Functional connectivity analysis of childhood depressive symptoms

BACKGROUND

Childhood depression is a highly distinct and prevalent condition with an unknown neurobiological basis. We wish to explore the resting state fMRI data in children for potential associations between neural connectivity and childhood depressive symptoms.

METHODS

A longitudinal birth cohort study with neuroimaging data obtained at 4.5, 6.0 and 7.5 years of age and the Children Depression Inventory 2 (CDI) administered between 8.5 and 10.5 years was used. The CDI score was used as the dependent variable and tested for correlation, both simple Pearson and network based statistic, with the functional connectivity values obtained from the resting state fMRI. Cross-validated permutation testing with a general linear model was used to validate that the identified functional connections were indeed implicated in childhood depression.

RESULTS

Ten functional connections and four brain regions (Somatomotor Area B, Temporoparietal Junction, Orbitofrontal Cortex and Insula) were identified as significantly associated with childhood depressive symptoms for girls at 6.0 and 7.5 years. No significant functional connections were found in girls at 4.5 years or for boys at any timepoint. Network based statistic and permutation testing confirmed these findings.

CONCLUSIONS

This study revealed significant sex-dependent associations of neural connectivity and childhood depressive symptoms. The regions identified are implicated in speech/language, social cognition and information integration and suggest unique pathways to childhood depressive symptoms.

Evaluation of the Psychometric Properties of the Persian Version of Children's Depression Inventory in Iranian Adolescents

Objectives: Children's Depression Inventory (CDI) is a self-report tool for measuring depression in children and adolescents. In this study, the psychometric properties of the Persian version of CDI were investigated in an Iranian adolescent population. Methods: This study was conducted on a sample of 480 adolescent boys and girls in the age range of 12-18 years. The results showed that 23.6% of the study population were 11-13 years old, 62.1% were 14-16 years old, and 14.3% were 17-18 years old. Also, 48.5% of the sample were girls, and 51.5% were boys. To investigate the convergent and divergent validity, Beck's Depression Inventory-Second Edition (BDI-II) and Teenage Inventory of Social Skills were used, respectively. Results: The reliability coefficient of CDI, based on Cronbach's alpha, indicated the relatively high internal consistency of the items (0.907). The results of the exploratory factor analysis showed that CDI has a saturated factor, explaining 50.11% of the variance in the data. Also, goodness-of-fit indices of confirmatory factor analysis showed that the model is well suited for explaining depression. The present results also showed a negative correlation between children's depression and the social skills subscale and a positive correlation between children's depression and BDI-II score. Conclusions: The construct validity of the questionnaire was confirmed. It can be concluded that the Persian version of CDI has adequate reliability and validity. Therefore, it can be used as a useful tool for early screening of depression in adolescents due to its easy use and specific design for children and adolescents.

Measuring depression in adolescence: Evaluation of a hierarchical factor model of the Children's Depression Inventory and measurement invariance across boys and girls

BACKGROUND

One of the most widely used instruments to measure depression in childhood and adolescence is Kovacs's Children's Depression Inventory (CDI). Even though this particular measure sparked massive interest among researchers, there is no clear consensus about its factorial structure. It has been suggested that inconsistencies in findings can be partly ascribed to the cultural context. The aim of this study was a) to examine and verify the factor structure of CDI in the Czech population and b) to assess gender-related psychometric differences using the mean and covariance structure (MACS) approach and differential item functioning (DIF) analysis.

METHODS

The research sample consisted of 1,515 adolescents (ages 12 to 16 years, 53.7% female) from a non-clinical general population. Based on exploratory factor analysis (EFA) on a random subsample (N = 500), we proposed a model that was subsequently tested on the rest of the sample (N = 1,015) using confirmatory factor analysis (CFA). Following the MACS procedure, we assessed measurement invariance in boys and girls. The between-group comparison was further supplemented by a DIF analysis.

RESULTS

The proposed hierarchical four-factor model (General Symptoms, Negative Self-Concept, Inefficiency, and Social Anhedonia) with a second-order factor of depression fitted the data reasonably well (χ2 = 1281.355; df = 320; RMSEA = 0.054, CFI = 0.925). Regarding gender differences, we found no substantial signs of measurement invariance using the MACS approach. Boys and girls differed in first-order latent means (girls scored higher on General Symptoms with a standardized mean difference of 0.52 and on Negative Self-Concept with a standardized mean difference of 0.31). DIF analysis identified three items with differential functioning. However, the levels of differential functioning were only marginal (in two items) or marginal/moderate and the presence of DIF does not substantially influence scoring of CDI.

CONCLUSION

In the general adolescent population in the Czech Republic, the CDI can be considered a reliable instrument for screening purposes in clinical settings and for use in research practice. Instead of the originally proposed five-factor model, we recommend using the newly established four-factor structure. The measure seems to show only marginal psychometric differences with respect to gender, and overall measurement invariance in boys and girls seems to be a tenable assumption.

Structure and Psychometric Properties of the Penn State Worry Questionnaire for Children in Chinese Adolescents

The present research introduced the Penn State Worry Questionnaire for Children (PSWQ-C) to China and evaluated its structure and psychometric properties in Chinese adolescent samples. The PSWQ-C is a 14-item self-report questionnaire designed to measure the generality, excessiveness, and uncontrollability aspects of pathological worries in children and adolescents. Factor analysis results suggested that the three reverse-scored items represented one or more unknown factors rather than worry; thus, they were discarded and the remaining 11 positively worded items formed the Chinese version of the PSWQ-C (CH-PSWQ-C). The CH-PSWQ-C was found to have acceptable internal consistency reliability and favorable convergent and divergent validity by examining its correlations with measures of anxiety, depression, and some personality characteristics. To illustrate the utility of the CH-PSWQ-C in Chinese adolescent samples, we used the CH-PSWQ-C to explore the moderating effect of neuroticism on the relationship between earthquake experiences and worry; the results suggested that adolescents with high neuroticism were more vulnerable to worry after experiencing serious disasters.

Reliability and validity of the Children's Depression Inventory-Japanese version

BACKGROUND

Depression has major negative consequences for individuals and society, and psychological assessment tools for early disease detection are needed. The aim of this study was to investigate the reliability and validity of an updated Japanese version of the Children's Depression Inventory (CDI-J) and set a cut-off score for the detection of depression.

METHODS

The participants consisted of 465 children and adolescents aged 7-17 years. The control (CON) groups consisted of students recruited from elementary and junior-high school (CONEJ) and children recruited from among hospital staff members (CONRE), while the outpatient clinical (OPC) groups consisted of pediatric psychosomatic outpatients (OPCPD) and adolescent psychiatric outpatients (OPCPS). The CON and OPC CDI-J scores underwent factor analysis using varimax rotation, followed by measurement invariance analysis. The Youth Self-Report (YSR) was administered to assess concurrent validity. The Mini-International Neuropsychiatric Interview was administered to the OPC group to diagnose current depressive symptoms. Receiver operating characteristics (ROC) analysis was conducted to evaluate case-finding performance and to set cut-off points for the detection of depression.

RESULTS

The CDI-J was reliable in terms of internal consistency (Cronbach α = 0.86; mean inter-item correlation, 0.16). Re-test reliability was substantial (mean interval 18 days: γ = 0.59, P < 0.05). The four-factor solution exhibited adequate internal consistency (range, 0.52-0.73) and correspondence (Pearson correlation of 0.65 with the YSR) for both the CON and OPC groups. On ROC analysis the optimal cut-off score was 23/24.

CONCLUSION

The CDI-J can be used as a reliable and well-validated instrument alongside standard diagnostic procedures.

The relationships between perfectionism, anxiety and depression across time in paediatric eating disorders

OBJECTIVE

The aim was to examine in children and adolescents with eating disorders the relationship between perfectionism, anxiety, and depression at intake assessment and whether intake perfectionism was significantly associated with anxiety and depression at 6 months and 12 months post-intake review.

METHOD

Participants were 167 females aged 10-17 years (M = 14.6, SD = 1.20) with a diagnosis of an eating disorder, who were assessed at intake to an eating disorders treatment program to receive either inpatient, day or outpatient care. Participants were re-assessed at 6 and 12 months post-intake review.

RESULTS

At intake and 6 and 12 months post intake review perfectionism had a significant positive correlation with anxiety and depression. Perfectionism did not however determine change in anxiety and depression over time at 6 and 12 months post-intake review.

CONCLUSIONS

Despite perfectionism being significantly associated with anxiety and depression, further research is required to explore the relationships between perfectionism, anxiety and depression over time.

A Factor Analysis and Test of Longitudinal Measurement Invariance of the Children's Depression Inventory (CDI) Across Adolescence

Depression increases dramatically during adolescence. This finding has been demonstrated using multiple measures, including the Children's Depression Inventory (CDI). The CDI is one of the most commonly used measures to assess depression in youth. However, there is little agreement on its factor structure, and it is possible that its factor structure changes over time. Yet, no study to date has investigated whether this structure is longitudinally invariant from early- to mid-adolescence. The present study examined the factor structure of the CDI in a sample of 227 adolescents aged approximately 13 at baseline and 16 at follow-up. The analyses revealed that a one-factor structure was a good fit to the data at each assessment. Moreover, tests of measurement invariance supported configural, metric, and scalar invariance across time. These findings suggest that changes in depressive symptoms during adolescence are due to true developmental changes, rather than changes in measurement properties.

The Psychometrics of the Children’s Depression Inventory When Used With Children Who Are Chronically Ill and Matched Community Comparison Peers

The Children’s Depression Inventory (CDI) is used to screen for depression in children aged 7 years to 16 years. The purpose of this study is to examine the psychometrics of the CDI in a sample of children who are chronically ill ( N = 350) and in a sample of matched community comparison peers ( N = 357), and determine if the psychometrics of the scale are similar in both groups. Data were aggregated from previous reports examining social and emotional functioning of children with six chronic diseases and matched comparisons. The CDI was completed in the homes of all participants. No significant differences between groups on CDI scores, distributions, reliability, or validity were observed. Findings suggest that the psychometrics of the CDI are similar for children with chronic diseases compared with typically developing children. The CDI may be an effective screening tool for use with children who have chronic health conditions.

Modelling the factor structure of the Child Depression Inventory in a population of apparently healthy adolescents in Nigeria

Background

Childhood and adolescent depression is common and often persists into adulthood with negative implications for school performances, peer relationship and behavioural functioning. The Child Depression Inventory (CDI) has been used to assess depression among adolescents in many countries including Nigeria but it is uncertain if the theoretical structure of CDI appropriately fits the experiences of adolescents in Nigeria. This study assessed varying theoretical modelling structure of the CDI in a population of apparently healthy adolescents in Benue state, Nigeria.

Methods

Data was extracted on CDI scale and demographic information from a total of 1, 963 adolescents (aged 10–19 years), who participated in a state wide study assessing adolescent psychosocial functioning. In addition to descriptive statistics and reliability tests, Exploratory Factor Analysis (EFA) and Confirmatory Factor analysis (CFA) were used to model the underlying factor structure and its adequacy. The suggested new model was compared with existing CDI models as well as the CDI’s original theoretical model. A model is considered better, if it has minimum Root Mean Square Error of Approximation (RMSEA<0.05), Minimum value of Discrepancy (CMIN/DF<3.0) and Akaike information criteria. All analyses were performed at 95% confidence level, using the version 21 of AMOS and the R software.

Results

Participants were 14.7±2.1 years and mostly male (54.3%), from Monogamous homes (67.9%) and lived in urban areas (52.2%). The measure of the overall internal consistency of the 2-factor CDI was α = 0.84. The 2-factor model had the minimum RMSEA (0.044), CMIN/DF (2.87) and least AIC (1037.996) compared to the other five CDI models.

Conclusion

The child depression inventory has a 2-factor structure in a non-clinical general population of adolescents in Nigeria. Future use of the CDI in related setting may consider the 2-factor model.

Possible Relationships Between Depressive Symptoms and Reading

One hundred and fifty-five students (average age of 127 months) were tested using the WRAT-3 reading and arithmetic subtests, the Self-Perception Profile for Children with Learning Disabilities (SPPLD) and the Children’s Depression Inventory (CDI). One year later they were again tested with the same instruments. The authors hypothesised that increases in depressive symptoms would lead to lowered performance in reading and arithmetic, over and above any changes in performance due to self-perceived competence in those areas. Although academic self-concept scores did not account for any significant variation in academic growth/decline, CDI scores did account for a small but significant portion of variance in academic score changes. Depressive symptoms, even at nonpatho-logic levels, are able to affect academic performance over time.

Racial/ethnic differences in youth depression indicators: An item response theory analysis of symptoms reported by White, Black, Asian, and Latino youths

Accurate assessment of dysfunction is central to clinical psychological science, essential for valid conclusions about prevalence, risk, and appropriate intervention. Measures applied without adjustment across diverse racial/ethnic groups may risk errors if measurement equivalence has not been established. We tested this possibility in the domain of youth depression, applying item response theory (IRT) and differential item functioning (DIF) analyses to reports by White, Black, Latino, and Asian youths (N = 2,335) on the most widely-used measure of symptoms, the Children's Depression Inventory (CDI). Analyses revealed that 77% of CDI items were non-equivalent indicators of symptom severity across groups. CDI sum scores exhibited marked over-estimations of group differences and inappropriate classification as "clinically-elevated" for 29% of Latino, 23% of Black, and 10% of Asian youths. Applying DIF adjustment corrected these errors. The study demonstrates a useful strategy for ethnically sensitive assessment, applicable to other symptom domains and ethnic groups.

Developing Partnerships in the Provision of Youth Mental Health Services and Clinical Education: A School-Based Cognitive Behavioral Intervention Targeting Anxiety Symptoms in Children

Clinical scientists are calling for strong partnerships in the provision of evidence-based treatments for child mental health problems in real-world contexts. In the present study, we describe the implementation of a cognitive-behavioral intervention (CBI) to address grade 5 children's anxiety symptoms. The CBI arose from a long-standing partnership between University and Education Department stakeholders. The partnership integrates school-based, evidence-informed treatment delivery with clinical education, and also supports a school-based psychology clinic to provide assessment and treatment services to children attending schools within the catchment area and clinical training for university graduate students. Children in the active condition (N=74) completed the CBI during regular class time, while children in the control condition (N=77) received the standard classroom curriculum. Children's anxiety and depressive symptoms, threat interpretation biases (perceived danger and coping ability), and perceptions of their social skills were assessed before and after condition. Children in the active condition reported significant improvements in self-reported anxiety symptoms, and perceptions of their social skills and coping ability, whereas no significant differences were observed for children in the control condition from pre- to post-assessment. For a subset of children assessed 12 months after the CBI (n=76), symptom improvement remained stable over time and estimates of danger and coping ability showed even greater improvement. Results demonstrate the value of strong stakeholder partnerships in innovative youth mental health services, positive child outcomes, and clinical education.

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

BACKGROUND

Depression symptom screening scales are often used to determine a clinical diagnosis of major depressive disorder (MDD) in prevention research. The aim of this review is to systematically examine the reliability, validity and diagnostic utility of commonly used screening scales in depression prevention research among children and adolescents.

METHODS

We conducted a systematic review of the electronic databases PsycINFO, PsycEXTRA and Medline examining the reliability, validity and diagnostic utility of four commonly used depression symptom rating scales among children and adolescents: the Children׳s Depression Inventory (CDI), Beck Depression Inventory (BDI), Center for Epidemiologic Studies - Depression Scale (CES-D) and the Reynolds Adolescent Depression Scale (RADS). We used univariate and bivariate random effects models to pool data and conducted metaregression to identify and explain causes of heterogeneity.

RESULTS

We identified 54 studies (66 data points, 34,542 participants). Across the four scales, internal reliability was 'good' (pooled estimate: 0.89, 95% Confidence Interval (CI): 0.86-0.92). Sensitivity and specificity were 'moderate' (sensitivity: 0.80, 95% CI: 0.76-0.84; specificity: 0.78, 95% CI: 0.74-0.83). For studies that used a diagnostic interview to determine a diagnosis of MDD, positive predictive power for identifying true cases was mostly poor. Psychometric properties did not differ on the basis of study quality, sample type (clinical vs. nonclinical) or sample age (child vs. adolescent).

LIMITATIONS

Some analyses may have been underpowered to identify conditions in which test performance may vary, due to low numbers of studies with adequate data.

CONCLUSIONS

Commonly used depression symptom rating scales are reliable measures of depressive symptoms among adolescents; however, using cutoff scores to indicate clinical levels of depression may result in many false positives.

Normative data for female adolescents with eating disorders on the Children's Depression Inventory

OBJECTIVE

Given the importance of assessing depressive symptoms and suicidal ideation in adolescents with eating disorders (EDs), the aim was to provide normative data on the Children's Depression Inventory (CDI) for female adolescents presenting for treatment of an ED.

METHOD

The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry (N = 1000), a prospective, ongoing registry study comprising consecutive pediatric tertiary ED referrals. Females (N = 256; 12-17 years) with DSM-5 EDs completed the CDI at intake.

RESULTS

Results on the CDI revealed a pattern of increasing depressive scores with age and higher scores among patients with anorexic spectrum disorders. The prevalence of suicidal ideation was high and had the same pattern as CDI scores. The mean score on the CDI in the sample was higher than community samples and clinical samples of adolescents with post-traumatic stress disorder, obsessive compulsive disorder, and other clinical disorders.

DISCUSSION

Females adolescents with EDs are at high-risk of depression and suicidal ideation. These data provide information about variation in CDI scores to guide clinicians in interpretation of scores.

Factor structure of the children's depression inventory in a multisite sample of children and adolescents with chronic pain

This study examined the factor structure of the Children's Depression Inventory (CDI) among children and adolescents with chronic pain using exploratory and confirmatory factor analysis in a large, multisite sample of treatment-seeking youth. Participants included 1,043 children and adolescents (ages 8-18) with a range of chronic pain complaints who presented for initial evaluation at 1 of 3 tertiary care pediatric chronic pain clinics across the United States. They completed the CDI and reported on pain intensity and functional disability. Factor analysis was conducted using a 2-step (exploratory and confirmatory) approach. Results supported a 5-factor model for the CDI with good fit to the data. The distribution and item-total correlations of the somatic items (eg, pain complaints, fatigue) were explored in this sample. Results indicate that the CDI is a useful tool for assessing depressive symptoms in youth with chronic pain, but some caution is warranted in interpreting the clinical significance of scores in light of the overlap of specific symptoms common to both pain and depression.

PERSPECTIVE

The CDI can be considered a valid tool for assessing mood symptoms in children with chronic pain. Caution is encouraged when interpreting the clinical significance of scores due to symptom overlap between chronic pain and depression.

Psychometric Properties of the Children's Depression Inventory in Community and Clinical Sample

The psychometric characteristics of the Children's Depression Inventory, CDI (Kovacs, 1992) in a sample of 1705 participants (792 boys and 913 girls) and a clinical sample of 102 participants (42 boys and 60 girls) between 10 and 18 years old are presented. Reliability coefficients range, for both samples, from .82 (test) to .84 (retest) in the community sample, and .85 (test, clinical sample); test-retest reliability is .81 in the community sample. The mean scores are similar to other Spanish and English ones. Girls score higher than boys. The cut-off point that best differentiates between depressive and community participants is 19, with a sensitivity of 94.7%, a specificity of 95.6%, a positive predictive value of .90, and a negative predictive value of .98.

Using the Children's Depression Inventory in youth with inflammatory bowel disease: support for a physical illness-related factor

The objective of the present investigation was to evaluate the factor structure of the Children's Depression Inventory (CDI) in adolescents with inflammatory bowel disease (IBD) to better understand the CDI's psychometric properties in a medically complicated population. An exploratory factor analysis was performed on CDI data collected from a clinical sample of 191 youth with IBD, aged 11 to 17 years. Exploratory factor analysis with quartimax rotation yielded 3 factors: mood, behavioral/motivational, and somatic complaints. Only the somatic factor (ie, fatigue, sleep, decreased appetite, and worry about aches and pain) showed a significant positive correlation with IBD severity. The CDI holds promise as a brief measure for the assessment of depressive features psychometrically independent of IBD severity and common steroid treatments as well as of nongastrointestinal specific somatic complaints in a sample of adolescents with IBD. Continued work in this area of research appears promising in honing the assessment of depressive and somatic symptoms in youths with IBD.

Age and gender differences in depression across adolescence: real or 'bias'?

BACKGROUND

Since developmental psychologists are interested in explaining age and gender differences in depression across adolescence, it is important to investigate to what extent these observed differences can be attributed to measurement bias. Measurement bias may arise when the phenomenology of depression varies with age or gender, i.e., when younger versus older adolescents or girls versus boys differ in the way depression is experienced or expressed.

METHODS

The Children's Depression Inventory (CDI) was administered to a large school population (N = 4048) aged 8-17 years. A 4-factor model was selected by means of factor analyses for ordered categorical measures. For each of the four factor scales measurement invariance with respect to gender and age (late childhood, early and middle adolescence) was tested using item response theory analyses. Subsequently, to examine which items contributed to measurement bias, all items were studied for differential item functioning (DIF). Finally, it was investigated how developmental patterns changed if measurement biases were accounted for.

RESULTS

For each of the factors Self-Deprecation, Dysphoria, School Problems, and Social Problems measurement bias with respect to both gender and age was found and many items showed DIF. Developmental patterns changed profoundly when measurement bias was taken into account. The CDI seemed to particularly overestimate depression in late childhood, and underestimate depression in middle adolescent boys.

CONCLUSIONS

For scientific as well as clinical use of the CDI, measurement bias with respect to gender and age should be accounted for.

Assessing Measurement Invariance of the Children’s Depression Inventory in Chinese and Italian Primary School Student Samples

This study tested the measurement invariance of Children’s Depression Inventory (CDI) and compared its factorial variance/covariance and latent means among Chinese and Italian children. Multigroup confirmatory factor analysis of the original five factors identified by Kovacs revealed that full measurement invariance did not hold. Further analysis showed that 4 of 21 factor loadings, 14 of 26 intercepts, and 12 of 26 item errors were noninvariant. Factor variance and covariance invariant tests revealed significant differences between Chinese and Italian samples. The latent factor mean comparison suggested no significant difference across the two groups. Nevertheless, the finding of partial metric and scalar invariance suggested that observed mean differences on the CDI items cannot be fully explained by the mean differences in the latent factor. These results suggest that researchers and practitioners exercise caution when gauging the size of the true national population differences in depressive symptoms among Italian and Chinese children when assessed via CDI. In addition to providing needed evidence on the use of the CDI in Italian and Chinese children specifically, the methods used in this research can serve more generally as an example for other cross-cultural assessment research to test structural equivalence and measurement invariance of scales and to determine why it is important to do so.

Assessing secondary control and its association with youth depression symptoms

Extensive research has linked youth depression symptoms to low levels of perceived control, using measures that reflect primary control (i.e., influencing objective conditions to make them fit one's wishes). We hypothesized that depressive symptoms are also linked to low levels of secondary control (i.e., influencing the psychological impact of objective conditions by adjusting oneself to fit them). To test the hypothesis, we developed the Secondary Control Scale for Children (SCSC), examined its psychometrics, and used it to assess the secondary control-depression symptomatology association. In a large adolescent sample, the SCSC showed factorial integrity, internal consistency, test-retest stability, convergent and discriminant validity, and accounted for more than 40% of the variance in depression symptoms. Consistent with evidence on risk and gender, depression symptoms were more strongly associated with secondary control in girls and primary control in boys. Assessing secondary control may help us understand youth depression vulnerability in girls and boys.

Long-Term Outcomes of an Australian Universal Prevention Trial of Anxiety and Depression Symptoms in Children and Youth: An Evaluation of the Friends Program

This study evaluated the long-term effectiveness of the FRIENDS Program in reducing anxiety and depression in a sample of children from Grade 6 and Grade 9 in comparison to a control condition. Longitudinal data for Lock and Barrett's (2003) universal prevention trial is presented, along with data from 12-month follow-up to 24- and 36-month follow-up. Results of this study indicate that intervention reductions in anxiety reported in Lock and Barrett were maintained for students in Grade 6, with the intervention group reporting significantly lower ratings of anxiety at long-term follow-up. A significant Time x Intervention Group x Gender Effect on Anxiety was found, with girls in the intervention group reporting significantly lower anxiety at 12-month and 24-month follow-up but not at 36-month follow-up in comparison to the control condition. Results demonstrated a prevention effect with significantly fewer high-risk students at 36-month follow-up in the intervention condition than in the control condition. Results are discussed within the context of prevention research.

A Study of the Predictive Validity of the Children’s Depression Inventory for Major Depression Disorder in Puerto Rican Adolescents

This study aims to evaluate the predictive validity of the Children’s Depression Inventory items for major depression disorder (MDD) in an outpatient clinic sample of Puerto Rican adolescents. The sample consisted of 130 adolescents, 13 to 18 years old. The five most frequent symptoms of the Children’s Depression Inventory that best predict the presence of MDD were “I worry about others’ aches and pains,” “I don’t have any friends,” “I have to push myself to do my schoolwork,” “I have trouble sleeping every night,” and “I do very badly in subjects I used to be good in.” Results demonstrated that the symptoms that best predict MDD in Puerto Rican adolescents are not necessarily the ones commonly described as characteristic of the disorder.

Testing the hierarchical structure of the Children's Depression Inventory: a multigroup analysis

Using exploratory and confirmatory factor analyses, the aims were (a) to obtain, describe, and compare different solutions of three, five, and six first-order factors raised in the previous literature about the Children's Depression Inventory (CDI); (b) analyze the number and nature of the second-order factors; (c) test which model best reproduces the CDI structure; and (d) test possible developmental differences between child and adolescent samples. The CDI was applied to 4,707 Spanish children and adolescents with an age range between 7 and 16 years. Results show that best models considered five or six factors, including Social Problems (Anhedonia), Negative Affect, Externalizing, School Problems, and Negative Self-Esteem (Self-Deprecation). Also, a factor of Biological Dysregulation obtained some support. Higher-order factors do not reproduce the classical distinction between internalizing and externalizing symptoms. Finally, no large developmental differences in the CDI structure were found between children and adolescents samples.

Early adolescent psychopathology as a predictor of alcohol use disorders by young adulthood

Few prospective studies have examined the relation between early adolescent conduct disorder (CD) symptoms and the development of alcohol use disorders (AUD) by young adulthood. The relative contribution of other forms of adolescent psychopathology (i.e., attention-deficit hyperactivity disorder, depression, anxiety/withdrawal) to the development of AUD also remains poorly understood. There is some suggestion that the co-occurrence of conduct disorder symptoms with other forms of psychopathology may interact synergistically in predicting later alcohol use problems. The current study explores these issues using data on 506 boys from the oldest sample of the Pittsburgh Youth Study (PYS). Consistent with prior research, early conduct disorder symptoms emerged as a consistent predictor of increased AUD symptoms and an alcohol dependence diagnosis by young adulthood. In contrast, adolescent boys with high levels of anxiety/withdrawal had lower levels of AUD symptoms and were less likely to develop alcohol dependence by young adulthood. Increased depression in early adolescence was associated with higher AUD symptoms and alcohol abuse and dependence diagnoses by young adulthood, but only for boys with high levels of conduct disorder symptoms. No evidence was found for a relation between attention-deficit hyperactivity disorder symptoms and AUD symptoms or diagnoses after controlling for co-occurring psychopathology.

Perceived control mediates the relation between parental rejection and youth depression

Previous research suggests that both perceived parental control and rejection may be linked to youth depression. However, research has not definitively determined which dimension matters more, nor examined mediation within a clinical sample. We used a sample of clinically referred youth (aged 7-17) to determine (a) which parenting dimension is more closely associated with youth depression, and (b) whether youngsters' perceptions of control mediated the association. Perceived parental rejection was strongly linked to depressive symptoms (perceived parental control was not); youth perceived control did in fact mediate the association, and robustly so across gender and age groups. The findings suggest a developmental process in depression, plus potential foci for prevention and treatment programs.

Association of depression with Body Mass Index, sedentary behavior, and maladaptive eating attitudes and behaviors in 11 to 13-year old children

We examined the relation of different behavioral dimensions of depression with weight-related variables (BMI percentile, sedentary behavior, eating attitudes, and weight control behaviors) in children aged 11 to 13 years. Depression was assessed using the Children's Depression Inventory (CDI). Sedentary behavior was measured in 45 sixth grade students (23 boys and 22 girls) using a validated 24-hour recall instrument, the Self-Administered Physical Activity Checklist. BMI was calculated directly from measured height and weight (kg/m2). The Children's Eating Attitudes Test (ChEAT) was used to measure eating attitudes and weight control behaviors. There were not significant gender differences in reported minutes (142 vs. 91 minutes for boys vs. girls; p=0.25) of sedentary behavior (i.e., television watching and video game playing). The major finding of this study was that certain aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) were correlated with higher levels of sedentary behavior in children aged 11 to 13. A factor analysis of the study variables indicated that most dimensions of depression, sedentary behavior, and body size represent distinct but correlated behavioral dimensions. This study provides support for a link between specific aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) and sedentary behavior in children.

An example of psychological adjustment in chronic illness: Hirschsprung's disease

The aim of this study was to investigate the outcomes after definitive surgical correction for children with Hirschsprung's disease (HD) and the psychosocial impact of HD on the child and family. The total sample comprised 72 children with HD along with their families. The development of a condition-specific questionnaire measured the functional and psychosocial outcomes for children with HD with parental perception of their child's condition. Psychiatric measures were also examined to assess psychiatric morbidity. The greatest functional problem after definitive surgery for HD was faecal soiling (76%). The principle findings of the study were that (1) HD did not have a significant impact on the child's rate of psychiatric morbidity and levels of hopefulness in comparison to the normal population, (2) surgical and psychosocial functioning improved with increasing age and, (3) families remain troubled about their future with HD and dealing with psychosocial difficulties related to the condition (such as distress because of faecal soiling). Specifically, faecal soiling was found to be physically, emotionally and psychosocially distressing complication. Bowel functioning and psychosocial distress improves with increasing age and parental and medical professional support. Despite the significant impairment of faecal continence, we found that children/young adults with HD have minimal psychiatric morbidity, yet experience condition-specific psychosocial problems (e.g. embarrassment and distress/discomfort). HD does not increase the rate of clinical psychiatric morbidity in children and families with HD, but does determine the context of their daily distress and concern.

Parent and Child Psychological Factors in Pediatric Syncope and Other Somatic Symptoms

The authors examined associations among parental and child adjustment, child syncope, somatic, and school problems. Participants were children (N = 56) ages 7-18 years with syncope. Measures included syncope severity, parental distress, and children's internalizing symptoms. For children diagnosed negative for neurocardiogenic syncope (NCS), their fathers' and their own psychological symptoms were positively associated with the severity of syncope, whereas their mothers' functioning was negatively associated with the severity of syncope. Also, for the negative NCS group, fathers' psychological functioning was associated with children's nonsyncope somatic complaints but not with their school problems. For the positive NCS group, few significant father-child associations were found, but several significant positive associations were revealed between mothers' psychological symptoms and their children's syncope as well as somatic and school problems.

A practical guide to using ratings of depression and anxiety in child psychiatric practice

The objective of this paper is to provide pragmatic information on commonly used rating scales of depression and anxiety disorders with established psychometric properties. A comprehensive Medline search on the rating scales of depression and anxiety was conducted. Relevant research findings were further synthesized where possible, with the information on clinical use of the scales from manuals. Research findings replicating original studies, strengths, weaknesses, and scoring information were summarized for each scale, and psychometric properties were tabulated. Several rating scales are available for screening, determining the severity, as well as estimating treatment effects in depression and anxiety. It is prudent to use more than two scales, especially a combination of self-rating scale and a clinician rating scale. It is recommended that the depression and anxiety scales are used in concert to aid in differentiating these two disorders. Several new and improved scales are available, although they await further replication.

Relations of positive and negative affectivity to anxiety and depression in children: evidence from a latent variable longitudinal study

The tripartite model of anxiety and depression has been studied with adults; however, support is still emerging with children concerning measurement and relations between positive (PA) and negative (NA) affect and psychopathology. In this longitudinal study of 270 4th- to 11th-grade children (mean age = 12.9 years, SD = 2.23). confirmatory factor analysis supported a 2-factor orthogonal model of children's self-reported affect and revealed that the concurrent relations of NA and PA to anxiety and depression symptoms were consistent with the tripartite model. Structural equation modeling demonstrated moderate cross-time stability of trait PA and NA, consistent with a temperament view of these factors, as well as partial support for the role of NA and PA in the development of anxiety and depression symptoms in children.

Positive and negative affectivity in children: a multitrait-multimethod investigation

Examined the validity of the tripartite model of anxiety and depression and its internal structure in children. Measures of positive affect/surgency (PA/S) and negative affect/neuroticism (NA/N) and self-report and peer nominations of symptoms of depression and anxiety were completed by 104 children (mean age = 14.9 years, SD = 1.9). Parents completed measures of temperament and anxious and depressive symptoms. Multitrait-multimethod and confirmatory factor analyses (CFA) supported a 3-factor model that included separate Child and Parent NA/N factors and a joint PA/S factor. Child and Parent NA/N were related to symptoms of both depression and anxiety, but neither parent nor peer symptom ratings related to Child NA/N. PA/S was primarily related to symptoms of depression. These results support aspects of the tripartite model in children and suggest caution in the use of multimethod assessment of children's temperament and internalizing symptoms.

An affect-based, hierarchical model of temperament and its relations with internalizing symptomatology

Examined the tripartite model of personality, which emphasizes negative affectivity (NA) and positive affectivity (PA) as central organizing dimensions of personality that are useful for discriminating psychopathologies. Conceptualizations of youth temperament also include second-order, organizing factors of negative emotionality/neuroticism and positive emotionality/extroversion that may differentially predict psychopathologies. A community sample of 290 10- to 17-year-old youth completed the Emotionality, Activity, and Sociability Temperament Survey (EAS), Positive and Negative Affectivity Schedule, and measures of symptoms of anxiety and depression. Factor analysis replicated the 5-factor structure of the EAS and revealed 2 independent second-order factors, negative temperament (NT) and positive temperament (PT). NT and PT demonstrated convergent and discriminant relations with NA and PA. Consistent with the tripartite model, NT was associated with both anxiety and depression scores, but PT was related to depression scores only.

An exploratory factor analysis of children's depression inventory scores in young children of substance abusers

A factor analytic study of scores obtained on the Children's Depression Inventory from a sample of 202 young children (M = 7.5 yr., SD = 2.2) of alcoholics and substance abusers was completed. A principal components factor analysis with an oblique rotation yielded five separate factors related to Negative Self-concept, Acting-out. Somatic/Disturbed Symptoms, Mood, and Hopelessness. In previous factor analytic studies of the Children's Depression Inventory with normal and clinical populations the primary factor obtained was formed by mood-related items. In contrast, the primary factor of the present analysis was formed by items concerning perceptions of self-concept, not mood. These results corroborated previously reported data from the Child Behavior Checklist suggesting that the depressive symptoms displayed by children of substance abusers are related to self-concept and externalization.

Ten-year review of rating scales. II: Scales for internalizing disorders

OBJECTIVE

This article, the second in the Journal's series of 10-year updates on rating scales, summarizes scales assessing internalizing disorders.

METHOD

The authors sampled articles on mood and anxiety disorders over the past 25 years, selected scales with multiple citations over many years, and reviewed their properties. Those with adequate psychometric properties, plus continued wide literature citations or a current special niche, are presented here.

RESULTS

Rating scales for depression were developed and/or examined in the 1980s. Despite generally strong properties, they lack clear construct validity. Most have parent-report forms that broaden their suitability with youths. Anxiety scales were developed bimodally. Those developed in the 1960s to 1970s were downward modifications of adult scales. They have been criticized for unclear constructs and unsuitability for youths. Newer scales developed in the 1990s have addressed these problems and have parent-report forms. However, their utility is still being determined.

CONCLUSIONS

Rating scales can reliably, validly, and efficiently measure youths' internalizing psychopathology. They have great utility in research, treatment planning, and accountability in practice. However, the user must define the goals of measurement, consider the construct the scale measures, and use the scale within its defined capabilities. The use of more than one scale for a task is recommended.

Perceived social inadequacy and depressed mood in adolescents

The goal of the study was to examine stability in, and the relationship between, perceived social inadequacy and depressed mood in a sample of community adolescents. The Checklist of Adolescent Problem Situations (CAPS) and Children's Depression Inventory (CDI) were administered to 224 high-school students on two occasions 4 months apart. CDI and CAPS scores were positively correlated and test-retest reliability was high in both instruments. Cross-lagged panel correlations, controlled for within-time associations, did not significantly differ. Results indicated that perceived social inadequacy in adolescents is stable over time-independent of its association with depressed mood.

Joint factor analysis of the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale

Used a joint factor analysis with the Children's Depression Inventory (CDI; Kovacs, 1980/81, 1992) and Revised Children's Manifest Anxiety Scale (RCMAS; C. R. Reynolds & Richmond, 1978, 1985) to identify items that uniquely measured depression and anxiety. Data from 750 youngsters in Grades 4 through 7 were analyzed using principal-axis factoring with an oblique rotation. Salient factors were identified using guidelines provide by Gorsuch (1997). Item overlap and the large negative affectivity component across instruments were evident. Items that overlapped or had nonsalient loadings were eliminated. The sample was randomly split into 2 groups of 375 and analyses were repeated. Results indicated that a unique 9-item depression factor composed largely of items representing a negative view of oneself existed. In addition, a unique 7-item anxiety factor emerged that consisted of items reflecting worry. The validity of these abbreviated scales was explored using a separate sample of 131 students in Grades 4 through 9. The abbreviated scales were correlated with scales of positive and negative affect consistent with predictions. Findings suggest exploring alternative scoring strategies for the CDI and RCMAS to eliminate problems associated with overlapping items.

Symptom endorsement differences on the Children's Depression Inventory with children and adolescents on an inpatient unit

Responses to the Children's Depression Inventory (CDI; Kovacs, 1992), administered during intake, were collected from 521 children and adolescents (aged 7 to 17) at an inpatient crisis stabilization unit. Participants were grouped into 1 of 3 diagnostic groups: solely depressive, solely aggressive, or both depressive and aggressive. Self-report of symptoms for each diagnostic group, age and gender differences, and racial and ethnic differences in symptoms were examined in this study. There was a significant difference between the endorsement pattern of solely depressive and solely aggressive participants, whereas those categorized as both depressive and aggressive displayed an endorsement pattern similar to those who were solely aggressive. There was a significant gender difference in overall symptom report, with girls showing higher overall symptom levels than boys. This gender difference was significant for both the younger and the older age groups. These results held true even when gender was covaried out of the diagnostic group analyses and when diagnostic group was covaried out of the gender analyses. Symptom endorsement did not differ based on race and ethnicity. The primary contribution of this study centers around the findings from the item analyses of the CDI. These results are discussed in relation to the discriminant validity of the CDI and the need for additional research into comorbidity.