Validity of the center for epidemiological studies depression (CES-D) scale for depression screening in postpartum adolescents in Uganda

Abstract

In Uganda, 25% of pregnancies occur among teenagers and an estimated 20.7% have postpartum depression. Postpartum depression is often underdiagnosed due to insufficient mental health resources and few validated screening tools for adolescent mothers. Addressing this gap, psychometric properties of the Center for Epidemiological Studies Depression Scale (CES-D) was evaluated for detection of probable depression among postpartum adolescents in urban Uganda. To determine the validity of the 20-item CES-D tool to detect depression among postpartum adolescent mothers attending an urban-based, postnatal clinic in Kawempe, Uganda. This cross-sectional study evaluated 200 adolescent mothers aged 11–19 years attending postnatal care in an urban-based health center in Kawempe, central Uganda. Depressive symptoms were screened using the CES-D (cutoff ≥ 26) and confirmed via the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Psychometric analyses evaluated sensitivity, specificity, predictive values with exact binomial (Clopper-Pearson) 95% confidence intervals, internal consistency (Cronbach’s α) and Area Under Receiver Operating Characteristic curve (AUROC). Participants’ mean age was 16.0 years (SD = 3.4), 31.5% (95%CI 25.1–37.9) screened positive for depression on the CES-D while 8.4% (95%CI 4.6–14.0) met MINI-KID criteria for depression. The CES-D demonstrated 76.9% (95%CI: 46.2–95.0) sensitivity, 66.0% (95%CI: 57.5–73.7) specificity, a 95.9% (95% CI: 91.3–98.5) negative predictive value, and a positive predictive value of 17.2% (95% CI: 8.6–29.4). Cronbach’s α was 0.86, and AUROC was 0.76, indicating acceptable diagnostic accuracy. The CES-D demonstrated acceptable screening performance and high internal consistency in this urban sample of adolescent mothers; however, given its low positive predictive value, positive screens require secondary diagnostic confirmation.