Reliability and validity of the center for epidemiologic studies-depression scaleinscreening for depression among HIV-infected and -uninfected pregnant women attending antenatal services in northern Uganda: a cross-sectional study
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Psychiatry
Abstract
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 assessingdepression. We employed measures of internal consistency (Cronbach’s alpha), and criterion validity [Area Underthe 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. Afteradjusting for baseline differences between the HIV subgroups (maternal age and marital status), HIV-infectedpregnant 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 womenof mixed HIV status attending antenatal services in northern Uganda.
Description
Keywords
Pregnancy, Major depression, Prenatal depression, Uganda, Africa, Screening
Citation
Natamba et al.: 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 14:303. doi:10.1186/s12888-014-0303-y