CES-D: Center for Epidemiologic Studies Depression Scale
The CES-D (Center for Epidemiologic Studies Depression Scale) is a 20-item self-report questionnaire that measures how often depressive symptoms occurred in the past week. Score 0–60; ≥16 indicates significant depressive symptoms. Radloff (1977).
CES-D Score Interpreter
Scores of 16 or higher indicate clinically significant depressive symptoms warranting further assessment.
20 items rated 0–3 for the past week. Items 4, 8, 12 and 16 are reverse-scored before summing.
| Total score | Interpretation |
|---|---|
| 16+ | Significant depressive symptomsScores of 16 or higher indicate clinically significant depressive symptoms warranting further assessment. |
| 0–15 | Below screening cutoffScores below 16 fall under the conventional screening cutoff. |
Radloff (1977); cutoff 16 as typically recommended and pooled in Vilagut et al. (2016) meta-analysis (sensitivity 0.87, specificity 0.70). Screening only, not a diagnosis.
For reference only — not an assessment, diagnosis, or medical advice. This page provides scoring reference material; interpretation and clinical decisions rest with a qualified clinician.
The CES-D is a 20-item validated measure of depressive symptom frequency over the past week. Score 0–60; cutoff ≥16 for significant depression. Originally developed at NIMH for epidemiological research. Check the copyright holder's terms before clinical or commercial use.
What the CES-D measures
The CES-D (Center for Epidemiologic Studies Depression Scale) was developed by Lenore Radloff at the National Institute of Mental Health (NIMH) in 1977. Originally designed for use in population surveys rather than individual clinical evaluation, it has since become widely used in both epidemiological research and clinical screening contexts. It measures the frequency of depressive symptoms experienced during the past week.
The 20 items cover four domains: depressed affect, positive affect (reverse-scored), somatic and retarded activity, and interpersonal difficulties. Before clinical or commercial use, check the copyright holder's terms. It is particularly useful for its four-subscale structure, which can help distinguish between different aspects of the depressive syndrome.
How to administer the CES-D
The CES-D is completed by the patient. Rate how often you felt each way during the past week. Each item is rated on a frequency scale from 0 (Rarely/None of the time) to 3 (Most or all of the time). The full 20-item form typically takes 5 to 10 minutes; a shorter 10-item version, the CES-D-10, takes approximately 3 to 5 minutes where brevity is a priority.
Educational reference only. Cannot diagnose or replace clinical evaluation.
CES-D scoring and interpretation
Four positively worded items (4, 8, 12, 16) are reverse-scored before summing. Total scores range from 0 to 60. A score of ≥16 indicates clinically significant depressive symptoms warranting further assessment.
Radloff (1977). The ≥16 cutoff has been validated across diverse populations in community and clinical samples.
Psychometric properties
A systematic review and meta-analysis of 28 studies (10,617 participants) in general population and primary care settings found an overall area under the curve of 0.87. At the cutoff of 16, pooled sensitivity was 0.87 and specificity 0.70; a cutoff of 20 gave a better trade-off (sensitivity 0.83, specificity 0.78) (Vilagut et al., 2016).
Limitations
- Screening, not diagnosis. The CES-D should not be used as an isolated diagnostic measure of depression; a positive screen calls for clinical interview.
- Cutoff choice. The conventional cutoff of 16 favours sensitivity over specificity, so false positives are common; a cutoff of 20 may suit some purposes better (Vilagut et al., 2016).
- Self-report. Scores depend on the respondent's recall of the past week and willingness to report symptoms.
- Designed for surveys. It was built for epidemiological research rather than individual clinical evaluation.
Measuring Depression in HiBoop
HiBoop does not offer the CES-D; this page is reference material. For depression, HiBoop offers the PHQ-9 and PHQ-8, scored on submission and tracked over time.
HiBoop does not offer this scale. This page is reference material.This library is an academic and clinical reference. A scale described here is not necessarily offered in HiBoop; each page says whether it is.
Bill this assessment
In the US, the CES-D: Center for Epidemiologic Studies Depression Scale is usually billed under these CPT codes. Payer rules vary.
Measurement-based care in practice
For clinicians
HiBoop does not offer this scale. For the scales it does offer, responses are scored on submission and tracked over time, and HiBoop automates delivery across your patient panel.
For individuals
This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.
Frequently Asked Questions
What is the CES-D?
The Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item self-report measure of depressive symptoms developed by Lenore Radloff at the National Institute of Mental Health in 1977. It was originally designed for use in population surveys but is now widely used in both epidemiological research and clinical screening. It assesses the frequency of depressive symptoms during the past week.
What is the CES-D clinical cutoff score?
A CES-D score of 16 or higher indicates clinically significant depressive symptoms warranting further evaluation. This cutoff has been validated across diverse community and clinical populations. Scores of 24 or above suggest a higher probability of major depressive disorder and should prompt a thorough clinical interview.
How does the CES-D compare to the PHQ-9?
The CES-D has 20 items and a reference period of one week, while the PHQ-9 has 9 items and a two-week reference period. Both use patient self-report. The PHQ-9 aligns directly with DSM diagnostic criteria for major depressive disorder, making it useful for tracking diagnostic-level symptoms. The CES-D is more commonly used in epidemiological research and captures a broader range of depressive experience, including positive affect through its reverse-scored items.
Is this scale available in HiBoop?
No. HiBoop does not offer the CES-D; this page is reference material. For depression, HiBoop offers the PHQ-9 and PHQ-8, scored on submission and tracked over time.
References
- 1.Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385-401.View source
- 2.Vilagut G, Forero CG, Barbaglia G, Alonso J. Screening for Depression in the General Population with the Center for Epidemiologic Studies Depression (CES-D): A Systematic Review with Meta-Analysis. PLoS One. 2016;11(5):e0155431.View source
Last reviewed: Jun 2, 2026
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