Selective Responsiveness of Chronically Ill Children to Assessments of Depression

Many investigators have noted that depression is a common symptom among pediatric cancer patients. However, prevalence rates vary widely across studies This variation in prevalence rates may be due, in part, to selective reporting of patients based on measure, used and environmental cues. In this study, we evaluated 50 chronically ill pediatric patients (19 cancer and 31 diabetic patients) for their use of selective reporting of depression. Factors in the 2 x 2 design were Intervention (disclosure videotape and cartoon videotape) and Examiner (familiar examiner and unfamiliar examiner). In the intervention manipulation, subjects were shown either a videotape prompting the child that self-disclosure was appropriate or a tape of a cartoon (control condition). In the Examiner manipulation, subjects were administered the experimental measures by either a familiar (parent) or unfamiliar (research assistant) examiner. Dependent variables were the Children's Depression inventory (CDI; Kovacs, 1981), the Depression scale of the Roberts Apperception Test for Children (RATC; McArthur & Roberts, 1982), and a depression measure taken from the Child Behavior Checktist (CBCL; Achenbach & Edelbrock, 1983). As hypothesized, the Examiner x intervention interaction revealed that children who did not view the disclosure videotape and who were tested by an unfamiliar examiner gave significantly lower self-reports of depression on the CDI than children in the other conditions. However, parent and child projective reports of depression did not vary as a function of experimental condition. The results are interpreted as selective responding on the part of pediatric patients. Limitations of assessing internal psychological states in children are discussed.     

The relations of thematic and nonthematic childhood depression measures to defensiveness and gender

The susceptibility of self-report and thematic measures of depression to the effects of a defensive test-taking approach was assessed among 44 child and adolescent psychiatric inpatients. It was hypothesized that scores on a measure of defensiveness would be associated with self-reported but not thematic measures of depression, and furthermore, that this finding would be more pronounced for girls than boys. Patients completed the Lie Scale of the Revised Children's Manifest Anxiety Scale (RCMAS), the Children's Depression Inventory (CDI), and the Roberts Apperception Test for Children. As predicted, RCMAS-Lie scores were significantly associated with CDI but not Roberts Depression scores, and this effect was more pronounced among females, primarily due to the high CDI scores of nondefensive girls. Implications of results for psychological assessment of children and adolescents are discussed.     

Norms and screening utility of the Dutch version of the Children's Depression Inventory in clinical and nonclinical youths

This study aimed to (a) assess relationships between the Children's Depression Inventory (CDI) and DSM-oriented depression and anxiety scales of the Youth Self Report, (b) develop reliable norms for the CDI, and (c) determine CDI cutoff scores for selecting youngsters at risk for depression and anxiety. A total of 3,073 nonclinical and 511 clinically referred children and adolescents from The Netherlands and Belgium were included. Results showed that CDI scores were significantly related to DSM-oriented symptoms of both depression and anxiety. CDI scores correlated highly with depression symptoms and moderately with anxiety symptoms. Norms for the CDI were determined by means of multiple regression analysis and depended on sex, age, and country. CDI cutoff scores for selecting individuals at risk for depression and anxiety as measured by the DSM-oriented depression and anxiety scales of the Youth Self Report were determined by means of multiple regression analysis and receiver operating characteristic analysis. A CDI score of 16 was found to have the most optimal balance between sensitivity and specificity for depression, whereas a score of 21 provided the best sensitivity and specificity for anxiety in a subsample of children. We conclude that the CDI is an effective instrument for screening depression and to a lesser extent anxiety in primary and secondary care centers, before applying further assessment of high-risk individuals.     

The relationship of anxiety to childhood depression

In order to investigate the relationship between anxiety and depression in emotionally disturbed children, 30 hospitalized inpatient children were individually administered the Children's Depression Inventory (CDI), the Children's Manifest Anxiety Scale-Revised (CMAS-R), and the State-Trait Anxiety Inventory for Children (STAIC). Results indicated a significant relationship between CDI scores, the CMAS-R and its factors, and the STAIC. Correlations between the various factors of anxiety and depression suggest a complex relationship between the two constructs. Stepwise regression analyses indicated further the complexity of this relationship. Results were discussed in terms of the possible differential role which the different anxiety factors play in depression.     

Correlates of depressed mood in normal children

Two instruments which have been proposed as measures of clinical depression in children and an ad hoc teacher rating were given to a group of 109 normal children. The Children's Depression Inventory (CDI), the Peer Nomination Inventory for Depression (PNID), and a teacher rating of depression were given along with the Conner s Teacher Rating Scale (TRS), teacher ratings of somatic complaints, peer popularity, and absenteeism, and peer ratings of popularity to examine the behavioral correlates of depressed mood in normal children. While few sex differences were found on mean depression scores, different patterns of correlations were found for the two sexes. For males, there were no significant correlations among the three depression measures, but all three depression measures were correlated with unpopularity and conduct problem ratings on the TRS. For females, the three depression measures were adequately intercorrelated. The teacher rating of depression was correlated with general deviance as measured by the TRS, but the CDI and PNID were correlated with TRS ratings of conduct problems, with peer ratings of unpopularity, and with teacher ratings of somatic complaints. Implications for the issue of the possible existence of a clinical syndrome of depression in children were discussed.     

The Children's Depression Inventory: error in cutoff scores for screening purposes

The Children's Depression Inventory (CDI) is used to screen for depression in school-age children. Such screening uses the manual's reported information on suggested cutoff scores. These cutoff scores are based on an erroneous base-rate calculation and an inadequate methodology. Data are provided showing that for the suggested cutoff scores of 13 or 20, the CDI has poor receiver-operating characteristics. Indeed, for the cutoff score of 20, suggested as being suitable for screening in the general population (e.g., schools), clinicians will miss 86% of depressed children. In conclusion, it is recommended that the CDI is better suited as a continuous measure of mood and that cutoff scores should not be used to screen for the likely presence or absence of depression.     

Using videotape modeling to prepare children psychologically for surgery: influence of parents and costs versus benefits of providing preparation services

Sixty pediatric patients having first-time elective surgery participated in this study. Surgery preparation using videotape procedures was employed. The research design included two viewing conditions (with parent present and without parent present) and three treatment procedures (adult-narrated videotape, peer-narrated videotape, and control/no-videotape condition). Results suggested that children who viewed the videotape with their parent present exhibited less preoperative arousal compared to children who did not. The patients undergoing preparation using the videotape model exhibited less arousal, less self-reported anxiety, and less behaviorally rated anxiety when compared to patients who did not view the videotape preparation. There was no difference between the patients who viewed the adult-narrated versus the peer-narrated videotape. In addition, parents who viewed the videotape or whose children viewed the videotape without them exhibited less arousal prior to the operation than parents who did not and whose children did not view the videotape preparation. Finally, a cost-benefit analysis revealed that preparation services could reduce individual and overall medical costs.     

The utility of the rorschach coping deficit index as a measure of depression and social skills deficits in children and adolescents

Little research has evaluated the validity of the Coping Deficit Index (CDI) of the Rorschach Comprehensive System (CS). Because the CS Depression Index (DEPI) has frequently been found to yield false negatives, the CDI has been proposed as an alternative means of assessing social coping skills that may relate to depression. This study examined potential correlates of the CDI using the Personality Inventory for Children-Second Edition (PIC-2). Sixty-five children and adolescents were assessed with the Rorschach CS and the PIC-2. None of the PIC-2 clinical scales or subscales measuring withdrawal or social skills predicted a positive CDI, and none of the depression-related PIC-2 scales predicted a positive CDI or DEPI. The only significant relationship found was a negative relationship between the CDI and a PIC-2 subscale measuring sleep problems and preoccupation with death. Implications of these findings for clinicians and further research are discussed.     

Moderators of the Relation Between Popularity and Depressive Symptoms in Children: Processing Strength and Friendship Value

Children with low (n = 25) and high (n = 38) peer-rated popularity completed an emotional Stroop task, using negative social words, a self-report measure of friendship value relative to other domains of competence, and the Child Depression Inventory (CDI). Six months later, they completed the CDI again. In regression analyses, after controlling for prior CDI scores, social status interacted significantly with both Stroop and value measures (separate regressions). For unpopular children, both greater friendship valuing and greater negative social word Stroop interference predicted increases in depressive symptoms. In contrast, neither predictor was significant for popular children. In a third regression that included friendship value and Stroop interference as joint predictors of depression change, their effects remained significant and independent. We discuss these findings' implications for 3 models of depression; Champion and Power's social-cognitive theory of depression (L. A. Champion and M. J. Power, 1995), Pyszczynski and Greenberg's self-regulatory perseveration theory of depression (T. Pyszczynski & J. Greenberg, 1992), and Harter's model of global self-worth (S. Harter, 1985).     

The assessment of depression in children: The internal structure of the child depression inventory (CDI)

In the present report three separate studies of childhood depression were conducted. First, the internal structure of the Child Depression Inventory (CDI), with 216 children representing various ethnic groups with equal numbers of boys and girls, was evaluated through a factor analysis and by various internal-reliability measures (e.g. split-half reliabilities, Pearson correlations of each item to the total score). Four factors were established and internal reliability of the scale proved to be high. The relationship of the factor structure of the CDI to Kendell's Type A and B categorization of depression are discussed. In Study 2 the relationship of demographic variables to the CDI using the same group of children described for Study 1 was employed. Evaluating the characteristics of depression across age, sex and so on in children has not been frequently studied, and was deemed appropriate for the present investigation. Age proved to be a significant factor in depression scores although race and gender did not. With respect to age, older children tended to display more symptomatology. Comparisons of depressed children to nondepressed children also showed that age was a factor in the obtained scores, and range of severity in both groups. Depressed children differed from nondepressed children on all 27 items indicating that all the items on the CDI seem to be measuring a unitary concept. Study 3 compared CDI scores to a measure of social behavior, the Matson Evaluation of Social Skills with Youngster (MESSY). Seventy-six children (36 girls and 40 boys), ages 4–10 yrs $\text{(}\text{X}\text{?}\text{= 7)}$ were evaluated. Appropriate Social Skills was negatively correlated with childhood depression, and Inappropriate Impulsive/Assertiveness was positively correlated with depressive features described under the factor Guilt/Irritability. The implications of these data for further research on assessment, differential diagnosis and evaluation of treatment research are discussed.     

Age,gender, race,socioeconomic status,and birth cohort differences on the children's depression inventory: a meta-analysis

A within-scale meta-analysis was performed on 310 samples of children (ages 8-16; N = 61,424) responding to the Children's Depression Inventory (CDI). Girls' depression scores stayed steady from ages 8 to 11 and then increased between ages 12 and 16. Boys' CDI scores were stable from ages 8 to 16 except for a high CDI score at age 12. Girls' scores were slightly lower than boys' during childhood, but girls scored higher beginning at age 13. There were no socioeconomic status effects and no differences between White and Black samples. However, Hispanic samples scored significantly higher on the CDI. Analyses for birth cohort showed a slight decrease in boys' CDI scores over time and no change for girls. Longitudinal studies demonstrated a marked testing effect.     

Choosing your informant: weighing familiarity and recent accuracy

In two experiments, children aged 3, 4 and 5 years (N= 61) were given conflicting information about the names and functions of novel objects by two informants, one a familiar teacher, the other an unfamiliar teacher. On pre‐test trials, all three age groups invested more trust in the familiar teacher. They preferred to ask for information and to endorse the information that she supplied. In a subsequent phase, children watched as the two teachers differed in the accuracy with which they named a set of familiar objects. Half the children saw the familiar teacher name the objects accurately and the unfamiliar teacher name them inaccurately. The remaining half saw the reverse arrangement. In post‐test trials, the selective trust initially displayed by 3‐year‐olds was minimally affected by this intervening experience of differential accuracy. By contrast, the selective trust of 4‐ and 5‐year‐olds was affected. If the familiar teacher had been the more accurate, selective trust in her was intensified. If, on the other hand, the familiar teacher had been the less accurate, it was undermined, particularly among 5‐year‐olds. Thus, by 4 years of age, children trust familiar informants but moderate that trust depending on the informants’ recent history of accuracy or inaccuracy.     

New perspectives on child and adolescent depression

The Children's Depression Index (CDI) was administered to a group of 304 regular school students in Grades 3–12. It was found that 21% of the students reported mild to moderate levels and 7% reported severe levels of depression. Females reported more overall depression than did males. Specific CDI items selected more frequently by females than by males supports previous work suggesting that females tend to internalize difficulties whereas males are more likely to externalize problems. There were no age differences associated with overall depression; however, there were some developmental differences in specific items cited. Finally, “red flags” were identified that may be helpful in spotting children suffering from severe levels of depression.     

The Influence of Indirect Knowledge of Previous Performance on Ratings of Present Performance: The Effects of Job Familiarity and Rater Training

In a 2 × 2 × 2 crossed factorial design, trained or untrained subjects viewed a videotape and evaluated performance on either a familiar (college lecturer) or unfamiliar (salesperson) job. Prior to viewing the videotape, some subjects reviewed positive information about the ratee's prior performance, whereas other subjects did not review any prior performance information. To determine whether assimilation or contrast effects occurred, we compared ratings provided by subjects who reviewed positive information about prior performance with ratings provided by subjects who did not review any prior performance information. A three-way interaction was obtained. Ratings of performance on the familiar job by untrained or trained subjects revealed only a small assimilation effect. However, when rating performance on the unfamiliar job, a large assimilation effect was observed among untrained subjects, whereas a large contrast effect was observed among trained subjects. The results indicate that rater error training may reverse, rather than reduce or eliminate, rating errors that arise from knowledge of a ratee's prior performance. Implications for further understanding and reducing assimilation and contrast effects are discussed.     

A Confirmatory Comparison of the Factor Structure of the Children's Depression Inventory between European American and African American Youth

We examined the factor structure of the Children's Depression Inventory (CDI) among a sample of 523 African American children (m age = 12.76) and a sample of 564 European American youth (m age = 12.43). Previous investigations have produced discrepant factor structures among samples of predominantly majority-culture children, but fewer investigations of the factor structure of the CDI have been conducted among non-European American samples. Confirmatory factor analyses of the original 5 factors identified by Kovacs (1983, 1991) revealed that the items had invariant measurement properties across the samples. The latent factor structure, however, revealed telling differences between the two samples. For European American youth, only one of the original five factors was meaningfully differentiated from the others, whereas for the African American youth, two of the factors clearly emerged as unique facets of depression. Consistent with other reports, between-group mean differences on the CDI and its factors were noted. We argue that further validation of the CDI among traditionally underserved populations is warranted. Predictive validation investigations, in particular, are needed to examine the relationship between CDI factor scores and clinical outcomes.     

Normative and reliability data for the children's depression inventory

The present study was undertaken to examine some of the psychometric properties of the Children's Depression Inventory (CDI), a self-report inventory devised by Kovacs and Beck (1977) to measure depression in children and adolescents. Normative and reliability data were obtained from three independent samples taken from eight public schools in central Pennsylvania. Age- and gender-related differences in reported characteristics of depression were also investigated. The subjects were 594 males and 658 females whose ages ranged from 8 to 16 years and whose combined mean age was 11.67 years (SD=1.91). The CDI was group-administered to all 1,252 subjects; 155 fifth-grade subjects (77 males and 78 females) were retested after 3 weeks, and 107 seventh- and eight-grade subjects (45 males and 62 females) were retested after 1 year. The distribution statistics for the combined samples yielded an overall CDI mean of 9.09, a standard deviation of 7.04, and a cutoff score of 19 for the upper 10% of the distribution. Reliability assessed through coefficient alpha, item-total score product-moment correlations, and test-retest coefficients proved acceptable. Gender differences were obtained for several item-total score correlations and for test-retest reliability of CDI scores.     

Teachers'' ratings of social competence of children with high versus low levels of depressive symptoms

This study examined the relationship between children's self-ratings of depressive symptoms on the Children's Depression Inventory (CDI) and teachers' ratings of the situational social competence of these children based on the Taxonomy of Problematic Social Situations (TOPS). Children in the high CDI group showed significantly higher teacher ratings (indicating lower social competence) than children in the low CDI group on four TOPS scales: peer group entry, response to provocation, response to success, and teacher expectations. Of the children in the high CDI group, 85% could be correctly classified with a discriminant analysis on the basis of TOPS ratings; of the children in the low CDI group, 77% were correctly classified. Implications of these findings, as well as limitations of the study, are discussed.     

Social skills and depression in adolescent suicide attempters

The relationship among depression, social skills, and suicidal behavior was examined in a sample of 41 adolescents hospitalized in a general medical setting following a suicide attempt. These subjects were compared to 40 nonsuicidal psychiatrically hospitalized adolescents. Level of depression, assessed using the Children's Depression Inventory (CDI), and social skills, assessed via the Matson Evaluation of Social Skills with Youngsters (MESSY), were evaluated for all subjects. The suicide attempters and psychiatrically hospitalized patients were not found to differ on either the CDI or MESSY. However, multiple regression analyses revealed the factor scores of the MESSY to be related to depression in both patient groups. The data provide support for the relationship between social skills and depression. Results are also discussed in terms of the similarities between adolescent suicide attempters and nonsuicidal psychiatrically disturbed adolescents.     

Comorbidity between SCARED anxiety factors and depressive symptomatology in 8- to 12-year-old children

The aim of this study was to examine the comorbidity between the SCARED anxiety factors and depressive symptoms in 8-12-year-old children. Participants were 792 girls and 715 boys, who completed: the 41-ítem version of the Screen for Child Anxiety Related Emotional Disorder (SCARED), the Children's Depression Inventory (CDI) and a Socio-demographic questionnaire. Of the sample, 47% showed anxiety symptoms and 11.5% showed depressive symptoms. Heterotypic comorbidity was 82% in children at risk of depression and 20% in children at risk of anxiety. Homotypic Comorbidity between anxiety factors was 87%. Homotypic comorbidity and heterotypic comorbidity were high; their early detection will prevent the continuity of an anxious disorder and the development of depression.     

Effects of intimacy of therapist's self-disclosure and formality on perceptions of credibility in an initial interview

A therapist's expertness, trustworthiness, empathy, and attractiveness were evaluated by 300 subjects after viewing a 5-min. videotape of a therapist-client interaction. Therapist's level of self-disclosure and formality were the independent variables. Ratings of trustworthiness were highest when the therapist was informal. Therapist's high disclosure of depression yielded decreased ratings of attractiveness, empathy, and expertness in comparison with no disclosure by the therapist.