Evidence based assessment/Depression in youth (assessment portfolio)

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Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians. Please refer to the full text of the Wikiversity medical disclaimer.

What is a "portfolio"?[edit]

For background information on what assessment portfolios are, click the link in the heading above.

Preparation phase[edit]

Diagnostic criteria for depression in youth[edit]

ICD-10 Diagnostic Criteria

For depression, ICD-10 uses an agreed list of ten depressive symptoms:[1]

  • Key symptoms
  • persistent sadness or low mood;and/or
  • loss of interests or pleasure
  • fatigue or low energy

At least one of these, most days, most of the time, for at least 2 weeks

  • If any of the above are present, ask about associated symptoms:
    • disturbed sleep
    • poor concentration or indecisiveness
    • low self-confidence
    • poor or increased appetite
    • suicidal thoughts or acts
    • agitation or slowing of movements
    • guilt or self-blame
  • The 10 symptoms then define the degree of depression, and management is based on the particular degree:
    • not depressed (fewer than four symptoms)
    • mild depression (four symptoms)
    • moderate depression (five to six symptoms)
    • severe depression (seven or more symptoms, with or without psychotic symptoms)
    • symptoms should be present for a month or more and every symptom should be present for most of every day

Changes in DSM-5[edit]

  • The diagnostic criteria for depressive disorders changed slightly from DSM-IV to DSM-5. Summaries are available here and here.

Base rates of adolescent depression in different clinical settings[edit]

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled, and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rates of adolescent depression that they are likely to see in their clinical practices.

  • To find prevalence rates across multiple disorders, click here.
Demography Setting Base Rate Diagnostic Method Best Recommended For
French general practitioner network Children and adolescents attending primary care[2] (2002) 5.0% CES-D, CBCL, Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (KSADS-PL) y
All of U.S.A. National Comorbidity Survey-Adolescent (ages 13-18))[3] (2010) 6.9%-15.4% National Comorbidity Survey-Adolescent (NCS-A) Interview Schedule p, y
North Carolina Great Smoky Mountains Study: Community Sample (ages 9-13) (1997)[4] .03-1.45% CAPA = Child and Adolescent Psychiatric Assessment[5]
All of U.S.A. Acute psychiatric hospitalizations in 2009-2010 children (under the age of 15) (Blader & Carlson, 2010) 13% Centers for Disease Control survey of discharge diagnoses
Northwestern U.S.A. high school High school students (1993)[6] 9.6% KSADS
All of U.S.A. Gender differences, males and females, respectively (2010)[3] 7.5%-15% NCS-A Interview Schedule p, y
Varied Meta-analysis, adolescents 13 to 18 years (2006)[7] 5.7% DISC, CIDI, SDI, K-SADS, CAS, CAPA, IOW, DAWBA
All of U.S.A. National Comorbidity Survey-Adolescent Supplement (NCS-A) (2015)[8] 11.0% CIDI
American middle school Ethnically diverse sample of middle school (Grades 6-8) students (1997)[9] 1.9% (Chinese descent) to 6.6% (Mexican descent) DISC
American public school High school freshman in public school (2009)[10] 18.4% GHQ-12 and BDI
Cross-sectional sample of socioeconomic groups Adolescents 12-17 (2016)[11] increased from 8.7% in 2005 to 11.3% in 2014 NCS-Replication
Epidemiological (CDC) 2.1%[12]

p:Parent interviewed as component of diagnostic assessment; y:youth interviewed as part of diagnostic assessment.

Prediction phase[edit]

Psychometric properties of screening instruments for adolescent depression[edit]

The following section contains a list of screening and diagnostic instruments for adolescent depression. The section includes administration information, psychometric data, and PDFs or links to the screenings.

  • Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
  • For a list of more broadly-reaching screening instruments, click here.
Screening instruments for adolescent depression
Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Mood and Feelings Questionnaire (MFQ) Self-report 6-17 5-10 minutes[13] NA A G A X
Reynolds Child Depression Scale (RCDS)

*not free

Self-report 7-13 years 2-15 minutes NA A A G Link to purchase RCDS
Reynolds Adolescent Depression Scale (RADS)

*not free

Self-report 11-20 years 5-10 minutes NA G G G X Link to purchase RADS
Children’s Depression Inventory (CDI and CDI2) *not free*[14] Self-report 7-17 years old 15-20 minutes or less NA A[15] G A[15] X Wikipedia page

Link to purchase

Website

Revised Children’s Anxiety and Depression Scale (RCADS) [16] Questionnaire (Child) 6-18 12 minutes G[17] G[18] G[17] A

PDFs for RCADS

Subscales

Translations

User Guide

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Likelihood ratios and AUCs of screening measures for adolescent depression[edit]

Screening Measure (Primary Reference) AUC LR+ (score) LR- (score) Citation Clinical Generalizability Download
Child Behavior Checklist (CBCL) Anxious/Depressed Scale T-score[19] .70 (N=470) 3.78 (60+) .39 (<60) (Nolan et al., 1996)[20] High. Large diverse sample with mixed depression sample compared to samples without depression.
CBCL Anxious/Depressed Scale T-score[19] .75 (N=1445) 1.49 (raw score 9+) .67 (raw score ≤) (Eimecke et al., 2011)[21]
CBCL Affective Problems Scale T-score[19] .78 (N=1445) 1.49 (raw score 9+) .67 (raw score ≤) (Eimecke et al., 2011)[21]
Youth Self Report (YSR)[19] .81 (N=207) -- -- (Rey, et al., 1992)[22] Link to purchase:

YSR

Teacher’s Report Form (TRF) Link to purchase:

TRF

WHO-Five Well-being Index (WHO-5) 3[23] .885 (N=294) 4.40 (raw score 11+) .15 (raw score ≤) (Christensen et al., 2015)[24] General sample of adolescents from Norway and Denmark Link to free download:

WHO-5

Hopkins Symptom Checklist-6 (HSCL-6) (short version of Symptom Checklist-90 (SCL-90))[25] .8547(N=294) 3.8 (raw score 9+) .19 (raw score ≤) (Christensen et al., 2015)[24] General sample of adolescents from Norway and Denmark
Hopkins Symptom Checklist-10 (HSCL-10) (short version of SCL-90)[26] .8862 (N=294) Boys: 7.2, Girls:3.2 (raw score 16/10) Boys:.14, Girls:.17 (raw score ≤) (Haavet et al., 2011)[27] General sample of adolescents from Norway and Denmark
Children’s Depression Inventory (CDI)[28] .877 (N=406) 4.82 (raw score 12) .2 (raw score ≤) (Allgaier et al., 2012)[29] Medically ill children (pediatric hospital patients) Link to purchase:

CDI

Children’s Depression Inventory Short Version (CDI:S)[28] .882 (N=406) 3.18 (raw score 3) .09 (raw score ≤) (Allgaier et al., 2012)[29] Medically ill children (pediatric hospital patients) Link to purchase:CDI:S
6-item Kutcher Adolescent Depression Scale (KADS)[30] .89 (N=309) 3.17 (raw score 6) .11 (raw score ≤) (LeBlanc et al., 2002)[30] Link to free download:

KADS

Mood Disorder Questionnaire (MDQ) 0.78 5.4[31] 0.22[31] Link to free download: MDQ

Interpreting depression screening measure scores[edit]

For information on interpreting screening measure scores, click here.

Prescription phase[edit]

Gold standard diagnostic interviews[edit]

  • For a list of broad-reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Diagnostic instruments specific for adolescent depression[edit]

Diagnostic instruments for adolescent depression
Measure Informant Parent Version (Age) Youth Version (Age) Format of Item Administration Format of Response Style Cost and Access Administration Time (for full interview in minutes) Rater Qualifications and Training
Child and Adolescent Psychiatric Assessment (CAPA)[32] Parent and Child 9-18 9-18 Structured with the option for additional semi-structured inquires Close-Ended (Y/N)

Mix of Close-Ended (Likert) and Open-Ended

Information available through the Developmental Epidemiology Center at Duke University 60-120 Bachelor’s degree plus required training by individuals trained on this interview (Angold & Costello, 2000)
Children’s Interview for Psychiatric Syndromes (ChIPS)[33] Parent or Child 6-18 6-18 Structured with the option for additional semi-structured inquires Close-Ended (Y/N) Approximately $90; Available through various retailers 20-50 Trained lay person supervised by a licensed clinician. Administration manual includes training materials. (Weller, Weller, Fristad, Rooney, & Schecter, 2000)
Diagnostic Individual Schedule for Children IV (DISC-IV)[34] Parent or Child 6-17 9-17 Structured Close-Ended (Y/N) Ranges from $150-$2000 per computer installation; Charge for paper version is minimal to cover copying and mailing expenses; email disc@worldnet.att.net 90-120 Lay person with supervision by a licensed clinician. Training is strongly recommended. Details on training available by contacting [[1]]

(“NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some... - PubMed - NCBI,” n.d.)

K-SADS-PL 2009 Parent and Child 6-18 6-18 Semi-Structured Close-Ended (Likert) and Open-Ended Free for download and use if specific criteria met 90 Trained professional; Training is required
Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KIDS) Parent or Child 6-17 13-17 Structured Close-Ended (Y/N) Free for download and use if specific criteria met 15-50 minutes Trained lay person supervised by a licensed clinician. Training by licensed clinician is recommended.

http://harmresearch.org/index.php/mini-international-neuropsychiatric-interview-mini/

(Sheehan et al., 1998)

Patient Health Questionnaire 9 (PHQ-9) Self 18+ Self Report Close-Ended (Likert) Free for download and use if specific criteria met 3-5 minutes No training required. Available for free online here

Severity scales for adolescent depression[edit]

Diagnostic instruments for adolescent depression
Measure Informant Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Children's Depression Rating Scale - Revised (CDRS-R) Parent Structured Interview[35] 6-12 15-20 minutes G A G G X, GATW2
Children's Depression Inventory 2 (CDI-2) Youth and Parent Questionnaire 7-17 15-20 minutes G A G A GATW2
  • Link to purchase CDI
Reynolds Child Depression Scale 2 (RCDS-2) Youth Questionnaire 7-13 5-10 minutes G[36] G G A
Reynolds Adolescent Depression Scale 2 (RADS-2) Youth Questionnaire 13-17 5-10 minutes G G G A GATW2
Revised Children's Anxiety and Depression Scale (RCADS) Youth Questionnaire 6-18 12 minutes A A G A X

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Process phase[edit]

The following section contains a brief overview of treatment options for depression and a list of process and outcome measures for adolescent depression. The section includes benchmarks based on published norms and on mood samples for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information on differences between process and outcome measures, see the page on the process phase of assessment.

Process measures[edit]

A. Mood and Energy Thermometer  This is an improved and practical way of monitoring complex mood cycles and daily schedules. Given that some clinicians and patients may get confused about different 1 to 10 scales (e.g., a 10 could mean extreme depression or extreme mania or no depression), the Mood & Energy Thermometer improves the language in communicating (and monitoring) mood. Moreover, many children report their energy levels more accurately than their moods and therefore, energy levels are incorporated into the mood rating. The Mood & Energy Thermometer that was developed at Western Psychiatric Institute and Clinic (WPIC; and used in about 400 kids) rates mania and increased energy on a 1 to 10 scale, rates depression and tiredness on a -1 to -10 scale, and attempts to form a common language between patients, families, and clinicians. This scale also takes into account the amount of time spent depressed or manic; for example, -4 would mean “mild depression” and “mild tiredness” present ≥50% of the time, and -3 would mean “mild depression” and “mild tiredness” present < 50% of the time. The inclusion of measuring energy levels is consistent with the DSM-5, as energy level is now included in the DSM-5 as a main mood symptom criterion. Bipolar track patients (whether they experienced mania, depression, or mixed features) rated their (Q: is the parent rating his/her own moods/energy, or his/her child's?) mood and energy levels every day on this scale, and a master’s-level clinician met with them on a daily basis to help them better identify and record their mood symptoms, which has significant clinical value not only for treatment but also to prevent future episodes.[37]

B. Life Charts

Outcome and severity measures[edit]

  • This table includes clinically significant benchmarks for Depression in Youth specific outcome measures
  • Information on how to interpret this table can be found here.
  • Additionally, these vignettes might be helpful resources for understanding appropriate adaptations of outcome measures in practice.
  • For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
Clinically significant change benchmarks with common instruments for adolescent depression
Measure Subscale Cut-off scores Critical Change
(unstandardized scores)
Benchmarks Based on Published Norms
A B C 95% 90% SEdifference
Beck Depression Inventory-II 4 22 15 9 8 4.8
CBCL T-scores
(2001 Norms)
Total 49 70 58 5 4 2.4
Benchmarks Based on Mood Samples
Gracious et al., 2002[38]
Young Mania Rating Scale - Parent
(Full)
n/a 5.2 22.1 14.4 4.3 3.6 2
Young Mania Rating Scale - Parent
(Brief)
n/a 6.8 27.4 17.5 5 4.2 2.5

4.1.b – Beck Depression Inventory- II, ages 13 and up[39]

4.1.c – KSADS Depression Rating Scale (Axelson, 2006)

4.1.d – Children’s Depression Rating Scale-Revised (CDRS-R; Elva et al., 1996)

4.1.e – Children’s Depression Inventory, ages 7-17 (CDI; Kovacs, 1992)

Treatment[edit]

For treatment of depression in youth, there are two main types of treatment: psychosocial interventions and medication. There has been significant controversy over the use of psychotropic medications with children and many studies have looked at the efficacy of medication, psychosocial interventions, or a combination of both.

One of the most effective treatments for depression in youth is psychosocial interventions, which has been shown to lead to substantial reduction in symptoms for children and adolescents. A recent meta-analysis found that psychosocial interventions had an effect size of 1.14 and the reduction in depressive symptoms was maintained over time. On the other hand, the meta-analysis reported that pharmacological treatments did not lead to significant symptom reduction and had an effect size of 0.19.[40] Additionally, medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) have presented concerns about increasing suicidality and harmful behavior.[41] One of the most commonly used psychosocial interventions is cognitive behavioral therapy, which consists of individual or group sessions in which the provider helps the client address cognitive distortions and maladaptive thinking patterns that contribute to the maintenance of depressive thoughts.[42]

  • Please refer to the page on adolescent depression for more information on available treatment for adolescent depression or go to Effective Child Therapy for a curated resource on effective treatments for adolescent depression.

External Resources[edit]

  1. ICD-10 diagnostic criteria
  2. Find-a-Therapist (a curated list of find-a-therapist websites where you can find a provider)
  3. NIMH (information about adolescent depression)
  4. John's Hopkins Resource Guide (a guide about adolescent depression, treatment, and more)
  5. OMIM (Online Mendelian Inheritance in Man)
    1. 608516
    2. 608520
    3. 608691
  6. eMedicine entry for adult depression
  7. Effective Child Therapy
    1. Effective Child Therapy is a website sponsored by Division 53 of the American Psychological Association (APA), or The Society of Clinical Child and Adolescent Psychology (SCCAP), in collaboration with the Association for Behavioral and Cognitive Therapies (ABCT). Use for information on symptoms and available treatments.

References[edit]

Click here for references
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