Screening for children’s depression symptoms in Greece: the use of the Children’s Depression Inventory in a nation-wide school-based sample

The objective of this study is to determine the level of depressive symptoms among a sample of Greek children aged 8–12 years, as measured by the Greek Children’s Depression Inventory (CDI), as well as to examine CDI’s psychometric properties. A nationwide school-based sample of 650 children was initially recruited and depressive symptoms were assessed with the CDI among 538 children who provided all relevant information. Statistical evaluation included assessment of CDI internal reliability, test–retest reliability, determination of age, gender and socioeconomic status (SES) effects. Based on the distributions of CDI scores observed in this normative sample, a recommended cutoff score, identifying a high probability of serious levels of depressive symptoms that need to be further evaluated, was defined. Internal reliability and test–retest reliability were satisfactory and the expected associations with age and gender were observed. High SES was correlated with significantly less depression symptoms. The prevalence of depressive risk, when the cutoff point of 19 or 13 was taken as threshold, was much lower than those obtained from studies in other countries. The cutoff point of 15, corresponding to 90th percentile of the present sample, may be used as a screening threshold for further assessment. The present results are encouraging providing evidence about the psychometric properties of the CDI and implications for child mental health promotion planning in Greece. Further validation of the CDI against other measures and psychiatric diagnoses is needed.

[1]  Alessio Zambon,et al.  The Family Affluence Scale as a Measure of National Wealth: Validation of an Adolescent Self-Report Measure , 2006 .

[2]  M. Molteni,et al.  Depressive symptoms as measured by the CDI in a population of northern Italian children , 2001, European Psychiatry.

[3]  J. Tsiantis,et al.  Competencies and problems reported by parents of Greek and American children, ages 6–11 , 2005, European Child & Adolescent Psychiatry.

[4]  M. Rutter,et al.  Effects of age and pubertal status on depression in a large clinical sample , 1992, Development and Psychopathology.

[5]  G. Kleftaras,et al.  Incidence and Teachers' Perceived Causation of Depression in Primary School Children in Greece , 2006 .

[6]  L. Dreessen,et al.  Assessing Depression in Youth: Relation Between the Children's Depression Inventory and a Structured Interview , 2004, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[7]  W. Reynolds Assessment of Depression in Children and Adolescents by Self-Report Questionnaires , 1994 .

[8]  J. Tsiantis,et al.  Schedule for affective disorders and schizophrenia for school-age children-present episode (K-SADS-P): a pilot inter-rater reliability study for Greek children and adolescents , 2003, European Psychiatry.

[9]  Gail M. Williams,et al.  The Relationship between Low Family Income and Psychological Disturbance in Young Children: An Australian Longitudinal Study , 1997, The Australian and New Zealand journal of psychiatry.

[10]  S. Ilardi,et al.  Factor analysis of the Children's Depression Inventory in a community sample , 1998 .

[11]  H. Inderbitzen,et al.  The Relationship Between Peer Status and Depressive Symptoms in Children and Adolescents , 1998, Journal of abnormal child psychology.

[12]  P. Kendall,et al.  High‐end specificity of the children's depression inventory in a sample of anxiety‐disordered youth , 2005, Depression and anxiety.

[13]  A. Kazdin Children's Depression Scale: validation with child psychiatric inpatients. , 1987, Journal of child psychology and psychiatry, and allied disciplines.

[14]  C. Hartman,et al.  Achenbach's Child Behavior Checklist and Teachers' Report Form in a normative sample of Greek children 6–12 years old , 1999, European Child & Adolescent Psychiatry.

[15]  M. Kovacs The Children's Depression, Inventory (CDI). , 1985, Psychopharmacology bulletin.

[16]  A. Kazdin,et al.  Child and parent evaluations of depression and aggression in psychiatric inpatient children , 1983, Journal of abnormal child psychology.

[17]  B. Larsson,et al.  Prevalence and short‐term stability of depressive symptoms in schoolchildren , 1992, Acta psychiatrica Scandinavica.

[18]  M. Marmot,et al.  Children's emotional and behavioural well-being and the family environment: findings from the Health Survey for England. , 2001, Social science & medicine.

[19]  Kathleenl N. Lohr,et al.  Assessing health status and quality-of-life instruments: Attributes and review criteria , 2002, Quality of Life Research.

[20]  L. Cronbach Essentials of psychological testing , 1960 .

[21]  K. Hoagwood,et al.  Early identification of mental health problems in schools: The status of instrumentation. , 2007 .

[22]  M. Marcheschi,et al.  Self-Reported Depressive Symptoms in a School Sample of Italian Children and Adolescents , 2003, Child psychiatry and human development.

[23]  J. Weisz,et al.  Developmental Differences in the Factor Structure of the Children's Depression Inventory , 1991 .

[24]  S. Kutcher,et al.  Diagnosis and measurement of adolescent depression: a review of commonly utilized instruments. , 2001, Journal of child and adolescent psychopharmacology.

[25]  R. Kessler,et al.  The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. , 1994, The American journal of psychiatry.

[26]  T. Ivarsson,et al.  The Children's Depression Inventory (CDI) as measure of depression in Swedish adolescents. A normative study , 2006, Nordic journal of psychiatry.

[27]  A. Spirito,et al.  The children's depression inventory: a systematic evaluation of psychometric properties. , 1984, Journal of consulting and clinical psychology.

[28]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[29]  C. Currie,et al.  Changes in HIV/AIDS education, knowledge and attitudes among Scottish 15-16 year olds, 1990-1994: findings from the WHO: Health Behaviour in School-aged Children Study (HBSC). , 1999, Health education research.

[30]  N. Tzavidis,et al.  Psychopathology and prosocial behavior in adolescents from socio-economically disadvantaged families: the role of proximal and distal adverse life events , 2008, European Child & Adolescent Psychiatry.

[31]  Vipan Nikore,et al.  Spanish Translation and Reliability Testing of the Child Depression Inventory , 2004, Child psychiatry and human development.

[32]  Elias Mossialos,et al.  Analysing the Greek health system: a tale of fragmentation and inertia. , 2005, Health economics.

[33]  William M. Reynolds,et al.  Handbook of depression in children and adolescents , 1994 .

[34]  P. Handal,et al.  Childhood depression: prevalence using DSM-III criteria and validity of parent and child depression scales. , 1985, Journal of pediatric psychology.

[35]  T. Charman,et al.  The Internal Structure of the Child Depression Inventory in Russian and UK Schoolchildren , 2001 .

[36]  A. Kazdin,et al.  Assessment of depression and diagnosis of depressive disorder among psychiatrically disturbed children , 1986, Journal of abnormal child psychology.

[37]  S. Nolen-Hoeksema,et al.  Age, gender, race, socioeconomic status, and birth cohort differences on the children's depression inventory: a meta-analysis. , 2002, Journal of abnormal psychology.

[38]  C. Sherbourne,et al.  The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. , 1994 .

[39]  M. Kovács,et al.  Depressive disorders in childhood. I. A longitudinal prospective study of characteristics and recovery. , 1984, Archives of general psychiatry.

[40]  M. Smucker,et al.  Normative and reliability data for the children's depression inventory , 1986, Journal of abnormal child psychology.

[41]  C. Bakoula,et al.  Social determinants of self-reported emotional and behavioral problems in Greek adolescents , 2007, Social Psychiatry and Psychiatric Epidemiology.

[42]  C. Currie,et al.  Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey. , 1997, Health education research.

[43]  V. Garvin,et al.  Children of divorce: predictors of change following preventive intervention. , 1991, The American journal of orthopsychiatry.

[44]  A. Kazdin Identifying depression in children: A comparison of alternative selection criteria , 1989, Journal of abnormal child psychology.

[45]  Louis Guttman,et al.  A basis for analyzing test-retest reliability , 1945, Psychometrika.

[46]  K. Myers,et al.  Ten-year review of rating scales. II: Scales for internalizing disorders. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[47]  M. Kovács Rating scales to assess depression in school-aged children. , 1981, Acta paedopsychiatrica.

[48]  R. Roberts,et al.  Ethnocultural Differences in Prevalence of Adolescent Depression , 1997, American journal of community psychology.

[49]  J E Ware,et al.  Methods for validating and norming translations of health status questionnaires: the IQOLA Project approach. International Quality of Life Assessment. , 1998, Journal of clinical epidemiology.

[50]  Judith Trowell,et al.  Childhood depression: a place for psychotherapy. An outcome study comparing individual psychodynamic psychotherapy and family therapy. , 2007, European child & adolescent psychiatry.

[51]  S. Nolen-Hoeksema,et al.  Age, gender, race, socioeconomic status, and birth cohort difference on the children's depression inventory: A meta-analysis. , 2002 .

[52]  Phil A. Silva,et al.  DSM-III disorders in preadolescent children. Prevalence in a large sample from the general population. , 1987, Archives of general psychiatry.

[53]  J. Morrison,et al.  Socioeconomic disadvantage and child morbidity: an Australian longitudinal study. , 1993, Social science & medicine.

[54]  M. Sisask,et al.  Children’s Depression Inventory in Estonia , 2008, European Child & Adolescent Psychiatry.

[55]  M. Sisask,et al.  Children's Depression Inventory in Estonia. Single items and factor structure by age and gender. , 2008, European child & adolescent psychiatry.

[56]  L. Doerfler,et al.  Depression in children and adolescents: a comparative analysis of the utility and construct validity of two assessment measures. , 1988, Journal of consulting and clinical psychology.

[57]  M. Frydenberg,et al.  The Children’s Depression Inventory and classification of major depressive disorder , 2005, European Child & Adolescent Psychiatry.