Description

The Center for Epidemiologic Studies Depression Scale-Revised (CESDR-10), is a 10-item symptom measure that has been validated in Native communities. CESDR-10 is a self-report scale used to measure depressive symptoms. The full version has been widely used among adolescent and AI populations, including Apache youth. Depression symptoms are highly correlated with substance use, particularly for mothers with a history of substance misuse before pregnancy, with both maternal depressive symptoms and substance misuse significantly impacting children’s immediate risks (e.g., risk of neglect) and long term outcomes, making maternal depressive symptoms a key target for prevention. The CESDR-10 asks respondents to rate the frequency of specific depressive symptoms in the past two weeks. The more often depressive symptoms that are experienced by the respondent and the more depressive symptoms they experience in general, the higher the risk for major depressive disorder. Any score 8 and over (0.80 average score or above) is considered high risk.

AI/AN Communities where the measure has been used

Southwest tribal communities. Midwest community.

Demographics of AI/AN participants where the scale has been used

Women ages 14+ with young children; youth ages 14-30 at risk of suicide.

Notes on adaptations or modifications

  1. One question added (“Thinking about your mental health, which includes stress, depression, and problems with emotions, how many days during the past 30 days was your mental health NOT good?”). This additional question is from the 4-item Healthy Days Core Module from the CDC’s Health-Related Quality of Life Measure.

Modality and administration

Self-report; Participants are handed a tablet, or pen and paper, or otherwise sent a link to a REDCap survey to complete the CESDR-10.

Scoring

Sum the likert scale responses; divide by the number of items answered to find the average; use a predetermined cutoff to determine eligiblity. Can alternatively use total score to determine the severity of depressive episodes

Psychometric evidence

Cronbach’s alpha ranged from 0.90 to 0.91 in a validation study

Citation(s)

Cole, A. B., Sittner, K. J., Bruyere, T., & Walls, M.L. (2025). Intergenerational impacts of historical trauma on contemporary depression symptoms among Indigenous communities. Journal of the American Academy of Child & Adolescent Psychiatry,  64(12), 1401-1411. https://doi.org/10.1016/j.jaac.2025.01.009

Gillson, S., Hautala, D., Steinberg, R., & Walls, M. (2026) The ongoing legacy of Indigenous family separation: Long-term outcomes of child welfare involvement among American Indian and First Nations youth. Child Abuse & Neglect, 173, 107884. https://doi.org/10.1016/j.chiabu.2026.107884

Haroz, E. E., Ivanich, J. D., Barlow, A., O’Keefe, V. M., Walls, M., Kaytoggy, C., Suttle, R., Goklish, N., & Cwik, M. (2022). Balancing cultural specificity and generalizability: Brief qualitative methods for selecting, adapting, and developing measures for research with American Indian communities. Psychological Assessment, 34(4), 311–319. https://doi.org/10.1037/pas0001092

Ingalls, A., Rosenstock, S., Foy Cuddy, R., Neault, N., Yessilth, S., Goklish, N., Nelson, L., Reid, R., & Barlow, A. (2019). Family Spirit Nurture (FSN) – a randomized controlled trial to prevent early childhood obesity in American Indian populations: trial rationale and study protocol. BMC obesity, 6, 18. https://doi.org/10.1186/s40608-019-0233-9

O’Keefe, V. M. (2012). The relationship between hope, optimism, and suicidal ideation and behavior among American Indian/Alaska Native college students (Publication No. 1534724). [Doctoral dissertation, ProQuest Dissertations & Theses Global] https://www.proquest.com/dissertations-theses/relationship-between-hope-optimism-suicidal/docview/1319845114/se-2

O’Keefe, V. M., Haroz, E. E., Goklish, N., Barlow, A., & Cwik, M. (2019). Employing a sequential multiple assignment randomized trial (SMART) to evaluate the impact of brief risk and protective factor prevention interventions for American Indian youth suicide. BMC Public Health, 19, 1675. https://doi.org/10.1186/s12889-019-7996-2

Walls, M., Pearson, C., Kading, M., & Teyra, C. (2016). Psychological wellbeing in the face of adversity among American Indians: Preliminary evidence of a new population health paradox? Annals of Public Health Research, 3(1), 1034.

Walls, M. L., Whitbeck, L., & Armenta, B. (2016). A cautionary tale: Examining the interplay of culturally specific risk and resilience factors in Indigenous communities. Clinical Psychological Science, 4(4), 732-743. https://doi.org/10.1177/2167702616645795

Walls, M. L., & Whitbeck, L. B. (2011). Distress among Indigenous North Americans: Generalized and culturally relevant stressors. Society and Mental Health, 1(2), 124-136. https://doi.org10.1177/2156869311414919

Walls, M. L., & Whitbeck, L. B. (2012). The intergenerational effects of relocation policies on Indigenous families. Journal of Family Issues, 33(9), 1272-1293. https://doi.org/10.1177/0192513X12447178