The 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) is a depression screening tool that has been used in the South African National Income Dynamics Study (NIDS), a national household panel study. This screening tool has not yet been validated in South Africa. This study aimed to establish the reliability and validity of the CES-D-10 in Zulu, Xhosa and Afrikaans. The CES-D-10’s psychometric properties were also compared to the Patient Health Questionnaire (PHQ-9), a depression screening tool already validated in South Africa.
Stratified random samples of Xhosa, Afrikaans and Zulu-speaking participants aged 15 years or older (N = 944) were recruited from Cape Town Metro and Ethekwini districts. Face-to-face interviews included socio-demographic questions, the CES-D-10, Patient Health Questionnaire (PHQ-9), and WHO Disability Assessment Schedule 2.0 (WHODAS). Major depression was determined using the Mini International Neuropsychiatric Interview. All instruments were translated and back-translated to English. Construct validity was examined using exploratory factor analysis with varimax rotation. Receiver Operating Characteristics (ROC) curves were used to investigate the CES-D-10 and PHQ-9’s criterion validity, and compared using the DeLong method.
Overall, 6.6, 18.0 and 6.9% of the Zulu, Afrikaans and Xhosa samples were diagnosed with depression, respectively. The CES-D-10 had acceptable internal consistency across samples (α = 0.69–0.89), and adequate concurrent validity, when compared to the PHQ-9 and WHODAS. The CES-D-10 area under the Receiver Operator Characteristic curve was good to excellent: 0.81 (95% CI 0.71–0.90) for Zulu, 0.93 (95% CI 0.90–0.96) for Afrikaans, and 0.94 (95% CI 0.89–0.99) for Xhosa. A cut-off of 12, 11 and 13 for Zulu, Afrikaans and Xhosa, respectively, generated the most balanced sensitivity, specificity and positive predictive value (Zulu: 71.4, 72.6% and 16.1%; Afrikaans: 84.6%, 84.0%, 53.7%; Xhosa: 81.0%, 95.0%, 54.8%). These were slightly higher than those generated for the PHQ-9. The CES-D-10 and PHQ-9 otherwise performed similarly across samples.
The CES-D-10 is a valid, reliable screening tool for depression in Zulu, Xhosa and coloured Afrikaans populations.
World Health Organization. The global burden of disease: 2004 update. Geneva: World Health Organization; 2008.
Stein DJ, Seedat S, Herman A, Moomal H, Heeringa SG, Kessler RC, Williams DR. Lifetime prevalence of psychiatric disorders in South Africa. Br J Psychiatry. 2007;192(2):112–7. CrossRef
Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401. CrossRef
Chishinga N, Kinyanda E, Weiss HA, Patel V, Ayles H, Seedat S. Validation of brief screening tools for depressive and alcohol use disorders among TB and HIV patients in primary care in Zambia. BMC Psychiatry. 2011;11(75). doi: 10.1186/1471-244X-11-75.
Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: Evaluation of a short form of the CES-D. Am J Prev Med. 1994;10(2):77–84. PubMed
Leibbrandt M, Woolard I, de Villiers L. Methodology: Report on NIDS wave 1. In: Technical paper no1. Cape Town, South Africa: University of Cape Town; 2009.
Meffert SM, McCulloch CE, Neylan TC, Gandhi M, Lund C. Increase of perceived frequency of neighborhood domestic violence is associated with increase of women's depression symptoms in a nationally representative longitudinal study in South Africa. Soc Sci Med. 2015;131:89–97. CrossRefPubMedPubMedCentral
Ardington C, Case A. Interactions between mental health and socioeconomic status in the South African national income dynamics study. Tydskrif vir studies in ekonomie en ekonometrie = J Studies Econ Econometrics. 2010;34(3):69.
Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32(9):1–7. CrossRef
Bhana A, Rathod SD, Selohilwe O, Kathree T, Petersen I. The validity of the Patient Health Questionnaire for screening depression in chronic care patients in primary health care in South Africa. BMC Psychiatry. 2015;15(1)
Statistics South Africa. Census 2011: Census in brief. Pretoria: Statistics South Africa; 2012.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–33. PubMed
Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. Can Med Assoc J. 2012;184(3):E191–6. CrossRef
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2095–128. CrossRef
Murray CJ, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C, et al. GBD 2010: a multi-investigator collaboration for global comparative descriptive epidemiology. Lancet. 2013;380(9859):2055–8. CrossRef
Peltzer K, Phaswana-Mafuya N. Levels of ability and functioning of persons living with HIV and AIDS using the WHO DAS II in a South African context. J Soc Dev Afr. 2008;23(2):33–53.
Üstün TB. Measuring health and disability: manual for WHO disability assessment schedule WHODAS 2.0. Geneva: World Health Organization; 2010.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837-45.
Fan J, Upadhye S, Worster A. Understanding receiver operating characteristic (ROC) curves. Can Assoc Emerg Physicians. 2006;8(01):19–20.
- Validation of the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) in Zulu, Xhosa and Afrikaans populations in South Africa
Emily Claire Baron
- BioMed Central