Screening for depressive symptoms among older adults in Taiwan: Cutoff of a short form of the Center for Epidemiologic Studies Depression Scale

Ken-Fu Chang^*, Li-Jen Weng

Department of Psychology, National Taiwan University, Taipei City.

DOI: 10.4236/health.2013.53A078                

Abstract

Screening for elders at risk for depression is crucial for promoting mental health in later life. The present study investigates the cutoff score of a short form of the CES-D for screening of depressive symptoms in the elderly population of Taiwan. This particular short form of CES-D is repeatedly used in the Taiwan Longitudinal Study on Aging (TLSA), a national survey of representative older adults in Taiwan, and is therefore referred to as the TLSA form. Data collected from five waves of TLSA were analyzed in this study. Participant responses repeatedly measured in 1989 and 1993 were used to identify a cutoff for the TLSA form of the CES-D with sensitivity and specificity using the cutoff of 4 on the Boston form of the CES-D as the criterion. Longitudinal data from the years 1996, 1999, and 2003 were used to validate the proposed cutoff by comparing the prevalence rates for depressive symptoms among older Taiwanese estimated from the identified cutoff and reported in previous studies. The score of 10 on the TLSA form of the CES-D was suggested, yielding a specificity of 0.93 and a sensitivity of approximately 0.96. The estimated prevalence rates for depressive symptoms among Taiwanese elders based on the suggested cutoff were between 18.9% and 23.7%, which are similar to previously reported rates. The cutoff score of 10 on the TLSA form of the CES-D is therefore recommended for screening depressive symptoms among older adults in Taiwan.

Keywords

CES-D; Cutoff; Depressive Symptoms; Older Adults; Screening; Taiwan Longitudinal Study on Aging

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Mui, A.C. and Yang, P.S. (2005) The foundations of gerontological social work practice in Taiwan. YehYeh Publishing House, Taipei.
[2]	Small, G.W. (1998) Treatment of geriatric depression. Depression and Anxiety, 8, 32-42. doi:10.1002/(SICI)1520-6394(1998)8:1+<32::AID-DA6>3.0.CO;2-J
[3]	Katona, C.L.E. (1994) Depression in old age. Wiley, New York.
[4]	Radloff, L.S. (1977) The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. doi:10.1177/014662167700100306
[5]	Bureau of Health Promotion, Department of Health (2006) 2003 Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan Survey Report. Bureau of Health Promotion, Department of Health, Taichung.
[6]	Roberts, R.E. and Vernon, S.W. (1983) The Center for Epidemiologic Studies Depression Scale: Its use in a community sample. American Journal of Psychiatry, 140, 41-46.
[7]	Irwin, M., Artin, K.H. and Oxman, M.N. (1999) Screening for depression in the older adult: Criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Archives of Internal Medicine, 159, 1701-1704. doi:10.1001/archinte.159.15.1701
[8]	Andresen, E.M., Malmgren, J.A., Carter, W.B. and Patrick, D.L. (1994) Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 77-84.
[9]	Kohout, F.J., Berkman, L.F., Evans, D.A. and Cor-noni-Huntley, J. (1993) Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health, 5, 179-193. doi:10.1177/089826439300500202
[10]	Myers, J.K. and Weissman, M.M. (1980) Use of a self- report symptom scale to detect depression in a community sample. American Journal of Psychiatry, 137, 1081-1084.
[11]	Haringsma, R., Engels, G.I., Beekman, A.T. and Spinhoven, P. (2004) The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology. International Journal of Geriatric Psychiatry, 19, 558-563. doi:10.1002/gps.1130
[12]	Lewinsohn, P.M., Seeley, J.R., Roberts, R.E. and Allen, N.B. (1997) Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging, 12, 277-287. doi:10.1037/0882-7974.12.2.277
[13]	Hanley, J.A. and McNeil, B.J. (1982) The meaning and use of the area under receiver operating characteristic (ROC) curve. Radiology, 143, 29-36.
[14]	Sheehan, B. and Banerjee, S. (1999) Review: Somatization in the elderly. International Journal of Geriatric Psychiatry, 14, 1044-1049. doi:10.1002/(SICI)1099-1166(199912)14:12<1044::AID-GPS55>3.0.CO;2-0
[15]	Himmelfarb, S. and Murrell, S.A. (1983) Reliability and validity of five mental health scales in older persons. Journal of Gerontology, 38, 333-339. doi:10.1093/geronj/38.3.333
[16]	Cheng, S.T. and Chan, A.C.M. (2005) The Center for Epidemiologic Studies Depression Scale in older Chinese: Thresholds for long and short forms. International Journal of Geriatric Psychiatry, 20, 465-470. doi:10.1002/gps.1314
[17]	Waston, L.C., Lewis, C.L., Kistler, C.E., Amick, H.R. and Boustani, M. (2004) Can we trust de-pression screening instruments in healthy “old-old” adults? International Journal of Geriatric Psychiatry, 19, 278-285. doi:10.1002/gps.1082
[18]	Boey, K.W. (1999) Cross-validation of a short form of the CES-D in Chinese elderly. International Journal of Geriatric Psychiatry, 14, 608-617. doi:10.1002/(SICI)1099-1166(199908)14:8<608::AID-GPS991>3.0.CO;2-Z
[19]	American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. 4th Edition, American Psychiatric Association, Washington DC.
[20]	Robison, J., Gruman, C., Gaztambide, S. and Blank, K. (2002) Screening for depression in middle-aged and older Puerto Rican primary care patients. Journals of Gerontology Series A: Biological Sciences and Medical, 57, M308-M314. doi:10.1093/gerona/57.5.M308
[21]	Ku, P.W., Fox, K.R. and Chen, L.J. (2009) Physical activity and depressive symptoms in Taiwanese older adults: A seven-year follow-up study. Preventive Medicine, 48, 250-255. doi:10.1016/j.ypmed.2009.01.006
[22]	SAS Institute, Inc. (2001) Sample 25017: Nonparametric comparison of areas under correlated ROC curves. http://support.sas.com/kb/25/017.html
[23]	Fleiss, J.L. (1981) Statistical methods for rates and proportions. 2nd Edition, Wiley & Sons, New York.
[24]	Lu, C.H., Liu, C.Y. and Yu, S. (1998) Depressive disorders among the Chinese elderly in a suburban community. Public Health Nursing, 15, 196-200. doi:10.1111/j.1525-1446.1998.tb00339.x
[25]	Chong, M.Y., Tsang, H.Y., Chen, C.S., et al. (2001) Community study of depression in old age in Taiwan: Prevalence, life events and socio-demographic correlates. British Journal of Psychiatry, 178, 29-35. doi:10.1192/bjp.178.1.29
[26]	Chiu, H.C., Chen, C.M., Huang, C.J. and Mau, L.W. (2005) Depressive symptoms, chronic medical conditions and functional status: A comparison of urban and rural elders in Taiwan. International Journal of Geriatric Psychiatry, 20, 635-644. doi:10.1002/gps.1292
[27]	Tsai, Y.F., Yeh, S.H. and Tsai, H.H. (2005) Prevalence and risk factors for depressive symptoms among community-dwelling elders in Taiwan. International Journal of Geriatric Psychiatry, 20, 1097-1102. doi:10.1002/gps.1413
[28]	Beekman, A.T., Copeland, J.R. and Prince, M.J. (1999) Review of community prevalence of depression in later life. British Journal of Psychiatry, 174, 307-311. doi:10.1192/bjp.174.4.307