Using the 11-item Version of the RCADS to Identify Anxiety and Depressive Disorders in Adolescents

Jerica Radez,Tessa Reardon,Faith Orchard,Ray Percy,Bruce Chorpita,Susan H Spence,Cathy Creswell,Polly Waite

doi:10.1007/s10802-021-00817-w

Abstract

The purpose of this study was to identify items from the Revised Children’s Anxiety and Depression Scale – RCADS-C/P that provided a brief, reliable and valid screen for anxiety and/or depressive disorders in adolescents. In addition, we examined whether adding items assessing suicidal ideation (Moods and Feelings Questionnaire – MFQ- C/P) and symptom impact and duration (items adapted from the Strengths and Difficulties Questionnaire – SDQ) improved the identification of adolescents with anxiety and/or depressive disorders. We compared two samples of adolescents and their parents – a community sample, recruited through secondary schools in England (n = 214) and a clinic-referred sample, who met diagnostic criteria for anxiety and/or depressive disorder and were recruited through a university-based research clinic (n = 246). Participants completed the RCADS-C/P with additional symptom impact and duration items, and the MFQ-C/P. Using ROC curve analyses, we identified a set of 11 RCADS-C/P items (6 addressing anxiety and 5 depression symptoms) for adolescent- and parent-report. This set of 11 symptom items achieved sensitivity/specificity values > .75, which were comparable to corresponding values for the RCADS-47-C/P. Combining adolescent and parent-report improved the identification of anxiety/depression in adolescents compared to using adolescent-report alone. Finally, adding two symptom impact items further improved the sensitivity/specificity of the 11 symptom items, whereas adding suicidal ideation items did not. The 11 RCADS items accurately discriminated between the community and clinic-referred sample with anxiety and/or depressive disorders and have the potential to quickly and accurately identify adolescents with these disorders in community settings.

Highlights

Anxiety and depressive disorders are the most common mental health disorders in adolescents
The original RCADS and RCADS25 are 1) > 15 items, and 2) consistent with DSM-IV, rather than DSM-5 diagnostic criteria (American Psychiatric Association, 2013), and do not consider either 3) adolescents’ suicidal ideation, which is a common symptom of depression in adolescents (Orchard et al, 2017), or 4) the impact or duration of anxiety/depression symptoms on adolescents’ lives, which may provide a more reliable estimate of emotional disorders than items that only assess the presence of symptoms (Evans et al, 2017; Goodman, 2001)
We set out to determine 1) if adding items that assess suicidal ideation improves the ability of the depression item subset to discriminate between the community sample and clinicreferred with a depressive disorder diagnosis, 2) if adding items associated with symptom impact and duration improves the ability of the total brief item set to discriminate between the community sample and clinic-referred sample with any anxiety/depressive disorder diagnosis, and 3) whether using a combination of reporters provides more accurate identification of adolescents with an anxiety/depressive disorder diagnosis compared to adolescent-report alone

Summary

Introduction

Anxiety and depressive disorders are the most common mental health disorders in adolescents. Brief tools for detecting anxiety and depression in adults, such as the GAD-7 (Spitzer et al, 2006) and the PHQ-9 (Kroenke et al, 2001), provide evidence that brief questionnaires can demonstrate good (> 0.80) sensitivity and specificity in primary care settings. The original 47-item and the shortened 25-item RCADS (Ebesutani et al, 2012) are questionnaire measures of adolescent- and parent-reported symptoms of anxiety and depression in children aged 8 to 18 years Both RCADS questionnaires demonstrate robust internal consistency in different settings and countries (Piqueras et al, 2017) and are successful in discriminating between clinical samples of young people with a diagnosis of an anxiety disorder or depressive disorder and community samples (Chorpita et al, 2005; Ebesutani et al, 2010, 2017). We evaluated the internal consistency, criterion, convergent and divergent validity, and identified optimal cut-off scores for the final brief item set in terms of 1) anxiety score 2) depression score and 3) total score, and compared these psychometric properties with corresponding properties for the original RCADS and the RCADS-25

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Conclusion