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Youth Depression Screening with Parent and Self-Reports: Assessing Current and Prospective Depression Risk

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Abstract

Few studies have examined the incremental validity of multi-informant depression screening approaches. In response, we examined how recommendations for using a multi-informant approach may vary for identifying concurrent or prospective depressive episodes. Participants included 663 youth (AgeM = 11.83; AgeSD = 2.40) and their caregiver who independently completed youth depression questionnaires, and clinical diagnostic interviews, every 6 months for 3 years. Receiver operating characteristic (ROC) analyses showed that youth-report best predicted concurrent episodes, and that both youth and parent-report were necessary to adequately forecast prospective episodes. More specifically, youth-reported negative mood symptoms and parent-reported anhedonic symptoms incrementally predicted future depressive episodes. Findings were invariant to youth’s sex and age, and results from person and variable-centered analyses suggested that discrepancies between informants were not clinically meaningful. Implications for future research and evidence-based decision making for depression screening initiatives are discussed.

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Notes

  1. As the overwhelming number of caregivers were mothers, and past research suggests non-significant differences between informants who are caregivers [23], all caregivers were included and treated equally in the present study.

  2. Additional analyses showed that all findings presented in this manuscript were invariant to data method collection (e.g., in-person versus phone versus mail).

  3. Cutoffs for pediatric depression screens ideally have a sensitivity and specificity level of 90% [32]. However, preliminary analyses showed that using a 90% sensitivity cutoff for subthreshold scores was not clinically useful (i.e., over 80% of youth reported scores above the cutoff). Thus, 70% sensitivity was used to determine the subthreshold cutoff as this is the average level of sensitivity for cutoff scores on existing screening measures [36].

  4. All statistics reported are based on the findings at baseline. As covariates can lead to unstable class solutions [50], analyses were also conducted without age and sex in the model. The pattern of findings was identical. Please contact the first author for statistics for non-significant models or models replicated past baseline.

  5. Different cut-off scores for boys and girls and youth of different ages were also tested, but did not lead to a significant improvement in sensitivity/specificity, nor alter the pattern of findings.

  6. As this study specifically focused on first lifetime episodes as opposed to prospective episodes more broadly, base rates were dissimilar between the two studies. We therefore used the AUC and DLRs, which are unaffected by base rate, to compare the two studies.

  7. We note that in Youngstrom’s original model, red references “acute treatment.” As our findings are based on non-clinician administered inventories, we recalibrated the recommendations within the model.

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Funding

This research was supported by National Institute of Mental Health Grants 5R01MH077195 and 5R01MH077178 awarded to Benjamin Hankin and Jami Young by the National Institute of Mental Health. The authors have no other conflicts of interest to report.

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Authors and Affiliations

  1. Department of Psychology, University of Illinois Urbana-Champaign, 603 E. Daniel St., Champaign, IL, 61820, USA

    Joseph R. Cohen, Felix K. So, Benjamin L. Hankin & Brenda A. Lee

  2. Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Jami F. Young

  3. Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA

    Felix K. So

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  1. Joseph R. Cohen
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Correspondence to Joseph R. Cohen.

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Cohen, J.R., So, F.K., Young, J.F. et al. Youth Depression Screening with Parent and Self-Reports: Assessing Current and Prospective Depression Risk. Child Psychiatry Hum Dev 50, 647–660 (2019). https://doi.org/10.1007/s10578-019-00869-6

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