BOCA RATON, FLA. – Major depression in children and adolescents can be assessed quickly using a 10-item scale designed for adults. Results correlate well with a standard 45-minute pediatric measure, according to a study presented at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.
Major depression in pediatric patients is typically measured with the Child Depression Rating Scale-Revised (CDRS-R). This measure is not only time consuming but it requires clinician training to administer, according to Dr. Shailesh Jain, who is a National Institute of Mental Health fellow at the Mood Disorders Research Program and Clinic at the University of Texas Southwestern Medical Center, Dallas.
Right now, typically, practitioners interview the child or adolescent first, then talk with the parent(s), and use clinical judgment to combine the components.
“It takes a long time. For busy clinicians in child psychiatry, it's difficult to spend 45 minutes,” Dr. Jain said.
In addition, certain items on the scale rely on clinician judgment, and subjective assessments vary with clinician experience, according to Dr. Jain.
Dr. Jain and his associates compared the CDRS-R to the Montgomery-Asberg Depression Rating Scale (MADRS) in 96 children (aged 8–11 years old) and 123 adolescents (12–18 years).
All participants were outpatients with nonpsychotic major depressive disorder.
Participants were culled from a randomized trial of fluoxetine 10 mg/day for 1 week followed by a titration to 20 mg/day continued for 8 weeks vs. placebo.
The researchers rated depressive symptoms using both measures.
“The MADRS has advantages–it has 10 items,” Dr. Jain said in an interview at his poster presentation.
“But the MADRS has been used primarily in adults, and little is known about its psychometric properties in evaluation of pediatric patients,” Dr. Jain said.
Total score correlation between CDRS-R and MADRS was 0.85 at study completion for both children and adolescents, which shows that both scales agree to a considerable extent for assessment of depression, Dr. Jain said.
“When measuring the effect of antidepressants (fluoxetine), CDRS-R was statistically more sensitive in detecting changes in symptoms in response to medication in both children and adolescents,” Dr. Jain said.
Effect size for CDRS-R was 0.78 in children and 0.61 in adolescents, compared with the MADRS 0.38 in children and 0.15 adolescents.
These differences are statistically significant, but the clinical difference is less important because it can take three times longer to complete the CDRS-R, Dr. Jain said.
In addition, adolescents often do not like the CDRS-R requirement that clinicians ask parents about their functioning at each visit.
“This is not to suggest that clinicians completely circumvent parents, but the MADRS provides a reasonable alternative for assessment of depression severity and response to treatment,” Dr. Jain said.
“We now know how the scales correlate and, most importantly, the conversion factors between the scales.”
Busy practitioners can quickly assess symptoms of major depression in adolescents with the MADRS.
Dr. Jain said the scale is also useful for children, who are typically poor historians and very influenced by environmental conditions.
The meeting was cosponsored by the American Society for Clinical Psychopharmacology.