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Center for Epidemiologic Studies Depression Scale:
Scoring and Interpretation
The Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item self-report measure of how often depressive symptoms occurred during the past week, built for general-population research and scored from 0 to 60 (Radloff, 1977). Below you will find CES-D scoring with the four positive-affect reversals, what a total of 16 or more does and does not mean, code for SPSS and R, Radloff's original reliability evidence and a short paragraph for the measures section.
What the CES-D Measures
Radloff (1977) developed the CES-D for epidemiological work on depressive symptoms in the general population, including household surveys. The original inventory records how frequently each of twenty symptoms was experienced during the previous week, and its total expresses symptom burden, not a psychiatric diagnosis.
That origin explains how it is used. Researchers apply it in observational studies that relate depressive symptoms to psychosocial, demographic and health characteristics, where a brief, repeatable instrument is needed. Radloff (1977) and later validation work established internal consistency and correlations with related constructs, yet the total remains a self-reported measure that needs careful handling when a binary threshold is applied.
Structure of the CES-D
- Items: twenty self-report symptom items, each referring to the past week.
- Response scale: four frequency options coded 0 to 3.
- Reverse-scored items: 4, 8, 12 and 16, the four positive-affect items.
- Subscales: none in standard analysis. Psychometric studies describe four content clusters (depressed affect, positive affect, somatic and retarded activity, and interpersonal problems), but these are not separate diagnostic scales.
- Total: one summed score from 0 to 60.
- Shorter forms: the 10-item CES-D has a 0 to 30 range and its own threshold, so its totals are not interchangeable with the 20-item score.
The instrument itself is available from Radloff (1977), the original publication of the scale in Applied Psychological Measurement, and from US public research repositories.
How to Score the CES-D
- Check that ces1 to ces20 are integers coded 0 to 3 in the original item order, since the reversal rule depends on the item numbers.
- Reverse items 4, 8, 12 and 16 as 3 minus the response, then add all twenty keyed items.
- Store the result as cesd_total, which ranges from 0 to 60.
- Choose a missing-item rule. Radloff (1977) does not specify one. A commonly applied convention prorates when up to four items are missing (at least 16 answered) and sets the total to missing otherwise; describe it as a convention, not a developer rule. The code below requires all twenty items.
* Illustrative syntax: variables must already be valid item scores (0 to 3).
COMPUTE ces4_r = 3 - ces4.
COMPUTE ces8_r = 3 - ces8.
COMPUTE ces12_r = 3 - ces12.
COMPUTE ces16_r = 3 - ces16.
COMPUTE cesd_total = SUM.20(ces1, ces2, ces3, ces4_r, ces5, ces6, ces7, ces8_r, ces9, ces10, ces11, ces12_r, ces13, ces14, ces15, ces16_r, ces17, ces18, ces19, ces20).
EXECUTE.# data: one row per respondent; items ces1 to ces20 coded 0 to 3.
data$ces4_r <- 3 - data$ces4
data$ces8_r <- 3 - data$ces8
data$ces12_r <- 3 - data$ces12
data$ces16_r <- 3 - data$ces16
data$cesd_total <- rowSums(data[c("ces1", "ces2", "ces3", "ces4_r", "ces5", "ces6", "ces7", "ces8_r", "ces9", "ces10", "ces11", "ces12_r", "ces13", "ces14", "ces15", "ces16_r", "ces17", "ces18", "ces19", "ces20")], na.rm = FALSE)Interpreting CES-D Scores
| Score band | Interpretation |
|---|---|
| 0 to 15 | Below the conventional elevated-symptoms screening threshold |
| 16 or more | At or above a commonly used elevated depressive-symptoms threshold |
Source: Radloff (1977); Weissman et al. (1977).
Higher totals indicate more frequent depressive symptoms in the preceding week. A score of 16 or above is widely used in research to flag elevated symptom burden, but it is a screening convention and not a diagnosis, and its sensitivity and specificity differ across settings and populations. In a sample with a low base rate of depression, many people above the line will not meet diagnostic criteria.
The scale was designed for research and screening, so a binary result should never stand in for clinical assessment. The original threshold may be less specific in people with medical illness or a different symptom distribution. The 10-item version (Andresen et al., 1994) runs from 0 to 30 with a conventional threshold of 10 or more, and cannot be read against the 20-item bands.
Psychometric Properties
| Property | Published finding | Source |
|---|---|---|
| Internal consistency | Approximately α = .85 in general-population samples and .90 in patient groups during original development | Radloff (1977) |
| Test-retest | Variable over longer intervals, reflecting symptom fluctuation; not one fixed stability estimate | Radloff (1977) |
| Construct validity | Associations with other depressive symptom measures and clinician ratings across psychiatric populations | Radloff (1977); Weissman et al. (1977) |
| Factor structure | Original research described four content factors while the total remains the common summary | Radloff (1977) |
| Diagnostic accuracy | A score of 16 or more is a conventional screen; no universal sensitivity or specificity is claimed for all groups | Radloff (1977); Weissman et al. (1977) |
These are source-specific results and cannot be assumed to hold as reliability or accuracy estimates in a new sample.
Using the CES-D in a Study
Use the continuous total for cross-sectional, etiologic and longitudinal analyses, because it keeps the variation that a threshold discards. When the research question needs a binary outcome, the cut-off of 16 can serve as a descriptive endpoint in a Logistic Regression, as long as the result is described as elevated symptoms and not as prevalence of depression. If you validate the threshold against a diagnostic interview, Sensitivity & Specificity (Diagnostic Accuracy) sets out how to report it with confidence intervals.
Missing items are common in survey data, so document the handling rule and consider whether Missing Data Analysis is needed for incomplete responses. Compute reliability from your own responses with Reliability Analysis (Cronbach’s Alpha), describe the effect of the positively worded items, and inspect floor effects and confounding by physical illness. Base the sample size on the main effect size, the model and the precision you plan.
Related field: Epidemiology
Reporting the CES-D
Depressive symptoms during the previous week were measured with the 20-item Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977). Four positively worded items (4, 8, 12 and 16) were reverse scored and all items were summed to give totals from 0 to 60, with higher scores indicating greater symptom burden. Internal consistency in this sample was [α = XX].
References
Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D. American Journal of Preventive Medicine, 10(2), 77-84. https://doi.org/10.1016/S0749-3797(18)30622-6
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401. https://doi.org/10.1177/014662167700100306
Weissman, M. M., Sholomskas, D., Pottenger, M., Prusoff, B. A., & Locke, B. Z. (1977). Assessing depressive symptoms in five psychiatric populations: A validation study. American Journal of Epidemiology, 106(3), 203-214. https://doi.org/10.1093/oxfordjournals.aje.a112455
Frequently Asked Questions
Which CES-D items are reverse coded?
In the original 20-item form, items 4, 8, 12 and 16 are positively worded and reversed as 3 minus the response before all twenty items are added.
Does a CES-D score of 16 or more establish clinical depression?
No. It is a screening convention for elevated depressive symptoms. Treat a score at or above it as a reason for assessment, and describe it in your report as an elevated-symptom group.
Can I analyze the CES-D as a continuous variable?
Yes. The scale was meant for epidemiological symptom research, and a continuous total usually retains useful variation that a binary split would lose.
Can CES-D-10 scores stand in for a 20-item total?
Not without a separate scoring and validation approach. The versions have different ranges and thresholds, so record which form each participant completed and analyze them separately.
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