Research report
The ability of YSR DSM-oriented depression scales to predict DSM-IV depression in young adults: A longitudinal study

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Abstract

Background

The Achenbach child behaviour checklist (CBCL/YSR) is a widely used screening tool for affective problems. Several studies report good association between the checklists and psychiatric diagnoses; although with varying degrees of agreement. Most are cross-sectional studies involving adolescents referred to mental health services. This paper aims to evaluate the performance of the youth self report (YSR) empirical and DSM-oriented internalising scales in predicting later depressive disorders in young adults.

Methods

Sample was 2431 young adults from an Australian birth cohort study. The strength of association between the empirical and DSM-oriented scales assessed at 14 and 21 years and structured-interview derived depression in young adulthood (18 to 22 years) were tested using odds ratios, ROC analyses and related diagnostic efficiency tests (sensitivity, specificity, positive and negative predictive values).

Results

Adolescents with internalising symptoms were twice (OR 2.3, 95%CI 1.7 to 3.1) as likely to be diagnosed with DSM-IV depression by age 21. Use of DSM-oriented depressive scales did not improve the concordance between the internalising behaviour and DSM-IV diagnosed depression at age 14 (ORs ranged from 1.9 to 2.5).

Limitations

Some loss to follow-up over the 7-year gap between the two waves of follow-up.

Conclusion

DSM-oriented scales perform no better than the standard internalising or anxious/depressed scales in identifying young adults with later DSM-IV depressive disorder.

Introduction

Identifying early onset depression may be important in order to reduce the risk of future impairment, severity and reoccurrence of psychopathology (Pignone et al., 2002). Structured psychiatric interviews have been developed to obtain categorical diagnoses, they are commonly long, expensive and are however problematic to use with children and adolescents (Angold et al., 1999). By way of contrast, continuous psychometric measures are inexpensive and potentially suitable for generalised primary care screening (Aschenbrand et al., 2005). Adequate concordance between screening measures and categorical diagnoses may translate into improved detection of young people at risk of depression (Gilbody et al., 2001, Najman et al., 2008).

The Achenbach Child Behaviour Checklist (CBCL) and Youth Self-report (YSR) are popular screening tools used to assess behaviour and emotional problems in a range of studies (Achenbach, 1991, Achenbach and Edelbrock, 1983). Several studies have documented moderate to high levels of association between the CBCL/YSR and diagnoses derived from structured psychiatric interviews (Doyle et al., 2007, Ferdinand, 2008, Hofstra et al., 2001, Krol et al., 2006, Petty et al., 2008, Rey et al., 2002, van Lang et al., 2007, Warnick et al., 2008). Most, but not all, found acceptable congruence between CBCL/YSR internalising problem scales and a current diagnosis of depression (Achenbach and Dumenci, 2001, Hofstra et al., 2002, Petty et al., 2008, Rishel et al., 2005, Warnick et al., 2008). To improve the congruence between the empirical scales and structured psychiatric diagnoses, several researchers have grouped items from the CBCL/YSR internalising scales that match more closely the structure of DSM-IV depressive disorders (Major Depressive Disorder (MDD) and dysthymia). Each research group constructed different scales, which form, in effect, three ‘DSM-oriented depression scales’ that they argue match more closely the structure and item content of DSM-IV depressive disorders; (see Supplementary web table).

Only a few studies have examined the associations between these DSM-oriented scales and DSM-IV MDD. These are primarily cross-sectional and based on samples of adolescents referred to psychiatric services (Connor-Smith and Compas, 2003, Ferdinand, 2008, Krol et al., 2006, Lengua et al., 2001, Petty et al., 2008, Rey and Morris-Yates, 1992, Rishel et al., 2005), or specific at risk groups such as homeless (Morgan and Cauce, 1999) or incarcerated youth (Vreugdenhil et al., 2006). Only three epidemiologic studies have examined this subject (Hofstra et al., 2002, Hofstra et al., 2001, Najman et al., 2008, van Lang et al., 2005, van Lang et al., 2007). We have previously found that mother-reported (CBCL) anxious/depressed behaviour had a sensitivity of only 13% for MDD while child-reported (YSR) anxious/depressed behaviour predicted only a third of cases (30%) 7 years later (Najman et al., 2008). One of two Dutch studies found significant correlations between YSR internalising, Achenbach's DSM-oriented affective problem scale in early and late adolescents and MDD in young adults aged 20 to 25 years (van Lang et al., 2005) but poor sensitivities for predicting later MDD (van Lang et al., 2007). A second Dutch study found that internalising problems in childhood predicted later DSM-IV depressive disorder in males only (Hofstra et al., 2001). In this study, we aim to extend our previous work by comparing the correspondence of the empirical internalising scales and the DSM-oriented depression scales using the YSR with DSM-IV depressive diagnoses. We will explore whether: i) the use of DSM-oriented depression scales improves the predictive utility of the Achenbach behaviour checklists in detecting major depression in young adults; and, ii) if either of the published DSM-oriented depression scales performed better than the empirical internalising scale.

Section snippets

Participants

Data from the Mater-University of Queensland study of pregnancy and its outcomes (MUSP), a 21-year prospective birth cohort study that investigates the health and behaviour of mother and child pairs, were used. Baseline data were collected at the first antenatal visit from 7223 consecutive women who gave birth during the period 1981 to 1984, to live singleton babies (48.1% females). Mother–child pairs were subsequently followed up (FU) 6 months, 5, 14, and 21 years after the birth, full details

Characteristics of the sample

Overall 2431 young adults (51.2% women) had complete data. The average age of the children was 13.9 years (SD = 0.34) at the 14-year FU, and 20.4 years (SD = 0.83) when assessed 7 years later. One-fifth (20%, n = 485) of young adults reported ever having DSM-IV major depression, nearly half (n = 226) had depression within the previous 12 months. The majority of depressed young adults had MDD (between 18 and 22 years n = 379) and not dysthymia. Comorbid anxiety and depression was common, just under half

Discussion

This study investigated the predictive validity of three DSM-oriented depression scales in an Australian population-based birth cohort, who were assessed at age 14 years then 7 years later at 21. We examined the extent to which DSM-oriented scales reflect symptoms of DSM-IV major depression assessed by the computerised structured psychiatric interview undertaken at the 21-year FU. As well we examined whether the DSM-oriented depression scales showed a stronger correspondence with symptoms of

Role of funding sources

Core funding for this study was provided by National Health and Medical Research Council of Australia (NHMRC); the NHMRC had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. NHMRC also funded: A.C. (Capacity Building Grant) and R.A. (NHMRC Career Development Award in Population Health, ID: 519721) and Kaeleen Dingle (NHMRC Public Health Postgraduate Research

Conflict of interests

All authors declare that they have no conflicts of interest.

Acknowledgements

The authors wish to thank the mothers and child participants over the 21 years of the MUSP and the MUSP21 data collection team; especially project manager Rosemary Aird and data manager Greg Shuttlewood.

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