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Adolescent Depression (description, assessment and diagnosis)

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Demographic Information

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This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled, and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of adolescent depression that they are likely to see in their clinical practice.

Base Rates of Adolescent Depression in Different Clinical Settings

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Setting (Reference) Base Rate Demography Diagnostic Method
Children and adolescents attending primary care (Mathet et al., 2002)[1] 5.0% French general practitioner network CES-D, CBCL, KSADS-PL y
National Comorbidity Survey-Adolescent (ages 13-18) (Merikangas et al., 2010)[2] 6.9%-15.4% All of U.S.A. NCS-A Interview Schedule p, y
Great Smoky Mountains Study: Community Sample (ages 9-13) (Costello et al. 1997)[3] .03-1.45% North Carolina CAPA
Acute psychiatric hospitalizations in 2009-2010 – children (under the age of 15) (Blader & Carlson, 2010) 13% All of U.S.A. Centers for Disease Control survey of discharge diagnoses
High school students (Lewinsohn et al., 1993)[4] 9.6% Northwestern U.S.A. high school KSADS
Gender differences, males and females, respectively (Merikangas et al., 2010))][2] 7.5%-15% All of U.S.A. NCS-A Interview Schedule p, y
Meta-analysis, adolescents 13 to 18 years (Costello, 2006)[5] 5.7% Varied DISC, CIDI, SDI, K-SADS, CAS, CAPA, IOW, DAWBA
National Comorbidity Survey-Adolescent Supplement (NCS-A) (Avenevoli et al., 2015)[6] 11.0% All of U.S.A. CIDI
Ethnically diverse sample of middle school (Grades 6-8) students (Roberts et al., 1997)[7] 1.9% (Chinese descent) to 6.6% (Mexican descent) American middle school DISC

p:Parent interviewed as component of diagnostic assessment; y:youth interviewed as part of diagnostic assessment.

Note: BDI = Beck Depression Inventory, PHQ = Patient Health Questionnaire, KSADS = Kiddie Schedule for Affective Disorders and Schizophrenia, PL = Present and Lifetime version, NCS-A = National Comorbidity Survey- Adolescent, CAPA = Child and Adolescent Psychiatric Assessment[8]

Diagnosis

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Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly attributable to another medical condition.

  1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
  3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
  4. Insomnia or hypersomnia nearly every day.
  5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
  6. Fatigue or loss of energy nearly every day.
  7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

Diagnostic Changes

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DSM-5 contains several new depressive disorders, including

  • disruptive mood dysregulation disorder
  • premenstrual dysphoric disorder

DSM-5 conceptualizes chronic forms of depression in a somewhat modified way. What was referred to as dysthymia in DSM-IV now falls under the category of persistent depressive disorder.

Major Depressive Disorder

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Neither the core criterion symptoms applied to the diagnosis of major depressive episode nor the requisite duration of at least 2 weeks has changed from DSM-IV. Criterion A for a major depressive episode in DSM-5 is identical to that of DSM-IV, as is the requirement for clinically significant distress or impairment in social, occupational, or other important areas of life, although this is now listed as Criterion B rather than Criterion C. The coexistence within a major depressive episode of at least three manic symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier “with mixed features.” The presence of mixed features in an episode of major depressive disorder increases the likelihood that the illness exists in a bipolar spectrum; however, if the individual concerned has never met criteria for a manic or hypomanic episode, the diagnosis of major depressive disorder is retained.

In DSM-IV, there was an exclusion criterion for a major depressive episode that was applied to depressive symptoms lasting less than 2 months following the death of a loved one (i.e., the bereavement exclusion).

Specifiers for Depressive Disorders

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Suicidality represents a critical concern in psychiatry. Thus, the clinician is given guidance on assessment of suicidal thinking, plans, and the presence of other risk factors in order to make a determination of the prominence of suicide prevention in treatment planning for a given individual. A new specifier to indicate the presence of mixed symptoms has been added across both the bipolar and the depressive disorders, allowing for the possibility of manic features in individuals with a diagnosis of unipolar depression. A substantial body of research conducted over the last two decades points to the importance of anxiety as relevant to prognosis and treatment decision making. The “with anxious distress” specifier gives the clinician an opportunity to rate the severity of anxious distress in all individuals with bipolar or depressive disorders.

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  • Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS PL)- Hardcopy in assessment file cabinet at Finley.
  • Diagnostic Interview for Children and Adolescents
  • Child and Adolescent Psychiatric Assessment (CAPA)
  • Child Behavior Checklist (CBCL)- Hardcopy in assessment file cabinet at Finley.
  • Teacher’s Report Form (TRF)- Hardcopy in assessment file cabinet at Finley.
  • Youth Self Report (YSR)- Hardcopy in assessment file cabinet at Finley.

Areas Under the Curve (AUC) and Likelihood Ratios (LR) for Potential Screening Measures

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Screening Measure (Primary Reference) AUC LR+ (score) LR- (score) Citation Clinical Generalizability
CBCL Anxious/Depressed Scale T-score (Achenbach, 1991)[9] .70 (N=470) 3.78 (60+) .39 (<60) (Nolan et al., 1996)[10] High. Large diverse sample with mixed depression sample compared to samples without depression.
CBCL Anxious/Depressed Scale T-score (Achenbach, 1991)[9] .75 (N=1445) 1.49 (raw score 9+) .67 (raw score ≤) (Eimecke et al., 2011)[11] --
CBCL Affective Problems Scale T-score (Achenbach, 1991)[9] .78 (N=1445) 1.49 (raw score 9+) .67 (raw score ≤) (Eimecke et al., 2011)[11] --
YSR (Achenbach, 1991)[9] .81 (N=207) -- -- (Rey, et al., 1992)[12] --
WHO-5 (Bech et al., 2003)[13] .885 (N=294) 4.40 (raw score 11+) .15 (raw score ≤) (Christensen et al., 2015)[14] General sample of adolescents from Norway and Denmark
HSCL-6 (short version of SC-90) (Christensen et al., 2005)[15] .8547(N=294) 3.8 (raw score 9+) .19 (raw score ≤) (Christensen et al., 2015)[14] General sample of adolescents from Norway and Denmark
HSCL-10 (short version of SCL-90) (Haavet et al., 2007)[16] .8862 (N=294) Boys: 7.2, Girls:3.2 (raw score 16/10) Boys:.14, Girls:.17 (raw score ≤) (Haavet et al., 2011)[17] General sample of adolescents from Norway and Denmark
CDI (Kovacs, 1985)[18] .877 (N=406) 4.82 (raw score 12) .2 (raw score ≤) (Allgaier et al., 2012)[19] Medically ill children (pediatric hospital patients)
CDI:S (Short version of CDI) (Kovacs, 1985)[18] .882 (N=406) 3.18 (raw score 3) .09 (raw score ≤) (Allgaier et al., 2012)[19] Medically ill children (pediatric hospital patients)
6-item KADS (LeBlanc et al., 2002)[20] .89 (N=309) 3.17 (raw score 6) .11 (raw score ≤) (LeBlanc et al., 2002)[20] --

Note: CBCL = Child Behavior Checklist, YSR = Youth Self Report, HSCL-6 = Hopkins Symptom Checklist-6, HSCL-10= Hopkins Symptom Checklist-10, SCL-90= Symptom Checklist-90, CDI = Children’s Depression Inventory , CDI:S = Children’s Depression Inventory Short Version, KADS = Kutcher Adolescent Depression Scale

Empirically Supported Treatments

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  1. CBT Treatment
    1. Group plus parent component, individual, and individual plus parent/family component
    2. Additional psychotropic medication (David-Ferdon & Kaslow, 2008)
  2. Interpersonal Psychotherapy (Mufson et al., 2012)
    1. Brief 12-16 session therapy

Process and Outcome Measures

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4.1 Severity and Outcome
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4.1.a – Table of Clinically Significant Change Benchmarks (Table 3)
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Measure Subscale Cut-off scores Critical Change
(unstandardized scores)
Benchmarks Based on Published Norms
A B C 95% 90% SEdifference

Beck Depression Inventory-II

4 22 15 9 8 4.8
CBCL T-scores
(2001 Norms) 		Total 49 70 58 5 4 2.4
Benchmarks Based on Mood Samples
Gracious et al., 2002[21]
Young Mania Rating Scale - Parent
(Full) 		n/a 5.2 22.1 14.4 4.3 3.6 2
Young Mania Rating Scale - Parent
(Brief) 		n/a 6.8 27.4 17.5 5 4.2 2.5
INSERT NEW TEXT HERE
4.1.b – Beck Depression Inventory- II, ages 13 and up (BDI; Beck et al., 1996)
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4.1.c – KSADS Depression Rating Scale (Axelson, 2006)
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4.1.d – Children’s Depression Rating Scale-Revised (CDRS-R; Elva et al., 1996)
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4.1.e – Children’s Depression Inventory, ages 7-17 (CDI; Kovacs, 1992)
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Local Resources

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Mitch Prinstein, Ph.D. & Jennifer Kogos Youngstrom, Ph.D.-- especially for diagnostic evaluation, consultation, and psychosocial interventions; The Durham County Guidance Clinic (CGC); The Duke Program in Child Anxiety and Affective Disorders

References

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  1. ^ Mathet, F; Martin-Guehl, C; Maurice-Tison, S; Bouvard, MP (2002). "Prevalence of depressive disorders in children and adolescents attending primary care. A survey with the Aquitaine Sentinelle Network". L'Encephale. 29 (5): 391–400. PMID 14615688.
  2. ^ a b Merikangas, KR; He, JP; Burstein, M; Swanson, SA; Avenevoli, S; Cui, L; Benjet, C; Georgiades, K; Swendsen, J (October 2010). "Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A)". Journal of the American Academy of Child and Adolescent Psychiatry. 49 (10): 980–9. PMID 20855043.
  3. ^ Costello, EJ; Farmer, EM; Angold, A; Burns, BJ; Erkanli, A (May 1997). "Psychiatric disorders among American Indian and white youth in Appalachia: the Great Smoky Mountains Study". American journal of public health. 87 (5): 827–32. PMID 9184514.
  4. ^ Lewinsohn, PM; Hops, H; Roberts, RE; Seeley, JR; Andrews, JA (February 1993). "Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students". Journal of abnormal psychology. 102 (1): 133–44. PMID 8436689.
  5. ^ Costello, EJ; Erkanli, A; Angold, A (December 2006). "Is there an epidemic of child or adolescent depression?". Journal of child psychology and psychiatry, and allied disciplines. 47 (12): 1263–71. PMID 17176381.
  6. ^ Avenevoli, S; Swendsen, J; He, JP; Burstein, M; Merikangas, KR (January 2015). "Major depression in the national comorbidity survey-adolescent supplement: prevalence, correlates, and treatment". Journal of the American Academy of Child and Adolescent Psychiatry. 54 (1): 37-44.e2. PMID 25524788.
  7. ^ Roberts, RE; Roberts, CR; Chen, YR (February 1997). "Ethnocultural differences in prevalence of adolescent depression". American journal of community psychology. 25 (1): 95–110. PMID 9231998.
  8. ^ Angold, A; Costello, EJ (January 2000). "The Child and Adolescent Psychiatric Assessment (CAPA)". Journal of the American Academy of Child and Adolescent Psychiatry. 39 (1): 39–48. PMID 10638066.
  9. ^ a b c d Achenbach, Thomas M. (1991). Child behavior checklist for ages 4-18 ([11th print.] ed.). Burlington, VT: T.M. Achenbach. ISBN 0938565087.
  10. ^ Nolan, EE; Sverd, J; Gadow, KD; Sprafkin, J; Ezor, SN (December 1996). "Associated psychopathology in children with both ADHD and chronic tic disorder". Journal of the American Academy of Child and Adolescent Psychiatry. 35 (12): 1622–30. PMID 8973069.
  11. ^ a b Eimecke, SD; Remschmidt, H; Mattejat, F (March 2011). "Utility of the Child Behavior Checklist in screening depressive disorders within clinical samples". Journal of affective disorders. 129 (1–3): 191–7. PMID 20825996.
  12. ^ Rey, JM; Schrader, E; Morris-Yates, A (September 1992). "Parent-child agreement on children's behaviours reported by the Child Behaviour Checklist (CBCL)". Journal of adolescence. 15 (3): 219–30. PMID 1447409.
  13. ^ Bech, P; Olsen, LR; Kjoller, M; Rasmussen, NK (2003). "Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five Well-Being Scale". International journal of methods in psychiatric research. 12 (2): 85–91. PMID 12830302.
  14. ^ a b Christensen, KS; Haugen, W; Sirpal, MK; Haavet, OR (June 2015). "Diagnosis of depressed young people--criterion validity of WHO-5 and HSCL-6 in Denmark and Norway". Family practice. 32 (3): 359–63. PMID 25800246.
  15. ^ Christensen, KS; Fink, P; Toft, T; Frostholm, L; Ornbøl, E; Olesen, F (August 2005). "A brief case-finding questionnaire for common mental disorders: the CMDQ". Family practice. 22 (4): 448–57. PMID 15814580.
  16. ^ Haavet, OR; Christensen, KS; Sirpal, MK; Haugen, W (13 July 2007). "Diagnosis of depression among adolescents--a clinical validation study of key questions and questionnaire". BMC family practice. 8: 41. PMID 17626643.
  17. ^ Haavet, OR; Sirpal, MK; Haugen, W; Christensen, KS (April 2011). "Diagnosis of depressed young people in primary health care--a validation of HSCL-10". Family practice. 28 (2): 233–7. PMID 20937663.
  18. ^ a b Kovacs, M (1985). "The Children's Depression, Inventory (CDI)". Psychopharmacology bulletin. 21 (4): 995–8. PMID 4089116.
  19. ^ a b Allgaier, AK; Frühe, B; Pietsch, K; Saravo, B; Baethmann, M; Schulte-Körne, G (November 2012). "Is the Children's Depression Inventory Short version a valid screening tool in pediatric care? A comparison to its full-length version". Journal of psychosomatic research. 73 (5): 369–74. PMID 23062811.
  20. ^ a b LeBlanc, JC; Almudevar, A; Brooks, SJ; Kutcher, S (2002). "Screening for adolescent depression: comparison of the Kutcher Adolescent Depression Scale with the Beck depression inventory". Journal of child and adolescent psychopharmacology. 12 (2): 113–26. PMID 12188980.
  21. ^ Gracious, BL; Youngstrom, EA; Findling, RL; Calabrese, JR. (November 2002). "Discriminative validity of a parent version of the Young Mania Rating Scale". Journal of American Academy of Child and Adolescent Psychiatry. 41 (11). Retrieved 10 February 2014.
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