Depression and suicidal behavior in adolescents: a multi-informant and multi-methods approach to diagnostic classification.

Andrew J Lewis,Catherine M Bailey,Joanna Skewes,John W Toumbourou,Dan I Lubman,Melanie D Bertino

doi:10.3389/fpsyg.2014.00766

Andrew J Lewis, Catherine M Bailey + Show 4 more

Open Access

https://doi.org/10.3389/fpsyg.2014.00766

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Abstract

Background: Informant discrepancies have been reported between parent and adolescent measures of depressive disorders and suicidality. We aimed to examine the concordance between adolescent and parent ratings of depressive disorder using both clinical interview and questionnaire measures and assess multi-informant and multi-method approaches to classification.Method: Within the context of assessment of eligibility for a randomized clinical trial, 50 parent–adolescent pairs (mean age of adolescents = 15.0 years) were interviewed separately with a structured diagnostic interview for depression, the KID-SCID. Adolescent self-report and parent-report versions of the Strengths and Difficulties Questionnaire, the Short Mood and Feelings Questionnaire and the Depressive Experiences Questionnaire were also administered. We examined the diagnostic concordance rates of the parent vs. adolescent structured interview methods and the prediction of adolescent diagnosis via questionnaire methods.Results: Parent proxy reporting of adolescent depression and suicidal thoughts and behavior is not strongly concordant with adolescent report. Adolescent self-reported symptoms on depression scales provide a more accurate report of diagnosable adolescent depression than parent proxy reports of adolescent depressive symptoms. Adolescent self-report measures can be combined to improve the accuracy of classification. Parents tend to over report their adolescent’s depressive symptoms while under reporting their suicidal thoughts and behavior.Conclusion: Parent proxy report is clearly less reliable than the adolescent’s own report of their symptoms and subjective experiences, and could be considered inaccurate for research purposes. While parent report would still be sought clinically where an adolescent refuses to provide information, our findings suggest that parent reporting of adolescent suicidality should be interpreted with caution.

Highlights

The classification of psychiatric disorders is an area of controversy and challenging in child and adolescent mental health
Adolescent self-report measures can be combined to improve the accuracy of classification
While parent report would still be sought clinically where an adolescent refuses to provide information, our findings suggest that parent reporting of adolescent suicidality should be interpreted with caution

Summary

Introduction

The classification of psychiatric disorders is an area of controversy and challenging in child and adolescent mental health. Researchers conducting clinical trials need to make use of valid measures for diagnostic classification to examine both eligibility and intervention outcomes (Lewis et al, 2012b). Eligibility criteria for entry to a clinical trial are ideally based on a valid and reliable diagnostic measure in order to ensure that any claim that the intervention is effective can be used as an evidentiary recommendation for all patients presenting with the same psychiatric disorder. There is much to be gained from the adoption of a multi-methods approach derived from multiple informants within clinical research designs, in the assessment of children and adolescents. We aimed to examine the concordance between adolescent and parent ratings of depressive disorder using both clinical interview and questionnaire measures and assess multi-informant and multi-method approaches to classification

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