Can the Center for Epidemiologic Studies Depression Scale Be Used to Screen for Depression in Children and Adolescents? An Updated Systematic Review

The impact of primary mental healthcare on core symptoms of depression among underrepresented adolescents: a network analysis perspective

BACKGROUND

Depression has emerged as a leading contribution of the global mental health burden, particularly among underrepresented adolescents. Despite the World Health Organization's promotion of primary mental healthcare as a critical solution, its real-world effectiveness in low- and middle-income countries remains debated due to high costs and insufficient follow-up. This study aimed to explore the impact of primary mental healthcare on the core symptoms of adolescent depression using network analysis, while examining the influence of demographic factors such as gender, age, and family support, to identify more precise and targeted healthcare strategies, improving its effectiveness.

METHODS

A citywide, multi-center, longitudinal cohort study was conducted in Nanchong, Sichuan Province, China, involving 73,750 adolescents (34,606 girls and 39,144 boys) with median age of 14.00 years old. The Comprehensive Primary Healthcare for Adolescents Program (CPHG) involved two rounds of psychological screening and early intervention. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Network analysis was employed to map the interrelations between depressive symptoms and evaluate the healthcare's impact.

RESULTS

The CPHG program significantly reduced CES-D median scores from 6.00 to 2.00 (p < 0.001). Network analysis revealed changes in the structure and centrality of depressive symptoms post-intervention, with specific symptoms such as sadness (C18) showing consistent reductions across subgroups. Gender disparities were evident, with female adolescents exhibiting stronger symptom interconnectivity. Junior high school students also demonstrated a more robust symptom network compared to senior high school students. Adolescents living in social welfare institutions exhibited higher global expected influence of depressive symptoms than those living with both parents.

CONCLUSIONS

Primary mental healthcare effectively modifies the network structure of depressive symptoms in adolescents, with specific symptoms like sadness being critical targets. Gender and grade-level differences highlight the need for tailored mental healthcare strategies. The findings underscore the importance of addressing both core and peripheral symptoms to enhance treatment efficacy and reduce the severity and recurrence of depression among underrepresented adolescents.

Cross-sectional and longitudinal influences of stress mindset on adolescent depressive symptoms and cannabis use

BACKGROUND AND OBJECTIVE

A stress-is-enhancing mindset refers to viewing the nature of stress as enhancing rather than debilitating and has been linked to better mental health in response to stressors. We examined the cross-sectional and longitudinal link between stress mindset and two mental health outcomes, depressive symptoms and cannabis use, over the COVID-19 pandemic in a diverse sample of adolescents.

DESIGN AND METHODS

A community sample of adolescents completed measures assessing depressive symptoms, cannabis use, and intentions to use cannabis at three time points (T1: 2018-2020, N = 299, T2: 2020, N = 219, T3: 2021, N = 173). Participants completed the stress mindset measure at T2.

RESULTS

Cross-sectionally, a more stress-is-enhancing mindset was associated with fewer depressive symptoms and reduced intentions to use cannabis, which in turn were associated with less cannabis use. Longitudinally, a more stress-is-enhancing mindset was associated with fewer depressive symptoms and indirectly associated with less future cannabis use through behavioral intentions to use cannabis.

CONCLUSION

This study establishes a stress-is-enhancing mindset as a protective factor against cannabis use and contributes to a growing literature that stress mindset is protective against depression, indicating that stress mindset may be an important protective factor even in the face of naturalistic, chronic stressors.

Changes in depressive symptoms and antibody production following influenza vaccination in adolescents and adults

OBJECTIVE

Psychological distress has been associated with dampened antibody production following vaccination. Questions remain, however, about whether psychological distress influences vaccine response uniformly across the lifespan, and whether changes in distress result in changes in antibody production across the same period.

METHODS

Participants (N = 148; Mage = 32.2 years, SD = 19.7, range = 12-80 years) took part in consecutive vaccine studies during the 2017-2018 and 2018-2019 influenza seasons. Each influenza season, they reported on their depressive symptoms, provided blood samples, and received the standard influenza vaccine. Participants then provided a second blood sample one month later. Antibody titers were examined pre- and post-vaccination.

RESULTS

Analyses examined both within-season and across-season effects of depressive symptoms, age, and their interaction on vaccine response. Within-season analyses revealed that age predicted antibody response during both seasons (2017-2018 and 2018-2019). Neither depressive symptoms nor the interaction with age were associated with antibody response to vaccination within either season. Across the two seasons, age significantly moderated the association between change in depressive symptoms and change in antibody production. For people who were 48 or older, increases in depressive symptoms across the two seasons were associated with a less robust response to the vaccine in the second season relative to the first season. For people younger than 48, changes in depressive symptoms were not significantly related to changes in antibody production.

CONCLUSIONS

These findings highlight the important role of mental health for older adults' vaccine response, which could have clinical relevance for protection against disease.

A bifactor representation of the Center for Epidemiological Studies Depression Scale for children: gender and age invariance and implications for adolescents' social and academic adjustment

BACKGROUND

The Center for Epidemiological Studies Depression Scale for Children (CES-DC) is a widely used scale for screening depressive symptoms in children and adolescents. This study aims to uncover the optimal factor structure of the DES-DC and presents an alternate conceptualization of adolescent depression by estimating bifactor models and several competing models using a sample of Chinese adolescents.

METHODS

The participants were 533 adolescents (49.7% boys, 49.7% girls, 3 participants did not report) between 12 and 18 years of age attending public secondary schools in the middle part of mainland China. Data were collected in classrooms using a questionnaire survey. A structural equation modeling approach was used to estimate and compare a series of competing models for the DES-DC.

RESULTS

A Bifactor exploratory structural equation model (Bi-ESEM) with the best model fit was retained for representing the current data. Tests of measurement invariance demonstrated strict measurement equivalence across gender and age. No gender and age differences have been found in the general depression factor. Findings provided evidence for the composite reliability and construct validity of DES-DC. Depressive symptoms positively related to the Big Five trait neuroticism, negative emotions, loneliness, social anxious behaviors, and disruptive behaviors during school and negatively related to agreeableness, conscientiousness, extraversion, physical health status, school connectedness, and academic self-efficacy.

CONCLUSIONS

This study provides support for the one general factor construct of the CES-DC and the continuum concept structure of adolescent depression. Moreover, this research offers empirical evidence for comparing depression symptoms among adolescent populations with diverse genders and age groups. Additionally, the findings replicate and expand upon the implications of depressive symptoms on adolescents' traits, well-being, social-relational adjustment, and academic adaptation.