Examining parent and child agreement in the diagnosis of adolescent depression

Abstract

Background The diagnosis of depression in adolescents relies on identifying the presence of specific core and additional symptoms. Symptoms can be identified using structured or unstructured interviews and a range of questionnaire measures, which are completed by the young person and by a parent or carer. The aim of this research was to examine the inter‐ and intra‐rater reliability of parent report and adolescent self‐report of depression symptoms. Method In a sample of parent–child dyads, where young people aged 13–17 were referred to a mental health service for depression, we examined adolescents’ (n = 46) and parents’ (n = 46) independent responses to the Schedule for Affective Disorders and Schizophrenia in School‐Age Children (Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1997, 980) and the Mood and Feelings Questionnaire (Journal of the American Academy of Child and Adolescent Psychiatry, 27, 1988, 726). Results In the clinical interview, diagnostic criteria were more often met based on the adolescent's report, and adolescents endorsed more symptoms of depression than their parents. Tentative results also suggest that parent–child agreement about specific symptoms was low. Comparing different measures of depression revealed that adolescent report on the questionnaire and interview was significantly correlated. However, there was no significant correlation between parent questionnaire and interview report. Conclusion These results suggest that relying solely on parents to identify depression in their children may result in young people with depression being missed and therefore untreated. Young people themselves should be encouraged and enabled to recognise the symptoms of depression and have an established pathway to services that offer assessment and treatment. Diagnosis of depression in adolescents requires the identification of specific symptoms and can be identified using interviews or questionnaires. Previous research has suggested that parents and young people provide differing reports regarding symptoms of adolescent depression. Results indicated that diagnostic criteria were more often met based on young person report and that parents reported significantly less symptoms. Parent–child agreement about specific symptoms was found to be low. Assessment of adolescent depression should not rely solely on parental report. Young people should be encouraged and enabled to recognise symptoms of depression and be able to access mental health services.

Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health

“…YES is a non-randomized, exploratory program evaluation; procedures and analyses were preregistered on Open Science Framework [ 50 ]. In order to maintain anonymity and minimize access barriers (eg, discomfort disclosing psychological distress, as parents are often unaware of their adolescents’ depressive symptoms, including suicidal and morbid ideation, in up to 80% of cases [ 51 , 52 ]), parent permission is not required to participate (waived by the University IRB). After clicking the YES participation link and advancing past a “Project Information” page where agreement to participate is indicated, participants provide non-identifying demographic information; select one of three SSIs to complete; and may then complete pre-SSI questionnaires, the SSI, and post-SSI questionnaires, designed to gauge the SSI’s acceptability and short-term effects.…”

Practitioner Review: Effectiveness of indicated school‐based interventions for adolescent depression and anxiety – a meta‐analytic review

“…Adolescent reported outcomes were prioritised for two reasons. First these data were more often available than symptom reports from parents; second, there is evidence of significant discrepancy between adolescent and parent reports of the young person's symptoms, meaning that these cannot be considered inter-changeable (Orchard, Pass, Cocks, Chessell, & Reynolds, 2019).…”

Who should we ask about mental health symptoms in adolescents with CFS/ME? Parent-child agreement on the revised children’s anxiety and depression scale

“…This is consistent with previous research showing that parental proxy-report identifies depressive symptoms less frequently than their child’s self-report ( Eg et al, 2018 ; Orchard et al, 2017 ). Higher agreement has been demonstrated for externalising behaviours ( Comer & Kendall, 2004 ; Hemmingsson et al, 2017 ; Orchard et al, 2019 ), which are often directly observable or occur in the home environment. This is true for both mental and physical health parameters.…”

“…One large meta-analysis of 341 studies demonstrated only low to moderate correlations between children and parents in relation to mental health symptoms ( De Los Reyes et al, 2015 ). Recent evidence evaluating depression found that parents identified fewer symptoms than their adolescent children, meaning adolescents met the diagnostic criteria less frequently based on parental responses ( Orchard et al, 2019 ). This is consistent with previous research showing that parental proxy-report identifies depressive symptoms less frequently than their child’s self-report ( Eg et al, 2018 ; Orchard et al, 2017 ).…”