Symptom screening scales for detecting major depressive disorder in children and adolescents: a systematic review and meta-analysis of reliability, validity and diagnostic utility

Comparison and application of depression screening tools for adolescents: scale selection and clinical practice

BACKGROUND

Clinical assessments rely primarily on patients' emotional expressions and scale scores. However, due to cognitive differences and the complexity of emotional expression among adolescents, existing assessment tools often present challenges in their selection and application. This study reviews and analyzes the literature related to 8 commonly used adolescent depression assessment scales, including the Hamilton Depression Scale (HAMD), the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CES-D), the Reynolds Adolescent Depression Scales (RADS), the Children's Depression Inventory (CDI), the Kutcher Adolescent Depression Scale (KADS), the Patient Health Questionnaire (PHQ) and the Depression Screener for Teenagers (DesTeen). Through a comprehensive analysis of each scale's strengths, limitations and practical applications, this narrative review aims to guide healthcare practitioners and researchers in selecting optimal measurement tools for different clinical and research contexts.

METHODS

Relevant studies on 8 frequently used or well-supported adolescent depression assessment scales (CDI, RADS, CES-D, BDI, PHQ, KADS, HAMD, DesTeen) were retrieved from PubMed, Web of Science, CNKI, and Wanfang databases. A total of 102 articles were ultimately selected for data extraction to determine the reliability and validity of these scales. Additionally, 13 original development studies of the included scales were further reviewed to extract and analyze information on their developmental background, structural dimensions, item composition, and applicability.

RESULTS

Recent studies on depression assessment scales have focused on the development of precise diagnosis and personalized evaluation. All 8 adolescent depression assessment scales generally exhibit good reliability and validity. Among them, the HAMD is used for detailed clinical evaluation of depressive symptoms but suffers from complexity due to its reliance on professional assessors. The BDI and the CES-D provide the most comprehensive dimensions. While the BDI is suitable for clinical assessments, it has the drawback of containing items that may be difficult to understand. The CES-D is well-suited for epidemiological research and large-scale screenings but has the limitation of unclear differentiation between emotional and somatic symptoms. The RADS is recognized for its comprehensive items and high reliability and validity, although its lengthy items may lead to respondent fatigue. The CDI allows multidimensional assessment of depressive symptoms but has been debated regarding its applicability across different age groups. The KADS, explicitly designed for adolescents, is a promising tool; however, its relatively recent development has resulted in limited validation studies. The PHQ is appropriate for rapid screening and tracking treatment effects but lacks sufficient emotional evaluation. The DesTeeen, designed for adolescents, features concise and clear item phrasing, but it's only available in the German language.

CONCLUSIONS

The 8 standard scales demonstrate high accuracy in screening adolescent depression, but challenges persist in selecting scales for different contexts and ensuring their cross-cultural validity.

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

This study is an updated systematic review verifying whether the Center for Epidemiologic Studies Depression Scale (CES-D) is a valuable screening tool for children and adolescents. Electronic searches were performed on MEDLINE, EMBASE, CINAHL, and PsycArticles, using depression and CES-D as keywords. Fourteen studies that included 7,843 children and adolescents were analyzed. In the meta-analysis by CES-D type, the pooled sensitivity and specificity for the long version were 0.81 and 0.72, respectively; they were 0.80 and 0.74 for the short version, respectively. The summary receiver operating characteristic (sROC) curves were 0.83 and 0.86, respectively. Compared to the CES-D and other tools, the pooled sensitivity (0.84 vs. 0.83) and the pooled specificity (0.72 vs. 0.74) were similar, and the sROC curve was the same at 0.83. This review indicates that the CES-D is an available and valuable tool for screening depression in children and adolescents.

Who Are You? Views of Self as Reported by 90 Depressed Adolescent Psychiatric Inpatients

Background

The factors contributing to adolescents' views of self can be complex and idiosyncratic. Self-esteem can hinge upon a narrow or broad set of factors, depending on how the adolescent conceptualizes the self. The present study examines how narrow and broad views of self may be differentially related to measures of depression severity and suicide risk among adolescents.

Methods

In total, 90 adolescent psychiatric inpatients were evaluated while hospitalized during a major depressive episode. All patients completed the Children's Depression Inventory, the Hopelessness Scale for Children, the Rosenberg Self-Esteem Scale, and the Self-Esteem Worksheet-an idiographic measure that allows each person to rate the importance and success related to enter their personal values and priorities.

Results

Compared to depressed adolescent inpatients, depressed and suicidal teens reported significantly higher levels of depression and hopelessness, along with significantly lower levels of self-esteem on both measures of self-esteem. Further, lower scores on the Self-Esteem Worksheet were associated with more severe depression, elevated hopelessness, and elevated suicidal ideation.

Conclusions

The Self-Esteem Worksheet provides insights into the mind of vulnerable teens that may help to guide treatment and prevention efforts.

Childhood Physical Fitness as a Predictor of Cognition and Mental Health in Adolescence: The PANIC Study

BACKGROUND

Cognitive and mental health problems are highly prevalent in adolescence. While higher levels of physical fitness may mitigate these problems, there is a lack of long-term follow-up studies on the associations of physical fitness from childhood with cognition and mental health in adolescence.

OBJECTIVE

We investigated the associations of physical fitness from childhood to adolescence over an 8-year follow-up with cognition and mental health in adolescence.

METHODS

The participants were 241 adolescents (112 girls), who were 6-9 years at baseline and 15-17 years at 8-year follow-up. Average and change scores for cardiorespiratory fitness (maximal power output [Wmax]; peak oxygen uptake [VO2peak]), motor fitness (10 × 5-m shuttle run), and muscular fitness (standing long jump; hand grip strength) were calculated. Global cognition score was computed from six individual cognitive tasks, and perceived stress and depressive symptoms were assessed at the 8-year follow-up. The data were analysed using linear regression models adjusted for age, sex, and parental education.

RESULTS

Average motor fitness was positively associated with global cognition score (standardised regression coefficient [β] - 0.164, 95% confidence interval [CI] - 0.318 to - 0.010) and inversely with perceived stress (β = 0.182, 95% CI 0.032-0.333) and depressive symptoms (β = 0.181, 95% CI 0.028-0.333). Average cardiorespiratory fitness was inversely associated with perceived stress (Wmax: β =  - 0.166, 95% CI - 0.296 to - 0.036; VO2peak: β =  - 0.149, 95% CI - 0.295 to - 0.002) and depressive symptoms (Wmax: β =  - 0.276, 95% CI - 0.405 to - 0.147; VO2peak: β =  - 0.247, 95% CI - 0.393 to - 0.102). A larger increase in cardiorespiratory fitness was associated with lower perceived stress (Wmax: β =  - 0.158, 95% CI - 0.312 to - 0.003; VO2peak: β =  - 0.220, 95% CI - 0.395 to - 0.044) and depressive symptoms (Wmax: β =  - 0.216, 95% CI - 0.371 to - 0.061; VO2peak: β =  - 0.257, 95% CI - 0.433 to - 0.080).

CONCLUSIONS

Higher levels of motor fitness in childhood and adolescence were associated with better cognition in adolescence. Higher levels of and larger increases in cardiorespiratory fitness from childhood to adolescence were associated with better mental health in adolescence.

Psychosocial Interventions for Preventing Mental Health Conditions in Adolescents With Emotional Problems: A Meta-Analysis

Mental health conditions constitute a major burden of disease for adolescents globally and can lead to significant adverse consequences. This systematic review aimed to identify if psychosocial interventions are effective in preventing mental health conditions in adolescents already experiencing emotional problems. We searched for randomized controlled trials comparing psychosocial interventions for preventing mental health conditions with care as usual in adolescents aged 10-19 who are experiencing symptoms of emotional problems. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE, and ASSIA databases to identify studies. We found 82 eligible studies (n = 13,562 participants). Findings show that interventions can reduce mental health conditions and increase positive mental health. Across all reported time points, psychosocial interventions showed significant, small-to moderate-sized beneficial effects on preventing mental health conditions (SMD: -0.26, 95% CI [-0.42, -0.19] and small positive effects on positive mental health (SMD: 0.17, 95% CI [0.097, 0.29]. There were no statistically significant pooled findings suggesting that psychosocial interventions had either a positive or negative effect on self-harm or suicide; aggressive, disruptive and oppositional behavior; substance use; or school attendance. Despite the positive findings, a critical gap exists in the design of effective psychosocial interventions to reduce self-harm and suicide, and other risk behaviors in adolescents with symptoms of emotional problems.

Parental acceptance of school-based universal depression screening for children and adolescents in primary and secondary school in China

INTRODUCTION

School-based universal depression screening (SBUDS) is an effective method for early identification of depression. As parents are the primary decision-makers for their children's acceptance of healthcare services, this study aims to examine rural and urban parental acceptance of SBUDS.

METHODS

The study assessed parental acceptance of SBUDS for their children and its association with self-reported parental perception of depression (i.e., parental knowledge of depression, self-efficacy to identify child depression, and depression stigma) and parental belief regarding the benefits and risks of SBUDS. The analysis included 13,480 parents with at least one child in grades 4-12 from 29 primary and secondary schools in four cities across China.

RESULTS

In this large and diverse sample, 92.4% of the participants supported SBUDS for their children despite concerns about the risks of SBUDS (e.g., accuracy and privacy of screening results). Most parents supported SBUDS starting in 4th (25.5%) or 7th (24.7%) grades, though 7.6% responded no screening should be done. Regression analysis revealed that parents with a higher level of knowledge about depression (OR = 1.496, 95%CI [1.08, 2.073]; P = 0.015) had higher odds of parental acceptance of SBUDS. However, this association was not evident among rural parents stratified by urban-rural locality.

CONCLUSIONS

In this survey study, most Chinese parents accept SBUDS for their children despite concerns. Guidelines for maintaining adolescent confidentiality and ensuring the accuracy of results in an SBUDS will require careful consideration. Additionally, the study findings indicate that improving parental knowledge about adolescent depression is essential for promoting parental acceptance of SBUDS.

Do coping strategies mediate the effects of childhood adversities and traumata on clinical high-risk of psychosis, depression, and social phobia? A cross-sectional study on patients of an early detection service

BACKGROUND

Childhood adversities and traumata (CAT) increase the risk for various mental disorders, including the clinical high-risk of psychosis (CHR-P) state and its main comorbidities, i.e., depression, and social phobia. However, these relations are likely mediated by personal coping behaviors. This cross-sectional study investigates the relationships between the main CAT domains, coping, CHR-P, depression, and social phobia.

METHODS

Using path analyses, we analyzed data of 736 patients (mean age 24 years, 67% male) who presented at an early detection service between 2002 and 2013, answered questionnaires on CAT, coping, depressiveness, and social phobia, and underwent clinical examination for CHR-P according to the recommendations of the Guidance project of the European Psychiatric Association.

RESULTS

All path models (total sample, males and females) showed good to excellent fit to the data. In all models, higher scores on maladaptive coping mediated the negative effect of emotional abuse on mental health outcomes. Additionally, in the total sample and males, lower scores on adaptive coping mediated the negative effect of emotional abuse and neglect, and physical neglect was associated with lower scores on adaptive coping that, in turn, were linked to depression and social phobia but not CHR-P. Overall, effects of maladaptive coping were higher than those of adaptive coping, although adaptive coping was more diversely associated with CAT. Furthermore, the interrelated depression and social phobia were more widely explained by the models than CHR-P, which was not significantly associated with them.

CONCLUSIONS

Our findings underscore the complex interplay of the CAT domains and their relevant mediators with mental health outcomes that likely reflect underlying sex-specific psychological, social, cultural and neurobiological mechanisms. Supporting a broader view on CAT than the traditional focus on sexual abuse, results indicate an important role of emotional abuse that, descriptively, is most strongly mediated by maladaptive coping strategies on mental health outcomes. A detailed understanding of the effects of CAT will in future help to develop a multi-dimensional, holistic and sex-specific approach to the treatment of patients who have experienced CAT.

TRIAL REGISTRATION

The study was registered in the German Clinical Trial Register ( https://drks.de/ ) as DRKS00024469 at 02/24/2021.

Comprehensive investigation of factor structure and gender equivalence of the Beck Depression Inventory-II among nonclinical adolescents

The Beck Depression Inventory-II (BDI-II) is a widely used tool for rating the severity of depressive symptoms. Studies on the factor structure of the BDI-II in adolescents have yielded controversial findings. Most studies have reported an oblique two-factor model that describes the 'cognitive' and 'somatic-affective' dimensions. However, there is variation in the item composition of each factor across studies. Alternative factor structures have been proposed, including one-factor, three-factor, hierarchical, and bifactor models. Additionally, there is limited data on measurement invariance across genders. This study aimed to examine hypothetical factor structures and gender equivalence of the BDI-II in a sample of Brazilian nonclinical adolescents (N = 1,184, aged 13-18 years, 59.1% females). Cross-validation of the BDI-II was performed through exploratory (EFA) and confirmatory factor analysis (CFA). Measurement invariance was evaluated using multigroup-CFA (MG-CFA). EFA suggested an oblique two-factor model depicting "affective-cognitive" and "somatic" dimensions. CFA tested competing models for the structure of BDI-II, including the simple one- and two-factor models, a bifactor model, and the EFA model along with its corresponding bifactor model. All models demonstrated adequate and similar fitness, well-defined factors, and good reliability. Bifactor analyses indicated a robust general factor with low reliable variance in total scores attributed to multidimensionality caused by the group factors in bifactor models. MG-CFA supported invariance across gender, suggesting that the same BDI-II construct could be applied to both female and male adolescents. This study provides evidence that the BDI-II could be used as a unidimensional measure of depressive symptoms in adolescents by researchers and clinicians.

Gender Difference in the Onset of Adolescent Depressive Symptoms: A Cross-Lagged Panel Network Analysis

Depressive symptoms are prevalent in adolescents, especially girls, underscoring the need for early detection and targeted interventions. Identifying initial symptoms and their temporal associations is vital for such interventions. This study used cross-lagged panel network (CLPN) analysis to examine the central depressive symptoms and their interconnections within a national cohort derived from the China Family Panel Study (CFPS). The participants included 2524 adolescents (45.8% girls), with depressive symptoms assessed using the Epidemiological Studies Depression Scale (CES-D-8) in 2016 (Mage = 12.30) and 2018 (Mage = 14.25). The CLPN model showed that "loneliness" and "not getting going (fatigue)" at T1 were the strongest predictors of subsequent depressive symptoms at T2, after controlling for demographic variables and depressive symptoms at T1. Conversely, depressed mood and anhedonia at T2 were most likely to be influenced by other symptoms at T1. Gender-stratified analyses identified "loneliness" as the initial symptom in girls and "fatigue" for boys. Additionally, girls exhibited stronger reciprocal associations among depressive symptoms than boys. The findings suggest that addressing interpersonal loneliness is crucial for adolescent girls, whereas somatic fatigue should be a focus for adolescent boys, highlighting the need for gender-specific approaches in early intervention strategies. This research provides insights into the distinct gendered networks of depressive symptomatology in adolescents, informing tailored prevention and intervention efforts.

The association of personal, parental, school and community factors with depressive symptoms among a sample of Colombian students of ages 9 to 12 years

Few studies have examined how the personal characteristics of students, together with factors from their local social environments and communities, affect students living in generally high levels of social disruption. We examined the influence that personal characteristics as well as factors from the local social environments and communities may have on Colombian students' levels of depressive symptoms shortly after the end of the of armed conflict. Data were collected from 710 students attending the fifth grade in a random sample of elementary schools in the province of Sucre in Colombia. Information was gathered on the students' ages and gender as well as characteristics of their parents, school factors, and community factors. A five-level hierarchical regression model was used to determine the extent to which all these variables predicted depression scores, as measured by the Adolescent Depression Rating Scale. While personal, parental, school and community factors were all found to predict depression scores, the category, parental factors had the most impact. That was followed by school factors, community factors and finally personal characteristics. Multiple social and environmental factors were associated with the level of depression experienced by Colombian students.

Discriminability of the Beck Depression Inventory and its Abbreviations in an Adolescent Psychiatric Sample

Background

The Beck Depression Inventory (BDI) is a widely acknowledged self-report screening tool for evaluating the presence and intensity of depressive symptoms. The BDI-IA, although an older version, is highly correlated with the updated BDI-II, remains clinically valuable, and is widely used due to its free availability.

Aim

This study aimed to examine the psychometric properties of the BDI-IA and compare its diagnostic accuracy with the abbreviated BDI-SF, BDI-PC, and BDI-6 versions against gold-standard research diagnoses in a representative Finnish adolescent clinical population.

Methods

The participants were referred outpatient adolescents aged 13-20 years (N = 752, 73% female). We investigated structural validity with item factor analysis and evaluated the criterion validity of mean scores and factor scores with various diagnostic measures. Sample-optimal cut-offs (criterion unweighted Cohen's kappa) were estimated with a bootstrap procedure.

Results

The sample-optimal cut-off for the full BDI was 19, slightly higher than that suggested by the previous literature. The abbreviations of the BDI-IA were demonstrated to be as good as the full scale in detecting depressive symptoms in all three diagnostic categorizations.

Conclusion

The use of brief and user-friendly questionnaires such as the BDI-PC or BDI-6 is recommended to ensure optimal depression screening and minimize the administrative burden, especially in primary care settings where clinical decision-making and referrals often need to occur within a limited time frame.

Detecting and tracking depression through temporal topic modeling of tweets: insights from a 180-day study

Depression affects over 280 million people globally, yet many cases remain undiagnosed or untreated due to stigma and lack of awareness. Social media platforms like X (formerly Twitter) offer a way to monitor and analyze depression markers. This study analyzes Twitter data 90 days before and 90 days after a self-disclosed clinical diagnosis. We gathered 246,637 tweets from 229 diagnosed users. CorEx topic modeling identified seven themes: causes, physical symptoms, mental symptoms, swear words, treatment, coping/support mechanisms, and lifestyle, and conditional logistic regression assessed the odds of these themes occurring post-diagnosis. A control group of healthy users (284,772 tweets) was used to develop and evaluate machine learning classifiers-support vector machines, naive Bayes, and logistic regression-to distinguish between depressed and non-depressed users. Logistic regression and SVM performed best. These findings show the potential of Twitter data for tracking depression and changes in symptoms, coping mechanisms, and treatment use.

Discriminant analysis of occupational performance characteristics in patients with major depressive disorders and healthy individuals

Aim

Assessing symptoms and daily functioning in patients with major depressive disorder (MDD) can be challenging, as their limited self-monitoring abilities may result in behavior observed during structured interviews not accurately reflecting their daily lives. This study aimed to determine if specific occupational behaviors could distinguish individuals with MDD from healthy individuals.

Methods

Baseline data were collected from medical records and activity programs. Three occupational therapists conducted content analysis to assess occupational performance characteristics. Chi-squared tests compared the prevalence of these characteristics between patients with MDD and healthy controls. Multivariable logistic regression controlled for potential confounders, with independent variables selected based on clinical relevance and sample size (p < 0.01). Discriminant analysis was used to enhance group differentiation, assessing prediction rates using area under the curve (AUC) values.

Results

A total of 69 occupational performance characteristics were identified, with 12 showing significant differences between 27 patients with MDD and 43 healthy controls. Key discriminators included "Ask questions and consult" (p < 0.001, odds ratio [OR] = 0.051, 95% confidence interval [CI] = 0.009-0.283), "Concentrate on work" (p = 0.003, OR = 0.078, 95% CI = 0.015-0.416), "Choose simple work" (p = 0.004, OR = 17.803, 95% CI = 2.446-129.597), and "Punctual" (p = 0.017, OR = 0.030, 95% CI = 0.002-0.530). Discriminant analysis using these variables yielded a Wilks' λ of 0.493 (p < 0.001), achieving an 88.6% accuracy rate. The receiver operating characteristic curve's AUC value was 0.911 (sensitivity = 95.3%, specificity = 77.8%).

Conclusion

This study highlights the importance of occupational performance characteristics in tailoring treatment strategies for MDD, providing insights beyond traditional assessment methods.

Latent Structure and Item Functioning of Self-Referent Encoding Task Word Stimuli in Preadolescent Youth

The Self-Referent Encoding Task (SRET) can be used to measure self-concept via endorsement of trait words, a robust metric associated with depression severity. Our study is the first to investigate the structural validity and item functioning of SRET endorsement scores using confirmatory factor analysis and item response theory. Community-dwelling preadolescent youth (N = 508; Mage = 12.39 years, SDage = .72) were shown a list of positive and negative trait adjectives and made binary ratings of whether words were self-descriptive. The SRET exhibited a two-factor structure, comprising positive and negative factors. Positive items were endorsed by most children and best estimated information about positive self-concepts below average levels of positivity. Conversely, negative items were unendorsed by most children and best estimated information about negative self-concepts above average levels of negativity. We identify standardized, psychometrically sound, and developmentally sensitive SRET items for assessing youth self-concept and its associations with depression risk.

Prevalence of psychotic-like experiences and their association with depression symptoms among patients entering adolescent psychiatric care

BACKGROUND

Psychotic-like experiences (PLEs) are common in clinical adolescent samples and form a continuum based on their frequency and intensity. PLEs can have harmful effects on both behaviour and affect.

METHODS

Prevalence and subjective distress due to PLEs were assessed with the Prodromal Questionnaire-Brief (PQ-B) and depressive symptoms with the Beck Depression Inventory (BDI-21A) among adolescents (N = 399; 71.7% female, mean age 14.9 years, range 13-18) entering specialized adolescent psychiatric services. Various PQ-B Distress scale cut-off points were tested for their ability to detect high and low BDI scores using the superiority index, the effect size for mean difference, and spline regressions.

RESULTS

The mean number of endorsed PLEs assessed with the PQ-B was 3.27 (SD 3.64; males: M 1.75; SD 2.78; females: M 3.89; SD 3.78), while mean PQ-B Distress scores were 20.33 (SD 18.03; males: M 11.84; SD 13.90; females: M 23.74; SD 18.40). The most common PLE within both genders were experiences of paranoia and suspiciousness, with a prevalence of 59.9%. BDI scores and PQ-B distress scores were strongly associated (r = 0.534, p<.001). Superiority indices, effect sizes, and spline regressions indicated that a low PQ-B Distress cut-off of 2 or 3 was most informative both when using BDI as a continuous variable and when dichotomized as mild depression (≥10) or major depressive disorder (≥16).

CONCLUSION

PLEs are common among adolescent entering psychiatric care. Even a relatively small amount of distress due to PLEs indicates clinical levels of depressive symptoms.

Gender, age, and longitudinal measurement invariance of child and adolescent depression scales: A systematic review

Understanding developmental trajectories and gender differences in depressive symptoms is clinically relevant. Discerning true differences across gender, age groups, and time is based on the often-neglected premise of measurement invariance (MI) of child and adolescent depression scales. In this systematic review, we assessed available evidence for MI across gender, age groups, and time for depression scales validated in children and adolescents, in studies with at least one assessment under age 18. A literature search using Medline, PsychInfo, Scopus, Web of Science, and Google Scholar databases identified 42 studies that examined MI. MI of eleven scales was tested in 1-9 studies per scale. Conclusions are hampered by different factor solutions tested within some scales. All included questionnaires showed preliminary evidence for MI across gender. Across some studies, crying had higher factor loadings in females compared to males, indicating that crying may be differently related to depression across gender. MI evidence was preliminary in just four scales across time, mostly confined to ages 13-17. One study showed developmental conclusions differed when non-invariance is not accounted for in observed scores. Overall, evidence for MI in child and adolescent depression scales is currently limited.

Improvement in Symptoms of Depression and Anxiety and Cardiometabolic Risk Factors in Children and Adolescents with Overweight and Obesity Following the Implementation of a Multidisciplinary Personalized Lifestyle Intervention Program

Background/Objectives: Childhood obesity is one of the most challenging contemporary public health problems. Children and adolescents with obesity experience multiple psychosocial difficulties, such as low self-esteem, depression, anxiety, and behavioral problems, which persist for a long time. The aim of the study was to assess the effect of a multidisciplinary personalized lifestyle intervention for depressive and anxiety symptoms, as evaluated by psychometric questionnaires, and their effect and association with cardiometabolic parameters in children and adolescents with overweight and obesity before and after the intervention. Methods: Six hundred and eleven (n = 611) children and adolescents (mean age ± SE: 10.39 ± 0.10 years; 51.5% females, 46.6% pubertal) were studied prospectively. Subjects were classified as being obese (50.2%), overweight (33.5%), or having a normal BMI (16.2%) according to IOTF criteria. All participants entered a 1-year lifestyle intervention program; laboratory investigations were obtained at the beginning and end of the study and two psychometric questionnaires were completed, the CDI and SCARED, which evaluate symptoms of depression and anxiety, respectively. Results: Following the lifestyle intervention, a significant decrease was noted in anxiety scores in all subjects and in depression scores in youth with obesity, as well as in adolescents with obesity, while females displayed a reduced response to the intervention. Insulin resistance and metabolic syndrome parameters, cortisol, PRL, and LH concentrations were positive predictors for depressive and anxiety symptoms. Conclusions: The implementation of a multidisciplinary personalized lifestyle intervention program in the management of childhood obesity is associated with a significant decrease in cardiometabolic and psychosocial comorbidities in children with and without excess adiposity. The improvement in mental health is likely mediated by an improvement in energy metabolism with subsequent improvement in neuroinflammation owing to lifestyle changes.

Patterns of depression symptoms in relation to stressors and social behaviors during the COVID-19 pandemic among older youth and emerging adults in the United States

Substantial increases in depression at the outset of the pandemic were previously reported in NCANDA, a longitudinal sample of adolescents and young adults. The current NCANDA study examined depression symptoms before and during the COVID-19 pandemic. It evaluated the influence of stressors and social behavior (e.g., in-person and online socializing) with linear mixed effects models. A strong, positive association between COVID-19-related stressors and depression symptoms was observed. The frequency of in-person socializing did not account for the totality of the changes in depression observed during the early COVID-19 pandemic. It may be that pandemic-related stressors counteracted the benefits of in-person interactions during the early stages of the COVID-19 pandemic. Future studies can continue to elucidate the interactions among psychosocial, genetic, and behavioral factors contributing to depression symptoms in the unprecedented context of the COVID-19 pandemic.

Building RECOVERY: development of the registry of eating disorders and their co-morbidities OVER time in youth

BACKGROUND

Eating disorder (ED) research is limited by the lack of longitudinal cohort studies, particularly those in adolescents, and the lack of inclusion of multiple perspectives and diagnoses. The objective of this study was to describe the development of a longitudinal cohort of adolescents/young adults representing varied ED diagnoses and including perspectives of parents and multi-disciplinary clinicians in addition to those of patients.

METHODS

Patients of an outpatient ED program who were age 10-27 years, along with their parents and clinicians, were recruited to participate in a longitudinal web-based study. Using univariate, bivariate, and multivariate analyses, we assessed rates of participation among different groups (i.e., parents, patients, different clinical disciplines) as well as factors related to attrition.

RESULTS

71% of patients, 75% of parents, 56% of adolescent medicine providers, 20% of primary care physicians, 83% of dietitians, and 80% of mental health clinicians invited agreed to participate. At 12 months, 32% of patient participants had not completed their on-line surveys. Attrition rates were higher for parents (55%) and clinicians (45% of nutritionists, 55% of primary care physicians, 51% of Adolescent/Young Adult providers, and 64% of mental health providers) at 12 months.

CONCLUSIONS

A longitudinal registry of patients with EDs is feasible and efficient when using web-based surveys. However, clinician participation is particularly hard to secure and maintain.

Psychometric validation of the Montgomery-åsberg Depression Rating Scale - Youth (MADRS-Y) in a clinical sample

BACKGROUND

Depression in adolescence is a serious major global health problem with increasing rates of prevalence. Measures of depression that are valid for young people are clearly needed in clinical contexts.

METHODS

The study included 577 patients from child and adolescent psychiatry (n = 471) and primary care (n = 106) aged 12-22 years in Sweden (Mage=16.7 years; 76% female). The reliability and validity for Montgomery-Åsberg Depression Rating Scale - Youth (MADRS-Y) were investigated. To confirm the latent structure, we used a single-factor confirmatory factor analysis (CFA). A Kruskal-Wallis test was performed to test total score differences between diagnostic groups. Using Spearman's rho correlations, we examine whether single items in the MADRS-Y correlate with suicidal ideation measured by The Suicidal Ideation Questionnaire-JR (SIQ-JR).

RESULTS

The internal consistency using McDonald's coefficient omega was excellent. The CFA of the 12-item MADRS-Y supported a one factor structure. Evidence of convergent and discriminant validity was shown. There was a significant difference in MADRS-Y scores across diagnostic groups, with higher results for depressive disorders. A strong correlation with suicidal ideation was found for two items.

CONCLUSIONS

The results support MADRS-Y as a brief, reliable, and valid self-report questionnaire of depressive symptoms for young patients in a clinical setting.

Longitudinal Associations Between Depression, Suicidal Ideation, and Lack of Certainty in Control among Adolescents: Disaggregation of Within-Person and Between-Person Effects

PURPOSE

Depression and suicidal ideation (SI) are common in adolescents. However, the relation between the two is unclear. According to the cognitive model of suicidal behavior and learned helplessness theory, lack of certainty in control (LCC), referring to individuals' deficiency in predictability, certainty, and control of life, may be an important factor linking the two. Thus, the current study aimed to investigate the temporal relation between depression and SI in adolescents and to assess the mediating role of LCC in this relation.

METHODS

A three-wave survey was carried out at intervals of 1 and 1.5 years among 516 adolescents at several middle schools in Sichuan Province, China. The random-intercept cross-lagged panel model was used to examine the temporal relations between depression, SI, and LCC among adolescents, which can effectively distinguish between-person and within-person differences.

RESULTS

The results revealed that depression, SI, and LCC had positive intercorrelations at the between-person level. At the within-person level, early depression predicted subsequent depression and SI via LCC among adolescents. Additionally, early LCC promoted later SI through depression.

DISCUSSION

These findings highlight the mediating role of LCC, clarify the temporal relation between depression and SI, and provide theoretical support for interventions to address depression and suicide.

Effect of elevated depressive symptoms during adolescence on health-related quality of life in young adulthood-a six-year cohort study with repeated exposure measurements

Objectives

Depression is a major contributor of young people's burden of disease. In this study we aim to estimate the effect of elevated depressive symptoms on physical health-related quality of life.

Design

We used self-reported information from the prospective BELLA cohort study, which included adolescents selected from the general population in Germany. The baseline assessment (2003-2006) and the 1-, 2-, and 6-year follow-up waves provide the data basis.

Participants

The baseline study population consisted of 1,460 adolescents between the ages of 12 and 17 who, according to their caregivers, did not suffer from depression.

Variables

The primary outcome, as measured by the physical component score (PCS) of the SF-36 at a 6-year follow-up (range: 0-100), is physical health-related quality of life. The exposure of interest is depressive symptoms, as measured by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) at baseline, 1-year follow-up and 2-year follow-ups (range: 0-60). We dichotomized the exposure into subthreshold (≤15) and elevated depressive symptoms (>15). For the main analyses we considered a cumulative index for elevated depressive symptoms across the three time points (range: 0-3). Considered confounders are sex, age, socioeconomic status, migrant background, social support, anxiety symptoms, physical activity, chronic diseases, and sleeping problems.

Statistical methods

We used multiple imputation to account for missing values. Within each imputed dataset, we applied inverse probability weighting (IPW) to estimate the effect of the cumulative index for elevated depressive symptoms at baseline, 1- and 2-year follow-up on physical health-related quality of life at 6-year follow-up. We derived 95% confidence intervals by bootstrapping.

Results

After adjusting with IPW, the effect of the cumulative index per one unit increase of elevated depressive symptoms on the physical component score was -1.71 (95% CI: -3.51 to -0.04). The adjusted effect estimates of single exposure of elevated depressive symptoms on physical health-related quality of life were -0.83 (95% CI: -3.69 to 1.87) at baseline, -2.96 (95% CI: -4.94 to -0.52) at 1-year follow-up and -1.32 (95% CI: -3.85 to 1.15) at 2-year follow-up.

Conclusion

Findings suggest that elevated depressive symptoms during adolescence decrease physical health-related quality of life in young adulthood.

Efficacy of addition of the anti-inflammatory, IV glutathione to standard ketamine IV therapy in major depressive disorder

Ketamine, a N-methyl-D-aspartate (NMDA) antagonist, is used for treatment-resistant depression (TRD). Recent studies have shown that there are increased levels of pro-inflammatory cytokines in individuals with major depressive disorder (MDD) and those with higher levels of oxidative stress markers have a decreased or null response to conventional antidepressants. Glutathione (GSH) as an antioxidant adjuvant to ketamine has not been well studied. This double-blind study with 30 patients divided into 2 groups of 15 each, aimed to determine if GSH, added to standard ketamine infusion (GSH+K), rendered better outcomes in MDD patients versus patients receiving ketamine infusions with a normal saline placebo (K+NS). There were significant drops in BDI-II scores from day 1 to day 14, PHQ- scores from day 1 to day 14 and PHQ-9 scores day 14 to day 28, suggesting the overall treatment was effective. There were no statistically significant differences between the groups over time. However, a sustained improvement in depressive symptoms was observed for 14 days post-infusion in both groups.

Is there a basis for a weight cut-off point? A large-scale investigation of atypical anorexia and anorexia nervosa subtypes among patients at a residential treatment centre

OBJECTIVE

There is debate surrounding how to differentiate between anorexia nervosa (AN) and atypical AN (atypAN) as diagnostic entities, and whether a distinction based on BMI is warranted. Better understanding eating disorder (ED) and emotional symptoms across atypAN and AN subtypes [AN-restricting (AN-R), AN-binge/purge (AN-BP)], with and without controlling for BMI, can elucidate how atypAN differs from AN subtypes and whether there is a basis for a BMI cut-off.

METHODS

1810 female patients at an ED treatment centre completed intake surveys. ANCOVAs assessed differences across AN-R (n = 853), AN-BP (n = 726), and atypAN (n = 231) groups on ED, depressive, and anxiety symptoms, anxiety sensitivity, experiential avoidance, and mindfulness, with and without controlling for BMI.

RESULTS

Relative to AN-R, atypAN and AN-BP groups endorsed significantly higher ED and depressive symptoms, anxiety sensitivity, experiential avoidance, and significantly lower mindfulness (all p < 0.001), but atypAN and AN-BP groups did not differ from one another. When controlling for BMI, all previously significant differences between atypAN and AN-R did not remain significant.

CONCLUSION

Individuals with atypAN who have a higher BMI experience more pronounced ED and emotional symptoms, suggesting that relying solely on BMI as a marker of illness severity may be problematic.

Content agreement of depressive symptomatology in children and adolescents: a review of eighteen self-report questionnaires

Identifying major depression in children and adolescents is more challenging than in adults. Questionnaires are often used for screening or guiding clinical assessment. Several instruments of different lengths are used as equivalent measures in diagnostic decisions. In this paper, we explore to what extent 18 commonly used depression scales for children and adolescents explore depression clinical symptoms as established by standard DSM-5 diagnosis criteria. We analyzed scale content adequacy by examining the overlap between scale contents and consensus clinical symptoms, the diagnostic time frame for active symptom assessment, and readability for the target age group. The 18 scales encompassed 52 distinct symptoms. These scales included just 50% of clinical symptoms required for diagnosis. The content overlap was low; on average, 29% of symptoms coincide across scales. Half of the scales did not use the standard period for active symptom appraisal, and some did not include a period for assessment. The reading levels on six scales were inappropriate for the scale's target population age group. The substantial heterogeneity in defining the depressive syndrome, the low overlap among scales, different periods of a positive diagnosis, and mismatch of reading competence for detecting may lead to heterogeneity in clinical diagnoses when using different scales. Improving the content of self-report in terms of homogeneity of diagnostic criteria would lead to better diagnostic decisions and patient management.

Comparing frequencies of adolescent suicide attempters pre- and during COVID-19 pandemic school terms

BACKGROUND

The COVID-19 pandemic had and still have a major impact on adolescent mental health and consequently on suicidal behavior. However, few studies have investigated whether the pandemic has changed the patterns and the triggers of suicidality peaks in adolescents, e.g., seasonal patterns or family conflicts. We hypothesized that the pandemic modified suicidality rates: an increment of suicide attempts would be observed in the first semester of the academic year during COVID-19 pandemic compared to the same period of previous academic year; and the precipitating factors would be more related to social stressors during the pandemic school year.

METHODS

A retrospective cross-sectional study was conducted to assess the precipitating factors, also including school-related factors and cognitive skills, of adolescent suicide attempters occurred in the first and second semesters of the year before the pandemic lockdown (study periods 1 and 2) and the year after (study periods 3 and 4).

RESULTS

The sample consisted of 85 adolescents aged between 12 and 17 recruited consecutively from March 2019 to March 2021 at emergency ward because of suicide attempt. Forty-eight adolescents (55.3% of the sample) were attended before the lockdown (pre-pandemic group) and 38 (44.7%) the year after. The results showed a higher proportion of female suicide attempters in period 4 (Sept 2020-Feb 2021) respect to period 3 (Mar 2020-Aug 2020), i.e., pandemic semesters compared with the increment observed between period 2 and 1 (prepandemic semesters; Fisher's exact test = 4.73; p = 0.026). The multinomial regression models showed a significant effect in the frequency of adolescents who attempted suicide (ratio χ2 = 15.19, p = 0.019), accounted by the differences between period 4 (Sept 2020-Feb 2021) and period 1 (Mar 2019-Aug 2019), with depressive symptoms being a significant contributing factor (Exp(b) = 0.93; p = 0.04). Additionally, social triggers and age were found to be significant risk factors for suicide attempts in the first semester of the pandemic academic year (period 4) compared to the same semester of the pre-pandemic year (period 2; Exp(b) = 0.16, p = 0.01, and Exp(b) = 1.88, p = 0.006, respectively).

CONCLUSIONS

During the pandemic, the decrement between first and second semester of the number of females attempting suicide was more pronounced than in the prepandemic school year -though this findings lacked statistical power due to very limited sample size-. Change in the frequency of adolescent attempting suicide in the different school periods was associated with greater severity of depressive symptoms. Social relations in back-to-school after the lockdown were also associated with the number of adolescents attempting suicide.

Multiple Adaptive Attention-Bias-Modification Programs to Alter Normative Increase in the Error-Related Negativity in Adolescents

In the current article, we examined the impact of two home-delivered attentional-bias-modification (ABM) programs on a biomarker of anxiety (i.e., the error-related negativity [ERN]). The ERN is sensitivity to ABM-related changes; however, it is unclear whether ABM exerts its influence on the ERN and anxiety by increasing general attentional control or by disengaging spatial allocation of attention. In this study, we measured the ERN, anxiety, attention bias, and attention control before and after two versions of ABM training and a waitlist control group in 546 adolescents. An ABM designed to increase attention control modulated the ERN but had no impact on anxiety. An ABM designed to reduce attentional bias changed bias and self-reported anxiety in youths but had no impact on the ERN or parent-reported anxiety. These results suggest that the ERN and normative anxiety may be modified using attention training.

Association between mental disorders with detectable viral load and poor adherence to antiretroviral therapy among adolescents infected with Human Immunodeficiency Virus on follow-up at Chantal Biya Foundation, Cameroon

INTRODUCTION

Perinatally HIV-Infected Adolescents (HIVIA) are more likely to have mental health problems than their uninfected peers. In resource-limited settings, mental health disorders are rarely taken into account in the care offered to HIVIA and have an impact on their routine follow-up. The objective of this study was to assess the baseline socio-demographic factors and mental health conditions associated with detectable viral load or poor ART adherence in HIVIA on ART followed at the Mother and Child Centre of the Chantal Biya Foundation in Yaoundé (CME-FCB), Cameroon.

METHODS

A cross-sectional study was conducted in HIVIA aged 10 to 19 years, followed at CME-FCB during the period from December 2021 to March 2022. Sociodemographic, clinical, and mental characteristics were collected using a structured questionnaire administered face-to-face by trained healthcare providers. The primary outcome was viral load ≥ 40 copies/mL in HIVIA on ART for at least six months. The secondary outcome was poor ART adherence, defined as ≥ 1 missed dose of antiretroviral therapy within the last past three days. The main exposure variables were mental health disorders, including the level of anxiety, depression and low self-esteem.

RESULTS

In total, 302 adolescents were interviewed, 159 (52.7 %) were girls and median age was 15.2 years (IQR: 12.0-17.5). Having missed at least 1 dose of ART drugs during the last 3 days before screening concerned 53 (35.0 %) cases. Of the 247 adolescents with an available viral load (VL) in the last 12 months prior to screening, 33 (26.7 %) had a VL ≥ 40 copies/mL. Among participating adolescents, 29.1 % presented with high or very high anxiety, 26.5 % with severe depression, 36.4 % with history of suicidal ideation, and 20.5 % low self-esteem. Low self-esteem was strongly associated with a higher risk of poor ART adherence (adjusted odds ratio(aOR) (95 % confidence interval (95 %CI)): 2.2 (1.1-4.3); p = 0.022). Living with the father (aOR (95 %CI): 0.6 (0.3-1.1); p = 0.085) or in a household with a televisor (aOR (95 %CI): 0.5 (0.2-1.1); p = 0.069) were slightly associated with a lower risk of poor adherence to ART. Having both parents alive (aOR (95 %CI): 0.4 (0.2-0.9); p = 0.031) or receiving ART with efavirenz or dolutegravir (aOR (95 %CI): 0.5 (0.2-0.9); p = 0.047) was strongly associated with a lower likelihood of having a detectable VL. Moreover, detectable viral load was slightly less frequent in adolescents whose household was equipped with a television (p = 0.084) or who were completely disclosed for HIV status (p = 0.070).

CONCLUSION

This study found that co-morbid low self-esteem had higher odds of poor ART adherence in HIVIA. Moreover, both poor ART adherence, and detectable viral load were associated with impaired life conditions in HIVIA.

A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review

Background

Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities.

Objectives

The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability).

Search Methods

The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases.

Selection Criteria

Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included.

Data Collection and Analysis

Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models.

Main Results

Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations.

Authors' Conclusions

At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.

Measurement-Based Care for Depression in Youth: Practical Considerations for Selecting Measures to Assess Depression, Associated Features and Functioning

Identification and management of major depressive disorder (MDD) in children and adolescents remains a significant area of public health need. The process for identifying depression (e.g. screening) and management (e.g. measurement based care [MBC]) is substantially enhanced by utilization of clinical measures and rating scales. Measures can be self- or caregiver reported or clinician rated. They can aid recognition of at-risk individuals for future assessment and assist in clinical diagnosis and management of depression. In addition to assessing symptoms of depression, rating scales can be used to assess important associated features (e.g. anxiety, trauma) and functional outcomes (e.g. quality of life, performance/productivity). In this manuscript, we discuss practical considerations for clinicians and researchers when selecting rating instruments for assessing depression, associated factors, functioning, and treatment outcomes (i.e. adherence and side effects) as part of MBC in youth and provide a summary of rating scales commonly used in research and clinical settings.

Living through a pandemic: depression and anxiety experienced by youth living with HIV in South Africa

Youth living with HIV (YLHIV) face significant psychosocial challenges and are at increasedrisk of developing depression and anxiety. This study aims to invesBgate symptoms ofdepression, anxiety and associaBons with psychosocial factors in YLHIV during the first andthird waves of the COVID-19 pandemic. This longitudinal study enrolled 135 YLHIV (ages 12-21) in Cape Town, South Africa. Measures administered telephonically included theCoRonavIruS Health Impact Survey (CRISIS quesBonnaire), Center for Epidemiologic StudiesDepression Scale (CES-D), Beck Anxiety Inventory and Beck Youth Inventory. During the firstwave of COVID-19, 7.5% and 8.0% of YLHIV were depressed (<18 and ≥18 years,respecBvely), and 10% and 4% of parBcipants were anxious (<18 and ≥18 years). During thethird wave, 8.9% and 40.6% of YLHIV were depressed (<18 and ≥18 years), and 13.3% and12.5% (<18 and ≥18 years) were anxious. Depression and anxiety were measured using cutoffscores provided by clinical measures. Symptoms of depression and anxiety in YLHIVescalated over the course of the COVID-19 pandemic. Socio-economic factors, substanceuse, disrupted support and stability concerns were associated with depression and anxiety.These data highlight the increasing need of mental health support and social intervenBonsfor YLHIV in post-pandemic South Africa.

Project ASPIRE: A feasibility randomized controlled trial of a brief intervention for reducing risk of depression and alcohol-related harms among South African adolescents

OBJECTIVE

Brief interventions could reduce adolescents' risk of depression and alcohol-related harms, but evidence of their feasibility and acceptability for low-and middle-income countries is lacking. To address this gap, we conducted a feasibility trial of the ASPIRE intervention, a four-session multi-component counselling intervention for South African adolescents.

METHOD

We recruited 117 adolescents who met our inclusion criteria. Participants were randomly assigned to the ASPIRE intervention or a comparison condition. Outcomes were assessed at baseline, six-week, and three-month post-randomization time points. Primary outcomes were based on feasibility of study procedures and intervention delivery (assessed on seven predetermined progression criteria). Clinical outcomes (risk of depression and alcohol harms) were secondary.

RESULTS

Despite modifications to all study procedures arising from Covid-19 restrictions, five of the seven key progression criteria were fully met, including: feasibility of data collection and outcome measures, counsellor competencies, randomization and blinding, adverse advents, and acceptability of the intervention. The progression criterion for recruitment and intervention retention were not fully met.

CONCLUSION

Findings suggest that the ASPIRE intervention was generally feasible to deliver and acceptable to adolescents. However, modifications to the trial design and intervention delivery are needed to optimize the validity of a definitive randomized controlled trial of the ASPIRE intervention.

The complex associations between adiposity, fitness, mental wellbeing and neurocognitive function after exercise: A randomized crossover trial in preadolescent children

The aim of the present study was to examine the associations of adiposity and fitness on the preadolescent brain's response to acute exercise. In a sample of 58 children (ages 8-10; 19 females), demographic measures of age, sex, IQ, puberty, and socioeconomic status were considered. Children participated in a randomized crossover study, whereby they completed two different interventions; seated rest or treadmill walking, counterbalanced across participants. Associations between adiposity measures (standardized body mass index [BMI-Z], whole body percent fat [%Fat], visceral adipose tissue [VAT]), cardiorespiratory fitness measures (VO2max and Fat-Free VO2) were assessed on self-reported measures of mental wellbeing, and cognitive performance (response accuracy, reaction time) and neuroelectric (P3 amplitude and latency) indices of a Go/NoGo task following both exercise and rest interventions. Higher adiposity (whole-body percent fat, BMI-Z) was associated with higher trait anxiety (P's≤0.05) and disordered eating (P's≤0.05) scores. Higher fitness (VO2max) was associated with lower childhood depression scores (P=0.02). Regression analyses yielded specific post-exercise neurocognitive associations with adiposity-related (VAT, BMI-Z), and fitness-related (FF-VO2) outcomes, after controlling for post-rest neurocognitive outcomes. VAT was positively associated with post-exercise P3 ERP Latency for the Go task (P≤0.001); BMI-Z was negatively associated with P3 ERP amplitudes for the Go task (P's≤0.005); FF-VO2 was negatively associated with P3 ERP latency for the Go/NoGo task (P's≤0.05), and positively associated with NoGo task accuracy (P≤0.001). Overall, adiposity and fat-free fitness measures yield sensitive and differential associations with neurocognitive performance after exercise and after rest interventions.

Factor and network analysis of psychosis-like experiences and depressive symptoms in a sample of Finnish adolescents entering psychiatric services

AIM

Psychosis-Like Experiences (PLEs) and depressive symptoms are correlated in clinical adolescent populations. However, symptom-level associations between the two phenomena are not clear.

METHODS

We analysed factor structures of a PLE instrument, the Prodromal Questionnaire-Brief (PQ-B), based on dimensions of positive symptoms of schizophrenia, and a depression measurement instrument, the Beck Depression Inventory (BDI-21A) and performed a network analysis of item-level associations between the two measures. The sample consisted of 417 adolescents (range 13-18 years of age, mean 14.9 years, 72.4% females) entering secondary psychiatric services at Helsinki metropolitan area, Finland.

RESULTS

Confirmatory factor analysis resulted in adequately fitting 2-factor solution, one for PQ-B and one for BDI-21, with a strong correlation coefficient of 0.605 between the two factors. In the network analysis, PQ-B and BDI-21 both formed their own clusters, and two significant pathways were estimated between PQ-B and BDI-21 clusters: 1. the association between paranoid thinking and distorted body image, and 2. the association between somatic preoccupation and worry about problems of one's mind.

CONCLUSIONS

Even though on a general, factor level, PLEs and depressive symptoms were strongly correlated, unique associations between symptoms of the two constructs were sparse. These findings should be considered in the psychiatric assessment and in the care of adolescents.

Forced labor and health-related outcomes. The case of beggar children

BACKGROUND

Limited qualitative research indicates that beggar children might be victims of forced labor, and/or modern slavery. However, research quantifying the manifestations and health-related implications of forced child begging is missing in the literature. Because forced child begging might be physically, mentally, socially and morally harmful to children, research on the subject is needed to inform policymaking.

OBJECTIVE

This study addressed the gap in the literature on child begging. The work aimed to examine whether beggar children are victims of forced labor, as well as to identify the manifestations of forced labor in beggar children, and assess whether forced child begging relates to deteriorated health-related quality of life and mental health.

PARTICIPANTS AND SETTING

The study focused on the capital city of Greece, Athens, where beggar children are not a hard-to-reach group. Cross-sectional data were collected in 2011, 2014, 2018 and 2022, with 127 beggar children taking part in the study.

METHODS

The study adopted the Anti-Slavery International research toolkit, which sets methodological guidelines on researching child begging. A scale was developed to quantify forced child begging based on the International Labour Organization's definition of forced labor. Multivariate regressions were performed with a view to answering the research questions.

RESULTS

The study found that most beggar children were forced by others to beg, experienced threats of violence, physical and verbal harassment aimed at forcing them to beg, and difficulty in terms of being allowed by others to stop begging. Moreover, it was found that forced child begging was positively associated with living with unknown people, hunger due to food unavailability the previous week, and negatively associated with native beggar children. In addition, it was discovered that forced child begging was negatively associated with health-related quality of life and mental health for beggar children.

CONCLUSION

Based on the study's findings, child begging encompasses elements of coercion and the deprivation of human freedom. These factors collectively amount to instances of forced labor and/or modern slavery. Policies should ensure that beggar children are removed from harm's way, and that those forcing children to beg are brought to justice, thus preventing forced child begging. Policies to reduce poverty, which constitutes the root of forced child begging, should also be considered. The goal is to create a protective environment where children can thrive, free from forced labor. In line with Sustainable Development Target 8.7, policy makers should take immediate and effective measures to eradicate forced labor, and end modern slavery.

Longitudinal Relationships Between Help-Seeking Intentions and Depressive Symptoms in Adolescents

PURPOSE

Cross-sectional studies have shown an association between lower help-seeking intentions and greater depressive symptoms among adolescents. However, no longitudinal study has examined the direction of this association. The current study investigated whether help-seeking intentions and depressive symptoms are reciprocally associated at the within-person (individual) level during early to mid-adolescence.

METHODS

Longitudinal data on help-seeking intentions and depressive symptoms in adolescents were obtained from a population-based birth cohort study (Tokyo Teen Cohort; N = 3,171) at four time points (10y, 12y, 14y, and 16y). A random intercept cross-lagged panel model was used to evaluate the within-person prospective associations between help-seeking intentions and depressive symptoms.

RESULTS

At the within-person level, significant associations were consistently observed between antecedent greater depressive symptoms and subsequent lower help-seeking intentions across all time points (10y-12y: standardized regression coefficient (β) = -0.12, p < .001; 12y-14y: β = -0.07, p < .05; and 14y-16y: β = -0.09, p < .01). Meanwhile, significant within-person associations were partly observed between antecedent lower help-seeking intentions and subsequent greater depressive symptoms from 10y to 12y (β = -0.07, p < .05) and from 14y to 16y (β = -0.12, p < .001). These prospective associations were almost the same when adjusted for the number of potential confidants as a time-varying confounder.

DISCUSSION

Adolescents with worsening depressive symptoms may become increasingly reluctant to seek help over time. Proactive early recognition and intervention with support from parents, teachers, and other individuals may facilitate the management of depression in adolescents.

The Global Diet Quality Score is associated with nutrient adequacy and depression among Vietnamese youths

The Global Diet Quality Score (GDQS) has been recommended as a simple diet quality metric that is reflective of both nutrient adequacy and noncommunicable disease outcomes. It has been validated among women of reproductive age (15-49 years) in diverse settings but not specifically among younger women. This paper examines the relationship between the GDQS and nutrient adequacy, anthropometric outcomes, and depressive symptoms among 1001 Vietnamese young women aged 16-22 years. In energy-adjusted models, the GDQS was significantly (p < 0.05) and positively correlated with intakes of protein (ρ = 0.23), total fat (ρ = 0.06), nine micronutrients (calcium, iron, zinc, vitamin C, riboflavin, niacin, vitamin B6, folate, and vitamin A) (ρ = 0.12-0.35), and the mean probability of adequacy of micronutrients (ρ = 0.28). Compared to young women with optimal GDQS, those with low and very low GDQS were two to five times more likely to have a mean probability of nutrient adequacy less than 50% and showed two to three times higher odds for depression. No association was observed for GDQS and anthropometric outcomes. In conclusion, the GDQS performed well in capturing nutrient adequacy and depressive symptoms among Vietnamese young women. Further research is warranted to explore the relationship between diet quality and depression in other settings.

Red cell distribution width and depressive symptoms: A failed replication in female adolescents

OBJECTIVES

Despite the increasingly high prevalence and serious consequences of depression in adolescents, there is a lack of economical and reliable biomarkers to aid the diagnostic process. Recent findings suggest that red blood cell distribution width (RDW) is an easily obtainable biomarker of depression in adults. Here, we aimed to replicate the finding of increased RDW in clinically depressed adolescents.

METHODS

Data from depressed adolescent female patients (n = 93) and healthy controls (HC) (n = 43) aged 12-17 years from the AtR!Sk-bio cohort study were retrospectively analysed. We compared RDW between groups and tested whether there was an association between RDW and depression severity and global (psychiatric) symptom severity. We also examined the influence of age on RDW.

RESULTS

There was no significant difference between depressed patients and healthy controls and no association between RDW and depression severity. However, higher RDW values were associated with greater global symptom severity. Regardless of group, there was a positive association between RDW and age.

CONCLUSIONS

RDW appears to be unfit as an aid for clinical diagnosis of depression in adolescents, but may be useful in assessing global psychiatric symptom burden.

What Can Facial Movements Reveal? Depression Recognition and Analysis Based on Optical Flow Using Bayesian Networks

Recent evidence have demonstrated that facial expressions could be a valid and important aspect for depression recognition. Although various works have been achieved in automatic depression recognition, it is a challenge to explore the inherent nuances of facial expressions that might reveal the underlying differences between depressed patients and healthy subjects under different stimuli. There is a lack of an undisturbed system that monitors depressive patients' mental states in various free-living scenarios, so this paper steps towards building a classification model where data collection, feature extraction, depression recognition and facial actions analysis are conducted to infer the differences of facial movements between depressive patients and healthy subjects. In this study, we firstly present a plan of dividing facial regions of interest to extract optical flow features of facial expressions for depression recognition. We then propose facial movements coefficients utilising discrete wavelet transformation. Specifically, Bayesian Networks equipped with construction of Pearson Correlation Coefficients based on discrete wavelet transformation is learnt, which allows for analysing movements of different facial regions. We evaluate our method on a clinically validated dataset of 30 depressed patients and 30 healthy control subjects, and experiments results obtained the accuracy and recall of 81.7%, 96.7%, respectively, outperforming other features for comparison. Most importantly, the Bayesian Networks we built on the coefficients under different stimuli may reveal some facial action patterns of depressed subjects, which have a potential to assist the automatic diagnosis of depression.

Exposure to ambient air pollution with depressive symptoms and anxiety symptoms among adolescents: A national population-based study in China

BACKGROUND

Air pollution threatens adolescents' physical health and adversely affects adolescents' mental health. Previous studies mostly focused on the effects of air pollution on physical health, but there were few studies on the effects of air pollution on mental health.

METHODS

We collected scores of depressive symptoms and anxiety symptoms from 15,331 adolescents from 43 schools in eleven provinces in September and November 2017. The data on air pollution comes from the China High Air Pollutants dataset, which included concentrations of particulate matter with diameters of ≤1.0 μm (PM₁), diameters of ≤2.5 μm (PM_2.5), and diameters of ≤10 μm (PM₁₀), as well as nitrogen dioxide (NO₂). The associations between air pollution and depressive and anxiety symptoms among adolescents were estimated using generalized linear mixed models.

RESULTS

Depressive and anxiety symptoms among Chinese adolescents were 16% and 32%, respectively. In the adjusted model, an interquartile range (IQR) increase from PM_2.5 was associated with the odds of anxiety symptoms [odds ratio (OR) = 1.01; 95% confidence interval (CI): 1.00, 1.01, P = 0.002]. Also, an IQR increase in PM₁₀ was significantly associated with the odds of anxiety symptoms (OR = 1.01; 95% CI: 1.00, 1.01, P = 0.029). Compared with the lowest quartile, the adjusted OR of anxiety symptoms for the highest quartile of PM_2.5 and PM₁₀ were 1.29 (1.15, 1.44) and 1.23 (1.06, 1.42), respectively. In addition, the association between PM_2.5 and depressive symptoms was significant. The robustness of the results was also confirmed by stratification and sensitivity analyses.

CONCLUSIONS

Exposure values for airborne particulate matter were associated with depressive symptoms and anxiety symptoms in adolescents, particularly for PM_2.5 and PM₁₀ with anxiety symptoms among adolescents.

Factorial and network structure of the Reynolds Adolescent Depression Scale (RADS-2) in Peruvian adolescents

Depression in young people is considered a public health problem, given that it affects their personal, social, and academic lives; therefore, early detection of depressive symptoms is of importance for a favorable prognosis. This study aimed to estimate the psychometric properties of the second edition of the Reynolds Adolescent Depression Scale (RADS-2) in Peruvian adolescents. The sample was composed of 917 Peruvian adolescents, aged 13 to 18 years (M = 15,241, SD = 1,020), who were selected from two public educational institutions in Metropolitan Lima. Confirmatory factor analysis supported the 25-item model with the four-dimensional structure and its overall and interdimensional reliability. This structure was found to be gender invariant. Finally, network analysis was performed to assess the relationships and centralities of the depressive symptoms of the validated version of the RADS-2. The results show that the RADS-2 measure is a consistent and reliable test that yields valid results in the Peruvian adolescent context.

Perceived Gender Transition Progress, Gender Congruence, and Mental Health Symptoms Among Transgender Adolescents

PURPOSE

Transgender adolescents (TGAs) have high risk for experiencing mental health problems, but little is known about how aspects of gender identity relate to their mental health symptoms. Evidence from child and adult samples of transgender individuals indicates making progress in gender transition milestones and higher levels of congruence between gender identity and gender expression are related to fewer mental health problems. We examined associations between perceived transition progress, gender congruence, and mental health symptoms in a diverse, nationwide sample of TGAs.

METHODS

TGAs (n = 1,943) participated in a cross-sectional online survey. Perceived gender transition progress, gender congruence, and depressive and anxiety symptoms were assessed. Path analysis was conducted to examine whether transition progress was related to mental health symptoms via higher levels of gender congruence.

RESULTS

Most TGAs had undertaken at least one social transition step (98%), but only 11% had taken medical transition steps. Higher gender congruence was associated with lower mental health symptoms. Greater transition progress was associated with higher gender congruence, and perceived transition progress evidenced negative indirect associations with mental health symptoms. TGAs identifying with binary identities (transmasculine and transfeminine youth) reported lower levels of transition progress and gender congruence compared to other subgroups of TGAs.

DISCUSSION

Higher levels of perceived transition progress and gender congruence are related to lower mental health symptoms among TGAs. Mental health interventions tailored to the unique developmental needs of TGAs are needed given high risk for mental health problems within this population, and interventions addressing transition progress and gender congruence should be examined.

Prevalence of depression and anxiety, and associated factors, among Chinese primary and high school students: A cross-sectional, epidemiological study

INTRODUCTION

This study aimed to investigate the prevalence of depression and anxiety, and associated factors, among Chinese children and adolescents aged 8-18 years who attend primary or high school.

METHODS

A total of 23 005 primary and high school students were recruited from February to December, 2019 for this cross-sectional study. The questionnaire included demographic information, questions assessing suicidality, resilience, depression (Center for Epidemiological Studies Depression Scale for Children), and anxiety (Screen for Child Anxiety Related Disorders). Binary logistic regression was used to analyze the independent correlates of depression and anxiety.

RESULTS

Overall, 13.06% of participants experienced depressive symptoms, 22.34% experienced anxiety symptoms, 26.34% experienced transient suicidal ideation, 2.23% had serious suicidal ideation, and 1.46% had a history of suicide attempts. Anxiety (odds ratio [OR], 4.935; 95% confidence interval [CI][4.442-5.485]), suicidality (OR, 2.671; 95% CI[2.203-3.237]), skipping breakfast (OR, 1.920; 95% CI[1.348-2.736]), sleep duration (OR, 0.470; 95% CI[0.398-0.556]) and self-expectations (OR, 1.924; 95% CI[1.550-2.389]) were associated with depression (all p < .05). Depression (OR, 4.424; 95% CI[3.983-4.914]), female sex (OR, 1.903; 95% CI[1.759-2.060]), school-based traumatic experience(s) (OR, 1.905; 95% CI[1.747-2.077]), relationships with teachers (OR, 1.575; 95% CI[1.103-2.249]), and suicidality (OR, 1.467; 95% CI[1.218-1.766]) were associated with anxiety symptoms (all p < .05).

DISCUSSION

Depression and anxiety are common among school-age children and adolescents in China. Childhood school- and family-based traumatic experience(s), female sex, and lifestyle factors (eating breakfast, sleep duration, exercising, and Internet use) are significantly associated with mental health among children and adolescents. Developing interventions targeting these factors to protect students from depression and anxiety are needed.

[Problèmes de santé mentale chez les adolescents camerounais infectés par le VIH par voie verticale]

INTRODUCTION

Adolescents living with HIV are more likely to experience mental health challenges compared to their peers who do not have HIV. However, there is a lack of data regarding the mental health of adolescents living with HIV in Cameroon. Understanding risk factors and protective factors that influence mental health amongst adolescents is critical for effective programming. The purpose of this study was to estimate the prevalence and the factors associated with depression in adolescents infected with HIV and receiving ART in a Cameroonian referral hospital.

METHODS

This was a cross-sectional study which enrolled adolescents perinatally infected with HIV, aged 10-19 years, on antiretroviral treatment and cared for at "Centre Mère et Enfant de la Fondation Chantal Biya", Yaounde, Cameroon. Structured questionnaires, including validated French versions of the Coopersmith Child Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC) and the Coopersmith Self Esteem Inventory (SEI), were administered to the study participants by the healthcare providers.

RESULTS

All in all, 302 adolescents were recruited in the study at a median age of 15.2 years (interquartile range : 12.0 - 17.5), including 159 (52.7 %) girls. Both parents had died for 57 (18.9 %) adolescents ; only the father was alive for 64 (21.2 %) ; only the mother was alive for 48 (15.9 %), both parents were alive for 133 (44.0 %). This study found prevalence of 26.5 % for severe depression, 36.4 % for suicidal ideation, 29.1 % for high/very high anxiety, and 20.5 % for low self-esteem. No factor was found significantly associated with severe depression but there was a trend towards decreased risk of severe depression among adolescents whose mother was alive [OR= 0.4 (0.1-1.0), p = 0.084].

CONCLUSION

This study found that elevated depression, anxiety, and low self-esteem symptoms were prevalent among Cameroonian adolescents perinatally infected with HIV. Services and systems should go beyond clinical management of HIV and address the psychosocial and mental health of adolescents. The indicators of mental health among adolescents infected with HIV should be included in HIV program reporting.

Increasing Confident Thoughts in an Adolescent With Autism: A Pilot Study

Private events such as thoughts and feelings occur within the individual and are inaccessible to outside observers. Creating interventions for troublesome private events, therefore, is challenging. Precision teaching has a number of studies where participants self-count targeted private events and intervene by engaging in 1-min timings of positive thoughts. The present pilot study extended the 1-min timing procedure to a 15-year-old girl with autism spectrum disorder. After the intervention, the participant's level of despondent thoughts dropped by ÷4.55 in level, with lower levels of anxiety and depression as measured by the Beck Anxiety Inventory and the Beck Depression Inventory.

Psychometric properties of the Swedish version of the Reynolds Adolescent Depression Scale second edition (RADS-2) in a clinical sample

Objective: Observed and predicted increases in the global burden of disease caused by major depressive disorder (MDD) highlight the need for psychometrically robust multi-dimensional measures to use for clinical and research purposes. Reynolds Adolescent Depression Scale second edition (RADS-2) is an internationally well-validated scale measuring different dimensions of adolescent depression. The Swedish version has previously only been evaluated in a normative sample.Methods: We collected data from patients in child and adolescent psychiatry and primary care and performed: (1) Confirmatory factor analysis (CFA) to evaluate the established four-factor structure, (2) Analyses of reliability and measurement invariance, (3) Analyses of convergent and discriminant validity using the Montgomery-Asberg Depression Rating Scale, the depression subscales of the Beck Youth Inventories and the Revised Child Anxiety and Depression Scale, as well as the Patient Reported Outcome Measurements Information System, peer-relationships and physical activity item banks.Results: Recruited participants (n = 536, 129 male and 407 female, mean age 16.45 years, SD = 2.47, range 12 - 22 years) had a variety of psychiatric diagnoses. We found support for the four-factor structure and acceptable to good reliability for the subscale and total scores. Convergent and discriminant validity were good. Measurement invariance was demonstrated for age, sex, and between the present sample and a previously published normative sample. The RADS-2-scores were significantly higher in the present sample than in the normative sample. In this clinical study, the Swedish RADS-2 demonstrated good validity and acceptable to good reliability. Our findings support the use of RADS-2 in Swedish clinical and research contexts.

Diagnostic Test Accuracy of the Beck Depression Inventory for Detecting Major Depression in Adolescents: A Systematic Review and Meta-Analysis

Major depressive disorder in adolescents is closely linked to poor social, cognitive, and academic outcomes, including suicidality. The Beck Depression Inventory (BDI), a screening tool, is one of the most widely used instruments for detecting depression; however, its diagnostic test accuracy has not yet been thoroughly examined. This study, therefore, aimed to systematically review and perform a meta-analysis to evaluate the accuracy of the BDI for detecting depression in adolescents. In August 2020, a search was conducted in the EMBASE, MEDLINE, CINAHL, and PsycArticles databases, and following a review against predefined eligibility criteria, 22 studies were finally included. The quality of the included articles was evaluated, and a hierarchical regression model was used to calculate the pooled estimates of sensitivity and specificity; 73.0% (95% CI; 62.0%, 81.8%) and 80.3% (72.8%, 86.1%) in cutoff 16, respectively. The findings indicated the BDI is a reliable and useful tool to screen adolescents' depression.

Psychometric validity of the Montgomery and Åsberg Depression Rating Scale for Youths (MADRS-Y)

BACKGROUND

Because of all the serious consequences of major depressive disorder (MDD), it is important to screen for MDD in adolescents. The aim of this study was to test the psychometric properties of the newly developed self-report depression scale MADRS-Y for adolescents in a normative Swedish sample.

METHODS

The study included 620 adolescents in the age range of 12-20 years old. The normative sample was randomly split into two equal parts, to perform principal component analysis (PCA) on sample one and confirmatory factor analysis (CFA) on sample two. We investigated the psychometrics.

RESULTS

The result from the PCA suggested that all 12 potential items should be used, and the items loaded on the same construct of depression. The CFA supported the one-factor structure with good fit indices. Measurement invariance was confirmed, allowing interpretation regardless of gender or age differences. Reliability was good, α .89, for both samples separately. Test-retest reliability was good to excellent (intraclass correlation coefficients = .87 and .91). Evidence of convergent and discriminant validity was shown.

CONCLUSIONS

The results in the current study suggest that the MADRS-Y is a brief, reliable, and valid self-report questionnaire of depressive symptoms for adolescents in the general population.

Adjusted Cutoff Scores Increase Sensitivity of Depression Screening Measures in Adolescents With Type 1 Diabetes

OBJECTIVE

To measure the acceptability and diagnostic accuracy of commonly used depression screening measures to determine ideal cutoff scores that sensitively identify depressive disorders in adolescents with type 1 diabetes (T1D).

RESEARCH DESIGN AND METHODS

One hundred adolescents (12-17 years old) completed a reference standard, semistructured diagnostic interview and both long and short versions of five commonly used depression screening measures in the United States. To assess feasibility and acceptability, we used screener completion time and participant ratings, respectively. We used descriptive statistics, area under the receiver operating characteristic (ROC) curve analyses, and paired-sample area differences under the ROC curve to assess each measure's diagnostic validity against our reference standard and to determine ideal cutoff scores for this sample.

RESULTS

Adolescents had a mean age of 15.0 ± 1.7 years, time since T1D diagnosis of 6.0 ± 4.1 years, and glycated hemoglobin (HbA1c) of 8.9 ± 1.8%. Sixty percent of adolescents were male, 15% endorsed a current depressive disorder, and 15% endorsed lifetime suicidality. Measures demonstrated low sensitivity (0.33-0.67) to detect current depressive disorders using preexisting cutoff scores. However, adjusted cutoff scores increased sensitivity and reduced false negatives. All depression screening measures demonstrated "good" to "excellent" predictive validity, and the Children's Depression Inventory-2 Short version demonstrated significantly greater diagnostic accuracy than the Patient Health Questionnare-2 item version for adolescents.

CONCLUSIONS

Clinics should consider using screening measures with the greatest diagnostic accuracy as identified in this study and adjusting measure cutoff scores to increase sensitivity and reduce false negatives.