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. 2012 Dec;51(12):1284-92.
doi: 10.1016/j.jaac.2012.09.003. Epub 2012 Nov 8.

Validating the Center for Epidemiological Studies Depression Scale for Children in Rwanda

Theresa Betancourt  1 , Pamela Scorza, Sarah Meyers-Ohki, Christina Mushashi, Yvonne Kayiteshonga, Agnes Binagwaho, Sara Stulac, William R Beardslee
Affiliations

Validating the Center for Epidemiological Studies Depression Scale for Children in Rwanda

Theresa Betancourt et al. J Am Acad Child Adolesc Psychiatry. 2012 Dec.

Abstract

Objective: We assessed the validity of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) as a screen for depression in Rwandan children and adolescents. Although the CES-DC is widely used for depression screening in high-income countries, its validity in low-income and culturally diverse settings, including sub-Saharan Africa, is unknown.

Method: The CES-DC was selected based on alignment with local expressions of depression-like problems in Rwandan children and adolescents. To examine criterion validity, we compared CES-DC scores to depression diagnoses on a structured diagnostic interview, the Mini International Neuropsychiatric Interview for Children (MINI KID), in a sample of 367 Rwandan children and adolescents aged 10 through 17 years. Caregiver and child or adolescent self-reports endorsing the presence of local depression-like problems agahinda kenshi (persistent sorrow) and kwiheba (severe hopelessness) were also examined for agreement with MINI KID diagnosis.

Results: The CES-DC exhibited good internal reliability (α = .86) and test-retest reliability (r = .85). The area under the receiver operating characteristic curve for the CES-DC was 0.825 when compared to MINI KID diagnoses, indicating a strong ability to distinguish between depressed and nondepressed children and adolescents in Rwanda. A cut point of≥30 corresponded with a sensitivity of 81.9% and a specificity of 71.9% in this referred sample. MINI KID diagnosis was well aligned with local expressions of depression-like problems.

Conclusion: The CES-DC demonstrates good psychometric properties for clinical screening and evaluation in Rwanda, and should be considered for use in this and other low-resource settings. Population samples are needed to determine a generalizable cut point in nonreferred samples.

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Conflict of interest statement

Disclosure: Drs. Betancourt, Kayiteshonga, Binagwaho, Stulac, and Beardslee, and Ms. Scorza, Ms. Meyers-Ohki, and Ms. Mushashi report no biomedical financial interests or potential conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Recruitment and assessment process for participants in receiver operating characteristic curve (ROC) analysis. Note: CES-DC = Center for Epidemiological Studies Depression Scale for Children; MINI KID = Mini International Neuropsychiatric Interview for Children and Adolescents.
FIGURE 2
FIGURE 2
Receiver operating characteristic curve (ROC) for the Center for Epidemiological Studies Depression Scale for Children (CES-DC).
See this image and copyright information in PMC

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