefecture, were recruited 3 months after the disaster. We measured the subjects׳ total scores on the Japanese version of the Checklist Individual Strength questionnaire (CIS), the Trait Anxiety (T-A) subscale of the State–Trait Anxiety Inventory (STAI), the Center for Epidemiologic Studies Depression Scale (CES-D), and four subscores on the posttraumatic growth inventory (PTGI). Stepwise regression analyses were conducted with score on the CIS as the dependent variable and other scores as independent variables. Scores on the “relating to others” factor of the PTGI showed a significant negative relationship with the CIS score, whereas the scores on the T-A subscale of the STAI and the CES-D were positively related to the CIS score. Human ties and mutual help were negatively related to the degree of the chronic fatigue.

Cannabis use has been associated with a continuum of psychotic experiences. However, it is unclear whether mood and anxiety symptoms account for increases in attenuated positive psychotic symptoms (APPS) among cannabis users. We predicted that depression and anxiety symptoms would mediate the relation between cannabis use and APPS, and between cannabis use and endorsement of eight or more distressing APPS (D-APPS), a potentially more clinically meaningful group. Young adults (n=674) completed the Prodromal Questionnaire (PQ); Drug Use Frequency measure; Center for Epidemiologic Studies Depression Scale; State-Trait Anxiety Inventory, Trait Form, Anxiety Subscale; and Social Phobia Scale. Results indicated that symptoms of trait anxiety, but not symptoms of depression or social anxiety, mediated the relationship between cannabis use and APPS, as well as the relationship between cannabis use and D-APPS. Results indicate that symptoms of trait anxiety may play a role in the relation between cannabis use and APPS. Findings underscore the importance of considering clinical characteristics co-occurring with psychotic symptoms, such as affective symptoms, when examining the association between cannabis use and psychotic symptoms.

We sought to explore the relationship between depressive symptoms and urinary 8-hydroxydeoxyguanine (8-OHdG), a biomarker of systemic oxidative DNA damage and repair, among 301 men and 210 women aged 21–67 years working in two municipal offices. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D). The geometric mean and its 95% confidence interval (CI) of urinary 8-OHdG concentrations were calculated according to the quartile of CES-D score. The prevalence of depressive symptoms, defined as having CES_D of ≥16, was 35.9% in men and 35.2% in women. There was no significant difference in geometric mean of urinary 8-OHdG concentrations according to the levels of depressive symptoms. In men, the multivariable-adjusted geometric mean of urinary 8-OHdG concentrations (95% CIs) in the first, second, third, and fourth category of depressive symptoms was 1.09 (1.02–1.16), 1.16 (1.08–1.24), 1.15 (1.07–1.24), and 1.10 (1.02–1.18), respectively ( p for trend=0.86). Similarly, no significant association was found in the analyses among women, nonsmoking men, and smoking men. The lack of association between depressive symptoms and urinary 8-OHdG concentrations may indicate the absence or more complex interactions between milder forms of depression and systemic oxidative DNA damage and repair in well-functioning population.

It has been eight years since the Wenchuan earthquake. We don't know how the lives of those affected by the disaster may remain blighted by its effects, or how many remain thus affected. The aim of the present study was to examine the relationship of disaster exposure, PTSD, depression and suicidal behaviors, using data from a cross-sectional survey conducted in earthquake-affected areas of China. 1369 participants were recruited from two different sites that were severely affected by the Wenchuan earthquake. The survey assessed suicidality (suicidal ideation, plans and attempts) and other mental health issues. Probable PTSD was assessed using the Impact of Event Scale-Revised (IES-R). The Center for Epidemiologic Studies Depression Scale (CES-D) Chinese edition was used to assess depressive symptoms. The results showed that 11.2% of participants felt that their lives had not yet recovered from the effects of the Wenchuan earthquake, even after eight years. Suicidal ideation, plans, and attempts were reported by 9.1%, 2.9%, and 3.3%, respectively, of the respondents. PTSD, depression, and perceived non-recovery were highly associated with suicidality. These results indicate that suicidality can be a long-term mental health sequela of disaster. Targeted, long-term suicide prevention programs for adult survivors should be further developed.

The Center for Epidemiologic Studies Depression Scale (CES-D) has been used extensively in community-based surveys to describe and explain the prevalence of depression in the general population. Yet, questions have been raised regarding its adequacy for use among ethnic minority because of its factor variance. Employing a within-gender and race approach, we test the validity of the CES-D for use among a sample of African American women family caregivers. Using data from a cross-sectional community sample of 521 urban and rural African American women family caregivers, this study examines the dimensionality of the CES-D by testing four different measurement models through confirmatory factor analyses. Among the four measurement models tested using Weighted Least Squares estimation, our findings support previous research that has identified four dimensions in the CES-D: depressed affect, positive affect, somatic complaints, and interpersonal relations for our sample. Additionally, a three-factor (somatization) model and a four-factor model were shown to be equivalent. Implications for further measurement and model testing, and the use of the CES-D for research among African American women caregivers are discussed.

The Center for Epidemiologic Studies-Depression scale (CES-D) is one of the five most frequently used measures of depressive experiences. Previous research has suggested that the scale may consist of two separate factors of happiness and depression, respectively. However, recent methodological research has demonstrated that standard factor analysis cannot be used in this situation to demonstrate such factors are substantive. The substantive factor structure of the CES-D was therefore tested with two samples of younger (N=8857; age range 27-35) and older (N=6125; age range 64-65) people. Using a recent correction to CFA, we demonstrate that a two factor structure arises through purely artifactual reasons, and that the CES-D actually has only one substantive factor, providing evidence for a single continuum ranging from happiness to depression.

The objective of the study was to evaluate relationships between sleep habits and depressive symptoms. Pilot study data were collected about sleep schedules, related factors and depression in female college students to find whether their sleep schedules correlate with affective symptoms. In the subsequent main study, similar information was collected under more controlled conditions. Depression was measured using the CES-D (Center for Epidemiologic Studies Depression Scale) and HAM-D-3 (modified Hamilton Depression Rating Scale). Response rates were 31.3% of eligible students for the pilot survey and 71.6% for the main study. Both studies showed that about 20% of students reported weekday sleep debts of greater than 2 h and about 28% reported significantly greater sleep debt and had significantly higher depression scores (P0.0001) than other students. Melancholic symptoms indicated by high CES-D scores (24), were observed in 24% of students. Sleep problems explained 13% of the variance for both the CESD scale and the HAM-D-3 scale. Among female college students, those who report a sleep debt of at least 2 h or significant daytime sleepiness have a higher risk of reporting melancholic symptoms than others.

This study's aim was to examine the relation between depression and stress-coping strategy among the general population. The survey was conducted in June 2000, using a large sample representative of the Japanese general population. A total of 24,551 responses from individuals aged 20 years or older were analyzed. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess the prevalence of depression with two different cut-off points; 16 and 26. Stress-coping strategies were asked based on given examples of actual behaviors covering problem-focused, emotion-focused, and avoidant ones. There was no marked gender difference in the prevalence of a problem-solving strategy, while various types of gender differences were found with respect to the prevalence of emotion-focused and avoidant strategies. In relation to depression, multivariate logistic regression analyses revealed the significantly highest odds ratios (OR) for avoidant coping strategies and the lowest OR for problem-focused ones in both genders. The fact that depression was associated positively with avoidant strategies but negatively with problem-solving strategies indicates that individual stress-coping strategies have their own significance with respect to depression, and may be utilized in establishing an evidence-based cognitive behavioral approach to depressive patients.

According to the dual-process theory of coping flexibility (Kato, 2012), coping flexibility is the ability to discontinue an ineffective coping strategy (i.e., evaluation coping process) and implement an alternative strategy (i.e., adaptive coping process). The coping flexibility hypothesis (CFH) proposes that the ability to engage in flexible coping is related to better psychological functioning and physical health, including less depression. I the present study, participants were 393 American Whites, 429 Australian Whites, and 496 Chinese, selected from the data pool of the 2013 Coping and Health Survey (see Kato, 2014b). They completed both the Coping Flexibility Scale (Kato, 2012), which is based on the dual-process theory of coping flexibility, and the Center for Epidemiologic Studies Depression Scale (CES-D). For all nationalities and genders, evaluation coping and adaptive coping were significantly correlated with lower levels of depressive symptoms. Structural equation modeling revealed that evaluation coping was associated with lower depressive symptoms for all nationalities and genders, whereas no significant relationships between adaptive coping and depressive symptoms were found for any nationalities. Our results partially supported that the CFH fits with the dual-process theory of coping flexibility.

Depression has been linked to the overall diet using both exploratory and pre-defined methods. However, neither of these methods incorporates specific knowledge on nutrient-disease associations. The aim of the present study was to empirically identify dietary patterns using reduced rank regression and to examine their relations to depressive symptoms. Participants were 2006 Japanese employees aged 19-69 years. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Diet was assessed using a validated, self-administered diet history questionnaire. Dietary patterns were extracted by reduced rank regression with 6 depression-related nutrients as response variables. Logistic regression was used to estimate odds ratios of depressive symptoms adjusted for potential confounders. A dietary pattern characterized by a high intake of vegetables, mushrooms, seaweeds, soybean products, green tea, potatoes, fruits, and small fish with bones and a low intake of rice was associated with fewer depressive symptoms. The multivariable-adjusted odds ratios of having depressive symptoms were 0.62 (95% confidence interval, 0.48-0.81) in the highest versus lowest tertiles of dietary score. Results suggest that adherence to a diet rich in vegetables, fruits, and typical Japanese foods, including mushrooms, seaweeds, soybean products, and green tea, is associated with a lower probability of having depressive symptoms.

This study examined the factor structure of the Center for Epidemiologic Studies Depression Scale (CES-D) in low socioeconomic status African Americans (ns426). Confirmatory factor analysis indicated that the four factors— (1) depressed affect, (2) positive affect, (3) somatic complaints, and (4) interpersonal problems—of the CES-D scale previously foundin the general population were supportedin this sample. These results were cross-valid atedin other nationally representative samples of African-American participants (ns988) andCaucasians (ns666), andthe fourfactor structure of the CES-D scale replicated in all three groups in this study. An alternative model was also tested with the factors d epressedaffect andsomatic complaints combinedas a single factor, a find ing often reportedin minority groups. Results indicated a significantly poorer fit for the three-factor model compared with the four-factor model for all three groups. In addition, higher loading differences were significantly evident between AfricanAmerican andCaucasian groups, while higher load ing similarities were foundbetween the two African-American groups. These findings provide further evidence of measurement equivalency of the CES-D scale in samples with differential characteristics including race and socioeconomic status. 2004 Elsevier Ireland Ltd. All rights reserved.

The current study examines the association between low birth weight and risk for major depression from early adolescence to early adulthood. It accounts for eight documented confounders, and depression within families. Data were analyzed from the National Longitudinal Survey of Youth 1979 on mothers and offspring. Major depression was assessed with the Center for Epidemiologic Studies Depression Scale Short-Form (CES-D-SF) among offspring (N=3398) biannually, from 2000 to 2010 (aged 14-25). Competing models were examined with survival analysis and Generalized Estimated Equations (GEE). CES-D-SF based major depression was reported by 33.46% (n=1137) of participants. Among persons with very low birth weight (1500 g), 47.5% (n=19/40) were classified with CES-D-SF depression (OR=1.81, 95% CI=0.97, 3.39). Similar results were found with survival analysis (HR=1.97, 95% CI=0.97, 4.01). Among multiple offspring families, GEE modeling showed a similar trend. On aggregate (unadjusted OR=2.46, 95% CI=1.07, 5.63; adjusted OR=2.43, 95% CI=0.94, 6.23), and within families of mothers with CES-D-SF depression (unadjusted OR=2.54, 95% CI=0.55, 11.66; adjusted OR=1.79, 95% CI=0.28, 11.42). Compelling evidence is lacking in favor of an association between very low birth weight (1500 g), and suspected major depression from early adolescence to early adulthood after accounting for documented confounders.

The operating characteristics of the Center for Epidemiologic Studies Depression Scale were compared between Japanese and U.S. adult workers. Data were analyzed from age- and education-matched male white collar workers ( n = 368 for each) selected from 2016 workers in Japan and 3059 in the United States. The U.S. data were obtained from the 1974–1975 Augmentation Survey of the National Health and Examination Survey I. The Japanese responses to positively worded items markedly differed from those of U.S. workers, whereas responses to negatively worded items were generally comparable in the two groups. Thus, spuriously higher positive subscale and whole scale scores were found among the Japanese workers compared with U.S. workers (mean scores: 6.03 vs. 1.83 for the positive subscale and 9.94 vs. 5.35 for the whole scale, respectively; both differences were statistically significant). Negative subscale scores did not differ significantly in the two samples (3.91 vs. 3.52). The present study confirmed the hypothesis of Iwata et al. that Japanese respondents have a tendency to suppress the expression of positive affect.

We are pleased to see an additional validation of the Center for Epidemiologic Studies Depression Scale – Revised (CESD-R:(Eaton et al., 2004)) in the article in Psychiatry Research by Van Dam and Earleywine (Van Dam and Earleywine, 2011). We wish to make readers aware that an electronic version of the CESD-R is freely and publicly available at http://cesd-r.com. The web version includes symptom score interpretations that can be emailed to the subject, to his or her clinician, or to a research project site. The output includes a profile suggesting which of the nine symptom criteria are occurring most frequently, as well as recommendations to seek help if the pattern of responses suggests depression may be present. The output includes a ‘depression score’ based upon the original CESD-R continuous scale (analogous to the original CESD scale (Radloff, 1977), as well as a categorization of that score (e.g., “Possible major depressive episode”) based on an algorithm different from that of Van Dam and Earleywine, as documented on the web site (http:// cesd-r.com/cesdr/). Notably, the most severe category in the web algorithm reflects a pattern of selfreported answers that fully meet the criteria for DSM IV-defined major depressive disorder.

The criterion validity of the Center for Epidemiologic Studies Depression Scale (CES-D) is examined in 120 adult Northwest Coast American Indians. The criterion was a DSM-III-R diagnosis derived from the Lifetime version of the Schedule for Affective Disorders and Schizophrenia. Sensitivity for major depression was 100% (95% confidence limits 36%, 100%); specificity was 82.1% (75.1%, 89%). For a broad category of depressive disorders ( n =9), sensitivity was 77.8% and specificity was 84.7%. Cut points based on receiver operating characteristic analyses did not greatly improve the performance of the CES-D. The use of factor scores instead of total scores made little difference.

Abnormalities in amygdala activity have been implicated in adolescents and older adults with major depressive disorder (MDD), but few studies have focused on young adults with early-onset MDD. In this study, we measured amygdala activity in 27 young adults with early-onset MDD and 25 healthy controls (HC) using functional magnetic resonance imaging (fMRI) with an emotional processing task. Both groups showed significant bilateral activation within the amygdala to threat-related facial expressions. In the matching face task, the activations of the left amygdala, thalamus, prefrontal and temporal cortex were significantly greater while the activation of the right prefrontal was significantly lower for the MDD group compared with the HC group. For the MDD group, there was a significant positive correlation between the activity of the amygdala and scores on the Chinese version of the Center for Epidemiologic Studies Depression Scale. Overall, our findings suggest that young adults with early-onset MDD may be characterized by abnormalities in nodes along the fronto-limbic pathways when facing threat-related facial expression.

Depression has a huge societal impact, making accurate measurement paramount. While there are several available measures, the Center for Epidemiological Studies Depression Scale (CESD) is a popular assessment tool that has wide applicability in the general population. In order to reflect modern diagnostic criteria and improve upon psychometric limitations of its predecessor, the Center for Epidemiologic Studies Depression Scale--Revised (CESD-R) was recently created, but has yet to be publicized. This study explored psychometric properties of the CESD-R across a large community sample (N=7389) and smaller student sample (N=245). A newly proposed algorithmic classification method yielded base-rates of depression consistent with epidemiological results. Factor analysis suggested a unidimensional factor structure, but important utility for two separate symptom clusters. The CESD-R exhibited good psychometric properties, including high internal consistency, strong factor loadings, and theoretically consistent convergent and divergent validity with anxiety, schizotypy, and positive and negative affect. Results suggest the CESD-R is an accurate and valid measure of depression in the general population with advantages such as free distribution and an atheoretical basis.

In 2000, Schroevers and colleagues examined the reliability and validity of a two-factor structure for the Dutch version of the Center for Epidemiologic Studies-Depression (CES-D) scale in cancer patients and in a community sample. The authors concluded that a two-factor structure assessing Positive Affect (PA) and Depressed Affect was a better fit to the data than the standard four-factor structure. They argued further that the four reverse-scored items composing the PA scale should be dropped. Using similar measures and analyses as Schroevers and colleagues, we examined the factor structure and concurrent validity of the English version of the CES-D in university student and community samples. Across both samples the factor structure was more similar to Radloff's (1977) original four-factor structure than to the proposed two-factor structure. Additionally, our validity analyses indicated no problems with the PA items and suggested that PA might be more specifically related to depression than to other forms of psychopathology. We recommend that clinicians and researchers using the English version of the CES-D continue to use the full 20-item version.

The evidence obtained from prospective studies to support the hypothesis that fish consumption may improve mental status remains limited. The current study prospectively assessed a low frequency of fish consumption as a risk factor for depressed mood. Included were 5068 adults aged 25-74 years examined in 1971-1975 as the baseline of the First National Health and Nutrition Examination Survey Follow-up Study. Frequency of eating fish at baseline was obtained using a 3-month food frequency questionnaire. Severely depressed mood (SDM) was defined as the Center for Epidemiologic Studies Depression Scale scores ≥22 or taking anti-depressants. After an average of 10.6 years of follow-up, among men (n=2039), the percentage of individuals with SDM was 11.7%. Compared with frequent consumers (more than once a week), the odds ratios (ORs) were 1.43 (95%CI=0.66-3.11) and 2.08 (1.08-4.09) respectively for the men eating fish once a week and less than once a week (p for trend=0.03). Among women (n=3029), the percentage of individuals with SDM was 17.89%. The ORs were 1 (reference), 0.91 (0.68-1.22) and 1.15 (0.83-1.59) respectively for the women eating fish more than once, once, and less than once a week. These estimates were obtained after adjustment for indicators of social deprivation and major physical diseases. The study concluded that independently from social deprivation and physical diseases, low fish consumption was a risk factor for SDM among men. Further studies are needed to confirm these findings and elucidate mechanisms for the difference between men and women.

Previous studies of the Center for Epidemiologic Studies Depression Scale (CES-D) in Chinese Americans describe internal reliability and factor structure. We report CES-D construct validity and diagnostic validity for major depression in a probability sample of 168 community-dwelling Chinese American women. Internal consistency was satisfactory (Cronbach's alpha=0.86). Good construct validity was indicated by significantly higher mean CES-D scores for respondents who reported lower social support, worse self-perceived general health, or stressful life events, including intimate partner violence. Cultural response bias was found, with positively-stated CES-D items (e.g. "I was happy") producing higher depression scores in immigrants and subjects who preferred to speak Chinese. Diagnostic validity for major depression was assessed using the Composite International Diagnostic Interview. A CES-D cut-off score of 16 had sensitivity of 100% (95% CI: 44% to 100%), specificity of 76% (95% CI: 69% to 82%), PPV of 7% (95% CI: 3% to 19%) and NPV of 100% (95% CI: 97% to 100%). Our findings suggest that the CES-D is useful for screening out non-depressed subjects in a first-stage assessment. However, it should be followed by a diagnostic tool in Chinese American women with scores above the cut-off in order to identify those with clinical depression.

The purpose of this report is to present data on the effects of language (English/Spanish) and ethnic status (white/non-Hispanic or Mexican origin) on the ability of the Center for Epidemiologic Studies Depression (CES-D) scale to detect cases of clinical depression and generalized anxiety identified using the Diagnostic Interview Schedule (DIS) in psychiatric treatment settings. The agreement between the CES-D scale and the DIS diagnoses of major depressive disorder (MDD) and generalized anxiety disorder (GAD) was poor, especially among Mexican-origin patients interviewed in Spanish. Multiple regression analysis revealed that the CES-D scale was positively associated with MDD in all groups. In addition, GAD also was associated with the CES-D scale in Anglos and English-speaking Mexican-Americans but not in Spanish-speaking Mexican-Americans.

This study investigates the extent to which the diagnostic performance of the Center for Epidemiologic Studies Depression Scale (CES-D; both 20- and 10-item versions) varies with cognitive status, and whether the same threshold can be applied regardless of cognitive status. Three hundred and ninety-six persons aged 60+ referred for psychiatric assessment were broken down into four groups depending on age (70 andor=70) and dementia status (mild vs. none). All were independently interviewed using the CES-D before their first evaluation by a psychiatrist. Receiver operating characteristic curves showed that both versions of the CES-D produced essentially identical results, regardless of age and dementia status. Both versions were more or less robust to the effect of mild dementia but were vulnerable to the effect of age itself. Furthermore, the optimal threshold for the 20-item version varied somewhat across the different age-dementia groups, and no clear-cut threshold existed in old-old persons with dementia. On the contrary, the same threshold of 12 can be adopted for the 10-item version, regardless of age and dementia status. Compared with the full 20-item scale, the 10-item version has the added advantage of an identical threshold across age and cognitive status.

To adapt the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations, a Spanish translation of the scale was interviewer-administered to 554 subjects aged 18–34 years (65.9% women) and the ratings so obtained were compared with the SCID-CV-based diagnoses of expert clinicians. The internal consistency of the scale was satisfactory (Cronbach's α =0.89). Four factors identified by exploratory factor analysis (Depressive/Somatic, Positive Affect, Retarded Activity and Interpersonal Relations) accounted for 55.9% of the variance. A score of 26 was identified as a suitable cut-off for screening purposes, affording a sensitivity of 0.906 and a specificity of 0.918.

The study assessed in normal subjects the hypothesis of a specific association between alexithymia and poor sleep quality, taking into consideration the contribution of depression. Five hundred fifty-four university students (480 F and 74 M) filled out the Italian version of the 20-item Toronto Alexithymia Scale (TAS-20), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Pittsburgh Sleep Quality Index (PSQI). TAS-20 scores were significantly correlated with many measures of self-rated poor sleep quality and also strongly correlated with depression scores. Any association between alexithymia and sleep complaints disappears when the contribution of depression is partialled out by multiple regressions, and only the well-known relationship between depression and impairment of sleep quality is confirmed.

The Beck Depression Inventory has undergone substantial revision recently as the BDI-II to correspond to DSM-IV criteria. We developed the Japanese version of the BDI-II and examined its psychometric properties. The linguistic equivalence was verified by a back-translation method. The final translation was administered to the visitors at a public health care center, and the responses of 766 adults (age = 24-82 years, women = 40%) were analyzed. Half of the participants completed the Center for Epidemiologic Studies Depression Scale (CES-D) as well. A high level of internal consistency reliability (Cronbach's alpha = 0.87) and item homogeneity was confirmed. Exploratory factor analysis showed a two-factor structure (cognitive and somatic-affective), which was almost identical to the original model demonstrated by Beck et al. (1996, Manual for the Beck Depression Inventor Psychological Corporation, San Antonio, TX, USA). The following confirmatory factor analysis also supported the two-factor structure. Adequate correlation (r = 0.69, P < 0.001) between the total score of the BDI-II and that of the CES-D was observed. A higher score for women compared to men, without significant age differences, was consistent with the results of previous reports. We conclude that the Japanese version of the BDI-II is psychometrically robust and can be used to assess depressive symptoms in Japanese people.

To examine variations in the manifestation of depressive symptomatology across racial/ethnic groups, analyses of differential item functioning (DIF) on the Center for Epidemiologic Studies Depression Scale (CES-D) were separately conducted for representative samples of young adults in the following groups: African-Americans (n = 434), Hispanics born in the US (n = 493), and Hispanics born outside the US (n = 395). Non-Hispanic whites (n = 463) were employed as the reference group in all analyses. The effects of gender and age were controlled. DIF analyses indicated that: (1) about half of the CES-D items functioned differently among non-Hispanic whites compared to each of the other racial/ethnic groups; (2) the manifestation of symptoms seemed to be similar for both Hispanic groups, except for low positive affect; (3) African-Americans tended to favor somatic symptoms over affective (depressive) symptoms; (4) Immigrant Hispanics appeared to inhibit the expression of positive affect, and thus more high scorers on the total CES-D were observed within this subgroup. In contrast, no differences were observed when only negative items were considered. The use of positive affect items might artifactually induce spurious differences among people who were born outside the United States or North America.

A new screen for depression was compared with clinician diagnoses based on the Structured Clinical Interview for DSM-IV (SCID) as the standard. Post-menopausal women (n=436) completed the Burnam screen, a short version of the Center for Epidemiologic Studies Depression Scale (CES-D). The Burnam screen had a sensitivity of 74% and a specificity of 87% for current major depression and dysthymia, but the positive predictive value was low (20%) and the overall error rate was 14%. For lifetime mood disorders, sensitivity was very low for detecting affected subjects, even though specificity and positive predictive value were higher than for current conditions. Substituting a more sensitive cutpoint slightly improved the screen's ability to detect subjects with lifetime mood disorders. Even algorithms that used coefficients optimized for these data gave little improvement in the psychometric properties of the Burnam screen. These results re-emphasize the difficulty of using a one-stage screen to detect accurately a depressive diagnosis.

The prevalence and correlates of symptoms of depression in a nationwide sample of Korean adults, collected during the National Health and Health Behavior Examination Survey, were examined. A probability sample of 3,711 respondents (a response rate of 81.3%) completed the Center for Epidemiologic Studies Depression Scale (CES-D) and a variety of sociodemographic questions. In this sample 23.1% of males and 27.4% of females had scores above the cutoff point of 16 (probable depression) on the CES-D scale, and 6.8% of males and 10.4% of females were above the cutoff point of 25 (severe, definite depression). Apart from a few reports describing Afro-American and Puerto-Rican samples, these rates were somewhat higher than those found in the US and Western countries. In this report, female gender, fewer than 13 years of education, and disrupted marriage (widowed/divorced/separated) proved to be statistically significant predictors of severe, definite symptoms of depression.

Response patterns on the Center for Epidemiologic Studies Depression Scale (CES-D) items among Japanese adolescents were compared with those of their U.S. counterparts. The data were obtained from approximately 1,500 junior high school students, aged 12-15 years. Japanese responses to positively worded items markedly differed from those of American adolescents, whereas responses to negatively worded items were comparable in the two groups. This resulted in poor psychometric properties for the CES-D and spurious higher positive subscale and whole scale scores among the Japanese sample. It is possible that Japanese respondents tend to suppress positive affect expression and, thus, the positively worded questioning is presumably inappropriate for Japanese samples.

Confirmatory factor-analytic models are used to examine gender biases of individual items of the Center for Epidemiologic Studies Depression (CES-D) Scale. In samples containing 708 cancer patients and 504 caregivers of the chronically ill elderly, two CES-D items are identified as producing biased responses in comparisons of male and female respondents. Three additional CES-D items are excluded on the basis of other psychometric problems, yielding a subset of 15 CES-D items that capture almost all the information of the original 20-item CES-D scale but are free of any gender bias. Gender differences in mean levels of depressive symptomatology are significantly reduced, but not eliminated, when the 15-item scale is used.

Reliability of the Center for Epidemiologic Studies Depression Scale, a 20-item symptom checklist, is examined using data from a sample of community respondents containing Anglos (254), Blacks (270), and Mexican Americans (181). Although the survey response rate was lower for Mexican Americans, quality of the data provided by this group was not significantly different from that for Anglos or Blacks. That is, there were no differences among these groups in terms of missing data or internal consistency reliabilty (as measured by Cronbach's alpha and Spearman-Brown split halves). Factor-analytic results also demonstrate the same general structure of responses among the three groups.

This study evaluates the validity of the Center for Epidemiologic Studies Depression Scale (CES-D) by comparing it to DSM-III diagnoses of major depression and generalized anxiety, using the National Institute of Mental Health Diagnostic Interview Schedule (DIS). Data were gathered on a sample of 310 mothers of children with chronic disabilities. The utility of the CES-D for detecting major depression was approximately equal to its utility for detecting generalized anxiety. Multivariate analysis revealed that the unique association of CES-D with current depression was equal to its association with current generalized anxiety and that the two disorders had additive effects on CES-D. The analysis did not identify any individual CES-D symptom as specific to either disorder. The findings, therefore, do not support the notion that the CES-D measures depression specifically.