Predicting caseness of major depressive disorder using the Center for Epidemiological Studies Depression Scale (CESD-R) among patients receiving HIV care.

Patients receiving HIV care at two public health facilities in South Africa were assessed using the Centres for Epidemiological Studies Depression Scale Revised (CESD-R) and the Structured Clinical Interview for DSM5 to assess major depressive disorder. Of the 688 study participants, 229 (33.3%; CI = 29.8%; 36.9%) scored in the elevated range on the CESD-R and 170 (24.7%; CI = 21.5% to 28.1%) met the diagnostic criteria for major depressive disorder (MDD). 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. For the purpose of routine screening in the context of HIV care, the CESD-R appears to hold promise in identifying cases of MDD. Those who screen positive may then undergo a formal diagnostic interview to determine whether they are true cases for MDD, and referred for treatment.