Open Access Open Badges Research article

Validation of the Turkish version of the Centre for Epidemiologic Studies Depression Scale (CES-D) in patients with Type 2 diabetes mellitus

Vicky Lehmann1, Ceylan Makine1, Çagatay Karşıdağ2, Pinar Kadıoğlu3, Kubilay Karşıdağ4 and François Pouwer1*

  • * Corresponding author: François Pouwer

  • † Equal contributors

Author Affiliations

1 Department of Medical Psychology and Neuropsychology, Centre of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands

2 Bakirkoy Mental and Neurological Disease Hospital, Istanbul, Turkey

3 Istanbul University, Cerrahpasa Medical Faculty, Turkey

4 Istanbul University, Istanbul Medical Faculty, Turkey

For all author emails, please log on.

BMC Medical Research Methodology 2011, 11:109  doi:10.1186/1471-2288-11-109

Published: 26 July 2011



Depression is a common co-morbid health problem in patients with diabetes that is underrecognised. Current international guidelines recommend screening for depression in patients with diabetes. Yet, few depression screening instruments have been validated for use in this particular group of patients. Aim of the present study was to investigate the psychometric properties of the Turkish version of the Centre for Epidemiologic Studies Depression Scale (CES-D) in patients with type 2 diabetes.


A sample of 151 Turkish outpatients with type 2 diabetes completed the CES-D, the World Health Organization-Five Well-Being Index (WHO-5), and the Problem Areas in Diabetes scale (PAID). Explanatory factor analyses, various correlations and Cronbach's alpha were investigated to test the validity and reliability of the CES-D in Turkish diabetes outpatients.


The original four-factor structure proposed by Radloff was not confirmed. Explanatory factor analyses revealed a two-factor structure representing two subscales: (1) depressed mood combined with somatic symptoms of depression and (2) positive affect. However, one item showed insufficient factor loadings. Cronbach's alpha of the total score was high (0.88), as were split-half coefficients (0.77-0.90). The correlation of the CES-D with the WHO-5 was the strongest (r = -0.70), and supported concurrent validity.


The CES-D appears to be a valid measure for the assessment of depression in Turkish diabetes patients. Future studies should investigate its sensitivity and specificity as well as test-retest reliability.