User:Sftomlinson/sandbox

Adolescent Depression (description, assessment and diagnosis)

Diagnostic Changes

DSM-5 contains several new depressive disorders, including

• disruptive mood dysregulation disorder
• premenstrual dysphoric disorder

DSM-5 conceptualizes chronic forms of depression in a somewhat modified way. What was referred to as dysthymia in DSM-IV now falls under the category of persistent depressive disorder.

Major Depressive Disorder

Neither the core criterion symptoms applied to the diagnosis of major depressive episode nor the requisite duration of at least 2 weeks has changed from DSM-IV. Criterion A for a major depressive episode in DSM-5 is identical to that of DSM-IV, as is the requirement for clinically significant distress or impairment in social, occupational, or other important areas of life, although this is now listed as Criterion B rather than Criterion C. The coexistence within a major depressive episode of at least three manic symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier “with mixed features.” The presence of mixed features in an episode of major depressive disorder increases the likelihood that the illness exists in a bipolar spectrum; however, if the individual concerned has never met criteria for a manic or hypomanic episode, the diagnosis of major depressive disorder is retained.

In DSM-IV, there was an exclusion criterion for a major depressive episode that was applied to depressive symptoms lasting less than 2 months following the death of a loved one (i.e., the bereavement exclusion).

Specifiers for Depressive Disorders

Suicidality represents a critical concern in psychiatry. Thus, the clinician is given guidance on assessment of suicidal thinking, plans, and the presence of other risk factors in order to make a determination of the prominence of suicide prevention in treatment planning for a given individual. A new specifier to indicate the presence of mixed symptoms has been added across both the bipolar and the depressive disorders, allowing for the possibility of manic features in individuals with a diagnosis of unipolar depression. A substantial body of research conducted over the last two decades points to the importance of anxiety as relevant to prognosis and treatment decision making. The “with anxious distress” specifier gives the clinician an opportunity to rate the severity of anxious distress in all individuals with bipolar or depressive disorders.

Demographic Information

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of adolescent depression that they are likely to see in their clinical practice.

Base Rates of Adolescent Depression in different clinical settings

Setting (Reference)	Base Rate	Demography	Diagnostic Method
Children and adolescents attending primary care (Mathet et al., 2003)	5.0%	French general practitioner network	CES-D, CBCL, KSADS-PL y
National Comorbidity Survey-Adolescent (ages 13-18) (Merikangas et al., 2010)	6.9%-15.4%	All of U.S.A.	NCS-A Interview Schedule p, y
Great Smoky Mountains Study: Community Sample (ages 9-13) (Costello et al. 1996)	.03-1.45%	North Carolina	CAPA
Acute psychiatric hospitalizations in 2009-2010 – children (under the age of 15) (Blader & Carlson, 2010)	13%	All of U.S.A.	Centers for Disease Control survey of discharge diagnoses
High school students (Lewinsohn et al., 1993)	9.6%	Northwestern USA high school	KSADS
Gender differences, males and females, respectively (Merikangas, 2010)	7.5%-15%	All of U.S.A.	NCS-A Interview Schedule p, y

^p:Parent interviewed as component of diagnostic assessment; ^y:youth interviewed as part of diagnostic assessment.

Note: BDI = Beck Depression Inventory, PHQ = Patient Health Questionnaire, KSADS = Kiddie Schedule for Affective Disorders and Schizophrenia, PL = Present and Lifetime version, NCS-A = National Comorbidity Survey- Adolescent, CAPA = Child and Adolescent Psychiatric Assessment

Diagnosis

Recommended Diagnostic Interviews

• Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS PL)- Hardcopy in assessment file cabinet at Finley.
• Diagnostic Interview for Children and Adolescents
• Child and Adolescent Psychiatric Assessment (CAPA)
• Child Behavior Checklist (CBCL)- Hardcopy in assessment file cabinet at Finley.
• Teacher’s Report Form (TRF)- Hardcopy in assessment file cabinet at Finley.
• Youth Self Report (YSR)- Hardcopy in assessment file cabinet at Finley.

Screening Instruments

Table 2 provides diagnostic efficiency information

Empirically Supported Treatments

1. CBT Treatment
   1. Group plus parent component, individual, and individual plus parent/family component
   2. Additional psychotropic medication (David-Ferdon & Kaslow, 2008)
2. Interpersonal Psychotherapy (Mufson et al., 2012)
   1. Brief 12-16 session therapy

• Please refer to the page on Adolescent Depression for more information on available treatment for Adolescent Depression, or go to Effective Child Therapy for a curated resource on effective treatments for Adolescent Depression.

Process and Outcome Measures

4.1.a – Table of Clinically Significant Change Benchmarks (Table 3)

Measure	Subscale	Cut-off scores			Critical Change (unstandardized scores)
Benchmarks Based on Published Norms
		A	B	C	95%	90%	SEdifference
Beck Depression Inventory-II	4	22	15	9	8	4.8
CBCL T-scores (2001 Norms)	Total	49	70	58	5	4	2.4
Benchmarks Based on Mood Samples
Gracious et al., 2002
Young Mania Rating Scale - Parent (Full)	n/a	5.2	22.1	14.4	4.3	3.6	2
Young Mania Rating Scale - Parent (Brief)	n/a	6.8	27.4	17.5	5	4.2	2.5
INSERT NEW TEXT HERE