The Romanian CES-D Scale: A Promising Instrument

for Clinical and Non-clinical Use

Michael J. Stevens, Illinois State University, PhD, DHC

Petru-Mădălin Constantinescu, University of Bucharest, MA
Lavinia Uscătescu, Babes-Bolyai University, B
Bogdan Cezar Ion, University of Bucharest, PhD
Butucescu Andreea, Ovidius University, MA
Sandu Cristina-Gabriela, University of Bucharest, MA

Abstract

Since its inception, the Center of Epidemiologic Depression Scale (CES-D; Radloff,
1977) has been a widely used instrument for screening depressive symptoms in the general
population, as well as in clinical settings. The CES-D has also been the focus of empirical
investigation, translation, and adaptation across the globe, and was shown to have good
psychometric properties. Until now, there has been no empirical attempt to translate and adapt
the instrument in Romania. In two studies, the CES-D was translated into Romanian using the
‘translation - back-translation’ method (Brislin, 1970). The equivalence of the translated
version was tested using Butcher and Gur’s (1974) bilingual test-retest technique as per
International Test Commision requirements (Hambleton & Patsula, 1999). Additionally, test-
retest and internal consistency reliabilities were calculated. The results established a suitable
translation and good reliability for the instrument. In the second study, we provide evidence of
the concurrent and convergent validity of the Romanian CES-D.

Rezumat

Încă de la începuturile sale, Scala de depresie a centrului epidemiologic (CES-

D;Radloff,1977)a fost un instrument des utilizat pentru evaluarea simptomelor depresive la
populaţia generală, precum şi in sitaţiile clinice. CES-D a fost de asemenea centrul
investigaţiei empirice, iar traducerea şi adaptarea ei în întreaga lume a demonstrat bune
proprietăţi psihometrice. Până în prezent nu a existat nicio încercare de a traduce si adapta
acest instrument în România. CES-D a fost tradus în România prin doua studii prin metoda
„traducere- retraducere” (Brislin, 1970). Echivalentul versiunii traduse a fost testat prin
folosirea tehnicii test-retest (Butcher si Gur, 1974) conform cerinţelor Internaţionale de testare
((Hambleton & Patsula, 1999). În plus, au fost calculate prin metoda test-retest fiabilitatea şi
consistenţa internă. Rezultatul a stabilit o traducere adecvată şi o fiabilitate bună a acestui
instrument. În cel de-al doilea studiu furnizăm dovezi ale concurenţei şi convergenţei
validităţii traducerii în limba română a CES-.D.
Michael J. Stevens, Illinois State University +309-438-5700 [email protected]
Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
Development of the CES-D

The Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item, self-
report scale designed to measure depressive symptomatology in the general population.
The scale was especially created for use in studies regarding the relationships between
depression and other variables across population subgroups (Radloff, 1977).
CES-D items are mostly concerned with the affective component of
depression, that is, depressed mood. They were selected from a pool of items belonging
to previously validated depression scales (e.g., Beck, Ward, Mendelson, Mock, &
Erbaugh, 1961; Raskin, Schulterbrandt, Reatig, & McKeon, 1969; Zung, 1965). The
clinical literature and factor-analytic studies were also reviewed in order to make a
selection based on the major components of depressive symptomatology.
Each response is scored from 0 to 3 according to how frequently the symptoms
occur. The range of scores varies from 0 to 60, with higher scores indicating more
frequent symptoms. The usual cut-off score for clinically depressive symptoms is 16
(Radloff, 1977).

Psychometric Properties of the CES-D

The CES-D has been translated into several languages and its psychometric
properties have been tested in African-American, Asian-American, French, Greek,
Hispanic, Japanese, and Yugoslavian populations (Naughton & Wiklund 1993).

Reliability

Radloff (1977) reported high reliability for the CES-D. International

consistency and test-retest reliabilities were determined. The design involved a normal
sample whose correlations where compared with those of seriously depressed persons.
Radloff expected considerable heterogenity in the normal sample, with many
participants experiencing a few depressives symptoms and a few experiencing many.
This fact may have resulted in low inter-item and item-scale correlations. Radloff
expected higher internationl consistency reliability in the depressed sample, which was
confirmed. Additionally, alpha and Spearman-Brown coefficients where higher in the
patient sample (about .90). The English and the Spanish versions of the measure also
attained higher reliability, with Cronbach alphas of 0.91 and 0.92 (Leykin, Torres,
Aguilera, & Muñoz, 2010). Some researchers indicated an internal consistence
slightly lower. For example, Williams et al. (2007) found r = 0.74 in a sample of
Africa- American women.
Regarding the test-retest method, which was calculated on time intervals
ranging from 3 to 12 months, Radloff (1977) reported that shorter test-retest intervals
Michael J. Stevens, Illinois State University +309-438-5700 [email protected]
Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
produced higher correlations than did longer intervals. All of these findings favor use
of the CES-D in the epidemiological study of depression.

Validity

After its publication, the CES-D was shown to have a good specificity and
sensitivity for identifying depressive disorders both in community samples (Boyd,
Weissman, & Thompson, 1982) and other populations, especially primary-care patients
and general inpatients (Caracciolo & Giaquinto, 2002; Schroevers, Sanderman, van
Sonderen, & Ranchor, 2000; Weissman, Schlomskas, Pottenger, Prusoff, & Locke,
1977). Moreover, the CES-D shows high convergent validity with both the Beck
Depression Inventory (BDI) (r = 0.81) and the Zung measure of depression (r = 0.90),
and is highly accurate in detecting depression among acute depressives, alcoholics, and
schizophrenics (Weissman et al., 1977). For a comprehensive review of the studies
conducted before the year 2000 on the psychometric properties of the CES-D, see
Radloff and Locke (2000).
The CES-D is used often when screening for depression, and continues to
prove its psychometric soundness. When used for clinical purposes, the criterion
validity of the CES-D revealed a specificity of 57% in orthopedic patients and 36% in
neurological patients and a sensitivity of 100% for major depressive disorder in both
groups; its positive predictive value was 24% in orthopedic patients and 31% in
neurological patients (Caracciolo & Giaquinto, 2002).
In a validation study on the Colombian general population (Arias, Martinez,
Jaimes, Afanador, & Hernandez, 2007), a cut-off score of 30 identified most accurately
persons with major depressive episode. With this cut-off score, the sensitivity was
0.55, specificity was 0.95, positive predictive value was 0.69, negative predictive value
was 0.91, and Cohen`s kappa was 0.54.
The optimal cut-off score of the CES-D varies with different populations. A
study that included a group of Japanese workers showed that a cut-off score of 19
reduced false positives with a minimum loss of sensitivity (sensitivity = 92.7%,
specificity = 91.8%, positive predictive value = 17.6%, negative predictive value =
99.9%). The optimal cut-off score for first-visit psychiatric patients in Japan whose
prevalence rate of depression was 38.9% was 26 if greater emphasis is placed on
sensitivity, 31 if equal weight is placed on sensitivity and specificity, and 34 if
specificity is considered more important (Furukawa, Hirai, Kitamura, & Takahashi,
1997). The optimal cut-off score for older Chinese was 22 (sensitivity = 0.75,
specificity = 0.51) using the diagnosis made by a physician as the gold standard (Cheng
& Chan, 2005).
Another study (Haringsma, Engels, Beekman, & Spinhoven, 2004) included a
group of elderly Dutch community residents who were self-referred to a prevention
program for depression. The study assessed the criterion validity of the CES-D with
Michael J. Stevens, Illinois State University +309-438-5700 [email protected]
Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
the Mini International Neuropsychiatric Interview (MINI), a clinical diagnostic
interview based on the DSM-IV. For major depressive disorder, the optimal cut-off
score was 25, (sensitivity = 85%, specificity = 64%, positive predicted value = 63%).
For clinically relevant depression, the optimal cut-off was 22 (sensitivity = 84%,
specificity = 60%, positive predicted value = 77%).

Factor Structure

Even though Radloff (1977) originally recommended that a total score be used
with the CES-D in epidemiological studies, a number of factors emerged in the original
research. These factors are: depressed affect, positive affect, somatic and retarded
activity, interpersonal (Radloff, 1977). Other research identified alternative factor
structures for the CES-D (e.g., Makambi, Williams, Taylor, Rosenberg, & Adams-
Campbell, 2009). Research also showed the factors depended on the meaning of
depressive symptoms assigned in different cultures (Leykin et al., 2010), and that the
relationship between factors vary according to different socioeconomic levels
(Williams et al., 2007). However, the four-factor model originally developed seems to
offer the best fit for the factor structure of the CES-D (e.g., Nguyen, Kitner-Triolo,
Evans, & Zonderman, 2004)

Usefulness of the CES-D

Even though the CES-D was originally designed to measure depression in the
general population (Radloff, 1977), other research has revealed its usefulness in
detecting depression in people with other disorders, including patients with multiple
sclerosis (Pandya, Metz, & Patten, 2005), epilepsy (Naserbakht, Shabani, Teimoori,
Gholami, & Asl, 2008), cancer (Schroevers et al., 2000), dementia (Cheng & Chan,
2008), diabetes (Sultan & Fisher, 2010), and medical-surgical patients (Goldberg,
1985), as well as screening out non-depressed patients (Li & Hicks, 2010). In fact,
studies have found that the CES-D has predictive value with respect mental health
concerns besides depression (Patten, Lavorato, & Metz, 2005). Most studies, however
emphasize the fact that the CES-D can be used as a screening tool, although one study
found that the CES-D performed better than the BDI in discriminating depressives and
assessing depressive severity (Santor, Zuroff, Ramsay, Cervantes, & Palacios, 1995).
Recent studies have also found that the CES-D can be useful for screening for major
depression (Yang, Soong, Kuo, Chang, & Chen, 2004). Eight cross-cultural
comparison studies have been conducted using the CES-D (Bracke, Levecque, &
Velde, 2008 ), identifying depressive symptoms in different nations and demonstrating
that this scale can be used in cross-cultural research. Regarding treatment, some
studies have shown that the CES-D can be useful in monitoring the progress in
psychotherapy with goal of reducing depression (Cinciripini et al., 2010). Wood,
Michael J. Stevens, Illinois State University +309-438-5700 [email protected]
Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
Taylor, and Joseph (2010) asserted that the CES-D can serve as a measure of well-
being since the scale taps the continuum between depression and happiness. Other
studies have revealed that the CES-D can measure depression as trait as well as a state
(Spielberger Ritterband, Reheiser, & Brunner, 2003), adding futher value to the scale
as an index of depression.
At present, there has been no empirical attempt to translate or validate the
CES-D in Romania, notwithstanding a strong need for measures of depression for use
with the general and clinical populations. Additionally, the CES-D, with its emphasis
on positive as well as negative affect, could be a valuable screening instrument in
assessing the multidimensional aspects of depression. The purpose of our first study
below was to translate the CES-D into Romanian, determine the equivalence of the
Romanian version to the original English CES-D, and provide evidence of the
reliability of the translated instrument.

STUDY 1

Method

Participants

For the linguistic validation of the CES-D, we recruited 25 volunteers, all of

whom were bilingual speakers (10 males, 15 females), between 21 and 30 years old.
88% of participants were students, of whom 82% studied linguistics. Participants’
monthly income varied as follows: 58% reported earning no more than 500 RON (117
EUR), 32% between 501 and 1000 RON (117-235 EUR), 8% between 1001-1500
RON (117-352 EUR), 4% between 2001-2500 RON (352-587 EUR), and 8% between
2500-3000 RON (587-705 EUR) (the exchange rate was calculated as 1EUR = 4.258
RON). Regarding participants`ethnicity, 88% were Romanian and 12% were
Hungarian. 80% of participants were Orthodox and 20% were Protestant. As for their
marital status, 92% had never been married or engaged and only 8% were married or
engaged at the time. None of the participants had children.

Measures

The Center for Epidemiological Studies Depression Scale (CES-D) (Radloff,

1977) is a self-report measure of depressive symptoms. The 20 items of the CES-D
measure affective and somatic dimensions of depression as reflected in depressed
mood, feelings of guilt and worthlessness, helplessness, psychomotor retardation, loss
of appetite, and sleep disturbance. Scores on the CES-D differentiate between
psychiatric and non-psychiatric samples. A score greater than 16 indicates depressive
symptoms.
Michael J. Stevens, Illinois State University +309-438-5700 [email protected]
Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
Procedure

The translation of the instrument into the Romanian language was as follows:
the translation was made by the second author and back-translation by the third author
who did not see the original English version of the CES-D. Both authors reviewed the
translation and found seven items that did not correspond. These items were then re-
translated and modified by the entire research team (Brislin,1970).
The test-retest method (Butcher & Gur,1974) involved recruiting bilingual
students and administering the English and Romanian versions of the CES-D in
counterbalanced order. Before completing the measures, participants were informed
that their scores would remain confidential and that they would have access to their
scores with an interpretation if they wished. The elapsed time between the two
administrations was 2 weeks. Participants completed both versions of the CES-D
anonymously (each participant was asked to provide a code that would allow only them
to identify their completed scores).

Results

To evaluate the stability of the translated CES-D, we performed a t-test for

correlated groups on English and Romanian scale scores produced by the sample. The
results did not yield a statistically significant difference between English and
Romanian scale-score means. Acceptance of the null hypothesis supports the
equivalence of the Romanian translation to the parent instrument, and indicates a good
translation (see Table1).

Table 1

Means, Standard Deviations, and t tests for English and Romanian Versions of the CES-D

Scale English Romanian

Version Version
CES- Mean SD Mean SD t-test
D
16.92 8.1 16.76 7.8 -.144
8 3

The next analysis was to determine the temporal stability of the translated
CES-D by correlating scores obtained from separate administrations of the English and
Romanian versions of the CES-D. A Pearson product-moment correlation of these
scores was highly significant, and confirms strong test-retest reliability (see Table 2).
Michael J. Stevens, Illinois State University +309-438-5700 [email protected]
Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
Table 2

Test-Retest Reliability of the CES-D

Scale Pearson Correlation

CES-D .759*

*p ≤ 0.01 (1-tailed level)

Internal consistency of the English and Romanian versons of the CES-D were
tested by calculating Cronbach alphas. Both akpha coefficients were quite high, and
showed acceptable internal consistency reliability (see Table 3).

Table 3

Internal-Consistency Relabilities of the English and Romanian Versions of the CES-D

Scale Cronbach's Alpha

CES-D Romanian .843
CES-D Romanian .813

Discussion

The purpose of this study was to translate the CES-D into Romanian and
establish the initial psychometric properties of the scale wth a sample of Romanians, in
keeping with ITC guidelines (Hambleton & Patsula, 1999). After translating and back-
translating the CES-D into the Romanian language (Brislin, 1970), the equivalence of
the translated vesion to the parent instrument was evaluated using the bilingual retest
technique (Butcher & Gur, 1974). The results showed equivalence of the Romanian
translation of the CES-D to the original English CES-D. The stability and internal
consistency reliabilities of the Romanian CES-D are good.
In the second study below, we investigated the concurrent and convergent
validity of the Romanian CES-D by comparing it with other well-known instruments
that have been translated into Romanian and which tap constructs that are theoretically
related to depression.

STUDY 2

Method

Michael J. Stevens, Illinois State University +309-438-5700 [email protected]

Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
Participants

A total of 73 participants (12 males, 61 females) volunteered to take part in the

study. Their age was between 19 and 50 years (M = 28.70, SD = 7.94). The majority
were Romanian (85%), Orthodox (84%), had graduated from a unversity (53%), and
had never been married or engaged (51%). 46% of participants had no children. Their
median income was the equivalent of 200-300 EURO.

Measures

The Center for Epidemiological Studies Depression Scale (CES-D) (Radloff,

1977) is a self-report measure of depressive symptoms. Scores on the CES-D
differentiate between psychiatric and non-psychiatric samples. A score greater than 16
indicates depressive symptoms. The 20 items of the CES-D measure affective and
somatic dimensions of depression as reflected in depressed mood, feelings of guilt and
worthlessness, helplessness, psychomotor retardation, loss of appetite, and sleep
disturbance. We selected and administered four instruments that we considered to be
psychometrically sound adequate to determine the concurrent and convergent validity
of the Romanian CES-D: the State Self-Esteem Scale - Current Thoughts (SGC), the
Hospital and Anxiety Scale (HAS), the Hospital Depression Scale (HAD), and the
Satisfaction With Life Scale (SWLS).
The SGC is an index of self-esteem that has a positive correlation of 0.82 with
the Rosenberg Self-Esteem Scale. It was developed by Marian Mihai (2009), who
granted permission to use the SGC in this research.
The HAS and HAD have proved valuable in the assessment of both the
incidence and severity of anxiety and depression, respectively, in psychiatric pacients
as well as in the general population. Both measures had been previously translated and
validated by Maria Ladea (2007)
The Satisfaction With Life Scale (SWLS) is a 5-item self-report measure of the
cognitive aspects of life satisfaction as experienced phenomenologically. Respondents
indicate on a 7-point Likert scale how much they agree or disagree with each item.
The SWLS is stable and reliable (Diener, Suh, & Oishi, 1997), and is correlated
positively with several other measures of well-being (Diener, Scollon, & Lucas, 2003;
Diener et al., 1997). The SWLS had been previously translated into the Romanian
language and validated (Stevens, Constantinescu, & Lambru, 2006; Stevens,
Constantinescu, Uscatescu, Ion, & Butucescu, 2011).

Procedure

After receiving permission to use the instruments described above, we

transposed these measures into two online forms using Google docs. Links to these
Michael J. Stevens, Illinois State University +309-438-5700 [email protected]
Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
online documents were then disseminated to various psychology-related websites and
online discussion groups. Interested individuals were invited to complete the forms
either by printing out a hard copy, filling in the blank spaces, and returning the
completed form, or by electronically selecting and entering the most appropriate
answer while online. Participantts were encouraged to take their time and provide
honest, thoughtful responses. Ten participants completed the measures in paper-and-
pencil format. Each participant took approximately 30 minutes to complete all of the
measures. Participants’ answers were automatically transferred to an output data form,
with the data then subjected to a series of statistical analyses

Results

Internal Consistency Reliability of the CES-D

Number of Items Cronbach alpha

20 0.72

Concurrent and Convergent Validity of the CES-D

Measure SGC HAS HAD SWLS

CES-D -0.46** 0.46* 0.37* -0.54**
* *

** p ≤ 0.01 (1-tailed)

Discussion

The purpose of this second study was to further evaluate the reliability and
validity of the Romanian CES-D. The Romanian CES-D has acceptable internal
consistency reliability. The Romanian CES-D also demonstrated acceptable
concurrent and convergent validity, as indicated by moderate positive correlations with
the HAS and HAD, which measure respectively anxiety and depressive symptoms and
disorders, as well as moderate negative correlations with the SGC and SWLS, which
measure self-esteem and subjective well-being. It is worth noting that there was no
strong correlation between CES-D and HAD. This could be interpreted either as a
limitation of our study or as evidence that the two scales assess highly divergent
constructs related only conceptually to depression. Similar evidence has been reported
in previous studies comparing the CES-D to the Hamilton Depression Rating Scale
(HDRS) (Roberts et al., 1991).

Michael J. Stevens, Illinois State University +309-438-5700 [email protected]

Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
 The main limitation of the studies reported here are the size and
representativeness of the sample. Therefore, the results should be interpretated and
generalized with caution. It will be important to repliecte our findings with a larger
and more a more representative sample in future research. However, as previously
mentioned, our results are in agreement with those obtained from other populations. In
addition, future studies should include a factorial analysis of the CES-D in order to
determine whether or not the four-factor structure that emerged in previous research
(Radloff, 1977) holds true for the Romanian population. Finally, field work with the
Romanian CES-D should attempt to establish optimal cut-off scores that maximize
both sensitivity and specificity in the detection of different levels of depression
amoung various groups who are likely to be screened for depression as part of their
medical or psychological treatment (e.g., Bracke et al., 2008).

References

Arias, A. C., Martinez, L. A. D., Jaimez, G .E. R., Afanador, L. P. C., Heernandez, N.
L. (2007). Psychometric properties of the CES-D Scale among Colombian
adults from the general population. Revista Colombiana de Psiquiatria, 4, 664-
674.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An
inventory for measuring depression. Archives of General Psychiatry, 4, 561-
571.
Boyd, J. H., Weissman, M. M., & Thompson W. D. (1982). Screening for depression
in a community sample: Understanding the discrepancies between depression
symptom and diagnostic scales. Archives of General Psychiatry, 39, 1195–
1200.
Bracke, P., Levecque, K., & Van de Velde, S. (2008, June). The psychometric
properties of the CES-D depression inventory and the estimation of cross-
national differences in the true prevalence of depression. Paper presented at
the International Conference on Survey Methods in Multinational,
Multiregional, and Multicultural Contexts (3MC), Berlin-Brandenburg
Academy of Sciences and Humanities, Berlin, Germany.
Brislin R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-
Cultural Psychology, 1, 185–216.
Butcher, J. N., & Gur, R. (1974). A Hebrew translation of the MMPI. An assessment of
translation adequacy and preliminary validation. Journal of Cross-Cultural
Psychology, 5, 220-227.
Caracciolo, B., & Giaquinto, S. (2002). Criterion validity of the Center for
Epidemiological Studies Depression (CES-D) Scale in a sample of
rehabilitation inpatients. Journal of Rehabilitation Medicine, 34, 221–225.

Michael J. Stevens, Illinois State University +309-438-5700 [email protected]

Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
Cheng, S-T,. & Chan, A. C. (2005). The Center for Epidemiologic Studies Depression
Scale in older Chinese: Thresholds for long and short forms. International
Journal of Geriatric Psychiatry, 20, 465–470.
Cheng, S-T., & Chan, A. C. M. (2008). Detecting depression in Chinese adults with
mild dementia: Findings with two versions of the Center for Epidemiologic
Studies Depression Scale. Psychiatry Research, 159, 44–49.
Cinciripini, P. M., Blalock, J. A., Minnix, J. A., Robinson, J. D., Brown, V. L., Lam,
C., ...Karam-Hage, M. (2010). Effects of an intensive depression-focused
intervention for smoking cessation in pregnancy. Journal of Consulting and
Clinical Psychology, 78, 44-54.
Diener, E., Scollon, C. N., & Lucas, R. E. (2003). The evolving concept of subjective
well-being: The multifaceted nature of happiness. Advances in Cell Aging and
Gerontology, 15, 187–219.
Diener, E., Suh, E., & Oishi, S. (1997). Recent findings on subjective well-being.
Indian Journal of Clinical Psychology, 24, 25-41.
Furukawa, T., Hirai, T., Kitamura, T., & Takahashi, K. (1997). Application of the
Center for Epidemiologic Studies Depression Scale among first-visit
psychiatric patients: A new approach to improve its performance. Journal of
Affective Disorders, 46, 1–13.
Goldberg, D. (1985). Identifying psychiatric illness among general medical patients.
British Medical Journal, 291, 161-162.
Hambleton, R. K., & Patsula, L. (1998). Adapting tests for use in multiple languages
and cultures. Social Indicators Research, 45, 153-171.
Haringsma, R., Engels, G. I., Beekman, A. T. F., & Spinhoven, P. (2004). The criterion
validity of the Center for Epidemiological Studies Depression Scale (CES-D)
in a sample of self-referred elders with depressive symptomatology.
International Journal of Geriatric Psychiatry, 19, 558–563.
Ladea, M. (2005). Validarea scalei de anxietate şi depresie (HADS). Revista
Română de Psihiatrie, 3-4(7), 104-109.
Leykin, A., Torres, L. D., Aguilera, A., & Muñoz, R .F. (2010). Factor structure of the
CES-D in a sample of Spanish- and English-speaking smokers on the Internet.
Psychiatry Research, 185, 269-274.
Li, Z., & Hicks, M. H. (2010). The CES-D in Chinese American women: Construct
validity, diagnostic validity for major depression, and cultural response bias.
Psychiatry Research, 175, 227-232.
Makambi, K. H., Williams, C. D., Taylor, T. R., Rosenberg, L., & Adams-Campbell,
L. L. (2009). An assessment of the CES-D scale factor structure in black
women: The Black Women’s Health Study. Psychiatry 168, 163-170.

Michael J. Stevens, Illinois State University +309-438-5700 [email protected]

Petru-Mădălin Constantin, University of Bucharest +031-425.34.45 [email protected]
Lavinia Uscătescu, Babeş-Bolyai University +40-264-405337 [email protected]
Bogdan Cezar Ion, University of Bucharest +031-425.34.45 [email protected]
Butucescu Andreea, Ovidius University 0241-606470 [email protected]
Sandu Cristina, University of Bucharest +031-425.34.45 [email protected]
Mihai, M. (2009). Validation of a scale for measuring state self-esteem. Revista
de Psihologie Şcolară, 2(4), 40-49.
Naserbakht, M., Shabani, A., Teimoori, H., Gholami, M., & Asl, M. A. (2008). Short
depression screening test for patients with epilepsy: CES-D with 10 items.
Iranian Journal of Psychiatry, 3, 32-36.
Naughton, M. J., & Wiklund, I. (1993). A critical review of dimension-specific
measures of health-related quality of life in cross-cultural research. Qualitative
Life Research, 2, 397-432.
Nguyen, H., Kitner-Triolo, M., Evans, M., & Zonderman, A. (2004). Factorial
invariance of the CES-D in low socioeconomic status African Americans
compared with a nationally representative sample. Psychiatry Research, 126,
177–187.
Pandya, R., Metz, L., & Patten S. B. (2005), Predictive value of the CES-D in detecting
depression among candidates for disease-modifying multiple sclerosis
treatment. Psychosomatics, 46, 131-134.
Patten, S. B., Lavorato, D. H., & Metz, L .M. (2005) Clinical correlates of CES-D
depressive symptom ratings in an MS population. General Hospital
Psychiatry, 27, 439-445.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in
the general population. Applied Psychological Measurement, 1, 385–401.
Radloff, L. S., & Locke, B. Z. (2000). Handbook of psychiatric measures. Washington,
DC: American Psychiatric Association.
Raskin, A., Schulterbrandt, J., Reatig, N., & McKeon, J. (1969). Replication of factors
of psychopathology in interview, ward behavior, and self-report ratings of
hospitalized depressives. Journal of Nervous and Mental Disease, 148, 87-96.
Roberts, R. E., Lewinsohn, P. M., & Seeley, J. R. (1991). Screening for adolescent
depression: A comparison of depression scales. Journal of the American
Academy of Child and Adolescent Psychiatry, 30, 58-66.
Santor, D. A., Zuroff, D. C., Ramsay, J. O., Cervantes, P., & Palacios, J. (1995).
Examining scalediscriminability in the BDI and CES-D as a function of
depressive severity. Psychological Assessment, 7, 131-139.
Schroevers, M. J., Sanderman, R., Van Sonderen, E., & Ranchor, A. V. (2000). The
evaluation of the Center for Epidemiologic Studies Depression (CES-D) scale:
Depressed and positive affect in cancer patients and healthy reference subjects.
Quality of Life Research, 9, 1015-1029.
Spielberger C. D., Ritterband L. M., Reheiser, E. C., & Brunner T. M. (2003). The
nature and measurement of depression. International Journal of Clinical and
Health Psychology, 3, 209-234.
Stevens, M. J., Constantinescu, P-M., & Lambru, I. (2006, July). Romanian translation
of the Satisfaction With Life Scale. Paper presented at the International
Congress of Applied Psychology, Athens, Greece.
Stevens, M. J., Constantinescu, P-M., Uscatescu, L., Ion, B. C., & Butucescu, A.
(2011, July). The Romanian CES-D Scale: A promising instrument for clinical
 and non-clinical use. Paper presented at the European Congress of Psychology,
Istanbul, Turkey.
Sultan, S., & Fisher, L. (2010). Depression as a proxy of negative affect? A critical
examination of the use of the CES-D in Type 2 diabetes. European Review of
Applied Psychology, 60, 97-104.
Weissman, M. M., Schlomskas, D., Pottenger, M., Prussoff, B. A., & Locke, B. Z.
(1977). Assessing depressive symptoms in five psychiatric populations: A
validation study. American Journal of Epidemiology, 106, 203-214.
Williams, C. D., Taylor, T. R., Makambi, K. H., Harrel, J., Palmer, J.R., Rosenberg, L.,
Adams-Campbell, L. L. (2007). CES-D four-factor structure confirmed, but
not invariant, in a large cohort of African-American women. Psychiatry
Research, 150, 173-180.
Wood, A. M., Taylor, P. J., & Joseph, S. (2010). Does the CES-D measure a
continuum from depression to happiness? Comparing substantive and
artifactual models. Psychiatry Research, 177, 120–123.
Yang, H-J., Soong, W-T., Kuo, P-H., Chang, H-L., & Chen, W. J. (2004). Using the
CES-D in a two-phase survey for depressive disorders among non-referred
adolescents in Taipei: A stratum-specific likelihood ratio analysis. Journal of
Affective Disorders, 82, 419–430.
Zung, W. W. K. (1965). A self-rating depression scale. Archives of General
Psychiatry, 12, 63-70.