Lay Summary

What we did: We tested the Center for Epidemiological Studies Depression Scale Revised (CESD-R) against the Structured Clinical Interview for the DSM5 to determine if it could accurately identify for major depressive disorder. What we found: We found that the CESD-R can often identify cases of MDD in HIV care. Those who screen positive may then undergo a formal diagnostic interview to determine whether they are true cases for MDD, and referred for treatment. Why it is important: People receiving HIV care who have major depression are vulnerable to poor adherence to antiretroviral therapy (ART), making them vulnerable to opportunistic infections. Identifying cases of depression with a view to treatment can increase (ART) adherence and quality of life.

Background

The various challenges facing persons living with HIV include common mental disorders (CMDs) such as depression, trauma, and substance use. These conditions impair functioning and quality of life and are associated with poor adherence to antiretroviral therapy (ART).

Methods

Patients receiving HIV care at two public health facilities in South Africa were assessed using the Center for Epidemiological Studies Depression Scale Revised (CESD-R) and the Structured Clinical Interview for the DSM5 to assess for major depressive disorder (MDD).

Results

The internal consistency of the CESD-R as measured by Cronbach's alpha was 0.95. The mean score on the CESD-R was 20.45 (SD = 19.36). Of the 688 study participants, 229 (33.3%; 95% CI = 29.8%; 36.9%) scored in the elevated range on the CESD-R and 170 (24.7%; 95% CI = 21.5% to 28.1%) met the diagnostic criteria for MDD. These findings indicate that up to one third of the sample reported experiencing elevated symptoms of depression. ROC curve analysis indicated that a CESD-R cut-point of 26.5 (rounded to 27) yielded optimal sensitivity (0.81) and specificity (0.82) in determining caseness for MDD. Positive and negative predictive values of the CESD-R were 60.26% and 92.98%, respectively. The AUC was 0.89 (89%) (95% CI = 0.86–0.92) indicating moderate to high accuracy.

Conclusion

The CESD-R appears to hold promise in identifying cases of MDD in HIV care. Those who screen positive may then undergo a formal diagnostic interview to determine whether they are true cases for MDD, and referred for treatment. However, case identification needs to occur in the context of a public health system where effective mental health services are provided by professionals or suitably trained paraprofessionals.