Depression Screening in Adolescents with Type 1 Diabetes

Marker, Arwen M.

Publication

Depression Screening in Adolescents with Type 1 Diabetes

Marker, Arwen M.

Abstract

Introduction: This study aimed to measure the acceptability and diagnostic accuracy of commonly used depression screening measures, determine ideal cut-off scores that sensitively identify depressive disorders and suicidality, and examine demographic and type 1 diabetes (T1D) related participant characteristics that confer risk for depression in adolescents with T1D. Methods: One hundred adolescents (12-17 year-olds) completed a semi-structured diagnostic interview and both long and short versions of five depression screening measures. Measure completion time, cost, and participant ratings were summarized to assess acceptability. Descriptives, area under the receiver operating characteristic (ROC) curve analyses, and paired-sample area differences under the ROC curve were used to assess each measure’s diagnostic validity against the interview. Similar analyses were used to examine the diagnostic accuracy of single suicide screening items and depressive symptom clusters. Finally, additional risk explained by demographic and T1D-related characteristics were examined using binary logistic regressions. Results: Fifteen percent of adolescents endorsed a current depressive disorder and 15% endorsed lifetime suicidality. Measures demonstrated low sensitivity (.33-.67) to detect current depressive disorders using pre-existing cut-off scores. Adjusted cut-off scores increased sensitivity and reduced false negatives. All depression screening measures demonstrated “good” to “excellent” predictive validity, and the CDI-2 Short demonstrated significantly greater diagnostic accuracy than the PHQ-2A. Demographic and T1D-related factors explained a non-significant amount of variance (14.3%) in risk for a current depressive disorder. Conclusion: Clinics should consider using screening measures with the greatest diagnostic accuracy as identified in this study and adjusting measure cut-off scores to increase sensitivity and reduce false negatives. Additional clinically relevant information is discussed.