analysis of childrens depression inventory brian mann

6.1 Research Project: Analysis of Children’s Depression Inventory

Brian Mann C! "#6 $%ne &1' &(1)

*he +ost co++on +ental disorder disorder a,ectin- children children and adolescents is depression' hich has an overall prevalence of &.) / for children and 0.# / for

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Analysis of Children’s Depression Inventory  Mann adolescents a-ed %nder 1) 23%an-' &(145. Depression is epressed thro%-h a series of sy+pto+s that incl%de loss of interest in activities nor+ally perfor+ed' lo self self estee+' social isolation' fati-%e' cryin-' sleep and eatin- disorders' and self defeatin- i+p%lses. In children and adolescents' irrita7ility' irrita7ility' di8c%lties to interact e,ectively ith class+ates and fa+ily +e+7ers' 7ehavior pro7le+s' co-nitive alterations' and decreased acade+ic perfor+ance are also o7served 29i-%eras Masip' &(1(5. *his paper disc%sses the %se of Children’s Depression Depression Inventory in the assess+ent of childhood and adolescent depression. *he clinical assess+ent of depression depression taes taes place in vario%s phases: dia-nosis and pro-nosis' treat+ent' follo%p' and eval%ation of treat+ent e8cacy. e8cacy. !elfreports !elfreports are %sef%l instr%+ents 7oth for dia-noses and to appraise treat+ent e8cacy. e8cacy. *he Children’s Depression Inventory is one of the +ost fre;%ently %sed self self reports for the assess+ent of depressive sy+pto+atolo-y in infancy and adolescence. *he CDI as created fro+ the Bec Depression Inventory to 7e ad+inistered to children and adolescents of school a-e 29i-%eras 29i-%eras Masip' &(1(5. *he CDI as ori-inally ori-inally p%7lished in 1<<&' 7ased on ite+s fro+ the Bec Depression Inventory 2BDI5 and is desi-ned to assess depressive sy+pto+s in children " to 1" years old. *here are fo%r versions of the CDI: 2a5 the ori-inal version 2CDI5' hich incl%des &" ite+s= 275 the CDI!hort 9or+ 2CDI: !5 ith 1( ite+s= 2c5 the CDIParent version 2CDI:P5 co+posed of 1 " ite+s= and 2d5 the CDI*eacher version 2CDI:*5 co+posed of 1& ite+s. *he latter to versions as parents and teachers' respectively' to rate a child>s depressive sy+pto+s as they have occ%rred in the



Analysis of Children’s Depression Inventory  Mann &(("5. *he cost of a sin-le ad+inistration of the CDI is a7o%t @&.&(' hereas the ea+iner it costs @1#).(( 2M%ller' &(1&5. *he CDI is availa7le availa7le for %se in &# lan-%a-es. *he CDI taes a7o%t 1) +in%tes to co+plete' and the CD?! taes a7o%t ) +in%tes to co+plete. Ite+s are ritten at a "yearold readin- level. *he CD?P and CD?* can 7e co+pleted in a7o%t ) +in%tes. !corin- taes a7o%t the sa+e a+o%nt of ti+e as ad+inistration and can 7e co+pleted 7y hand ith the %i!core for+ or 7y co+p%ter. co+p%ter. !cores for the CDI are reported on ve s%7scales 2i.e.' Anhedonia' Ine,ectiveness' Interpersonal Pro7le+s' e-ative Mood' and e-ative !elfstee+5 !elfstee+5 and are s%++ed to interpret a *otal *otal Depression Depression score. *his interpretive interpretive strate-y as s%pported 7y eploratory factor analysis. !cores on the CD?P and CD?* CD?* are interpreted as a total score or 7y %sin- to s%7scales: +otional Pro7le+s and 9%nctional 9%nctional Pro7le+s 2M%ller' &(1&5. *he CDI is a ?evel ?evel B instr%+ent desi-ned for %se as a screeninscreenin- +eas%re and sho%ld not 7e %sed to +ae dia-nostic decisions. decisions. *he levelin- syste+ 2A' B' C5 species p%7lisher re;%ire+ents to p%rchase and %se an instr%+ent. ?evel A instr%+ents are open access ith no ed%cational or licens%re re;%ire+ents re;%ire+ents for the ea+iner. ea+iner. ?evel B instr%+ents instr% +ents re;%ire that ea+iners have a +aster>s de-ree in co%nselin-' psycholo-y' or a related eld= a -rad%ate co%rse in assess+ent= and appropriate s%pervised eperience. ?evel C instr%+ents re;%ire a doctoral de-ree or state licens%re alloin- ad+inistration of the ?evel C test' alon- ith appropriate s%pervised eperience 2M%ller' &(1&5. *he CDI is a nor+referenced nor+referenced instr%+ent' 7%t it as as not standardied standardied on a



Analysis of Children’s Depression Inventory  Mann In clinical sa+ples' the internal consistency of the CDI ran-es 7eteen ."1 and .0< and 7eteen .)" and .04 and in co++%nity sa+ples' the internal consistency of the CDI ran-es 7eteen .") and .<4 and 7eteen ."# and .0< 29i-%eras Masip' &(1(5. *here are conEictinconEictin- res%lts on hether the CDI CDI can di,erentiate 7eteen yo%th ith and itho%t a depressive disorder. disorder. Most st%dies have fo%nd the CDI can s%ccessf%lly discri+inate psychiatric patients fro+ nonreferred yo%th. !everal st%dies also have fo%nd si-nicant di,erences in the CDI scores of depressed and nondepressed psychiatric yo%th 23od-es' 1<<(5' altho%-h other st%dies have not fo%nd si-nicant di,erences 2*i+7re+ont' &((45. *hro%-h vario%s st%dies' testretest testretest relia7ility is is stron- in the short ter+ hoever 7eco+es less relia7le over lon-er periods. *estretest relia7ility coe8cients of .0" at one ee' .04 at to ees' and .)4 at 6 +onth follo%p. *he CDI +eas%res a state rather than a trait' the interval 7eteen test and retest sho%ld 7e short' 7eteen to and fo%r ees 29i-%eras Masip' &(1(5. 9ristad recently revieed p%7lished st%dies of childhood depression. F3alf of the+ %sed the CDI. Gf these th ese st%dies' 60/ did not %se a clinical or str%ct%red intervie to deter+ine dia-nostic stat%s. Hhen the CDI as %sed alone to assess depressive sy+pto+s' 44/ of st%dies referred to hi-h CDI scorers as depressed itho%t providin- a clear ca%tionary state+ent 2i.e.' either statin- that the CDI cannot 7e %sed to dia-nose depression or clarifyin- li+itations re-ardin-eneraliation of ndin-s fro+ a nonclinical to a clinical sa+pleJ 29ristad' 1<<"5.



Analysis of Children’s Depression Inventory  Mann %se as a si+ple screenin- +eas%re ithin the +ore for+al process of dia-nosis. !econdly' in the a7sence of +ore for+al dia-nostic assess+ents each of these st%dies are inherently Eaed 7y the overreliance on this tool. *he CDI %ses a c%to, score' score' hich is a n%+erical val%e val%e %sed to select individ%als considered to 7e +eetin- a certain condition' in this case is presence of depressive sy+pto+s. *he reco++ended c%to, scores' esta7lished 7y the CDI developer' Kovacs' have 7een p%t into ;%estion. or+ative data are reported in the test +an%al on a s a+ple of 1'&66 A+erican p%7lic school children' a-e "L16 years. *hese children ere not assessed for the presence or a7sence of depression accordin- to dia-nostic criteria and so are ass%+ed to have a +i of cases 2those +eetin- dia-nostic criteria for a for+al depressive disorder5 and noncases. Data fro+ a separate clinical sa+ple of 1#4 adolescents ho did +eet criteria for depressive disorders ere collected over a < year period. Gn the 7asis of these data' Kovacs has reco++ended vario%s c%to, scores on the CDI hen screenin- for depression in children. Matthey fo%nd iss%es ith the statistical calc%lations %sed to deter+ine the 7ase rate of depression in the sa+ple= the %se of the 7ase rate as the criterion cr iterion a-ainst hich a c%to, score is calc%lated= and third' the clinical %sef%lness of the s%--ested c%to, scores' 7ased on the +ore %s%al +ethod of calc%latin- c%to, scores 2Matthey' &((&5. Base rates are the prevalence of a condition in the pop%lation and are calc%lated 7y ea+inin- reasona7ly lar-e representative sa+ples of the pop%lation of interest 2Anastasi' 1<005. Kovacs Kovacs has reported that %sin- her sa+ples of 1'&66



Analysis of Children’s Depression Inventory  Mann Ea in this calc%lation' hich renders the reported 7ase rate invalid. *he 1#4 depressed children ere not part of the ori-inal sa+plin- proced%re= rather' they ere a collection of cases seen clinically over a period of so+e < years. Kovacs co%ld have chosen to contin%e collectin- data on clinicreferred clinicreferred children for' say' a f%rther ) years. In this case' she +i-ht have ended %p ith CDI infor+ation on 6(( depressed children 2an ar7itrary -%re for the p%rpose of ill%stration5. Hith her ori-inal calc%lations' this o%ld then +ean the 7ase rate for depression o%ld 7e #&.1)/ not <.)"/. As this ill%strates' 7ase rates can 7e calc%lated only 7y o7servin- the occ%rrence of depression in the one sa+ple 2Anastasi' 1<005' in this case' on the sa+ple of 1'&66 children. nfort%nately' Kovacs did not assess the presence of dia-nostic criteria in this sa+ple' and so the 7ase rate for depression is %nnon 2Matthey' &((&5. Kovacs’ c%to, scores on the CDI have 7een calc%lated ith this 7aserate infor+ation' ith the -oal 7ein- to approi+ate approi+ate the act%al 7ase rates as closely as possi7le. *h%s' %sin- the c%to, score of &( prod%ces a predicted positive rate of <.06/ 2tr%e positives of 1.#6/' pl%s false positives of 0.)(/5' and hence the s%--estion that this score is 7est hen screenin- in a -eneral pop%lation in hich the previo%sly calc%lated 7ase rate is <.)"/. *his +ethod of calc%latin- c%to, scores is %n%s%al 2Matthey' &((&5. *he +ethod reported in the CDI +an%al for calc%latincalc%latin- the 7ase rate of depression in schoolchildren is Eaed. !econd' the %se of 7aserate infor+ation to deter+ine c%to, scores for screenin- for depression is ea. *hird' %sin- the data





Analysis of Children’s Depression Inventory  Mann the CDI is 7etter s%ited to +onitorin- chan-es in a child’s +ood rather than deter+inin- the need for intervention 2Matthey' &((&5. Despite the concerns centered on the ori-inal nor+ative data set' the CDI contin%es to 7e st%died ith respect to esta7lishin- i+proved c%t o, points. 9or ea+ple' in a recent st%dy involvin- a sa+ple of 1"() participants and a clinical sa+ple of 1(& participants' Massip fo%nd a relia7ility coe8cient ran-e' for 7oth sa+ples' fro+ .0& 2test5 to .04 2retest5 in the co++%nity sa+ple' and .0) 2test' clinical sa+ple5= testretest relia7ility is .01 in the co++%nity sa+ple. Massip deter+ined the c%to, point that 7est di,erentiates 7eteen depressive and co++%nity participants is 1<' ith a sensitivity of <4."/' a specicity of <).6/' a positive predictive val%e 2PPN5 of .<(' and a ne-ative predictive val%e 2PN5 of .<0 29i-%eras Masip' &(1(5. In another recent st%dy' *i+7re+ont fo%nd that a c%to, score of 1# had a PN of <"."/' s%--estin- this c%to, score o%ld res%lt in a s+all n%+7er of +issed cases. *herefore' this c%to, score can 7e %sed in a clinical sa+ple to identify children and adolescents ho can receive f%rther assess+ent. A hi-her c%to, score of 1< +ini+ies the proportion of false positives 7%t res%lts in a hi-her proportion of





Analysis of Children’s Depression Inventory  Mann that child and adolescent selfreport +eas%res are not sensitive in di,erentiatina+on- types of internaliin- disorders. *his has led so+e a%thors to 7elieve that selfreport selfreport +eas%res' s%ch as the CDI' assess ne-ative a,ectivity in -eneral' rather than depression in partic%lar. *he res%lts s%--est that the CDI s%ccessf%lly discri+inates depressive disorders fro+ aniety and disr%ptive 7ehavior disorders 2*i+7re+ont' &((45. It as +entioned earlier that racial or socioecono+ic de+o-raphic data as not collected as part of the initial nor+referencin- data set. *his raises o7vio%s concerns. Also' dependin- on the st%dies' so+e investi-ators have fo%nd th at +ales score hi-her than fe+ales hile other a%thors have fo%nd that fe+ales score hi-her than +ales 29i-%eras Masip' &(1(5. +phasis is no 7ein- placed on factor analysis as an i+proved ay of identifyin- the correlated ite+s into cl%sters associated ith depression. A st%dy as cond%cted in in &((6 hich +eas%red the the variance across -ender' a-e and ethnic -ro%ps. -ro%ps. !+%cer !+%cer and Crai-head identied the folloin- CDI factors: 215 Dysphoric Mood hich incl%des +eas%res of sadness' selfhate' selfhate' cryinspells' irrita7ility and loneliness= 2&5 Actin- G%t hich incl%des +eas%res of +is7ehavior' schoolor di8c%lty' drop in school perfor+ance' diso7edience' and





Analysis of Children’s Depression Inventory  Mann related ite+s. *he relationship 7eteen the CDI factors and the CA! sy+pto+ scales as ea+ined. A re-ression as cond%cted for each of the ve factors. 9or each of the CDI factors' the re-ression as si-nicant 23od-es' 1<<(5. In concl%sion' the CDI is a ellresearched ellresearched instr%+ent and the +ost pop%lar assess+ent tool %sed in the st%dy of child and adolescent depression. Gri-inally desi-ned to 7e a screenin- +eas%re that indicates the presence and severity of sy+pto+s associated ith depression' it has co+e to 7e %sed in research and clinical practice +ore of a dia-nostic tool. Its ease of %se and e8cient ad+inistration +ay lead so+e clinicians to over rely on it as a standalone tool' 7%t is not s%8cient for dia-nosis. *he CDI h as stron- psycho+etric properties of discri+inant validity' internal consistency' shortter+ test retest relia7ility. relia7ility. Gne of the pro7le+s relatin- to the CDI incl%de concerns over the ori-inal nor+ative data set %sed to esta7lish c%to, scores' hoever ne data has 7een -enerated hich appears to 7e o,settin- this deciency. deciency. Also' the lac of -ender' a-e and c%lt%ral data is no 7ein- addressed thro%-h st%dies that are foc%sed on factor analysis hich appears consistent ith the CA! intervie. intervie.





Analysis of Children’s Depression Inventory  Mann Carey' M. P.' Oresha+' 9. M.' R%--iero' ?.' 9a%lstich' M. .'  nyart' P. 21<0"5. Children>s depression inventory: Constr%ct and discri+inant validity across clinical and nonreferred 2control5 pop%lations. $o%rnal of Cons%ltin- and Clinical Psycholo-y' ))2)5' ")). Carle' A. C.' Millsap' R. .'  Cole' D. A. 2&((05. Meas%re+ent 7ias across -ender on the children>s depression inventory. inventory. d%cational and Psycholo-ical Meas%re+ent' 602&5' &01. Cole' D. A.'  Martin' . C. 2&(()5. *he lon-it%dinal str%ct%re of the children>s depression inventory: *estin*estin- a latent traitstate +odel. Psycholo-ical Assess+ent' 1"2&5' 144. Crai-head' H. .' !+%cer' M. R.' Crai-head' ?. H.'  Ilardi' !. !. 21<<05. 9actor analysis of the children>s depression inventory in a co++%nity sa+ple. Psycholo-ical Assess+ent' 1(2&5' 1)616). 9i-%eras Masip' A.' A+adorCa+pos' $. A.' OQ+eBenito' $.'  del Barrio Ondara' N. 2&(1(5. Psycho+etric properties of the children>s depression inventory in co++%nity and clinical sa+ple. *he !panish $o%rnal of Psycholo-y' 1#2&5' <<(. 9inch' A. $.' !aylor' C. 9.'  dards' O. ?. 21<0)5. Children>s depression inventory: !e and -rade nor+s for nor+al children. $o%rnal of Cons%ltin- and Clinical Psycholo-y' )#2#5' 4&44&). 9rnov' ?.' ?%avsS' ?%avsS' $.'  Preiss' M. 2&((05. Relationship of Children’s Depression Inventory 9actor 9actor !tr%ct%re to !chool Achieve+ent. !t%dia Psycholo-ica' )(245' #0#. 9ristad' M. A.' +ery' B. ?.'  Bec' !. $. 21<<"5. se and a7%se of the children>s depression inventory. inventory. $o%rnal of Cons%ltin- and Clinical Psycholo-y' 6)245' 6<<"(&. 3od-es' K.'  Crai-head' H. H. . 21<<(5. Relationship of children>s depression inventory factors to dia-nosed depression. Psycholo-ical Psycholo-ical Assess+ent: A $o%rnal of





Analysis of Children’s Depression Inventory  Mann M%ller' B. .'  rford' B. *. 2&(1&5. Choosin- assess+ent instr%+ents for depression o%tco+e research ith schoola-e yo%th. $o%rnal of Co%nselin- and Develop+ent' <(2&5' &(0. *he children>s depression depression inventory: inventory: A syste+atic eval%ation of of psycho+etric properties. 21<045. $o%rnal of Cons%ltin- and Clinical Psycholo-y' )&265' <))<6". !aylor' C. 9.' 9inch' A. $.' !pirito' A.'  Bennett' B. 21<045. *he children>s depression inventory: inventory: A syste+atic eval%ation of psycho+etric properties. $o%rnal of Cons%ltinand Clinical Psycholo-y' )&265' <))<6". !+%cer' M. R.' Crai-head' H. .' Crai-head' ?. H.'  Oreen' B. $. 21<065. or+ative and relia7ility data for the children>s depression inventory. inventory. $o%rnal of A7nor+al Child Psycholo-y' 14215' &)#<. *aylor' *aylor' $. $.' Orant' K. .' A+rhein' A+rhein' K.' Carter' $. !.' 9arah+and' 9arah+and' 9.' 9.' 3arrison' A.' . . . Kat' B. . 2&(145. *he +anifestation of depression in the contet of %r7an poverty: A factor analysis of the children>s depression inventory in loinco+e %r7an yo%th. Psycholo-ical Assess+ent' &6245' 1#1". *en-e' *en-e' $. M.'  olen3oese+a' olen3oese+a' !. 2&((&5. A-e' A-e' -ender' race' socioecono+ic socioecono+ic stat%s' and 7irth cohort di,erences on the children>s depression inventory: inventory: A +eta analysis. $o%rnal of A7nor+al Psycholo-y' 111245' )"0. *i+7re+ont' *i+7re+ont' B.' Braet' C.'  Dreessen' Dreessen' ?. 2&((45. Assessin- depression depression in yo%th: Relation Relation 7eteen the children>s depression inventory and a str%ct%red intervie. intervie. $o%rnal of Clinical Clinical Child  Adolescent Adolescent Psycholo-y' ##215' 14<1)".

analysis of childrens depression inventory brian mann

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