Objective: This is the first study to validate and to compare the Children's Depression Inventory (CDI) and its short version (CDI:S) as screening tools for medically ill children. The USPSTF found inadequate evidence regarding the harms of screening for MDD in children. There are five subscales within the assessment that measure different components of depression: The CDI is popular in part because it is easy to administer and score. 1 Month 2 Month 4 Month 6 Month. Results according to gender were inconsistent, and neither study stratified results according to age or ethnicity. In deciding whether to screen for MDD in children aged ≤11 years, primary care providers may want to consider the following issues. Kovacs M. Children's Depression Inventory (CDI). Tool by Author/Owner. E-mail: Copyright © 2016 by the American Academy of Pediatrics. Depression Screening Tools. No trials of psychotherapy or combined interventions in children examined harms. For example, because children don't have the same sophistication as adults related to understanding and reporting their emotions, their responses may not reflect their true emotional state. It also differentiates between major depressive disorder and dysthymic disorder in children and helps practitioners distinguish between these disorders and other psychiatric conditions. Initial screening in patients who may have depression NICE recommends that any patient who may have depression (especially those with a past history of depression or who suffer from a chronic physical illness associated with functional impairment) should be asked the following two questions [ … The CDI is a self-report assessment written at a first-grade reading level, which means that your child will be given the paper and pencil assessment to complete by themselves. This self-test is for personal use only. Depression outcomes were reported after 8 to 12 weeks of SSRI treatment or psychotherapy; the collaborative care study reported outcomes at 52 weeks. Both the American Academy of Pediatrics and the U.S. Preventive Services Task Force recommends that depression screening be conducted annually. It is useful in patients who are unlikely to call for help if needed i.e. García, MD, MPH (Pima County Department of Health, Tucson, AZ); Matthew Gillman, MD, SM (Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA); Jessica Herzstein, MD, MPH (independent consultant, Washington, DC); Alex R. Kemper, MD, MPH, MS (Duke University, Durham, NC); Alex H. Krist, MD, MPH (Fairfax Family Practice, Fairfax, and Virginia Commonwealth University, Richmond, VA); Ann E. Kurth, PhD, RN, MSN, MPH (New York University, New York, NY); Douglas K. Owens, MD, MS (Veterans Affairs Palo Alto Health Care System, Palo Alto, and Stanford University, Stanford, CA); William R. Phillips, MD, MPH (University of Washington, Seattle, WA); Maureen G. Phipps, MD, MPH (Brown University, Providence, RI); and Michael P. Pignone, MD, MPH (University of North Carolina, Chapel Hill, NC). If your child has been diagnosed with depression or will be evaluated for depression, you may have heard of the Children's Depression Inventory (CDI). MDD in children and adolescents is strongly associated with recurrent depression in adulthood; other mental disorders; and increased risk for suicidal ideation, suicide attempts, and suicide completion. Approximately 20% of deaths in people with anorexia nervosa are due to suicide. One study recruited adolescents from a primary care setting and compared the PHQ-A with a full diagnostic interview by a mental health professional. The number of items, administrative time to complete screening, and appropriate ages for screening vary. The USPSTF found no evidence on the long-term (>12 weeks) effects of SSRIs. Depression can also negatively affect the developmental trajectories of affected youth. Depression screening, reported with 96127, is typically a covered preventive service for adolescents age 12 to 18 and is a quality measure in many pediatric quality initiatives. 5 Depression: Incidence/Prevalence • In 2015, 30% of H.S. You will be redirected to aap.org to login or to create your account. New York: Multi-health Systems, Inc.; 1992. No studies found significant differences, although none of the studies was sufficiently powered for this outcome. In a separate recommendation statement, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in primary care settings, including among adolescents (I statement). (0) Not at Depression Scale for Children (DSC) The Center for Epidemiological Studies Depression Scale for Children (DSC) is a 20-item self-report for children and adolescents ages 6 to 17 years that screens for depression. A comparison to its full-length. Thank you, {{form.email}}, for signing up. The number of items in each tool, the administrative time required to complete them, and the appropriate ages for screening vary. Methods. In nationally representative US surveys, ∼8% of adolescents reported having major depression in the past year. Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions. This recommendation focuses on screening for MDD and does not address screening for other depressive disorders, such as minor depression or dysthymia. Screening positive on an initial screening test does not necessarily indicate the need for treatment. Other USPSTF recommendations on mental health topics pertaining to children and adolescents, including illicit drug and alcohol use, can be found on the USPSTF Web site (www.uspreventiveservicestaskforce.org). The following table is a snapshot of a work in progress of the American Academy of Pediatrics (AAP) Mental Health Leadership Work Group (MHLWG). MENTAL HEALTH TOOLS FOR PEDIATRICS . If your child has been diagnosed with depression or will be evaluated for depression, you may have heard of the Children's Depression Inventory (CDI). These chapters and Chapter 3, Office and Network Systems to Support Mental Health Care, offer general guidance concerning the selection of tools for use in primary care. The CRAFFT is a behavioral health screening tool for use with children and adolescents through age 20 years. NOTE: The American Academy of Pediatrics does not approve nor endorse any specific tool for screening purposes. Children and adolescents with MDD typically have functional impairments in their performance at school or work, as well as in their interactions with their families and peers. Is There a Test That Determines If You Have Depression? One recent RCT (N = 101) evaluated a 12-month collaborative care intervention in adolescents aged 13 to 17 years who screened positive for depression (60% with MDD) in 9 primary care clinics within 1 health system.17 The intervention was based on the Improving Mood-Promoting Access to Collaborative Treatment model and was adapted for adolescents. Pediatric Symptom Checklist (PSC) Penn State Worry Questionnaire for Children (PSWQ-C) Revised Child Anxiety Depression Scale (RCADS) Spence Children's Anxiety Scale (SCAS) Strengths and Difficulties Questionnaire (SDQ) Student Risk Screening Scale (SRSS) Vanderbilt ADHD Diagnostic Rating Scale; Multidimensional Anxiety Scale for Children (MASC 2) A modified version of the EPDS is included as part of the Family Questions section in the Survey of Well-being of Young Children (SWYC).. The Screening Tool Finder is not exhaustive, and other screening tools may be available. The same trial also reported on the harms of CBT plus fluoxetine versus placebo.10 No apparent differences were found. Screening is usually conducted in 2 phases: the initial screening is followed by a second phase in which skilled clinicians take into account contextual factors surrounding the patient’s current situation, either through additional probing or a formal diagnostic interview. Remission and residual symptoms after short-term treatment in the Treatment of Adolescents with Depression Study (TADS). Screening positive on an initial screening test does not necessarily indicate the need for treatment. The systematic review had eligibility requirements that excluded studies with subjects who had comorbid disorders. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. The causes of MDD are not fully known and likely involve a combination of genetic, biologic, and environmental factors. It also discriminates between ma… A number of chapters offer, in It was created by clinicians and researchers expert in the area of adolescent depression and the application of various scales and tools in clinical, research and institutional settings. Depression might also cause a child to make trouble or act unmotivated, causing others not to notice that the child is depressed or to incorrectly label the child as a trouble-maker or lazy. Understanding Your Liebowitz Social Anxiety Scale (LSAS) Results. • PHQ-9 Modified for • Pediatric Symptom Checklist (PSC-Y) The 2005 NHANES found that among children and adolescents aged 8 to 15 years, 2% of boys and 4% of girls reported having MDD in the past year. A raw score on the test is essentially meaningless without a professional's interpretation, so parents should always discuss the meaning of the results with the professional who evaluated the child. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. Centers for Disease Control and Prevention. The USPSTF found 8 fair- or good-quality RCTs that reported health outcomes in children or adolescents with MDD detected through screening who were treated with SSRIs (4 RCTs), psychotherapy (2 RCTs), SSRIs combined with psychotherapy (1 RCT), or collaborative care (1 RCT). Only a professional trained on the properties of the CDI can accurately interpret the results. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for MDD in children aged ≤11 years (I statement). This factor underscores the importance of additional research in child and adolescent populations that are similar to populations found in primary care settings; the goal is to study the effects of comorbid conditions on screening accuracy, type of MDD treatment selected, and benefits and harms. Based on a previous review, the USPSTF concludes that the use of SSRIs in children is associated with harms, specifically risk for suicidality. Morbidity in children and adolescents may be demonstrated through decreased school performance, poor social functioning, early pregnancy, increased physical illness, and substance abuse. from the PHQ-9 that is used for adults. It can also be used as an instrument to monitor changes in depression symptoms over time. *For children ages 8 to 11, it is recommended that the clinician explain all questions, or have the child answer the questionnaire sitting with an adult in case they have any questions. Information on this topic and other related recommendations from the Community Preventive Services Task Force is available at www.thecommunityguide.org/mentalhealth/index.html. Depression in Primary Care Toolkit (in multiple languages). What Parents Should Know About Childhood Depression, Benefits of Children Taking Antidepressants Can Outweigh the Risks, Psilocybin Effective for Treating Major Depressive Disorder, Research Suggests, The 7 Best Online Therapy Programs for Kids in 2021. The USPSTF examined the evidence on the benefits and harms of screening, the accuracy of primary care–feasible screening tests, and the benefits and harms of treatment with psychotherapy, medications, and collaborative care models in patients aged 7 to 18 years. One study evaluated the BDI, 1 study evaluated the Center for Epidemiologic Studies Depression Scale (CES-D), 1 study evaluated the BDI and the CES-D, and 1 study evaluated the Clinical Interview Schedule–Revised. The USPSTF concludes that the evidence on the harms of psychotherapy and collaborative care in adolescents is adequate to estimate that the magnitude of harms is small to none. The ASQ is free of charge and available in multiple languages. A comparison to its full-length, Anhedonia (inability or decreased ability to experience joy), Ineffectiveness (lack of motivation or inability to complete tasks), Interpersonal problems (difficulty making and keeping close relationships), Negative self-esteem (the belief that you are not good at anything). The CDI has excellent psychometric properties, which means that it measures depression in children accurately and reliably when used properly. The CES-D studies used different diagnostic cutoff scores.7,8 One study enrolled a slightly younger population than the other (range of 11 to 15 years vs average age of >16 years). Pediatrics, November 1, 2010.. The authors declare no conflicts of interest. For best results, it is recommended that users review available instruction manuals prior to administering, scoring, and analyzing results of the scoring tools. In addition, a child who receives a positive score on the CDI should be referred for a comprehensive evaluation by a licensed mental health professional. A child with age-appropriate reading abilities can complete the scale relatively quickly. The USPSTF also found adequate evidence that treatment of adolescents identified through screening is associated with beneficial reductions in MDD symptoms. Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York. Important . 7 The HEADS mnemonic has different variations, such as the HEADDS or HEEADSSS, but with commonality among all of them. Newer studies do not provide much additional evidence on treatment harms in children and adolescents but do not suggest more risks. If you have concerns about possible depression see a mental health professional. Medications for the treatment of depression, such as selective serotonin reuptake inhibitors (SSRIs), have acknowledged harms. In fact, many youth who attempt suicide had recent contact with a health professional Some researchers have also observed that children who do not have age-appropriate reading skills may receive an inaccurate diagnosis on the basis of their CDI score. Administration It is recommended that parents are informed that depression screening will be … The USPSTF recommends that screening be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. Enter multiple addresses on separate lines or separate them with commas. Author Information . Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation). The study did not report other outcomes or stratify results according to age, race, or ethnicity. This table is not exhaustive, and other screening tools may be available. Objective: Depression screening among children and adolescents is controversial, and no clinical trials have evaluated benefits and harms of screening programs. The authors declare no conflicts of interest. Depression screening, reported with 96127, is typically a covered preventive service for adolescents age 12 to 18 and is a quality measure in many pediatric quality initiatives. Objective: Depression screening among children and adolescents is controversial, and no clinical trials have evaluated benefits and harms of screening programs. Patients randomly assigned to the usual care control group received screening results and could access mental health services through the usual health care system. The CDI was tested on a large group that represents the population of children in the United States. This is the first study to validate and to compare the Children's Depression Inventory (CDI) and its short version (CDI:S) as screening tools for medically ill children. The scale emerged from a longer inventory of 37 items that had been described in the literature as associated with major depressive syndromes in childhood. Adolescent Depression Screening and Initial Treatment Toolkit for Primary Care Clinicians Edward Pickens, MD UNC Physicians Network Jill Wright, MD UNC Physicians Network Ty Bristol, MD UNC Department of Pediatrics and UNC Physicians Network Carl Seashore, MD UNC Department of Pediatrics Martha Perry, MD UNC Department of Pediatrics Ashley Nazworth, LCSW UNC Physicians Network … Opportunistic screening may be appropriate for adolescents, who can have infrequent health care visits. MDD is associated with significant morbidity and mortality. Block, MD, What You Should Know About Childhood Depression. Frick PJ, Barry CT, Kamphaus RW. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Fluoxetine is approved by the FDA to treat MDD in children aged ≥8 years, and escitalopram is approved to treat MDD in adolescents aged 12 to 17 years. Four studies recruited adolescents from school settings and compared the screening test with a diagnostic interview or different depression screening test. Treatment options for depression include pharmacologic, behavioral, multimodal, and collaborative care models, some of which require coordination. However, the prevalence of depression in primary care settings is often higher in studies with community samples of children and adolescents. One CBT study also included an arm that compared CBT plus fluoxetine with placebo.10 The CBT plus fluoxetine group showed a 71% response rate versus a 35% response rate in the placebo group, which received a placebo drug and weekly clinical monitoring (P = .001). Evidence-based screening tools that include reports from parents and early childhood professionals can help parents and healthcare professionals talk about the child’s development in a systematic way. Other psychosocial risk factors for MDD include childhood abuse or neglect, exposure to traumatic events (including natural disasters), loss of a loved one or romantic relationship, family conflict, uncertainty about sexual orientation, low socioeconomic status, and poor academic performance. Using Child Behavior Checklist (CBCL) to Assess Depression, The PHQ-9: Patient Healthcare Questionnaire for Depression. Implementation Many screening tools are available to identify depression in children and adolescents, and some have been used in primary care. Repeat screening may be most productive in adolescents with risk factors for MDD. What Are the Signs That You Are Severely Depressed? This guideline covers identifying and managing depression in children and young people aged 5 to 18 years. The USPSTF found no direct evidence regarding the harms of screening for MDD in adolescents or children. Many different screening tools are available to identify depression in children and adolescents, and some have been used in primary care. Journal of Nervous Mental Disorders 168(12):736–740. Little is known about the prevalence of MDD in children aged ≤11 years. It would be helpful to quantify the proportion of screen-detected subjects who are treated or referred, as well as their willingness and ability to obtain assessment and treatment. “Adequate systems in place” refers to having systems and clinical staff to ensure that patients are screened and, if they screen positive, are appropriately diagnosed and treated with evidence-based care or referred to a setting that can provide the necessary care. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. appropriately-used as a screening tool, not a tool for making a firm diagnosis; clinical validation by the primary care provider (PCP) is necessary to confirmation a diagnosis of major depression. For treatment of MDD, research needs include well-designed studies of psychotherapy and combined treatments, as well as studies of the benefits and harms of other treatments (eg, non-SSRI medications, complementary/alternative modalities). While depression is often thought of as an adult disorder, the Centers for Disease Control and Prevention (CDC) reports that 4.9% of children between the ages of 6 and 17 have been diagnosed with depression.. Although the data are limited, the USPSTF concludes that the evidence on the frequency of medication-related adverse events in adolescents is adequate to estimate that the magnitude of harms of pharmacotherapy is small if patients are closely monitored. Morsa Images / DigitalVision / Getty Images. Rather, the goal is for the results of the test to be shared with your doctor to inform further conversations about diagnosis and treatment. The USPSTF recommends screening for MDD in all adolescents but notes that several risk factors might help identify patients who are at higher risk for MDD. Reviewers collected patient demographics, indicated any depression screening and screening with a validated tool (PHQ-2/PHQ-9), and recorded initial plans of care (follow-up with primary care practitioner, referral to mental health professional, or depression already being addressed) for the eligible population. We do not capture any email address. As pediatric depression is common but under-detected, routine screening is essential to increase early identification, timely treatment, and symptom monitoring . It is a 14 question Psychological screening tool assessing the severity of symptoms. Members of the USPSTF at the time this recommendation was finalized were as follows: Albert L. Siu, MD, MSPH, Chair (Mount Sinai School of Medicine, New York, and James J. Peters Veterans Affairs Medical Center, Bronx, NY); Kirsten Bibbins-Domingo, PhD, MD, MAS, Co-Vice Chair (University of California, San Francisco, San Francisco, CA); David C. Grossman, MD, MPH, Co-Vice Chair (Group Health Research Institute, Seattle, WA); Linda Ciofu Baumann, PhD, RN, APRN (University of Wisconsin, Madison, WI); Karina W. Davidson, PhD, MASc (Columbia University, New York, NY); Mark Ebell, MD, MS (University of Georgia, Athens, GA); Francisco A.R. Author Information . You can call Samaritans free on 116 123 if you want to talk to someone now. REFERENCES Weissman MM, Orvaschel H, Padian N. 1980. Dementia Childhood Depression Adult Health Maintenance Screening Impairment Evaluation Psychological Testing Postpartum Major Depression Search other sites for 'Depression Screening Tools' NLM Pubmed Google Websites Google Images QuackWatch Drugstore.com Questions focus on feelings over the past week and the tool … Evaluation of the Patient Health Questionnaire-9 Item for Detecting Major Depression Among Adolescents. The school can also be included in the treatment plan. Results were not stratified according to age, gender, or ethnicity. Read our, Reviewed by Ann-Louise T. Lockhart, PsyD, ABPP, Medically reviewed by Daniel B. How Is Generalized Anxiety Disorder Diagnosed Using the DSM-5? Five SSRI trials reported on harms and found no significant differences between intervention groups, although none of the studies was powered to detect these differences. METHODS: The USPSTF reviewed the evidence on the benefits and harms of screening, accuracy of primary care–feasible screening tests, and benefits and harms of treatment with psychotherapy, medications, and collaborative care models in patients aged 7 to 18 years. Gundersen Health System Family Medicine Residency, La Crosse, WI. 5 Depression: Incidence/Prevalence • In 2015, 30% of H.S. Collaborative care for adolescents with depression in primary care: a randomized clinical trial. While the CDI is good at detecting the presence of depressive symptoms, it is not the best at determining their severity. BRIGHT FUTURES TOOL FOR PROFESSIONALS INSTRUCTIONS FOR USE Pediatric Symptom Checklist The Pediatric Symptom Checklist is a psychosocial screen designed to facili-tate the recognition of cognitive, emotional, and behavioral problems so that appropriate interventions can be initiated as early as possible. Learn more about depression in children external icon A number of screening and assessment tools have been validated and are generally available. The Depression Self-Rating Scale for Children was developed in 1978 as part of a Masters of Philosophy Thesis at the University of Edinburgh. Methods: A sample of 406 pediatric hospital patients, aged 9 to 12 years (56.2% male, 77.1% inpatients), completed the German CDI. Risk factors for MDD in children and adolescents include female gender, older age, family (especially maternal) history of depression, previous episode of depression, other mental health/behavioral problems, chronic medical illness, overweight and obesity, and, in some studies, Hispanic race/ethnicity. Recommendations. No studies included children aged <11 years. PHQ-2 b • Bright Futures sample form • Instructions. The current recommendation reaffirms these positions but removes the mention of specific therapies in recognition of decreased concern over the harms of pharmacotherapy in adolescents when patients are adequately monitored (Fig 1). Read more about online mental health screenings. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation). Everything feels more challenging when you're dealing with depression. How Does the Weschsler Adult Intelligence Scale Measure Intelligence? A list of examples of validated screening tools is available from the American Academy of Pediatrics external icon. 13-05192-EF-1, Agency for Healthcare Research and Quality. PHQ-9 modified for Adolescents (PHQ-A) Name: Clinician: Date: Instructions: How often have you been bothered by each of the following symptoms during the past two weeks?For each symptom put an “X” in the box beneath the answer that best describes how you have been feeling. Center for Epidemiological Studies Depression Scale for Children (CES-DC) Edinburgh Postnatal Depression Scale (EPDS) Geriatric Depression Scale (GDS) Hamilton Rating Scale for Depression (HAM-D) Hospital Anxiety and Depression Scale; Kutcher Adolescent Depression Scale (KADS) Major Depression Inventory (MDI) Montgomery-Åsberg Depression Rating Scale (MADRS) PHQ-9; Mood and … Care settings is often higher in studies with Community samples of children in the United States recommended intervals... High accuracy found significant differences, although none of the current USPSTF members is available www.thecommunityguide.org/mentalhealth/index.html... 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