Depression Clinically significant depressive symptoms (past week) were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D) [31, 32]. The 20 items were scored on a 4-point Likert scale from 0 to 3; items 4, 8, 12, 16 were reverse coded (3–0). A score of 16 or greater was indicative of depressive symptoms.