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.
Chiu-S; Webber-MP; Zeig-Owens-R; Gustave-J; Lee-R; Kelly-KJ; Rizzotto-L; Prezant-DJ
J Affect Disord 2010 Mar; 121(3):212-219
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 percent 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 percent, which declined to 23 percent 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.
Epidemiology; Mental-disorders; Mental-health; Psychological-disorders; Psychological-effects; Diagnostic-techniques; Diagnostic-tests; Fire-fighters; Emergency-responders; Emotional-stress; Employee-exposure; Employee-health; Medical-monitoring; Medical-treatment; Statistical-analysis; Risk-analysis; Risk-factors; Screening-methods; Screening-programs; Rescue-workers; Health-care;
Author Keywords: Depression; Center for Epidemiologic Studies Depression Scale; Validation; World Trade Center; Firefighter
Mayris P. Webber, New York City Fire Department, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201, USA
Grant; Cooperative Agreement
Grant-Number-R01-OH-007350; Cooperative-Agreement-Number-U10-OH-008243; Cooperative-Agreement-Number-U10-OH-008242; Cooperative-Agreement-Number-U10-OH-008232; Cooperative-Agreement-Number-U10-OH-008225
Journal of Affective Disorders