The Clinical Usefulness of Three Depression Screens for Adolescents in India: A Need in Primary-care Settings

Overview

Journal J Family Med Prim Care

Specialty Public Health

Date 2019 Jun 15

PMID 31198748

Authors

Sushila Russell

Shonima A Viswanathan

SatyaRaj Shankar

Priya M Mammen

Paul S S Russell

Affiliations

Soon will be listed here.

Abstract

Introduction: Adolescent Depression (AD) although is widely prevalent and is a prioritized disorder, it is under-diagnosed and under reported in primary-care. We document the post-test probability of three measures and select the best measure for identifying AD in primary-care settings in India based on the clinical utility.

Materials And Methods: Three measures have been validated in India for AD and thus can be further evaluated for primary-care use; we calculated the positive (+PTP) and negative (-PTP) post-test probability from the prevalence of AD in India for Beck Depression Inventory-21 item version (BDI-21), Patient Health Questionnaire-9 item version (PHQ-9), and Children's Depression Rating Scale-Revised version (CDRS-R) using the Bayes theorem. The usefulness of the measure was defined based on the odds ratio (OR) of +PTP (OR > 3) and -PTP (OR < 0.1).

Results: The +PTP and -PTP for BDI-21 was 43% (95%CI = 40, 45%; OR = 0.7) and 25% (95%CI = 13, 43%; OR = 0.3) respectively. Similarly, the +PTP and - PTP for PHQ-9 was 74% (95%CI = 66, 81%; OR = 2.9) and 10% (95%CI = 6, 17%; OR = 0.1). Finally, +PTP and - PTP for CDRS-R was 78% (95%CI = 69, 84%; OR = 3.5) and 12% (95%CI = 7, 18%; OR = 0.1). Only CDRS-R achieved the useful decided as can be seen in the Fagan's Nomograms.

Conclusion: This research provides the evidence base for selecting CDRS-R as the screening measure, for Adolescent Depression, for clinical use in Primary-care settings in India.

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