title: Symptom screening scales for detecting major depressive disorder in children and adolescents: a systematic review and meta-analysis of reliability, validity and diagnostic utility.
abstract: BACKGROUND
  Depression symptom screening scales are often used to determine a clinical diagnosis of major depressive disorder (MDD) in prevention research. The aim of this review is to systematically examine the reliability, validity and diagnostic utility of commonly used screening scales in depression prevention research among children and adolescents.
  
  
  METHODS
  We conducted a systematic review of the electronic databases PsycINFO, PsycEXTRA and Medline examining the reliability, validity and diagnostic utility of four commonly used depression symptom rating scales among children and adolescents: the Children׳s Depression Inventory (CDI), Beck Depression Inventory (BDI), Center for Epidemiologic Studies - Depression Scale (CES-D) and the Reynolds Adolescent Depression Scale (RADS). We used univariate and bivariate random effects models to pool data and conducted metaregression to identify and explain causes of heterogeneity.
  
  
  RESULTS
  We identified 54 studies (66 data points, 34,542 participants). Across the four scales, internal reliability was 'good' (pooled estimate: 0.89, 95% Confidence Interval (CI): 0.86-0.92). Sensitivity and specificity were 'moderate' (sensitivity: 0.80, 95% CI: 0.76-0.84; specificity: 0.78, 95% CI: 0.74-0.83). For studies that used a diagnostic interview to determine a diagnosis of MDD, positive predictive power for identifying true cases was mostly poor. Psychometric properties did not differ on the basis of study quality, sample type (clinical vs. nonclinical) or sample age (child vs. adolescent).
  
  
  CONCLUSIONS
  Some analyses may have been underpowered to identify conditions in which test performance may vary, due to low numbers of studies with adequate data.
  
  
  CONCLUSIONS
  Commonly used depression symptom rating scales are reliable measures of depressive symptoms among adolescents; however, using cutoff scores to indicate clinical levels of depression may result in many false positives.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, New South Wales 2031, Australia. Electronic address: e.stockings@unsw.edu.au.
authors.forename: Emily
authors.initials: E
authors.lastname: Stockings
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, New South Wales 2031, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.affiliation: Queensland Centre for Mental Health Research (QCMHR), School of Population Health, University of Queensland, Herston Road, Herston, Queensland 4006, Australia.
authors.forename: Yong Yi
authors.initials: YY
authors.lastname: Lee
authors.affiliation: Deakin Health Economics Unit, Population Health Strategic Research Centre, Deakin University, 211 Burwood Highway, Burwood, Victoria 3125, Australia.
authors.forename: Cathrine
authors.initials: C
authors.lastname: Mihalopoulos
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, New South Wales 2031, Australia.
authors.forename: Angus
authors.initials: A
authors.lastname: Liu
authors.affiliation: Clinical Research Unit for Anxiety and Depression (CRUfAD), University of Newcastle, St Vincent׳s Hospital, 390 Victoria Street, Darlinghurst 2010, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Hobbs
authors.affiliation: Centre for Adolescent Health, The Royal Children׳s Hospital, 50 Flemington Road, Parkville, Victoria 3025, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Patton
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002653:Child Behavior Disorders / Q000175:diagnosis*; D003865:Major Depressive Disorder / Q000175:diagnosis*; D006801:Humans; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D063189:Symptom Assessment / Q000592:standards*
keywords: Children and adolescents; Depression; Prevention; Psychiatric Symptom Rating Scales; Psychometrics; Validity