European Child & Adolescent Psychiatry

, Volume 17, Issue 1, pp 32–38 | Cite as

Screening of depression in adolescents through the Internet

Sensitivity and specificity of two screening questionnaires
  • Pim CuijpersEmail author
  • Petra Boluijt
  • Annemieke van Straten


The Internet may offer new opportunities for treating depressed adolescents. However, before such treatments are possible, well-validated screening instruments are needed. In the current study, we validate two Internet-based screening instruments for depression among adolescents, the major depression inventory (MDI), and the Center for Epidemiological Studies-Depression scale (CES-D). A total of 1,392 adolescents, recruited through high schools and the Internet, filled in the online questionnaires. Of these, 243 (17%) were interviewed with the MINI diagnostic interview to assess the presence of a mood disorder. Cronbach’s alpha was high for both the CES-D (0.93) and the MDI (0.88), and both correlated highly with each other (0.88; P < .001). The scores on both instruments were significantly increased in all subjects with a mood disorder, whether current or lifetime, except for lifetime minor depression. In the ROC analyses, high areas under the curve were found for the MDI (0.89) and CES-D (0.90). The best cut-off point for the MDI was 19 (sensitivity: 90.48; specificity: 71.53), and for the CES-D it was 22 (sensitivity: 90.48; specificity: 74.31). We conclude that the MDI and CES-D are reliable and valid instruments that can be used for this screening.


depression adolescents screening sensitivity specificity 


  1. 1.
    American Academy of Child, Adolescent Psychiatry (1998) Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry 37(10 suppl):63S–83SGoogle Scholar
  2. 2.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. Washington, DC: AuthorGoogle Scholar
  3. 3.
    Bech P, Rasmussen NA, Raabaek Olsen L, Noerholm V, Abildgaard W (2001) The sensitivity and specificity of the major depression inventory, using the present state examination as the index of diagnostic validity. J Affect Disord 66:159–164PubMedCrossRefGoogle Scholar
  4. 4.
    Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE, Perel J, Nelson B (1996) Childhood and adolescent depression, I: a review of the past 10 years. J Am Acad Child Adolsc Psychiatry 35:1427–1439CrossRefGoogle Scholar
  5. 5.
    Bouma J, Ranchor AV, Sanderman R, Sonderen E (1995) Het meten van symptomen van depressie met de CES-D; een handleiding. Noordelijk Centrum voor Gezondheidsvraagstukken, Rijksuniversiteit GroningenGoogle Scholar
  6. 6.
    Chabrol H, Montovany A, Chouicha K, Duconge E (2002) Study of the CES-D on a sample of 1,953 adolescent students. Encephale 28:429–432PubMedGoogle Scholar
  7. 7.
    Clarke GN, Hornbrook M, Lynch F, Polen M, Gale J, Beardslee W, O’Connor E, Seeley J (2001) A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Arch Gen Psychiatry 58:1127–1134PubMedCrossRefGoogle Scholar
  8. 8.
    Cuijpers P, Dekker J (2005) Psychologische behandeling van depressie: een systematisch overzicht van meta-analyses. Ned Tijdschr Geneesk 149:1892–1897Google Scholar
  9. 9.
    Faulstich ME, Carey MP, Ruggiero L, Enyart P, Gresham F (1986) Assessment of depression in childhood and adolescence: an evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Am J Psychiatry 143:1024–1027PubMedGoogle Scholar
  10. 10.
    Forsell Y (2005) The major depression inventory versus schedules for clinical assessment in neuropsychiatry in a population sample. Soc Psychiatry Psychiatr Epidemiol 40:209–213PubMedCrossRefGoogle Scholar
  11. 11.
    Gould MS, Munfakh JL, Lubell K, Kleinman M, Parker S (2002) Seeking help from the internet during adolescence. J Am Acad Child Adolesc Psychiatry 41:1182–1189PubMedCrossRefGoogle Scholar
  12. 12.
    Grillo E, da Silva RJ (2004) Early manifestations of behavioral disorders in children and adolescents. J Pediatr 80:S21–S27Google Scholar
  13. 13.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  14. 14.
    LeBlanc JC, Almudevar A, Brooks SJ, Kutcher S (2002) Screening for adolescent depression: comparison of the Kutcher Adolescent Depression Scale with the Beck Depression Inventory. J Child Adolesc Psychopharmacol 12:113–126PubMedCrossRefGoogle Scholar
  15. 15.
    Lewinsohn PM, Clarke GN (1999) Psychosocial treatments for adolescent depression. Clin Psychol Rev 19:329–342PubMedCrossRefGoogle Scholar
  16. 16.
    Pine DS, Cohen P, Gurley D, Brook J, Ma Y (1998) The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 55:56–64PubMedCrossRefGoogle Scholar
  17. 17.
    Plant EA, Sachs-Ericsson N (2004) Racial and ethnic differences in depression: the roles of social support and meeting basic needs. J Consult Clin Psychol 72:41–52PubMedCrossRefGoogle Scholar
  18. 18.
    Reynolds WM, Mazza JJ (1998) Reliability and validity of the Reynolds Adolescent Depression Scale with young adolescents. J School Psych 36:295–312CrossRefGoogle Scholar
  19. 19.
    Rushton JL, Forcier M, Schectman RM (2002) Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health. J Am Acad Child Adolesc Psychiatry 41:199–205PubMedCrossRefGoogle Scholar
  20. 20.
    Ryan ND (2005) Treatment of depression in children and adolescents. Lancet 366:933–940PubMedCrossRefGoogle Scholar
  21. 21.
    Sen B (2004) Adolescent propensity for depressed mood and help seeking: race and gender differences. J Ment Health Policy Econ 7:133–145PubMedGoogle Scholar
  22. 22.
    Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33PubMedGoogle Scholar
  23. 23.
    Spek V, Cuijpers P, Nyklíček I, Riper H, Keyzer J, Pop V (2006) Internet-based cognitive behavior therapy for mood and anxiety disorders: a meta-analysis. Psychol Med 37(3):319–328PubMedCrossRefGoogle Scholar
  24. 24.
    Timbremont B, Braet C, Dreessen L (2004) Assessing depression in youth: relation between the Children’s Depression Inventory and a structured interview. J Clin Child Adolesc Psychol 33:149–157PubMedCrossRefGoogle Scholar
  25. 25.
    Weisz JR, Hawley KM, Doss AJ (2004) Empirically tested psychotherapies for youth internalizing and externalizing problems and disorders. Child Adolesc Psychiatr Clin N Am 13:729–815PubMedCrossRefGoogle Scholar
  26. 26.
    Weisz JR, McCarty CA, Valeri SM (2006) Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychol Bull 132:132–149PubMedCrossRefGoogle Scholar
  27. 27.
    Zwaanswijk M, Ende J van der, Verhaak PF, Bensing JM, Verhulst FC (2003) Factors associated with adolescent mental health service need and utilization. J Am Acad Child Adolesc Psychiatry 42:692–700PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag 2008

Authors and Affiliations

  • Pim Cuijpers
    • 1
    Email author
  • Petra Boluijt
    • 1
  • Annemieke van Straten
    • 1
  1. 1.Dept. of Clinical PsychologyVrije UniversiteitAmsterdamThe Netherlands

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