Validity of the CES-D for depression screening in military service members with a history of mild traumatic brain injury

ABSTRACT

Primary Objective: To advance knowledge about the value of the Center for Epidemiologic Studies – Depression scale (CES-D) for depression screening in military service members with a history of mild traumatic brain injury (mTBI).

Research Design: Retrospective data from 336 military service members with a history of mTBI were extracted from a TBI Repository at a large military medical center. Participants included in this study screened positive for mTBI in a primary care clinic or soldier readiness processing center and were enrolled in the TBI repository from November 6, 2014 to May 31, 2017. At the time of enrollment, participants completed the CES-D and their electronic medical records (EMR) were searched for diagnoses of depressive disorders.

Methods and Procedures: Receiver-operating characteristic (ROC) analysis of the CES-D was used to discriminate cases with and without depression diagnoses.

Main Outcomes and Results: Area under the ROC curve (AUC) was .897. Sensitivity (.824) and specificity (.826) were maximized at a cut score of 18 or greater, slightly higher than the standard cut of 16 established for civilian samples.

Conclusions: Results suggest that the CES-D is a valid screening instrument for depressive disorders in military samples with a history of mTBI.

KEYWORDS:

• mild TBI
• military
• depression

Acknowledgments

The authors would like to thank LtCol Jeffrey McClean and Richard Montgomery for their administrative support of this project. We would also like to express our appreciation to the following individuals for their assistance with the study, including data collection, verification, and data entry: John Bruno, RN; Maria Lara, MS; Cynthia Muncy, MA; Felix Leal, MA and Jennifer Williams, MA. We appreciate the assistance of Hamid Ferdosi MD, MPH for assistance with the trend analysis. Many thanks to Joseph Warren, RN for keeping our regulatory processes in order. We would like to acknowledge the assistance and support of the McWethy Troop Medical Clinic staff and most of all thank the service men and women who participated in this research.

Declaration of Interest

The authors report no declarations of interest. The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components.