Screening for depression in clinical practice: reliability and validity of a five-item subset of the CES-Depression.

Individuals with chronic disease are not screened routinely for depression. Availability of an abbreviated test with demonstrated reliability and validity might encourage screening so we explored the reliability and validity of a 5-item subset of the 20-item Center for Epidemiological Studies Depression Scale among inner-city outpatients with chronic asthma or diabetes. Most patients were female (73.1%) and Hispanic (61.8%). Acceptable reliability was shown by Cronbach alpha (.76) for the subset of 5 items. Validity was supported by the high correlation of .91 between patients' scores on the 5-item subset and the full 20 items. The 5 items reflected a single factor (eigenvalue = 2.66). Receiver operating characteristic curve analysis identified cut-points for the 5 items that were sensitive (> .84) and specific (> or = .80) in identifying patients classified as depressed by full 20 items. The reduced patient and clinician burden of the subset of 5 items, as well as its desirable psychometric properties, support broader application of this subset as a screening tool for depression.