Center for Epidemiological Studies-Depression (CES-D) is a 20-item survey that asks caregivers to rate how frequently they had depressive symptoms in the previous week. Each item was scored using a four-point scale that ranged from 0 ("rarely or never") to 3 ("most or often"). All items are added up to produce a final score. A cutoff score of 16 or more denotes the presence of substantial depression symptoms.