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Screening for children’s depression symptoms in Greece: the use of the Children’s Depression Inventory in a nation-wide school-based sample

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Abstract

The objective of this study is to determine the level of depressive symptoms among a sample of Greek children aged 8–12 years, as measured by the Greek Children’s Depression Inventory (CDI), as well as to examine CDI’s psychometric properties. A nationwide school-based sample of 650 children was initially recruited and depressive symptoms were assessed with the CDI among 538 children who provided all relevant information. Statistical evaluation included assessment of CDI internal reliability, test–retest reliability, determination of age, gender and socioeconomic status (SES) effects. Based on the distributions of CDI scores observed in this normative sample, a recommended cutoff score, identifying a high probability of serious levels of depressive symptoms that need to be further evaluated, was defined. Internal reliability and test–retest reliability were satisfactory and the expected associations with age and gender were observed. High SES was correlated with significantly less depression symptoms. The prevalence of depressive risk, when the cutoff point of 19 or 13 was taken as threshold, was much lower than those obtained from studies in other countries. The cutoff point of 15, corresponding to 90th percentile of the present sample, may be used as a screening threshold for further assessment. The present results are encouraging providing evidence about the psychometric properties of the CDI and implications for child mental health promotion planning in Greece. Further validation of the CDI against other measures and psychiatric diagnoses is needed.

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References

  1. Anderson JC, Williams S, McGee R, Silva PA (1987) DSM-III disorders in preadolescent children. Prevalence in a large sample from the general population. Arch Gen Psychiatry 44:69–76

    PubMed  CAS  Google Scholar 

  2. Angold A, Rutter M (1992) Effects of age and pubertal status on depression in a large clinical sample. Dev Psychopathol 4:5–28

    Article  Google Scholar 

  3. Association AP (1994) Diagnostic and statistical manual of mental disorders, 4th edn (DSM IV). American Psychiatric Association, Washington DC

    Google Scholar 

  4. Bibou-Nakou I, Kiosseoglou G, Stogiannidou A (2001) Strengths and difficulties of school-aged children in the family and school context. Psychology 8:506–525

    Google Scholar 

  5. Blazer DG, Kessler RC, McGonagle KA, Swartz MS (1994) The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry 151:979–986

    PubMed  CAS  Google Scholar 

  6. Bor W, Najman JM, Andersen MJ, O’Callaghan M, Williams GM, Behrens BC (1997) The relationship between low family income and psychological disturbance in young children: an Australian longitudinal study. Aust NZ J Psychiatry 31:664–675

    Article  CAS  Google Scholar 

  7. Boyce W, Torsheim T, Currie C, Zambon A (2006) The Family Affluence Scale as a measure of national wealth: validation of an adolescent self report measure. Soc Indic Res 78:473–487

    Article  Google Scholar 

  8. Brooks SJ, Kutcher S (2001) Diagnosis and measurement of adolescent depression: a review of commonly utilized instruments. J Child Adolesc Psychopharmacol 11:341–376

    Article  PubMed  CAS  Google Scholar 

  9. Charman T, Pervova I (2000) The internal structure of the Child Depression Inventory in Russian and UK schoolchildren. J Youth and Adolesc 30:41–51

    Article  Google Scholar 

  10. Comer JS, Kendall PC (2005) High-end specificity of the children’s depression inventory in a sample of anxiety-disordered youth. Depress Anxiety 22:11–19

    Article  PubMed  Google Scholar 

  11. Craighead WE, Smucker MR, Craighead LW, Ilardi SS (1998) Factor analysis of the Children’s Depression Inventory in a community sample. Psychol Assess 10:156–165

    Article  Google Scholar 

  12. Cronbach LJ (1984) Essentials of psychological testing. Harper & Row, New York

    Google Scholar 

  13. Currie CE, Elton RA, Todd J, Platt S (1997) Indicators of socioeconomic status for adolescents: the WHO health behaviour in school-aged children survey. Health Educ Res 12:385–397

    Article  PubMed  CAS  Google Scholar 

  14. Davanzo P, Kerwin L, Nikore V, Esparza C, Forness S, Murrelle L (2004) Spanish translation and reliability testing of the Child Depression Inventory. Child Psychiatry Hum Dev 35:75–92

    Article  PubMed  Google Scholar 

  15. Doerfler LA, Feiner RD, Rowlison RT et al (1988) Depression in children and adolescents: a comparative analysis of the utility and construct validity of two assessment measures. J Consult Clin Psychology 56:769–772

    Article  CAS  Google Scholar 

  16. Flouri E, Tzavidis N (2008) Psychopathology and prosocial behavior in adolescents from socio-economically disadvantaged families: the role of proximal and distal adverse life events. Eur Child Adolesc Psychiatry 17:498–506

    Article  PubMed  Google Scholar 

  17. Frigerio A, Pesenti S, Molteni M, Snider J, Battaglia M (2001) Depressive symptoms as measured by the CDI in a population of northern Italian children. Eur Psychiatry 16:33–37

    Article  PubMed  CAS  Google Scholar 

  18. Gandek B, Ware JE (1998) Methods for validating and norming translations of health status questionnaires: the IQOLA project approach for the IQOLA project group health assessment. J Clin Epidemiol 51:953–959

    Article  PubMed  CAS  Google Scholar 

  19. Garvin V, Leber D, Kalter N (1991) Children of divorce: predictors of change following preventive intervention. Am J Orthopsychiatry 61:438–447

    Article  PubMed  CAS  Google Scholar 

  20. Guttman L (1945) A basis for analysing test–retest reliability. Psychometrica 10:255–282

    Article  Google Scholar 

  21. Hecht DB, Inderbitzen HM, Bukowski AL (1998) The relationship between peer status and depressive symptoms in children and adolescents. J Abnorm Child Psychol 26:153–160

    Article  PubMed  CAS  Google Scholar 

  22. Ivarsson T, Svalander P, Litlere O (2006) The Children’s Depression Inventory (CDI) as measure of depression in Swedish adolescents. A normative study. Nord J Psychiatry 60:220–226

    Article  PubMed  Google Scholar 

  23. Kapi A, Veltsista A, Kavadias G, Lekea V, Bakoula C (2007) Social determinants of self-reported emotional and behavioral problems in Greek adolescents. Soc Psychiatry Psychiatr Epidemiol 42:594–598

    Article  PubMed  Google Scholar 

  24. Kazdin AE (1987) Children’s Depression Scale: validation with child psychiatric inpatients. J Child Psychol Psychiatry 28:29–41

    Article  PubMed  CAS  Google Scholar 

  25. Kazdin AE (1989) Identifying depression in children: a comparison of alternative selection criteria. J Abnorm Child Psychol 17:437–454

    Article  PubMed  CAS  Google Scholar 

  26. Kazdin AE, Colbus D, Ridgers A (1986) Assessment of depression and diagnosis of depressive disorder among psychiatrically disturbed children. J Abnorm Child Psychology 14:499–515

    Article  CAS  Google Scholar 

  27. Kazdin AE, Esveldt-Dawson K, Unis AS, Rancurello MD (1983) Child and parent evaluations of depression and aggression in psychiatric inpatient children. J Abnorm Child Psychol 11:401–413

    Article  PubMed  CAS  Google Scholar 

  28. Kleftaras G, Didaskalou E (2006) Incidence and teachers’ perceived causation of depression in primary school in Greece. Sch Psychol Int 27:296–314

    Article  Google Scholar 

  29. Kolaitis G, Korpa T, Kolvin I, Tsiantis J (2003) Schedule for affective disorders and schizophrenia for school-age children-present episode (K-SADS-P): a pilot inter-rater reliability study for Greek children and adolescents. Eur Psychiatry 18:374–375

    Article  PubMed  CAS  Google Scholar 

  30. Kovacs M (1992) Manual for the Children’s Depression Inventory (CDI). Psychopharmacol Bull 21:995–998

    Google Scholar 

  31. Kovacs M (1981) Rating scales to assess depression in school-aged children. Acta Paedopsychiatr 46:305–315

    PubMed  CAS  Google Scholar 

  32. Kovacs M, Feinberg TL, Crouse-Novak MA, Paulauskas SL, Finkelstein R (1984) Depressive disorders in childhood. I. A longitudinal prospective study of characteristics and recovery. Arch Gen Psychiatry 41:229–237

    PubMed  CAS  Google Scholar 

  33. Larson B, Melin L (1992) Prevalence and short-term stability of depressive symptoms in schoolchildren. Acta Psychiatr Scand 85:17–22

    Article  Google Scholar 

  34. Levitt JM, Saka N, Romanelli LH, Hoagwood K (2007) Early identification of mental health problems in schools: the status of instrumentation. J Sch Psychol 45:163–191

    Article  Google Scholar 

  35. Lobovits DA, Handal PJ (1985) Childhood depression: prevalence using DSM-III criteria and validity of parent and child depression scales. J Pediatr Psychol 10:45–54

    Article  PubMed  CAS  Google Scholar 

  36. Madianos M (1998) Health and Hellenic Society: empirical research. National Centre for Social Research, Athens

    Google Scholar 

  37. McDonald VM, Tsiantis J, Achenbach TM, Motti-Stefanidi F, Richardson SC (1995) Competences and problems reported by parents of Greek and American children. Euro Child Adol Psych 4:1–13

    Article  Google Scholar 

  38. McHorney CA, Ware JE, Lu JF, Sherbourne CD (1994) The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care 32:40–66

    Article  PubMed  CAS  Google Scholar 

  39. McMunn AM, Nazroo JY, Marmot MG, Boreham R, Goodman R (2001) Children’s emotional and behavioural well-being and the family environment: findings from the Health Survey for England. Soc Sci Med 53:423–440

    Article  PubMed  CAS  Google Scholar 

  40. Mossialos E, Allin S, Davaki K (2005) Analysing the Greek health system: a tale of fragmentation and inertia. Health Econ 14:S151–S168

    Article  PubMed  Google Scholar 

  41. Myers K, Winters NC (2002) Ten-year review of rating scales. II: scales for internalizing disorders. J Am Acad Child Adolesc Psychiatry 41:634–659

    Article  PubMed  Google Scholar 

  42. Nunnally JC, Bernstein IH (1994) Psychometric theory. McGrow-Hill Book, New York

    Google Scholar 

  43. Poli P, Sbrana B, Marcheschi M, Masi G (2003) Self-reported depressive symptoms in a school sample of Italian children and adolescents. Child Psychiatry Hum Dev 33:209–226

    Article  PubMed  Google Scholar 

  44. Reynolds WM (1994) Assessment of depression in children and adolescents by self-report questionnaires. In: Reynolds WM, Johnston HF (eds) Handbook of depression in children and adolescents. Plenum Press, New York/London, pp 209–234

    Google Scholar 

  45. Roberts RE, Roberts CR, Chen YR (1997) Ethnocultural differences in prevalence of adolescent depression. Am J Community Psychol 25:95–110

    Article  PubMed  CAS  Google Scholar 

  46. Roussos A, Karantanos G, Richardson C, Hartman C, Karajiannis D, Kyprianos S, Lazaratou H, Mahaira O, Tassi M, Zoubou V (1999) Achenbach’s child behavior checklist and teachers’ report form in a normative sample of Greek children 6–12 years old. Eur Child Adolesc Psychiatry 8:165–172

    Article  PubMed  CAS  Google Scholar 

  47. Samm A, Värnik A, Tooding L-M, Sisask M, Kölves K, von Knorring A-L (2007) Children’s Depression Inventory in Estonia. Single items and factor structure by age and gender. Eur Child Adolesc Psychiatry 17:162–170

    Article  Google Scholar 

  48. Saylor CF, Finch AJ Jr, Spirito A, Bennett B (1984) The children’s depression inventory: a systematic evaluation of psychometric properties. J Consult Clin Psychol 52:955–967

    Article  PubMed  CAS  Google Scholar 

  49. Smucker MR, Craighead WE, Craighead LW, Green BJ (1986) Normative and reliability data for the Children’s Depression Inventory. J Abnorm Child Psychol 14:25–39

    Article  PubMed  CAS  Google Scholar 

  50. Sorensen MJ, Frydenberg M, Thastum M, Thomsen PH (2005) The Children’s Depression Inventory and classification of major depressive disorder: validity and reliability of the Danish version. Eur Child Adolesc Psychiatry 14:328–334

    Article  PubMed  Google Scholar 

  51. Thomson C, Currie C, Todd J, Elton R (1999) Changes in HIV/AIDS education, knowledge and attitudes among Scottish 15–16 year olds, 1990–1994: findings from the WHO: health behaviour in school-aged children study (HBSC). Health Educ Res 14:357–370

    Article  PubMed  CAS  Google Scholar 

  52. 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 33:149–157

    Article  PubMed  Google Scholar 

  53. Trowell J, Joffe I, Campbell J, Clemente C, Almqvist F, Soininen M, Koskenranta-Aalto U, Weintraub S, Kolaitis G, Tomaras V, Anastasopoulos D, Grayson K, Barnes J, Tsiantis J (2007) Childhood depression: a place for psychotherapy. An outcome study comparing individual psychodynamic psychotherapy and family therapy. Eur Child Adolesc Psychiatry 16:157–167

    Article  PubMed  Google Scholar 

  54. Trust SACotMO (2002) Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res 11:193–205

    Article  Google Scholar 

  55. Twenge JM, Nolen-Hoeksema S (2002) Age, gender, race, socioeconomic status, and birth cohort differences on the children’s depression inventory: a meta-analysis. J Abnorm Psychol 111:578–588

    Article  PubMed  Google Scholar 

  56. Weiss B, Weisz JR, Politano M, Carey M, Nelson WM, Finch AJ (1991) Developmental differences in the factor structure of the Children’s Depression Inventory. J Consult Clin Psychol 3:38–45

    Google Scholar 

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Acknowledgments

The project is co-funded by the European Social Fund & National Resources, EPEAEK II, PYTHAGORAS.

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Authors and Affiliations

  1. Centre for Health Services Research, Medical School, University of Athens, 25 Alexandroupoleos str, 115 27, Athens, Greece

    George Giannakopoulos, Maria Kazantzi, Christine Dimitrakaki & Yannis Tountas

  2. Association for the Psychosocial Health of Children and Adolescents (A.P.H.C.A.), 19, Aghiou Ioannou Theologou St, 155 61, Athens, Greece

    John Tsiantis

  3. Department of Child Psychiatry, Athens University Medical School, “Aghia Sophia” Children’s Hospital, Thivon & Levadias, 115 27, Athens, Greece

    Gerasimos Kolaitis

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  1. George Giannakopoulos
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  2. Maria Kazantzi
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Correspondence to Yannis Tountas.

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Giannakopoulos, G., Kazantzi, M., Dimitrakaki, C. et al. Screening for children’s depression symptoms in Greece: the use of the Children’s Depression Inventory in a nation-wide school-based sample. Eur Child Adolesc Psychiatry 18, 485–492 (2009). https://doi.org/10.1007/s00787-009-0005-z

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