Validation of the Center for Epidemiologic Studies Depression Scale in screening for major depressive disorder among retired firefighters exposed to the World Trade Center disaster

Sydney Chiu, Mayris P. Webber, Rachel Zeig-Owens, Jackson Gustave, Roy Lee, Kerry J. Kelly, Linda Rizzotto, David J. Prezant

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: We evaluated the performance of a modified Center of Epidemiologic Studies Depression Scale (CES-D-m), which captured symptoms in the past month, in comparison to the Diagnostic Interview Schedule (DIS) in identification of major depressive disorder (MDD) in World Trade Center (WTC)-exposed retired Fire Department, City of New York (FDNY) firefighters. Methods: From 12/2005 to 7/2007, FDNY enrolled retired firefighters in its Medical Monitoring and Treatment Program. All participants completed the CES-D-m and the DIS on the same day. Sensitivity, specificity, receiver operating characteristic (ROC) curves, and Youden's index were used to assess properties of the CES-D-m. Multivariate logistic regression analyses were also used. Results: 7% of 1915 retired male firefighters were diagnosed with MDD using the DIS. Using the most common CES-D cutoff score of 16, the prevalence of elevated risk was 36%, which declined to 23% using a cutoff score of 22, as determined by Youden's index. At 22, CES-D-m sensitivity was 0.84, specificity was 0.82, and the area under the ROC curve was 0.89 relative to DIS MDD diagnosis. Limitations: Participants were more likely than non-participants to live in the New York City area. Conclusions: This is the first study of WTC rescue/recovery workers to assess the performance of a one-month version of the CES-D. The CES-D-m performed well in identifying those at elevated risk. Since diagnostic follow-up is time consuming and costly, it is important to correctly distinguish those at elevated risk using a screening tool that has been validated in the population under study.

Original languageEnglish (US)
Pages (from-to)212-219
Number of pages8
JournalJournal of Affective Disorders
Volume121
Issue number3
DOIs
StatePublished - Mar 2010

Fingerprint

Firefighters
Major Depressive Disorder
Disasters
Epidemiologic Studies
Appointments and Schedules
Interviews
Depression
ROC Curve
Logistic Models
Regression Analysis
Sensitivity and Specificity
Population

Keywords

  • Center for Epidemiologic Studies Depression Scale
  • Depression
  • Firefighter
  • Validation
  • World Trade Center

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

@article{5efc68bb61e24443ae8c7b1cb9f24788,
title = "Validation of the Center for Epidemiologic Studies Depression Scale in screening for major depressive disorder among retired firefighters exposed to the World Trade Center disaster",
abstract = "Background: We evaluated the performance of a modified Center of Epidemiologic Studies Depression Scale (CES-D-m), which captured symptoms in the past month, in comparison to the Diagnostic Interview Schedule (DIS) in identification of major depressive disorder (MDD) in World Trade Center (WTC)-exposed retired Fire Department, City of New York (FDNY) firefighters. Methods: From 12/2005 to 7/2007, FDNY enrolled retired firefighters in its Medical Monitoring and Treatment Program. All participants completed the CES-D-m and the DIS on the same day. Sensitivity, specificity, receiver operating characteristic (ROC) curves, and Youden's index were used to assess properties of the CES-D-m. Multivariate logistic regression analyses were also used. Results: 7{\%} of 1915 retired male firefighters were diagnosed with MDD using the DIS. Using the most common CES-D cutoff score of 16, the prevalence of elevated risk was 36{\%}, which declined to 23{\%} using a cutoff score of 22, as determined by Youden's index. At 22, CES-D-m sensitivity was 0.84, specificity was 0.82, and the area under the ROC curve was 0.89 relative to DIS MDD diagnosis. Limitations: Participants were more likely than non-participants to live in the New York City area. Conclusions: This is the first study of WTC rescue/recovery workers to assess the performance of a one-month version of the CES-D. The CES-D-m performed well in identifying those at elevated risk. Since diagnostic follow-up is time consuming and costly, it is important to correctly distinguish those at elevated risk using a screening tool that has been validated in the population under study.",
keywords = "Center for Epidemiologic Studies Depression Scale, Depression, Firefighter, Validation, World Trade Center",
author = "Sydney Chiu and Webber, {Mayris P.} and Rachel Zeig-Owens and Jackson Gustave and Roy Lee and Kelly, {Kerry J.} and Linda Rizzotto and Prezant, {David J.}",
year = "2010",
month = "3",
doi = "10.1016/j.jad.2009.05.028",
language = "English (US)",
volume = "121",
pages = "212--219",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",
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TY - JOUR

T1 - Validation of the Center for Epidemiologic Studies Depression Scale in screening for major depressive disorder among retired firefighters exposed to the World Trade Center disaster

AU - Chiu, Sydney

AU - Webber, Mayris P.

AU - Zeig-Owens, Rachel

AU - Gustave, Jackson

AU - Lee, Roy

AU - Kelly, Kerry J.

AU - Rizzotto, Linda

AU - Prezant, David J.

PY - 2010/3

Y1 - 2010/3

N2 - Background: We evaluated the performance of a modified Center of Epidemiologic Studies Depression Scale (CES-D-m), which captured symptoms in the past month, in comparison to the Diagnostic Interview Schedule (DIS) in identification of major depressive disorder (MDD) in World Trade Center (WTC)-exposed retired Fire Department, City of New York (FDNY) firefighters. Methods: From 12/2005 to 7/2007, FDNY enrolled retired firefighters in its Medical Monitoring and Treatment Program. All participants completed the CES-D-m and the DIS on the same day. Sensitivity, specificity, receiver operating characteristic (ROC) curves, and Youden's index were used to assess properties of the CES-D-m. Multivariate logistic regression analyses were also used. Results: 7% of 1915 retired male firefighters were diagnosed with MDD using the DIS. Using the most common CES-D cutoff score of 16, the prevalence of elevated risk was 36%, which declined to 23% using a cutoff score of 22, as determined by Youden's index. At 22, CES-D-m sensitivity was 0.84, specificity was 0.82, and the area under the ROC curve was 0.89 relative to DIS MDD diagnosis. Limitations: Participants were more likely than non-participants to live in the New York City area. Conclusions: This is the first study of WTC rescue/recovery workers to assess the performance of a one-month version of the CES-D. The CES-D-m performed well in identifying those at elevated risk. Since diagnostic follow-up is time consuming and costly, it is important to correctly distinguish those at elevated risk using a screening tool that has been validated in the population under study.

AB - Background: We evaluated the performance of a modified Center of Epidemiologic Studies Depression Scale (CES-D-m), which captured symptoms in the past month, in comparison to the Diagnostic Interview Schedule (DIS) in identification of major depressive disorder (MDD) in World Trade Center (WTC)-exposed retired Fire Department, City of New York (FDNY) firefighters. Methods: From 12/2005 to 7/2007, FDNY enrolled retired firefighters in its Medical Monitoring and Treatment Program. All participants completed the CES-D-m and the DIS on the same day. Sensitivity, specificity, receiver operating characteristic (ROC) curves, and Youden's index were used to assess properties of the CES-D-m. Multivariate logistic regression analyses were also used. Results: 7% of 1915 retired male firefighters were diagnosed with MDD using the DIS. Using the most common CES-D cutoff score of 16, the prevalence of elevated risk was 36%, which declined to 23% using a cutoff score of 22, as determined by Youden's index. At 22, CES-D-m sensitivity was 0.84, specificity was 0.82, and the area under the ROC curve was 0.89 relative to DIS MDD diagnosis. Limitations: Participants were more likely than non-participants to live in the New York City area. Conclusions: This is the first study of WTC rescue/recovery workers to assess the performance of a one-month version of the CES-D. The CES-D-m performed well in identifying those at elevated risk. Since diagnostic follow-up is time consuming and costly, it is important to correctly distinguish those at elevated risk using a screening tool that has been validated in the population under study.

KW - Center for Epidemiologic Studies Depression Scale

KW - Depression

KW - Firefighter

KW - Validation

KW - World Trade Center

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