| Objective: To compare the validity of the common depression scales: the Centre for Epidemiologic Studies of Depression Symptom Scale(CES-D),The Center for Epidemiological Studies Depression Scale-10 item version(CES-D-10), Beck Depression Inventory-II in Chinese Version(BDI-II-C) and the Chinese version of the Patient Health Questionnaire 2-item(PHQ-2-C). Methods: A sample of 1113 junior-and high-school adolescents(aged 11-19 years) completed the PHQ-2-C, the Centre for Epidemiologic Studies of Depression Symptom Scale(CES-D) and Chinese Version of Beck Depression Inventory-II(BDI-II-C). Among the adolescents, 634 youths(mean age 14.36±1.71 years old; CES-D≥20,n=322;CES-D<20, n=312) subsequently completed a structured diagnostic interview with the Schedule for Affective Disorder and Schizophrenia for School-age Children(K-SADS). In the study, the diagnoses of depressive disorders, mainly including major depressive disorder(MDD) and any other depressive disorders, were made on the criteria of American Diagnostic and Statistical Manual of Mental Disorders in 4th Edition(DSM-IV). Criterion validity of the PHQ-2-C, CES-D, short form of CESD-10 item(CES-D-10) and BDI-II-C were assessed against the diagnoses of major depression and any depressive disorder provided by the structured diagnostic interview as the gold standard for validation. Sensitivity, specificity, the areas under receiver operating characteristic(ROC) curve(AUC), positive predict value(PPV) and negative predict value(NPV) were computed and compared for PHQ-2-C, CES-D, CES-D-10 and BDI-II-C at their optical cutoffs.Results:(1) A PHQ-2-C score of ≥ 3 had a sensitivity of 87%~94%, specificity of 73%~75%, AUC of 0.85, positive predict value of 14.9%~27.3% and negative predict value of 98.1%~99.5% for detecting MDD and any depressive disorder.(2) A CES-D score of ≥ 29 and ≥ 26 had a sensitivity of 95%~97%, and specificity of 75%~79%, and AUC of 0.89~0.92, and positive predict value of 19.2%~29.1% and negative predict value of 99.3%~99.7% for detecting MDD and any depressive disorder.(3) A CES-D-10 score of ≥ 15 and ≥ 13 had a sensitivity of 93%~97%, and specificity of 73%~78%, and AUC of 0.87~0.91, and positive predict value of 18.6%~27.1% and negative predict value of 99.1%~99.7% for detecting MDD and any depressive disorder.(4) A BDI-II-C score of ≥ 28 and ≥ 15 had a sensitivity of 94%~97%, and specificity of 79%~82%, and AUC of 0.91~0.93, and positive predict value of 21.5%~33.3% and negative predict value of 99.3%~99.6% for detecting MDD and any depressive disorder.(5) PHQ-2-C,compared with CES-D,CES-D-10 and BDI-II-C:its sensitivity(94% vs 94%~97%) and negative predict value(99.5% vs 99.3%~99.7%)for detecting MDD,and its negative predict value for detecting any depressive disorder.(98.1% vs 99.1%~99.6%)are similar with the above three scales(Ps >0.05).However, its specificity, AUC, and positive predict value for detecting MDD and its sensitivity for detecting any depressive disorder are significantly lower than the above three scales(Ps < 0.05).(6)Comparing between CES-D and BDI-II-C: for detecting MDD and any depressive disorder,they have similar sensitivity,AUC and NPV(P>0.05);But the specificity(79%) and PPV(33.3%)of BDI-II-C are significantly higher than CES-D(75%,29.1%, respectively; P=0.05) for detecting any depressive disorder. Conclusion: The PHQ-2-C,CES-D and BDI-II-C demonstrated high criterion validity for detecting depressive disorder in adolescents in school settings. The PHQ-2-C could be recommended as a useful tool for the first step in screening adolescent depression in school settings;While the CES-D and BDI-II-C can be used to screen the severity for the first step other than diagnose depressive disorder, as both of them have a relatively high false positive rate. |
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