Centre for Epidemiological Studies Depression Scale for Children (CES-DC)

Abstract

The Centre for Epidemiological Studies Depression Scale for Children (CES-DC) is a 20-item self-report questionnaire designed to assess current depressive symptomatology in children and adolescents aged 6 to 17 years. Formulated by Myrna M. Weissman, Helen Orvaschel, and Nancy Padian in 1980, the instrument represents a downward developmental adaptation of Lenore Sawyer Radloff’s adult Centre for Epidemiological Studies Depression Scale (CES-D; 1977). The scale evaluates the frequency and severity of depressive experiences occurring over the preceding week using a 4-point Likert scale ranging from 0 (“Not at all”) to 3 (“A lot”). Total cumulative scores range from 0 to 60, with four items reverse-scored to mitigate acquiescence bias. Psychometrically, the CES-DC captures four distinct yet intercorrelated dimensions: Depressed Affect, Positive Affect (Anhedonia), Somatic and Retarded Activity, and Interpersonal Difficulties. A conventional cutoff score of 15 is utilized across epidemiological, school-based, and clinical settings to identify youths exhibiting significant depressive distress warranting comprehensive clinical evaluation. Extensive psychometric evaluations demonstrate robust internal consistency, with Cronbach’s alpha coefficients typically ranging from .71 to .91 across diverse cultural and national cohorts. Test-retest reliability has demonstrated adequate stability among adolescents (.70 to .85), although lower temporal stability is noted in younger children, reflecting both developmental shifts in cognitive introspection and the state-dependent nature of the construct. The CES-DC exhibits convergent validity with established measures such as the Children’s Depression Inventory (CDI) and the Beck Depression Inventory (BDI), as well as robust criterion validity in discriminating clinical and non-clinical pediatric cohorts. While the CES-DC cannot establish a psychiatric diagnosis under the Diagnostic and Statistical Manual of Mental Disorders (DSM), it stands as a premier public-domain screening instrument for epidemiological surveillance, clinical triage, and treatment monitoring in pediatric mental health.

Keywords

Centre for Epidemiological Studies Depression Scale for Children, CES-DC, pediatric depression, adolescent mental health, depression screening, psychometrics, affective disorders, child psychopathology, confirmatory factor analysis, epidemiological assessment, depressive symptomatology, emotional distress

Authors

The Centre for Epidemiological Studies Depression Scale for Children (CES-DC) was developed and standardized by:

• Myrna M. Weissman, Ph.D. — Professor of Epidemiology and Psychiatry at the College of Physicians and Surgeons, Columbia University, and Chief of the Division of Translational Epidemiology at the New York State Psychiatric Institute (NYSPI). Dr. Weissman is an internationally distinguished psychiatric epidemiologist renowned for seminal research on the epidemiology of mood and anxiety disorders, interpersonal psychotherapy (IPT), and family genetic transmission of depression.
• Helen Orvaschel, Ph.D. — Clinical child psychologist and epidemiologist who held academic and clinical positions at the University of Pittsburgh School of Medicine and Nova Southeastern University. Dr. Orvaschel contributed extensively to the development of structured clinical diagnostic interviews for youths, including the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS).
• Nancy S. Padian, Ph.D. — Epidemiologist and public health researcher who served as Professor of Epidemiology at the University of California, Berkeley, specializing in quantitative epidemiological methodology, program evaluation, and global health intervention research.

Purpose

The primary purpose of the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) is to provide an accessible, developmentally sensitive, and psychometrically sound self-report measure for detecting depressive symptomatology in non-clinical child and adolescent populations, as well as monitoring clinical symptom trajectories over time. The development of the scale was prompted by the recognition that adult depression instruments possessed linguistic and conceptual complexities beyond the developmental comprehension of children, and that childhood depressive manifestations differ subtly in experiential and expressive features compared to adult presentations.

Major depressive disorder and subthreshold depressive conditions in childhood and adolescence carry profound prognostic implications, including impaired scholastic functioning, disrupted peer relationships, elevated risk of substance misuse, and heightened vulnerability to suicidal ideation and behaviors. Despite the pervasive prevalence and long-term morbidity associated with youth depression, emotional distress in youths is frequently overlooked in routine pediatric and educational environments. Youths often internalize dysphoria, social alienation, and anhedonia, which may not manifest as disruptive externalizing behaviors that typically alert parents, educators, and clinicians. The CES-DC was therefore created to serve as an economical, non-invasive, population-level screening instrument capable of capturing the subjective emotional state of youth respondents.

In clinical practice, the CES-DC operates as a frontline screening triage tool. A positive screen does not constitute a formal diagnosis of Major Depressive Disorder or Persistent Depressive Disorder; rather, it identifies youths exhibiting elevated psychological distress who require comprehensive psychiatric assessment. Because the scale specifically measures depressive experiences occurring within the previous week, it is sensitive to short-term changes in affective states. This temporal frame makes the CES-DC well-suited for repeated administrations to track symptom evolution during psychotherapy, pharmacotherapy, or psychosocial interventions. In research contexts, the scale is widely applied in epidemiological surveillance studies, longitudinal cohorts investigating developmental psychopathology, school-based prevention trials, and cross-cultural psychiatric investigations.

Psychological Construct

The psychological construct evaluated by the CES-DC is depressive symptomatology within a dimensional psychopathology framework. Rather than viewing depression as a categorical entity defined solely by diagnostic thresholds, the CES-DC conceives depressive phenomena along a continuum ranging from psychological well-being to severe affective disturbance. Adapted from Radloff’s adult conceptualization, the scale assesses core clinical features of childhood depression across four interrelated dimensions:

1. Depressed Affect

Depressed affect constitutes the emotional core of the depressive spectrum. In pediatric cohorts, this construct encompasses profound sadness, persistent tearfulness, fearfulness, loneliness, and pervasive discouragement. Children experiencing elevated depressed affect report feelings of dysphoria, hopelessness regarding future outcomes, and subjective despondency. On the CES-DC, items capturing this dimension reflect feelings of being down and unhappy (Item 6), feeling scared (Item 10), experiencing intense loneliness (Item 14), crying spells (Item 17), and deep sadness (Item 18). Unlike adults who may describe feelings of existential emptiness or classic melancholy, children frequently frame depressed affect around feeling frightened, helpless, or overwhelmed by negative emotions.

2. Positive Affect and Anhedonia

The positive affect dimension assesses the child’s capacity for joy, positive self-regard, optimistic expectancy, and hedonic pleasure. The absence of positive affect is a hallmark of anhedonia, one of the two cardinal diagnostic criteria for major depression. In the CES-DC, this construct is evaluated through four reverse-scored items: perceived self-worth relative to peers (“I felt like I was just as good as other kids”, Item 4), optimistic anticipation of future positive events (“I felt like something good was going to happen”, Item 8), generalized happiness (“I was happy”, Item 12), and active subjective enjoyment of activities (“I had a good time”, Item 16). Low scores across these reverse-coded items signify profound loss of pleasure, demoralization, and compromised self-esteem, which are central markers of pediatric mood disturbance.

3. Somatic Complaints and Retarded Activity

The somatic and retarded activity subscale reflects the vegetative and psychomotor disruptions of pediatric depression. Youths experiencing mood disturbance frequently present with somatic manifestations rather than articulated psychological despair. This construct includes appetite suppression and nutritional disinterest (Item 2), cognitive inefficiencies including concentration impairment and distractibility (Item 5), psychomotor fatigue and subjective exhaustion (“I felt like I was too tired to do things”, Item 7), sleep disruptions and non-restorative sleep patterns (Item 11), behavioral withdrawal and reduced verbalization (Item 13), and executive avolition or initiation difficulty (Item 20). Item 1 (“I was bothered by things that usually don’t bother me”) reflects generalized irritable reactiveness and sensory intolerance, which serves as a developmental substitute for dysphoria in younger individuals.

4. Interpersonal Difficulties

Depression in children and adolescents significantly affects interpersonal schemas and peer relationships. The interpersonal difficulties dimension captures subjective experiences of rejection, interpersonal paranoia, perceived hostility, and perceived social unacceptability. In the CES-DC, this construct is measured by items addressing perceived peer unfriendliness or social exclusion (“I felt like kids I know were not being friendly or didn’t want to be with me”, Item 15) and generalized perceived antipathy (“I felt people didn’t like me”, Item 19). These items tap into the hypersensitivity to interpersonal rejection, negative social attributional biases, and withdrawal patterns characteristic of depressed youth.

Theoretical Framework

The CES-DC is grounded in developmental psychopathology and cognitive theories of depression. The theoretical underpinnings integrate Aaron T. Beck’s cognitive triad, the learned helplessness and hopelessness paradigms, and contemporary developmental adaptation theories.

Cognitive Formulations of Childhood Affective Disturbance

According to Beck’s cognitive model of depression, individuals vulnerable to depressive disorders possess hyperactive latent negative self-schemas that distort information processing. When activated by environmental stressors or developmental transitions, these schemas yield automatic thoughts reflecting systematic negative cognitive biases regarding the self, the personal world, and the future. The CES-DC directly operationalizes elements of this cognitive triad:

• Negative View of the Self: Manifested in items addressing diminished self-competence relative to peers (Item 4) and internal attributions of perceived failure (Item 9: “I felt like things I did before didn’t work out right”).
• Negative View of the World / Social Environment: Reflected in items assessing perceived social rejection, interpersonal hostility, and alienation from peer networks (Items 15 and 19).
• Negative View of the Future: Captured through the absence of positive anticipation, anhedonia, and a sense of pervasive gloom (Item 8).

Learned Helplessness, Hopelessness, and Attributional Styles

The CES-DC also reflects the reformulated learned helplessness and hopelessness theories of depression developed by Abramson, Seligman, and Teasdale. In youths, depression often emerges when stressful life events interact with a depressogenic attributional style—the tendency to attribute negative events to internal, stable, and global factors, while viewing positive events as unstable, external, and uncontrollable. Items such as “I felt like things I did before didn’t work out right” tap into attributional demoralization and perceived behavioral futility. Furthermore, the somatic manifestations reflected in Items 7 and 20 represent behavioral sequelae of learned helplessness, wherein motivational and psychomotor energy collapse under perceived lack of environmental mastery.

Developmental Psychopathology and Dimensional Perspectives

From a developmental psychopathology perspective, childhood depression cannot be viewed merely as an adult condition in miniature. The expression of depressive symptoms varies markedly across developmental stages. Early school-age children often externalize depressive distress through somatic ailments, irritability, psychomotor agitation, or separation anxiety. In contrast, adolescents demonstrate more cognitive rumination, existential hopelessness, and anhedonia. Weissman, Orvaschel, and Padian (1980) recognized that although the underlying affective construct is continuous throughout the lifespan, the item expressions required developmental recalibration. By rephrasing complex, abstract adult items into concrete, accessible experiential statements (e.g., transforming “I felt that everything I did was an effort” into “I felt like I was too tired to do things”), the CES-DC maintains conceptual alignment with core depressive dimensions while accommodating the cognitive and introspective capacities of school-age children and adolescents.

Validity

The psychometric validity of the CES-DC has been established across clinical, educational, and epidemiological settings globally. Extensive empirical testing supports its construct, convergent, discriminant, and criterion-related validity.

Convergent and Concurrent Validity

The convergent validity of the CES-DC has been examined by evaluating its statistical association with other standardized measures of pediatric depression. Early validation research by Faulstich, Carey, Ruggiero, Enyart, and Gresham (1986) demonstrated strong bivariate correlations between the CES-DC and the Beck Depression Inventory (BDI) (r = .68 to .76, p < .001) in adolescent psychiatric inpatient and outpatient samples. In a comparative analysis of depression screening tools, Doerfler, Felner, Rowlinson, Raley, and Evans (1988) confirmed that the CES-DC correlates substantially with Maria Kovacs’ Children’s Depression Inventory (CDI), showing correlation coefficients ranging from .72 to .81 across adolescent cohorts.

Beyond depression-specific inventories, convergent validity has been documented with broader psychopathology measures. In studies evaluating Thomas Achenbach’s Child Behavior Checklist (CBCL), CES-DC scores demonstrated substantial positive correlations with the Internalizing Problems composite score, particularly the Withdrawn/Depressed and Anxious/Depressed subscales (Achenbach, 1979; Fendrich, Weissman, & Warner, 1990). Furthermore, Li, Chung, and Ho (2010) identified a statistically significant positive correlation between the Chinese version of the CES-DC and the State Anxiety Scale for Children (SACS; r = .58, p < .001), reflecting the recognized comorbidity between pediatric depressive and anxiety disorders.

Discriminant and Criterion-Related Validity

Discriminant validity involves the instrument’s capacity to differentiate between depressed youths and non-depressed peers, as well as between youths with clinical psychiatric diagnoses and general community samples. Initial validation work by Weissman et al. (1980) indicated that the scale successfully distinguished children of depressed parents (a high-risk group) from children of healthy control parents. Fendrich, Weissman, and Warner (1990) further evaluated the diagnostic accuracy of the CES-DC relative to DSM-III Axis I diagnoses derived from semi-structured clinical interviews (K-SADS). The scale yielded strong receiver operating characteristic (ROC) curves, with area under the curve (AUC) metrics ranging from .82 to .89 for detecting major depressive disorder.

At the standard cutoff score of 15, the CES-DC demonstrates sensitivity rates between 75% and 85% and specificity rates between 68% and 80% in detecting clinically significant depressive episodes in school-aged samples. When used within high-prevalence psychiatric outpatient samples, raising the threshold to 20 or 24 optimizes specificity while maintaining satisfactory sensitivity, thereby reducing false-positive classifications.

Cross-Cultural and Transnational Generalizability

The cross-cultural construct validity of the CES-DC has been confirmed across diverse linguistic and geographic contexts:

• Germany: In the representative population-based BELLA study, Barkmann, Erhart, and Schulte-Markwort (2008) and Bettge et al. (2008) evaluated the German version across more than 2,800 youths, confirming strong construct validity and replicating the core latent depression dimensions.
• Iran: Essau, Olaya, Gholamreza, Gilvarry, and Bray (2013) examined the scale among Iranian youths, finding robust criterion validity while identifying gender-specific elevations among adolescent girls tied to socio-environmental and attributional factors.
• Hong Kong and China: Li et al. (2010) demonstrated structural equivalence and convergent validity in Chinese school children, showing strong discrimination across varying levels of somatic and psychological distress.
• Sweden and Spain: Olsson and von Knorring (1997) in Sweden, and Aguilar and Berganza (1990) in Spain, supported the scale’s construct validity and capacity to detect youth depression across differing educational and cultural systems.

Reliability

The reliability of the CES-DC has been evaluated using internal consistency analysis, split-half reliability, and test-retest stability assessments across diverse pediatric populations.

Internal Consistency

Internal consistency metrics for the total CES-DC score are well-documented, with Cronbach’s alpha values consistently meeting or exceeding acceptable psychometric standards (.70) and frequently surpassing .85 in larger samples:

• In the German BELLA study, Barkmann et al. (2008) observed Cronbach’s alpha values of .88 for the general adolescent sample and .86 for the child cohort.
• Essau et al. (2013) reported a total scale alpha of .87 in an Iranian sample of children and adolescents aged 9 to 17 years.
• Li, Chung, and Ho (2010) documented an alpha of .82 in their Chinese psychometric evaluation.
• Faulstich et al. (1986) reported an internal consistency alpha of .89 in a mixed inpatient and outpatient adolescent psychiatric sample.

Test-Retest Stability

Test-retest reliability estimates vary systematically by sample age and inter-test interval, reflecting the state-dependent nature of the instrument. The scale explicitly measures depressive symptoms occurring “over the past week,” capturing transient affective fluctuations rather than static, unalterable personality traits.

Among adolescents aged 12 to 18 years, the CES-DC exhibits good test-retest reliability across short-to-moderate intervals (e.g., 2 to 4 weeks), with Pearson correlation coefficients ranging from r = .70 to r = .85 (Barkmann et al., 2008; Li et al., 2010). Over longer intervals (e.g., 3 to 6 months), stability coefficients attenuate to values between .45 and .60, consistent with expected developmental shifts and natural symptom fluctuations.

In younger children (ages 6 to 11), test-retest stability is markedly lower, with coefficients ranging from .35 to .55 over intervals of two to four weeks (Faulstich et al., 1986). Researchers attribute this lower stability in younger cohorts to several factors: rapid fluctuations in childhood affective states, heightened susceptibility to situational events, developmental shifts in subjective recall, and varying reading comprehension levels. Consequently, clinicians are advised to interpret self-reported CES-DC scores in children under 10 years with appropriate caution, supplementing results with parent-report instruments (such as the CBCL or parent-rated depression inventories) and clinical interviews.

Factor Analysis

Structural evaluations using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have established the latent construct organization of the CES-DC. Most empirical studies evaluate whether Radloff’s (1977) original four-factor model replicates in pediatric and adolescent cohorts.

The Four-Factor Correlated Model

Radloff’s foundational four-factor structure includes:

1. Depressed Affect: Items 6 (down and unhappy), 10 (scared), 14 (lonely), 17 (felt like crying), and 18 (sad).
2. Positive Affect: Items 4 (as good as other kids), 8 (something good was going to happen), 12 (happy), and 16 (good time) — all reverse-coded.
3. Somatic and Retarded Activity: Items 1 (bothered by things), 2 (not feeling like eating), 3 (unable to feel happy), 5 (couldn’t pay attention), 7 (too tired), 11 (sleep disruption), 13 (more quiet), and 20 (hard to get started).
4. Interpersonal Difficulties: Items 15 (kids not friendly) and 19 (people didn’t like me).

Confirmatory factor analytic investigations across multiple international samples have validated this four-factor correlated model (Bettge et al., 2008; Essau et al., 2013; Fendrich et al., 1990; Li et al., 2010; Olsson & von Knorring, 1997). Goodness-of-fit indices from these CFA studies consistently indicate satisfactory model fit:

• Comparative Fit Index (CFI) > .90 to .95
• Tucker-Lewis Index (TLI) > .90 to .94
• Root Mean Square Error of Approximation (RMSEA) ≤ .04 to .06
• Standardized Root Mean Square Residual (SRMR) ≤ .04 to .05

Alternative Structural Formulations

Despite the support for the traditional four-factor solution, psychometricians have explored alternative configurations:

• Second-Order General Factor Model: Demonstrates that the four primary factors load significantly onto a single, higher-order latent construct of “General Depression” or “Negative Affectivity.” In this model, second-order loadings for Depressed Affect and Somatic Activity typically exceed .80, indicating they represent the core expression of the general factor.
• Bifactor Model: A general depressive factor accounts for the shared variance among all 20 items, while orthogonal group factors capture specific residual variance for Positive Affect, Somatic Complaints, and Interpersonal Difficulties. Research by Barkmann et al. (2008) suggests that the general factor explains the majority of common variance (often exceeding 65%), supporting the use of a single aggregated sum score in screening contexts.
• Measurement Invariance: Multigroup CFA studies have tested for structural, metric, and scalar invariance across sex and developmental stages. Essau et al. (2013) demonstrated partial or full scalar invariance across boys and girls, confirming that observed gender differences (such as adolescent females scoring higher on somatic complaints and depressed affect) reflect genuine differences in depressive experiences rather than measurement artifact.

Instrument / Measurement Tool

The CES-DC is structured as follows:

• Test Construct: Current dimensional depressive symptomatology and psychological distress.
• Respondent Age Range: Children and adolescents aged 6 to 17 years. (For youths aged 6 to 9, clinical assistance or oral administration is recommended to address potential reading comprehension limitations).
• Number of Items: 20 items.
• Response Format: 4-point Likert-type frequency scale reflecting symptom occurrence during the preceding 7 days:
• 0 = Not at all
• 1 = A little
• 2 = Some
• 3 = A lot
• Positively Phrased Items (Reverse Scored): Items 4, 8, 12, and 16. For these four items, scoring is reversed:
• 0 is scored as 3
• 1 is scored as 2
• 2 is scored as 1
• 3 is scored as 0
• Scoring Methodology: Sum of all 20 items (following reverse transformation of Items 4, 8, 12, and 16). Theoretical score range is 0 to 60.
• Clinical Cutoff Scores and Interpretation Guidelines:
• Scores 0 – 14: Symptom levels within the non-significant or normal range. General re-evaluation or standard developmental monitoring as indicated.
• Scores 15 – 60: Clinically elevated depressive symptomatology. A total score ≥ 15 represents the standard validated cutoff indicative of significant psychological distress, warranting comprehensive diagnostic evaluation by a qualified mental health practitioner.
• Alternative Cutoff Considerations: In inpatient or specialized psychiatric settings where higher specificity is required, a cutoff score of ≥ 20 or ≥ 24 may be used to minimize false positives.
• Administration Time: Approximately 5 to 10 minutes.
• Administration Modality: Self-administered paper-and-pencil or computerized/digital format. Can be read aloud by an interviewer for younger children or individuals with reading difficulties.

Permissions & Fee and Test Year

The Centre for Epidemiological Studies Depression Scale for Children (CES-DC) was published in 1980 by Myrna M. Weissman, Helen Orvaschel, and Nancy Padian in their foundational psychometric study titled “Children’s symptom and social functioning self-report scales: Comparison of mothers’ and children’s reports”, appearing in the Journal of Nervous and Mental Disease.

Licensing and Fee Status: As a derivative of the adult CES-D originally developed under the auspices of the National Institute of Mental Health (NIMH), a United States government federal agency, the instrument is in the public domain. There are no royalty fees, licensing charges, or commercial permissions required for its clinical, educational, or academic research use. Researchers, clinicians, and organizations may reproduce, administer, and translate the scale without purchasing proprietary test forms, provided appropriate academic citation is extended to the original developers (Weissman et al., 1980; Radloff, 1977).

References

Achenbach, T. M. (1979). The Child Behavior Profile: An empirically based system for assessing children’s behavioral problems and competencies. International Journal of Mental Health, 7(3-4), 24–42. https://doi.org/10.1080/00207411.1978.11448809

Aguilar, G. X., & Berganza, C. E. (1990). The CES-DC as a screening instrument for depression in school-age children in Guatemala. Revista Latinoamericana de Psicología, 22(3), 365–378.

Barkmann, C., Erhart, M., & Schulte-Markwort, M. (2008). The German version of the Centre for Epidemiological Studies Depression Scale for Children: Psychometric evaluation in a population-based survey of 7 to 17 years old children and adolescents – results of the BELLA study. European Child & Adolescent Psychiatry, 17(Suppl 1), 116–124. https://doi.org/10.1007/s00787-008-1013-0

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.

Bettge, S., Wille, N., Barkmann, C., Schulte-Markwort, M., Ravens-Sieberer, U., & BELLA Study Group. (2008). Depressive symptoms of children and adolescents in a German representative sample: Results of the BELLA study. European Child & Adolescent Psychiatry, 17(Suppl 1), 71–81. https://doi.org/10.1007/s00787-008-1008-x

Doerfler, L. A., Felner, R. D., Rowlinson, R. T., Raley, P. A., & Evans, E. (1988). Depression in children and adolescents: A comparative analysis of the utility and construct validity of two assessment measures. Journal of Consulting and Clinical Psychology, 56(5), 769–772. https://doi.org/10.1037/0022-006X.56.5.769

Essau, C. A., Olaya, B., Gholamreza, P., Gilvarry, C., & Bray, D. (2013). Depressive symptoms among young children and adolescents in Iran: A confirmatory factor analytic study of the Centre for Epidemiological Studies Depression Scale for Children. Child Psychiatry & Human Development, 44(1), 123–136. https://doi.org/10.1007/s10578-012-0314-1

Faulstich, M. E., Carey, M. P., Ruggiero, L., Enyart, P., & Gresham, F. (1986). Assessment of depression in childhood and adolescence: An evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). American Journal of Psychiatry, 143(8), 1024–1027. https://doi.org/10.1176/ajp.143.8.1024

Fendrich, M., Weissman, M. M., & Warner, V. (1990). Screening for depressive disorder in children and adolescents: Validating the Center for Epidemiologic Studies Depression Scale for Children. American Journal of Epidemiology, 131(3), 538–551. https://doi.org/10.1093/oxfordjournals.aje.a115530

Li, H. C. W., Chung, O. K. J., & Ho, K. Y. (2010). Center for Epidemiologic Studies Depression Scale for Children: Psychometric testing of the Chinese version. Journal of Advanced Nursing, 66(11), 2582–2591. https://doi.org/10.1111/j.1365-2648.2010.05449.x

Li, H. C. W., & Lopez, V. (2007). Development and validation of a short form of the Chinese version of the State Anxiety Scale for Children. International Journal of Nursing Studies, 44(4), 566–573. https://doi.org/10.1016/j.ijnurstu.2005.12.004

Olsson, G., & von Knorring, A. L. (1997). Depression among Swedish adolescents measured by the self-rating scale Center for Epidemiological Studies Depression Scale for Children (CES-DC). European Child & Adolescent Psychiatry, 6(2), 81–87. https://doi.org/10.1007/BF00566670

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., Orvaschel, H., & Padian, N. (1980). Children’s symptom and social functioning self-report scales: Comparison of mothers’ and children’s reports. Journal of Nervous and Mental Disease, 168(12), 736–740. https://doi.org/10.1097/00005053-198012000-00005

13. Items of the Scale (Questionnaire)