Comparison of the CES-D and PHQ-9 depression scales in people with type 2 diabetes in Tehran, Iran

Mohammad E. Khamseh*, Hamid R. Baradaran, Anna Javanbakht, Maryam Mirghorbani, Zahra Yadollahi, Mojtaba Malek

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background: The quality of life in patients with various chronic disorders, including diabetes has been directly affected by depression. Depression makes patients less likely to manage their self-care regimens. Accurate assessment of depression in diabetic populations is important to the treatment of depression in this group and may improve diabetes management. To our best knowledge, there are few studies that have looked for utilizing questionnaires in screening for depression among patients with diabetes in Iran. Therefore the aim of this study was to assess the efficacy and accuracy of the Center for Epidemiological Studies Depression (CES-D) scale and the Patient Health Questionnaire-9 (PHQ-9), in comparison with clinical interview in people with type 2 diabetes.Methods: Outpatients who attended diabetes clinics at IEM were recruited on a consecutive basis between February 2009 and July 2009. Inclusion criteria included patients with type 2 diabetes who could fluently read and speak Persian, had no severe diabetes complications and no history of psychological disorders. The history of psychological disorders was ascertained through patients' medical files, taking history of any medications in this regard. The study design was explained to all patients and informed consent was obtained. Volunteer patients completed the Persian version of the questionnaires (CES-D and PHQ-9) and a psychiatrist interviewed them based on Structured Clinical Interview (SCID) for DSM-IV criteria.Results: Of the 185 patients, 43.2% were diagnosed as having Major Depressive Disorder (MDD) based on the clinical interview, 47.6% with PHQ-9 and 61.62% with CES-D. The Area Under the Curve (AUC) for the total score of PHQ-9 was 0.829 ± 0.30. A cut-off score for PHQ-9 of ≥ 13 provided an optimal balance between sensitivity (73.80%) and specificity (76.20%). For CES-D the AUC for the total score was 0.861 ± 0.029. Optimal balance between sensitivity (78.80%) and specificity (77.1%) was provided at cut-off score of ≥ 23.Conclusions: It could be concluded that the PHQ-9 and CES-D perform well as screening instruments, but in diagnosing major depressive disorder, a formal diagnostic process following the PHQ-9 and also the CES-D remains essential.

Original languageEnglish
Article number61
JournalBMC Psychiatry
Publication statusPublished - 16 Apr 2011

Bibliographical note

Authors would like to have their special thanks to all of the patients and staff who participated and helped with the study. This research was supported by a grant (M-288) from Tehran University of Medical Sciences.


  • Major Depressive Disorder
  • Clinical Interview
  • Optimal Balance
  • Receiver Operate Characteristic Curve


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