A computerised screening instrument for adolescent depression: population-based validation and application to a two-phase case-control study.
Computer-administered questionnaires have been little explored as a potentially effective and inexpensive alternative to pencil and paper screening tests. A self-administered computerised form of the revised Clinical Interview Schedule (CIS-R) was compared with the Composite International Diagnostic Interview (CIDI) in a two-phase study of 2032 Australian high school students (mean age 15.7 years) drawn from a stratified random sample of 44 schools in the state of Victoria, Australia. Prevalence, sensitivity and specificity were estimated using weighting to compensate for the two-phase sampling. Point prevalence estimates of depression using the CIS-R were 1.8% for males and 5.6% for females--an overall prevalence of 3.2%. Prevalence estimates for depression in the past 6 months using the CIDI were 5.2% for males and 16.9% for females--an overall estimate of 12.1%. The CIS-R had a positive predictive value (PPV) of 0.49 and negative predictive value (NPV) of 0.91 for CIDI depression in the past 6 months. Specificity was very high (0.97) but sensitivity low (0.18), indicating that a majority of those with a CIDI-defined depressive episode in the past 6 months were not recognised at a single screening using the CIS-R. Even so, the CIS-R has proved at least as good as any pencil and paper questionnaire in identifying cases for nested case-control studies of adolescent depression. Further exploration of strategies such as serial screening to enhance sensitivity is warranted.
D000293:Adolescent; D000465:Algorithms; D001315:Australia / Q000453:epidemiology; D016022:Case-Control Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation*; D011237:Predictive Value of Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D000297:Psychology, Adolescent / Q000706:statistics & numerical data*; D011594:Psychometrics; D012494:Sampling Studies; D011795:Surveys and Questionnaires