Factor analysis of the Children's Depression Inventory

Obsessive-Compulsive Symptomatology and Disgust Propensity in Disordered Eating Behaviors of Adolescents with Celiac Disease

BACKGROUND

Considering the importance of underlying psychopathological mechanisms that mediate maladaptive eating behaviors in celiac disease (CD) in the determination of cognitive-behavioral therapeutic approaches, we investigated the impact of obsessive-compulsive symptomatology and disgust propensity on disordered eating attitudes (DEA) and poor gluten-free diet (GFD) compliance in adolescents with CD.

METHOD

Adolescents with biopsy-proven CD (n = 148, aged 12-18 years) were compared with age- and sex-matched controls (n = 104) in terms of eating attitudes/behaviors, obsessive-compulsive symptoms, and disgust propensity, as well as depression and anxiety to rule out depression- and anxiety-related covariates. The clinical implications associated with poor GFD compliance were determined using between-subgroup analysis. Multivariate linear regression and multiple logistic regression were used to identify predictors of DEA and GFD noncompliance, respectively.

RESULTS

In adolescents with CD, DEA was remarkably associated with obsessive-compulsive symptom severity and disgust propensity, especially in contamination and core disgust sub-dimensions. Obsessionality and disgust propensity were independent predictors of DEA, of which the obsessive-compulsive symptom severity was the most decisive predictor of DEA. Higher DEA severity and lower body mass index were independent predictors of poor GFD compliance.

CONCLUSION

Higher obsessionality, accompanied by disgust-related evaluative conditioning processes, may contribute to constructing a cognitive network consisting of hypervigilance and catastrophic interpretations towards benign somatic stimulations, food-related preoccupations, and avoidant behaviors in the disordered eating of adolescents with CD. The reciprocal relationship between lifelong GFD and DEA, mediated by obsessionality and disgust propensity, was supported by current findings that could guide clinicians in the management of maladaptive eating behaviors in adolescents with CD.

Validating the Children's Depression Inventory-2: Results from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study

Childhood-onset depression has adverse consequences that are sustained into adulthood, which increases the significance of detection in early childhood. The Children's Depression Inventory (CDI) is used globally in evaluating depressive symptom severity in adolescents, and its second version, the CDI-2, was developed by taking into account advances in childhood depression research. Prior research has reported inconsistencies in its factor structure across populations. In addition, the CDI-2 has not yet been empirically validated with Southeast Asian populations. This study sought to empirically validate the CDI-2's psychometric properties and evaluate its factorial structure with a Singaporean community sample of non-clinical respondents. A total sample of 730 Singaporean children aged between 8.5 and 10.5 years was used. Psychometric properties of the CDI-2, including internal consistency as well as convergent and discriminant validity, were assessed. Factor analyses were conducted to assess the developers' original two-factor structure for a Southeast Asian population. This two-factor structure was not supported in our sample. Instead, the data provided the best fit for a hierarchical two-factor structure with factors namely, socio-emotional problems and cognitive-behavioural problems. This finding suggests that socio-cultural and demographic elements influence interpretation of depressive symptoms and therefore the emerging factor structure of the construct under scrutiny. This study highlights the need to further examine the CDI-2 and ensure that its interpretation is culture-specific. More qualitative work could also bring to light the idiosyncratic understanding of depressive symptomatology, which would then guide culture-specific validation of the CDI-2.

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.

Characterisation of depressive symptoms in young children with and without attention deficit hyperactivity disorder

Depressive symptoms and attention deficit hyperactivity disorder (ADHD) are prevalent and commonly co-occur in childhood. To assist with early identification of depression in children with ADHD, we aimed to: (1) use factor analysis to determine whether the construct of depression is measured consistently in those with and without ADHD; and (2) determine whether overall depressive symptoms and specific depressive symptoms were elevated in children with ADHD relative to controls. Participants comprised a community-based sample of 179 children with ADHD (51% Combined presentation, 35% Inattentive presentation) and 212 non-ADHD controls aged 6-8 years. Participants were screened for ADHD and underwent a structured diagnostic interview which confirmed ADHD status and assessed depressive symptoms. The factor structure of depressive symptoms was similar, enabling comparisons between the two groups to be made. Eighteen children with ADHD (10%) and three control participants (1%) experienced either MDD or subthreshold MDD. Children with ADHD experienced more depressive symptoms than controls (Cohen's d =1.19, p < 0.001), with the following symptoms elevated in children with ADHD relative to controls: sadness (32% vs. 14%, p < 0.001), irritability (52% vs. 19%, p < 0.001), insomnia (56% vs. 22%, p < 0.001), psychomotor agitation (53% vs. 9%, p < 0.001), feeling bad about oneself (50% vs. 24%, p < 0.001), difficulty concentrating (75% vs. 14%, p < 0.001) and making decisions (56% vs. 17%, p < 0.001). This study provides support for the occurrence of depressive symptoms in children with ADHD as young as six and highlights the importance of early assessment for depressive symptoms in children with ADHD.

The Fear of Pain Questionnaire: psychometric properties of a Brazilian version for adolescents and its relationship with brain-derived neurotrophic factor (BDNF)

Objectives

The primary aim was to assess the psychometric properties (including internal consistency, construct validity, criterion validity, criterion-group validity and responsiveness) of the Fear of Pain Questionnaire (FOPQ) for adolescents (FOPQ-A) and parents (FOPQ-P) translated to Brazilian Portuguese (BrP). The secondary aim was to analyze the factor structures and their ability to identify subjects with chronic pain conditions and identify the relationship of the BrP FOPQ-A with saliva brain-derived neurotrophic-factor (BDNF).

Methods

A cross-sectional study was conducted with 286 adolescents aged 11 to 18 (257 healthy adolescents [157 females] and 29 adolescents with chronic pain [16 females]). Parents and adolescents completed the BrP-FOPQ. A team of experts translated the FOPQ according to international guidelines. Convergent validity and factor analysis were performed. Later, a subsample (n=146) was used to correlate the BrP-FOPQ-A with saliva BDNF.

Results

The BrP-FOPQ for adolescents and parents presented strong psychometric properties (Cronbach’s α equal to 0.92 and 0.91, respectively). BrP-FOPQ-A confirmatory factor analysis yielded a two-factor structure while the factorial analyses of BrP-FOPQ-P demonstrated that the best solution was a three-structure factorial. The BrP-FOPQ-P scores in healthy adolescents and those in chronic pain conditions was 34.13 (16.71) vs 43.14 (18.08), respectively. A generalized mixed model demonstrated that the scores in the BrP-FOPQ-A are higher in those with chronic pain conditions compared to healthy subjects (29.20 [12.77] vs 33.80 [10.76], respectively; Wald χ²= 17.80; df=1, P<0.0001). The model revealed that the BDNF was positively correlated with the score of BrP-FOPQ-A and subjects with chronic pain showed higher levels of BDNF.

Conclusion

The BrP-FOPQ scores for adolescents and parents were found to be psychometrically robust and reliable instruments, with primary evidence of validity. Higher scores on the BrP-FOPQ-A were correlated positively with saliva BDNF and permitted the identification of subjects with chronic pain conditions.

A Factor Analysis and Test of Longitudinal Measurement Invariance of the Children's Depression Inventory (CDI) Across Adolescence

Depression increases dramatically during adolescence. This finding has been demonstrated using multiple measures, including the Children's Depression Inventory (CDI). The CDI is one of the most commonly used measures to assess depression in youth. However, there is little agreement on its factor structure, and it is possible that its factor structure changes over time. Yet, no study to date has investigated whether this structure is longitudinally invariant from early- to mid-adolescence. The present study examined the factor structure of the CDI in a sample of 227 adolescents aged approximately 13 at baseline and 16 at follow-up. The analyses revealed that a one-factor structure was a good fit to the data at each assessment. Moreover, tests of measurement invariance supported configural, metric, and scalar invariance across time. These findings suggest that changes in depressive symptoms during adolescence are due to true developmental changes, rather than changes in measurement properties.

Quality measures for the care of patients with insomnia

ABSTRACT

The American Academy of Sleep Medicine (AASM) commissioned five Workgroups to develop quality measures to optimize management and care for patients with common sleep disorders including insomnia. Following the AASM process for quality measure development, this document describes measurement methods for two desirable outcomes of therapy, improving sleep quality or satisfaction, and improving daytime function, and for four processes important to achieving these goals. To achieve the outcome of improving sleep quality or satisfaction, pre- and post-treatment assessment of sleep quality or satisfaction and providing an evidence-based treatment are recommended. To realize the outcome of improving daytime functioning, pre- and post-treatment assessment of daytime functioning, provision of an evidence-based treatment, and assessment of treatment-related side effects are recommended. All insomnia measures described in this report were developed by the Insomnia Quality Measures Workgroup and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with insomnia.

Age, clinical severity, and the differentiation of depressive psychopathology: A test of the orthogenetic hypothesis

Werner's orthogenetic principle states that human behavior proceeds from a state of global diffuseness to one of articulated complexity, and that as individuals develop, their responses to the environment become more specific and more differentiated. The present study evaluated this hypothesis, in relation to psychopathology in general and depression in particular. Child Behavior Checklist responses for 1, 345 outpatient and inpatient children and adolescents were compared along two developmental dimensions: age and clinical severity. Results failed to support the hypothesis that the psychopathology in general is more differentiated among older and more severely disturbed children. The findings did indicate, however, that depression was more distinct among the older, more severely disturbed subjects. Finally, little evidence of a categorical depression was found in any of the four age by severity groups.

Children's Depression Inventory in Estonia. Single items and factor structure by age and gender

The aim of study was to estimate the score of symptoms of depression with the Children's Depression Inventory (CDI) among Estonian schoolchildren aged 7-13-year-old, according to age and gender differences, and to identify the components in factor analysis characterising self-reported childhood symptoms of depression. The applicability of the CDI in 7-year-old children was also estimated. The number of subjects in the study was 725 (342 girls and 383 boys), and the mean age was 10.2 (SD 1.7). The mean total score of the CDI for the whole sample was 9.96 (SD = 6.3, range 0-39, median 9.0). The mean scores of symptoms of depression among children did not differ by gender or age. There were no significant differences in the CDI mean scores between 7-year-old compared to older schoolchildren in the present study. Factor analysis obtained five factors: anhedonia, ineffectiveness, negative self-esteem, negative mood and interpersonal problems. Significant gender and age differences were found: girls reported more symptoms of anhedonia and negative self-esteem, and boys reported more symptoms of ineffectiveness. Younger children reported more symptoms of anhedonia and ineffectiveness, and older children negative self-esteem. The study serves as baseline data before intervention of the EC project "European Alliance Against Depression".

Breakthrough pain in children with cancer

The aims of this prospective study were to determine the prevalence, characteristics, and impact of breakthrough pain in children with cancer. Twenty-seven pediatric inpatients with cancer (aged 7-18 years) who had severe pain requiring treatment with opioids and who received care in the Oncology Unit at the Children's Hospital at Westmead, Sydney, Australia participated in this study. The children responded to a structured interview (Breakthrough Pain Questionnaire for Children), designed to characterize breakthrough pain in children. Measures of pain, anxiety, and depressed mood were completed. Fifty-seven percent of the children experienced one or more episodes of breakthrough pain during the preceding 24 hours, each episode lasting seconds to minutes, occurring 3-4 times/d, and most commonly characterized as "sharp" and "shooting" by the children. Younger children (7-12 years) had a significantly higher risk of experiencing breakthrough pain compared to teenagers. No statistical difference could be shown between children with and without breakthrough pain in regard to anxiety and depression. The most effective treatment of an episode of breakthrough pain was a patient-controlled analgesia opioid bolus dose. Further studies of breakthrough pain in children and more effective treatment strategies in this age group are necessary.

An exploratory factor analysis of the children's depression rating scale-revised

An exploratory factor analysis was performed in a clinical sample of 314 children and adolescents to investigate the factor structure of the Children's Depression Rating Scale-Revised (CDRS-R; Poznanski et al. 1984). A maximum likelihood method followed by a Promax rotation yielded five factors: observed depressive mood, anhedonia, morbid thoughts, somatic symptoms and reported depressive mood. The age group and gender differences on the factors scores are evaluated. After controlling for gender, the adolescents had more severe depression in terms of observed depressive mood, anhedonia, and somatic symptoms. After controlling for age groups, girls had higher scores for reported depressive mood.

High-end specificity of the children's depression inventory in a sample of anxiety-disordered youth

Using a receiver operating characteristic (ROC) analysis, the present study investigated the ability of the Children's Depression Inventory (CDI) to correctly detect depression in a sample of treatment-seeking anxious youth (N=44). The ADIS-C/P was used to determine diagnostic status of participants. Anxious children who met diagnostic criteria for a depressive disorder scored higher on the CDI than anxious children who did not meet criteria for a depressive disorder, supporting the CDI as a continuous measure of depressive symptomatology. In contrast, with regard to detecting a depressive disorder, CDI cut scores did not achieve favorable values across diagnostic utility indices (including the cut score of 13 that has been recommended). These findings support the CDI as a continuous measure of depressive symptoms, but do not support the CDI as a sole assessment for a diagnosis of depression within a sample of anxiety-disordered youth.

"Everybody's Different": a primary prevention program among fifth grade school children

The aim of the present study was to assess the efficacy and effectiveness of the primary prevention program "Everybody's Different" among fifth grade school children. Pre and post measurements were made in both the intervention and control groups regarding body image, weight concern, emotional well-being, attitudes and behaviors associated with disordered eating, self-esteem, anxiety, and depression. The study did not result in any significant improvements regarding self-esteem, eating attitudes, or body image. The prevention program does not seem to be effective for children in grade five in its present form. Further research on and development of primary prevention programs is needed.

Escala de avaliação de depressão para crianças: um estudo de validação

A presente pesquisa teve por objetivo realizar um estudo de validação da "Escala de Avaliação de Depressão para Crianças" de Amaral e Barbosa (1990). Durante a realização da pesquisa a escala inicial foi modificada, obtendo-se quatro versões. Foi realizada análise semântica dos itens junto a duas amostras de crianças (N= 12 e N= 4). A seguir, quatro psicólogos clínicos e três psiquiatras analisaram a pertinência dos itens ao construto. E, finalmente, a escala foi aplicada à amostra de 362 estudantes, de escolas públicas e particulares, para o estudo da precisão e da validade de construto. Utilizou-se a análise fatorial exploratória; os índices de poder discriminativo dos itens, desvio-padrão e correlação corrigida item-total de Pearson; e o cálculo do Coeficiente Alfa (a), de Cronbach. Na compreensão semântica dos itens um item foi excluído e três foram reformulados. Não houve itens descartados na análise de juízes. Na análise fatorial exploratória observou-se que as quatro primeiras dimensões explicam 33,36% da variabilidade total dos dados, com autovalores acima de 1,4. Quatro itens foram descartados por apresentarem carga-fatorial menores do que 0,40. Na análise do poder discriminativo dos itens eliminaram-se seis itens com correlação item-total próximas de zero. A escala final ficou composta de 24 itens distribuídos segundo quatro fatores: resposta afeto-disfórico (a= 0,70); resposta afetivo-emocional com conteúdo de ansiedade (a= 0,65); resposta fisiológico-autonômica (a= 0,56); e resposta cognitiva com conteúdo de auto-estima (a= 0,50).

Friends as reporters of children's and adolescents' depressive symptoms

Obtaining information from multiple informants is important when assessing youth depression. Past studies have utilized adults' reports of youths' emotional functioning and aggregate reports from classmates but have not considered close friends as reporters of depressive symptoms. This is surprising given the important roles of friends as companions and confidants. This study investigated relations between friend-reported depressive symptoms and youths' self-reports. From a larger sample of fifth-, seventh-, and ninth-grade participants, self-reports and friend reports of depressive symptoms and friend reports of friendship quality were available for a subset of 367 participants. Significant positive relations emerged between friend reports and self-reports of affective depressive symptoms for girls and youth in high-quality friendships. Relations between friend reports and self-reports were stronger for conduct-related than affective depressive symptoms and reached significance for boys as well as for girls and for youth in low-quality friendships as well as for youth in high-quality friendships. Implications for identifying at-risk youth are discussed.

Self-reported depressive symptoms in a school sample of Italian children and adolescents

This study reports on self-reported depressive symptoms, assessed with the Children's Depression Inventory (CDI), in a school sample of 685 Italian students. The participants were 254 males and 431 females, the age range of the subjects was 8 to 17 years (mean age 13.0 +/- 2.8 years). The CDI mean score was 10.49 +/- 2.76. According to our data, about 10% of the subjects scored higher than the clinical threshold of 20. More than 1/3 of the students reported thoughts of death, but only 2.2% had explicit suicidal ideation. Girls scored higher than boys, and young adolescents (11-13 years) scored lower than pre-pubertal children and older adolescents, and showed fewer thoughts of death. Factorial analysis yielded seven factors, a general factor with no predominant theme, two factors related to academic self-image and body image, and four related to anhedonia-withdrawal, hypocondria-asthenia, irritability-opposition, and loss of appetite.

An exploratory factor analysis of children's depression inventory scores in young children of substance abusers

A factor analytic study of scores obtained on the Children's Depression Inventory from a sample of 202 young children (M = 7.5 yr., SD = 2.2) of alcoholics and substance abusers was completed. A principal components factor analysis with an oblique rotation yielded five separate factors related to Negative Self-concept, Acting-out. Somatic/Disturbed Symptoms, Mood, and Hopelessness. In previous factor analytic studies of the Children's Depression Inventory with normal and clinical populations the primary factor obtained was formed by mood-related items. In contrast, the primary factor of the present analysis was formed by items concerning perceptions of self-concept, not mood. These results corroborated previously reported data from the Child Behavior Checklist suggesting that the depressive symptoms displayed by children of substance abusers are related to self-concept and externalization.

Ten-year review of rating scales. II: Scales for internalizing disorders

OBJECTIVE

This article, the second in the Journal's series of 10-year updates on rating scales, summarizes scales assessing internalizing disorders.

METHOD

The authors sampled articles on mood and anxiety disorders over the past 25 years, selected scales with multiple citations over many years, and reviewed their properties. Those with adequate psychometric properties, plus continued wide literature citations or a current special niche, are presented here.

RESULTS

Rating scales for depression were developed and/or examined in the 1980s. Despite generally strong properties, they lack clear construct validity. Most have parent-report forms that broaden their suitability with youths. Anxiety scales were developed bimodally. Those developed in the 1960s to 1970s were downward modifications of adult scales. They have been criticized for unclear constructs and unsuitability for youths. Newer scales developed in the 1990s have addressed these problems and have parent-report forms. However, their utility is still being determined.

CONCLUSIONS

Rating scales can reliably, validly, and efficiently measure youths' internalizing psychopathology. They have great utility in research, treatment planning, and accountability in practice. However, the user must define the goals of measurement, consider the construct the scale measures, and use the scale within its defined capabilities. The use of more than one scale for a task is recommended.

Symptom endorsement differences on the Children's Depression Inventory with children and adolescents on an inpatient unit

Responses to the Children's Depression Inventory (CDI; Kovacs, 1992), administered during intake, were collected from 521 children and adolescents (aged 7 to 17) at an inpatient crisis stabilization unit. Participants were grouped into 1 of 3 diagnostic groups: solely depressive, solely aggressive, or both depressive and aggressive. Self-report of symptoms for each diagnostic group, age and gender differences, and racial and ethnic differences in symptoms were examined in this study. There was a significant difference between the endorsement pattern of solely depressive and solely aggressive participants, whereas those categorized as both depressive and aggressive displayed an endorsement pattern similar to those who were solely aggressive. There was a significant gender difference in overall symptom report, with girls showing higher overall symptom levels than boys. This gender difference was significant for both the younger and the older age groups. These results held true even when gender was covaried out of the diagnostic group analyses and when diagnostic group was covaried out of the gender analyses. Symptom endorsement did not differ based on race and ethnicity. The primary contribution of this study centers around the findings from the item analyses of the CDI. These results are discussed in relation to the discriminant validity of the CDI and the need for additional research into comorbidity.

Prevalence and short-term stability of depressive symptoms in schoolchildren

This study examined the prevalence of depressive symptoms in a sample of 471 Swedish schoolchildren aged 8-13 years from urban and rural areas. Children self-reported their experience of depressive symptoms on a Swedish version of the Children's Depression Inventory (CDI). Short-term stability of children's depressive symptoms was evaluated for a 6- to 9-week period. In addition, the children's satisfaction with their school, home and leisure time was assessed. The results indicated that the prevalence of depressive symptoms was related to neither location (urban vs rural) nor age. Although girls experienced significantly more depressive symptoms than boys, the clinical importance of this difference is negligible. Approximately 1% of the schoolchildren reported severe suicidal thoughts. As expected, children's depression was negatively associated with their home and school satisfaction and leisure interest. A cut-off score of 13 on the CDI could identify the upper 10% of the children in the school sample as depressed and, at the follow-up, 44% of these children continued to be depressed. Overall, the total CDI mean scores obtained in this study were lower than those reported in comparative surveys in Anglo-Saxon countries.

Self-report vs. biological markers in assessment of childhood depression

Sensitivity, specificity, and diagnostic confidence of the Children's Depression Inventory (CDI) and the dexamethasone suppression test (DST) in assessing childhood depression were determined. Parent and child forms of the CDI and plasma cortisol levels at 8 a.m. and 4 p.m. were used. Three groups of prepubertal children were sampled: (1) 63 depressed inpatients, (2) 14 non-depressed inpatient psychiatric controls, and (3) 21 normal community sample controls. Results suggest that scores greater than or equal to 15 on the CDI obtained from either parent or child provide a good screening instrument (sensitivity = 89%). If the DST is administered to all children with elevated CDI scores, diagnostic confidence is 97.5%. Cautions and recommendations for use of the CDI and DST are made.

Self-report measures for use with children: a review and comment

This article underscores the need for self-report instruments for children to complement the teacher and parent questionnaires traditionally used to assess various aspects of children's psychological lives. Some of the problems inherent in using teachers, parents, and children as informants are delineated. Many self-report instruments, in particular those that are used to assess children's self-concept, anxiety, depression, and personality, are reviewed. The Children's Self-Report Questionnaire (SRQ) was designed to assist in the diagnosis and detection of psychological deviance in 7- to 12-year-old children. The SRQ is easily administered, has broadly based norms, and has acceptable reliability and validity. The SRQ can be used as an aid to both research and clinical assessment and may provide insight into the inner world of the child.