Depressive symptoms

Depressive symptoms

LASA filenames:
LASA025 / LASA225
LASA606 / LASA706 / LASA906
LASEs806 / LASEs906
LASEt606 / LASEt706 / LASEt906

Contact: Almar Kok


Depression is among the most prevalent psychiatric disorders in late-life, but the prevalence appears to shift from a decrease in depressive disorders fulfilling rigorous diagnostic criteria according to DSM criteria, to an increasing prevalence of clinically relevant depressive symptomatology (also: sub threshold or minor depression), which are associated with declines in cognitive functioning, physical performance and conditions, health care utilization and mortality.

Measurement instrument in LASA

Within the LASA depressive symptoms are measured with the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977). The CES-D is a self-report scale designed to measure depressive symptoms in the general population. The items were chosen to represent depressive symptoms, common in the community. The development of the scale has been described in detail elsewhere (Radloff et al. 1977, 1986; Beekman et al. 1994; 1997). Since its introduction it has been used extensively: at all ages, in more than 15 languages, in both healthy and illness populations and in different health care settings.

The CES-D consists of 20 items covering depressive symptomatology experienced in the past week. Each answer is rated on a 4-point scale ranging from 0 ‘rarely or never’ to 3 ‘mostly or always’. The total score of the 20 items ranges from 0 to 60, higher scores indicating more depressive symptoms.

Scale construction

First, the values for the positive affect items are reverse coded (item 4, 8, 12 and 16). Then, the items scores are summed up to compute the total CES-D score. Missing items are imputed with the rounded average of the available items, to a maximum of 2 items. If more than 2 items are missing, no scale score is computed. Other reasons for missing data include type of interview or a prematurely terminated interview. For respondents who participated in the telephone interview, the total CES-D scores can be found in the files ending with 906.

The CES-D has good psychometric properties in elderly samples (Himmelfarb and Murrell 1983, Radloff et al. 1986, Hertzog et al. 1990). The psychometric properties of the Dutch translation were tested in three groups of older persons prior to its use in LASA. Results were favorable and have been described in detail elsewhere (Beekman et al. 1994; 1997). The factor structure of the Dutch translation of the CES-D as used in the baseline measurement of the LASA study was similar to the factor structure of the original CES-D and to several other translated versions: depressed affect (item: 3, 6, 9, 10, 14, 17, 18), positive affect (item: 4, 8,12, 16), somatic and retarded activity (item: 1, 2, 5, 7, 11, 13, 20) and an interpersonal factor (item 15, 19) (Beekman et al 1994, 1997).

In most studies a score of 16 is used as a cut-off point to identify subjects with clinically relevant levels of depressive symptomatology (Berkman et al. 1986). Using this cut-off, the criterion validity for major depression was very satisfactory (sensitivity 100% and specificity 88%; Beekman et al., 1997).

The CES-D is a self-report symptom rating scale. It has been administered in different ways (face-to-face interview (main interview), telephone interview, self administration). In LASA the effect of different modes of administration were studied. Self-administered CES-D scales were found to yield systematically higher scores than when the scale was administered in a face-to-face interview. This mode effect, including a method to adjust for the mode effect, has been described in a separate paper (Geerlings et al 1999).

The CES-D is also part from the telephone interview (from D on) that is performed when the respondent is not able or willing to perform the whole interview. A short version of the CES-D is part from the telephone interview with the proxy when the respondent is not able perform the (short) interview at all. This short form consists of 4 questions (1, 6, 10 and 14).


LASAB025 / LASAC025 / LASAD025 / LASAE025 / LAS2B025 / LASAF025 / LASAG025 / LASAH025 / LAS3B025 / LASAI025/ LASAJ025 (main interview, in Dutch)

LASAC606† / LASAD606 / LASAE606 (telephone interview with PROXY, in Dutch);
LASAD706 / LASAE706 / LASAF706 / LASAG706 / LASAH706 / LASAI706 / LASAJ706 (telephone interview with RESP, in Dutch)

† in C also with respondent

Interim measurement:

LASEs806 (self-admin. questionnaire, in Dutch)
LASEt606 (telephone interview with PROXY, in Dutch)
LASEt706 (telephone interview with RESP, in Dutch)

Variable information

LASAB025 / LASAC025 / LASAD025 / LASAE025 / LAS2B025 / LASAF025 / LASAG025 / LASAH025 / LAS3B025 / LASAI025 / LASAJ025;
LASAB225 / LASAC225 / LASAD225 / LASAE225 / LAS2B225 / LASAF225 / LASAG225 / LASAH225 / LAS3B225 / LASAI225/ LASAJ225 (scale scores)
LASAC606 / LASAD606 / LASAE606
LASAD706 / LASAE706 / LASAF706 / LASAG706 / LASAH706 / LASAI706 / LASAJ706;
LASAD906 / LASAE906 / LASAF906 / LASAG906 / LASAH906 / LASAI906 / LASAJ906 (scale scores)

Interim measurement:

LASEs806 / LASEs906 (scale scores)
LASEt706 / LASEt906 (scale scores)

Availability of information per wave


CES-D, short form-TpTpTpTp--------

¹ More information about the LASA data collection waves is available here.

* IM=interim measurement between E and F (first cohort only);
2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort;
K=future wave 2021-2022

in LASAC606 also with respondent

Ma=data collected in main interview;
Sa=data collected in self-admin. questionnaire;
Tr=data collected in telephone interview with respondent;
Tp=data collected in telephone interview with proxy and in C also with respondent (short form)

Previous use in LASA

– as a dichotomous variable using the generally accepted cut-off for clinically relevant depressive symptoms: CES-D ≥ 16.
– as a continuous variable measuring increasing levels of depressive symptoms.

Within LASA, numerous papers have been written using the CES-D: on the prevalence and risk factors for minor and major depression, on different symptoms profiles in specific risk groups, on the natural course of depression, on the association with different aspects of physical health (iatrogenic depression, pain, cognitive decline, cardiovascular diseases and mortality), on gender differences, on religion, on the comorbidity with anxiety disorders and about health care utilization.


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Date of last update: December, 2019