Reliability and validity of the center for epidemiologic studies-depression scale in screening for depression among HIV-infected and -uninfected pregnant women attending antenatal services in northern Uganda: a cross-sectional study

BMC Psychiatry. 2014 Nov 22;14:303. doi: 10.1186/s12888-014-0303-y.


Background: There are limited data on the prevalence and approaches to screening for depression among pregnant women living in resource poor settings with high HIV burden.

Methods: We studied the reliability and accuracy of the Center for Epidemiologic Studies Depression (CES-D) scale in 123 (36 HIV-infected and 87 -uninfected) pregnant women receiving antenatal care at Gulu Regional Referral Hospital, Uganda. CES-D scores were compared to results from the psychiatrist-administered Mini-International Neuropsychiatric Interview (MINI) for current major depressive disorder (MDD), a "gold standard" for assessing depression. We employed measures of internal consistency (Cronbach's alpha), and criterion validity [Area Under the Receiver Operating Characteristic Curve (AUROC), sensitivity (Se), specificity (Sp), and positive predictive value (PPV)] to evaluate the reliability and validity of the CES-D scale.

Results: 35.8% of respondents were currently experiencing an MDD, as defined from outputs of the MINI-depression module. The CES-D had high internal consistency (Cronbach's alpha = 0.92) and good discriminatory ability in detecting MINI-defined current MDDs (AUROC = 0.82). The optimum CES-D cutoff score for the identification of probable MDD was between 16 and 17. A CES-D cutoff score of 17, corresponding to Se, Sp, and PPV values of 72.7%, 78.5%, and 76.5%, is proposed for adoption in this population and performs well for HIV-infected and -uninfected women. After adjusting for baseline differences between the HIV subgroups (maternal age and marital status), HIV-infected pregnant women scored 6.2 points higher on the CES-D than HIV-uninfected women (p = 0.032).

Conclusions: The CES-D is a suitable instrument for screening for probable major depression among pregnant women of mixed HIV status attending antenatal services in northern Uganda.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Validation Study

MeSH terms

  • Adult
  • Area Under Curve
  • Comorbidity
  • Cross-Sectional Studies
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / epidemiology*
  • Depressive Disorder, Major / psychology
  • Developing Countries / statistics & numerical data
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / psychology
  • Humans
  • Interview, Psychological / methods
  • Interview, Psychological / standards
  • Mass Screening / standards*
  • Neuropsychological Tests / standards
  • Neuropsychological Tests / statistics & numerical data
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Pregnancy Complications / epidemiology*
  • Pregnancy Complications / psychology
  • Prenatal Care / methods
  • Prenatal Care / psychology
  • Prenatal Care / statistics & numerical data
  • Prevalence
  • Psychiatric Status Rating Scales / standards*
  • Psychiatric Status Rating Scales / statistics & numerical data
  • ROC Curve
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Uganda / epidemiology
  • Young Adult