Using the CES-D in a two-phase survey for depressive disorders among nonreferred adolescents in Taipei

Background: Efficient screening is important in two-phase surveys. We examined whether the Center for Epidemiologic Studies Depression Scale (CES-D) is an appropriate instrument for screening depressive disorders among adolescents in Taipei, an ethnic group whose depression is little known of. Methods: Among the 2440 students of a school in Taipei, aged 12 to 16 years who completed the CES-D and eating attitude test (EAT; response rate=98.5%), 178 were randomly selected from four subgroups defined by the 90th percentile of the two screening tools for face-to-face interview, using the Schedule for Affective Disorders and Schizophrenia for Children (K-SADS). Discriminatory validities of instruments for depressive disorders were estimated, and then a stratum-specific likelihood ratio (SSLR) analysis was conducted for instruments with sufficient validity. Results: The prevalence estimates of depressive disorders varied with different levels of impairment, with a value of 2.4% for major depressive disorder and 0.3% for dysthymic disorder if at least two impairment items were endorsed. The areas under the receiver operative characteristic (ROC) curves were consistently high (0.88-0.90) for major depressive disorder with or without impairment requirement, but low (0.49) for dysthymic disorder without impairment requirement. Three strata of CES-D scores (0-28, 29-48, and ≥49) were derived for major depressive disorder with (SSLR=0.63, 3.00, and 11.75) and without (SSLR=0.61, 5.09, and 10.42) impairment requirement. Conclusions: The CES-D is useful in screening for major depressive disorder among nonreferred adolescents. Three strata are recommended for its practical application.