Depression Scale for Children (CES-DC)

Abstract

The Center for Epidemiological Studies Depression Scale for Children (CES-DC) is a 20-item self-report questionnaire designed to assess the frequency and severity of depressive symptoms in children and adolescents. It is specifically tailored for young people between the ages of 6 and 17, asking them to rate their experiences over the past week. This instrument serves as a valuable tool for screening and longitudinally tracking changes in depressive symptoms over time, particularly useful in both epidemiological research and clinical settings.

Keywords

Depression Scale for Children, CES-DC, Pediatric Depression, Adolescent Assessment, Self-Report, Screening Tool, Dysthymia, Major Depression.

Authors

Weissman, M. M., Orvaschel, H., Padian, N.

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Purpose

The primary purpose of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) is to screen for and measure the severity of depressive symptoms in school-aged children and adolescents. It is designed for use in epidemiological studies and clinical settings where quick, standardized assessment of symptoms is required.

The scale is particularly useful for tracking symptom fluctuation across different time points, helping clinicians and researchers monitor treatment efficacy or the natural course of symptoms. A total raw score is calculated, and based on the interpretation guidelines, a cutoff score of 15 or above is typically utilized to indicate clinically significant depressive symptoms.

Construct

The CES-DC measures the frequency of symptoms related to the affective, somatic, and interpersonal components of depression, mirroring criteria found in established diagnostic systems like the DSM. It specifically assesses how often a child or adolescent has experienced 20 distinct depressive behaviors or feelings during the preceding week.

The underlying construct is the severity of clinically relevant depressive symptoms, which, when reaching a specific cutoff score, suggests significant distress potentially aligning with Major Depression or Dysthymic Disorder. The scale includes items related to mood, anhedonia, self-esteem, sleep disturbance, and appetite changes.

Validity

The validity of the CES-DC was initially evaluated by Faulstich et al. (1986) using a sample of 148 child and adolescent psychiatric inpatients. This clinical sample included individuals diagnosed with Major Depression, Dysthymic Disorder, or other severe mental health conditions requiring admission. The study demonstrated that the scale possessed adequate psychometric characteristics for identifying the presence of significant mental distress.

The scale achieved a high sensitivity of 80% when the established clinical cutoff score of 15 was applied. However, a notable finding in this inpatient population was the CES-DC’s limited ability to differentiate between those inpatients admitted specifically for depression versus those admitted for other serious mental illnesses, suggesting potential limitations regarding discriminant validity in highly acute clinical settings.

Reliability

Based on the psychometric evaluation conducted on the child and adolescent psychiatric inpatient sample (Faulstich et al., 1986), the CES-DC demonstrated strong internal consistency. The calculated coefficient for internal consistency (Cronbach’s alpha) was reported as $alpha = .89$, indicating that the 20 items consistently measure the same underlying construct of depressive symptomatology across the scale.

Factor Analysis

While the CES-DC is typically scored to yield a single total score reflecting overall symptom severity, factor analytic studies generally support a multidimensional structure, often reflecting the primary components of depression, similar to its adult counterpart, the Center for Epidemiological Studies Depression Scale (CES-D). The observed factors often include depressed affect, somatic and retarded activity, interpersonal difficulties, and a measure of positive affect (which includes the reverse-scored items).

The multidimensionality supports the scale’s breadth in capturing the wide range of symptoms associated with pediatric depression, ensuring that various diagnostic criteria are addressed within the 20 items.

Instrument

Test Type: Self-report questionnaire / Screening tool

Format: 20 items utilizing a 4-point Likert scale (ranging from 0=”Not At All” to 3=”A Lot”).

Language Available: English (Primary), with numerous translations available globally.

Population Group: Children and Adolescents.

Age Group: 6 to 17 years.

Population Details: Developed primarily for use in community and epidemiological samples but widely validated across both healthy and clinical psychiatric inpatient populations. Scoring ranges from 0 to 60. A score of 15 or above is considered indicative of clinically significant depressive symptoms.

Test Methodology: Respondents rate the frequency of symptoms experienced during the past week. Scoring involves summing the raw scores (with reverse scoring applied to positively worded items).

Keywords

Screening, CES-DC, Affective Symptoms, Somatic Symptoms, Adolescent Mental Health, Clinical Cutoff, Internal Consistency.

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Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

The CES-DC was developed and first published in 1980, adapting the adult CES-D for pediatric use. It is widely utilized and often considered to be in the public domain, particularly in its capacity as a screening tool derived from the NIMH-developed CES-D. Researchers and clinicians generally utilize the CES-DC without associated licensing fees for non-commercial academic or clinical purposes. Users should, however, confirm current permissions policies before widespread implementation.

Test Year: 1980.

Reference’s

• Faulstich, M. E., Carey, M. P., Ruggiero, L., Enyart, P., & Gresham, F. (1986). Assessment of depression in childhood and adolescence: An evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). The American journal of psychiatry.
• Fendrich, M., Weissman, M. M., & Warner, V. (1990). Screening for depressive disorder in children and adolescents: validating the center for epidemiologic studees depression scale for children. American Journal of Epidemiology, 131(3), 538-551.
• Weissman, M. M., Orvaschel, H., & Padian, N. (1980). Children’s Symptom and Social Functioning Self-Report Scales Comparison of Mothers’ and Children’s Reports. The Journal of nervous and mental disease, 168(12), 736-740.

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Items of the Depression Scale for Children (CES-DC)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Instructions: Below is a list of the ways you might have felt or acted. Please check how much you have felt this way during the past week.