Measuring depression in adolescence: Evaluation of a hierarchical factor model of the Children’s Depression Inventory and measurement invariance across boys and girls

Background One of the most widely used instruments to measure depression in childhood and adolescence is Kovacs’s Children’s Depression Inventory (CDI). Even though this particular measure sparked massive interest among researchers, there is no clear consensus about its factorial structure. It has been suggested that inconsistencies in findings can be partly ascribed to the cultural context. The aim of this study was a) to examine and verify the factor structure of CDI in the Czech population and b) to assess gender-related psychometric differences using the mean and covariance structure (MACS) approach and differential item functioning (DIF) analysis. Methods The research sample consisted of 1,515 adolescents (ages 12 to 16 years, 53.7% female) from a non-clinical general population. Based on exploratory factor analysis (EFA) on a random subsample (N = 500), we proposed a model that was subsequently tested on the rest of the sample (N = 1,015) using confirmatory factor analysis (CFA). Following the MACS procedure, we assessed measurement invariance in boys and girls. The between-group comparison was further supplemented by a DIF analysis. Results The proposed hierarchical four-factor model (General Symptoms, Negative Self-Concept, Inefficiency, and Social Anhedonia) with a second-order factor of depression fitted the data reasonably well (χ2 = 1281.355; df = 320; RMSEA = 0.054, CFI = 0.925). Regarding gender differences, we found no substantial signs of measurement invariance using the MACS approach. Boys and girls differed in first-order latent means (girls scored higher on General Symptoms with a standardized mean difference of 0.52 and on Negative Self-Concept with a standardized mean difference of 0.31). DIF analysis identified three items with differential functioning. However, the levels of differential functioning were only marginal (in two items) or marginal/moderate and the presence of DIF does not substantially influence scoring of CDI. Conclusion In the general adolescent population in the Czech Republic, the CDI can be considered a reliable instrument for screening purposes in clinical settings and for use in research practice. Instead of the originally proposed five-factor model, we recommend using the newly established four-factor structure. The measure seems to show only marginal psychometric differences with respect to gender, and overall measurement invariance in boys and girls seems to be a tenable assumption.

Evidencias de validez y fiabilidad de la versión en español del Children’s Depression Inventory-Short en población peruana

Evidence of validity and reliability of the Spanish version of the Children’s Depression Inventory-Short in Peruvian population Abstract: The objective of this study was to examine the validity evidence of the Children’s Depression Inventory-Short (CDI-S; Kovacs, 1992), in Peruvian school children. A total of 1059 children between 7 and 12 years old participated (Mean = 9.73, SD = 1.23). The results revealed the existence of two factors related to strong loads in the exploratory factor analysis, which were corroborated by confirmatory factor analysis with good goodness-of-fit indices (CFI ≥ .97, RMSEA ≤ .04). The reliability of the CDI-S, calculated with the internal consistency method, was good in both factors (ω > .80). We conclude that the CDI-S is a valid and reliable measure in Peruvian children and should be interpreted as a test with two factors (Dysphoria and Negative self-esteem), which is consistent with previous empirical and theoretical studies. Keywords: Validation; reliability; depression; children. Resumen: El presente estudio tuvo como objetivo examinar evidencias de validez y fiabilidad de la versión en español del Children’s Depression Inventory-Short (CDI-S, Kovacs, 1992), en población peruana. Participaron 1059 niños y niñas entre 7 y 12 años (Media = 9.73, DT = 1.23). Los resultados revelaron la existencia de dos factores relacionados con cargas fuertes enel análisis factorial exploratorio, los cuales fueron corroborados mediante el análisis factorial confirmatorio con buenos índices de bondad de ajuste (CFI ≥ .97, RMSEA ≤ .04). La fiabilidad del CDI-S, calculada con el método de consistencia interna, fue buena en los dos factores (ω > .80). Se concluye que el CDI-S es una medida valida y fiable en niños peruanos y debe ser interpretada como una prueba con dos factores (Disforia y Autoestima negativa), lo cual es coherente con estudios empíricos y teóricos previos. Palabras clave: Validación; fiabilidad; depresión; niños.

Systematic Review on the Use of the Children’s Depression Inventory-2 Among Hispanics

We systematically reviewed studies reporting the use of the Children’s Depression Inventory-2 (CDI-2) in samples with at least 30 children and significant Hispanics enrollment (≥14.5% of the sample and at least 20 Hispanics completing the scale). We grouped studies by form (short or full-length) and language used, developmental stage, report of psychometric data (particularly for Hispanics), and other characteristics. From 252 full-texts revised, 22 met selection criteria. Six reported psychometric data for Hispanics, either for the English full-length (α = .86–.92) and short form (α = .76–.81) or for the Spanish short form (α = .69–.80). Criterion-related validity was supported via correlation/regression or comparing group means, but not using another depression self-report scale. Current knowledge on the CDI-2 psychometrics among Hispanics is mostly based on studies with the English-language version. No study has reported the psychometrics of the full-length Spanish-language CDI-2 with Hispanics.

Association Between Depression and Cardiometabolic Risk Factors in Adolescents with Obesity

Objective: The aim of this study was to examine whether the presence of depression in adolescents who were overweight or obese increase the likelihood of cardiometabolic risk factors. Method: We performed a retrospective cross-sectional analysis of the data from adolescents who were overweight or obese, aged 11-18 years, who were evaluated in our clinic from January 2012 to December 2015. Depression was evaluated by “Children’s Depression Inventory”. Hypertension, dyslipidemia, hyperinsulinemia, hyperglycaemia and insulin resistance were defined as cardiometabolic risk factors. The degree of obesity was calculated as the body mass index standard deviation score. Results: Among 283 adolescents 75 (26.5%) were overweight, and 208 (73.5%) had obesity, the mean age was 14.02±1.67 years and 168 (59.4%) of the subjects were girls. The body mass index standard deviation score was in median 2.36±0.62, Children’s Depression Inventory score was in median 12.72±6.5, and 47 (16.6%) of the participants were found depressed. Depression frequency was found higher in females than in males (p=0.047). Body mass index standard deviation score had positive correlation with Children’s Depression Inventory scores (r=0.123, p= 0.038). In univariate analysis, in depressed group hyperinsulinemia was found 2.3 times more frequent than in nondepressed group (p=0.026). In logistic regression analysis this relation disappeared. Conclusion: We showed that severity of depression increased, as the degree of obesity increased, but we could not find any clear relationship between depression and cardiometabolic risk factors in adolescents who were overweight or obese.

Anxiety, depression, and behavioural rating scales in children with non-cardiac chest pain

Introduction:Chest pain is the second most common reason for referral to paediatric cardiologists after benign heart murmurs. Aetiology frequently depends on non-cardiac reasons. In addition, individuals may experience non-cardiac chest pain which is idiopathic or of unknown origin. The aim of this study is to examine psychological symptoms in children and adolescents with medically unexplained chest pain.Methods:A total of 76 patients (ages 8–18 years) were included in the study, who were referred to the paediatric cardiology department with the complaint of chest pain but did not have any detected cardiac aetiology or any other organic causes of chest pain. The control group was composed of 51 healthy volunteers. Self-evaluation scales were given to both groups which included Beck Anxiety Inventory and Children’s Depression Inventory. Also parents of both groups completed the Conner’s Parent Rating Scale for assessment of Attention-deficit/hyperactivity disorder.Results:Anxiety scores of the non-cardiac chest pain group were significantly higher compared to controls. No significant differences were found between patients and controls in terms of attention-deficit/hyperactivity disorder and depression scores. In patient group, patterns were similar for boys and girls and for children and adolescents; except girls scored significantly higher than boys in children’s depression inventory.Conclusions:In children and adolescents, non-cardiac chest pain is associated with increased levels of anxiety. These results show the importance of psychiatric evaluation in non-cardiac chest pain patients. Larger controlled studies are needed to determine the prevalence and impact of attention-deficit/hyperactivity disorder and depression in children and adolescents with non-cardiac chest pain.