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Reliability and validity of the Center for Epidemiologic Studies Depression (CES-D) scale in Serbian women with abnormal Papanicolaou smear results


Objectives Cervical cancer ranks as the second most frequent cancer among women in Serbia. Organized screening for detection of cervical cancer was introduced in Serbia in 2013 and provided free of charge in all state health facilities. Studies have shown that depression frequently follows the notification of abnormal findings on the Papanicolaou (Pap) screening test. The aim of this study was to examine the reliability and validity of the Center for Epidemiologic Studies Depression (CES-D) scale among women in Serbia receiving a report of abnormal cytology.

Methods This population-based study used cross-sectional, self-reported data involving 198 consecutive women attending cervical cancer screening who had received abnormal Pap smear results. All participants completed the socio-demographic questionnaire and CES-D scale. Reliability of the CES-D scale was assessed by internal consistency reliability (measured with standardized Cronbach’s coefficient α). Exploratory factor analysis was done using Promax rotation.

Results The overall Cronbach’s α coefficient of the CES-D scale was 0.865, while the Cronbach’s α coefficients for the subscales Depressed affect, Somatic complaints, Positive affect, and Interpersonal relationship were 0.885, 0.802, 0.851, and 0.593, respectively. Principal component analysis with Oblimin rotation indicated four main components that explained 62.0% of variance. Over one-quarter (28.8%) of the participants scored above the cut point (≥16) on the CES-D scale. The mean score for depressive symptoms was 13.0 for the study sample.

Conclusions The Serbian version of the CES-D scale proved to be a valid and reliable instrument for identifying patients with depressive symptoms among women with abnormal Pap smear results.

  • cervical cancer screening
  • depression
  • the center for epidemiologic studies depression scale
  • validity
  • reliability

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