A Psychometric Evaluation of the CDRS and MADRS in Assessing Depressive Symptoms in Children

Jain, Shailesh; Carmody, Thomas; Trivedi, Madhukar H.; Hughes, Carroll W.; Bernstein, Ira H.; Morris, David W.; Emslie, Graham J.; Rush, A. John

doi:10.1097/chi.0b013e3180cc2575

Cited by 41 publications

(20 citation statements)

References 31 publications

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“…On the CDRS-R, interviewers use information obtained from both the mother and child to rate each symptom (Poznanski et al, 1985). The CDRS-R has good internal consistency, construct validity, inter-rater reliability, and can capture changes in specific symptoms over time (Jain et al, 2007; Mayes, Berstein, Haley, Kennard, & Emslie, 2010). Reliability of the CDRS-R ratings at each time point was ≥ .72.…”

Section: Methodsmentioning

confidence: 99%

Trajectories of individual depressive symptoms in adolescents: Gender and family relationships as predictors.

Kouros

Garber

2014

Developmental Psychology

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Depressive syndrome and disorders increase substantially during adolescence. Little is known, however, about how individual symptoms of depression change over the course of this developmental period. The present study examined within-person changes in symptom severity of each individual symptom of depression, utilizing longitudinal data collected across six years of adolescence. Adolescent gender and family relationship variables were tested as predictors of the symptom trajectories (i.e., intercept and slope). Adolescents and their mothers (N = 240) were first evaluated when youth were in grade 6 (M = 11.86 years old; SD = 0.56; 54% female) and then annually through grade 12. Individual symptoms of depression were assessed by a clinical interviewer using the Children’s Depression Rating Scale-Revised (CDRS-R). Mothers and youth also completed measures about their relationship on the Children’s Report of Parent Behavior Inventory and the Family Environment Scale. Results showed that all depressive symptoms increased linearly over time except psychomotor disturbances and problems with concentration and decision making, which were best represented by a quadratic growth model. Sex differences were found such that significantly more rapid increases in worthlessness/guilt were found for girls than boys, and concentration/decision making problems decreased significantly for boys, but not girls. Poor family relationship quality (mother-reported) predicted a significantly faster rate of increase in adolescents’ symptoms of anhedonia, appetite/weight changes, and fatigue. High maternal psychological control (youth-reported) also predicted a faster rate of increase in anhedonia. Study limitations, future research directions, and clinical implications of the findings are discussed.

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Section: Methodsmentioning

confidence: 99%

Trajectories of individual depressive symptoms in adolescents: Gender and family relationships as predictors.

Kouros

Garber

2014

Developmental Psychology

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“…Previous factor analyses of the CDRS-R have described it as multidimensional (Guo et al 2006;Jain et al 2007;Bernstein et al 2010). However, these studies had either gathered data from a single session or a pair of sessions (baseline and exit), subjects had been randomized to different interventions, studies had lacked structured diagnostic interviewing, or the sample had been obtained from a heterogeneous population of depressed and nondepressed children.…”

Section: Discussionmentioning

confidence: 99%

“…In a combined sample of bipolar and unipolar depressed subjects (Mitchell et al 2013), lamotrigine was helpful in alleviating the dimensions of depressive cognitions and psychomotor retardation in subjects with bipolar depression. Results from adult studies have informed and guided similar studies of dimensions in childhood depression (Guo et al 2006;Jain et al 2007;Bernstein et al 2010;Tao et al 2010).…”

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confidence: 99%

“…These factors were: Observed depression (tempo of speech, hypoactivity, depressed affect), reported depression (weeping, depressed feeling, low self-esteem), anhedonia (social withdrawal, inability to have fun), morbid thoughts (morbid ideation, suicidal ideation), and somatic symptoms (excessive fatigue, sleep, physical complaints, schoolwork problems). Jain et al (2007) noted that the internal consistency of individual items when the baseline and exit CDRS scores were examined, improved remarkably at the end of the study. However, they found a threefactor solution to be more suitable.…”

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confidence: 99%

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Childhood Depression Subscales Using Repeated Sessions on Children's Depression Rating Scale – Revised (CDRS-R) Scores

Isa

Bernstein

Trivedi

et al. 2014

Journal of Child and Adolescent Psychopharmacology

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Background: Although acute treatments have been shown to be effective in treating early-onset depression, only one-third or thereabouts reach a remission within 3 months. Unfortunately, delayed time to remission in early-onset depression leads to poorer therapeutic outcomes. Clearly, there is a need to identify, diagnose, and provide effective treatment of a depressed patient quickly. A sophisticated understanding of depression subscales and their change over time with treatment could enhance pathways to individualized treatment approaches for childhood depression. Objective: Previous studies have found that the clinician-measured instrument, Children's Depression Rating Scale-Revised (CDRS-R) measures multiple subscales (or components) of depression. The aim of this study was to see how these subscales may change over the course of a 12-week study. This knowledge will help determine if dimensions/subscales of childhood depression (paralleling the adult literature) using the subscales derived from factor analysis procedure is useful. Methods: We examined two clinical trials in which youth (n = 234) with major depressive disorder (MDD) were treated openly with fluoxetine for eight sessions spread over 12 weeks. The CDRS-R was completed based on clinician interviews with parent and child at each session. Classical test theory and component analysis with associated parallel analysis (oblique rotation) were conducted on each week's scores. Results: Although more factors were needed for the baseline and first two therapy sessions, a two-factor solution sufficed thereafter. Depressed facial affect, listless speech, and hypoactivity best defined Factor I, whereas sleep problems, appetite disturbance, physical symptoms, irritability, guilt, and weeping best defined Factor II. All other symptoms cross-loaded almost equally on the two factors. The scale's reliability (internal consistency) improved from baseline to exit sessions (a = 0.65-0.91). As a result, the clinicians' assessments of the various symptoms became more highly related to one another. This caused the first eigenvalue to increase from 3.24 to 7.38 and the variance explained to increase (%) from 19% to 43% over sessions. These two factors may reflect 1) clinician-observed signs and 2) reported symptoms of depression. Conclusions: Factor analysis of CDRS-R data in a single session consistently generates a complex and difficult to interpret structure of at least three factors. This makes it very difficult to understand what these factors measure. However, when gathered over additional sessions, the CDRS-R structure tends to simplify to two factors. The reasons for this simplification are as yet unclear and in need of further study.

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“…This measure has shown good internal consistency, inter-rater reliability, convergent validity with measures of depressive severity and global functioning, ability to discriminate between depressed an non-depressed children, and sensitivity to change over treatment (Jain et al, 2007; Mayes et al, 2010; Poznanski et al, 1984; Poznanski and Mokros, 2005). Internal consistency was good in this sample (α = .82), with higher scores indicating greater depressive symptom severity.…”

Section: Methodsmentioning

confidence: 99%

Suicidal ideation in youth with tic disorders

Johnco

McGuire

McBride

et al. 2016

Journal of Affective Disorders

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Background This study examined the incidence and clinical correlates of suicidal ideation (SI) in youth with tic disorders (TD). The independent contribution of tics, anxiety, depressive and externalizing symptoms on SI severity in youth with TD was assessed. Method Participants were 75 treatment-seeking youth with a TD (N = 75) aged 6–18. Participants completed diagnostic assessments, clinician-ratings, self- and parent-report measures of emotional functioning and the presence and/or severity of suicidal ideation. Results Based on youth-report, 61% of youth endorsed at least some symptoms of SI, and 8% endorsed symptoms that exceeded the clinically significant cut-off. Parents reported SI in 11% of cases, with generally poor agreement between parent- and youth-report. Suicidal ideation correlated with higher anxiety, depressive and externalizing symptoms, affective lability, and with poorer distress tolerance and overall functioning. Anxiety, depressive and externalizing symptoms showed an independent relationship with SI. Tic severity was not associated with SI. Rather, higher tic severity was associated with an increase in anxiety symptoms, which in turn, was associated with greater SI severity. Limitations Cross-sectional data limits causal conclusions. Diagnosis was based on unstructured assessments by expert clinicians, including consensus diagnosis, rather than structured clinical interviews. Conclusions Around 8–11% of youth with TD experienced SI. Tic severity did not have any direct influence on SI, however the presence of comorbid anxiety and depressive symptoms significantly increases this risk. Results suggest that it is psychiatric comorbidity, rather than tics themselves, that predispose youth with tic disorders to increased risk of suicidality.

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A Psychometric Evaluation of the CDRS and MADRS in Assessing Depressive Symptoms in Children

Cited by 41 publications

References 31 publications

Trajectories of individual depressive symptoms in adolescents: Gender and family relationships as predictors.

Trajectories of individual depressive symptoms in adolescents: Gender and family relationships as predictors.

Childhood Depression Subscales Using Repeated Sessions on Children's Depression Rating Scale – Revised (CDRS-R) Scores

Suicidal ideation in youth with tic disorders

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