Choosing Assessment Instruments for Depression Outcome Research with School-Age Youth

Article excerpt

Depression is one of the most studied categories of mental disorders, and numerous scales have been developed to assess depression severity in youth and adults (Moran & Mohr, 2005; A. B. Shafer, 2006). Depression assessment is usually conducted either by using an interview format or via inventories using a self-report, clinician-report, parent-report, or teacher-report format. Some batteries of instruments may provide a combination of these formats to measure the severity of depression. For example, both the Achenbach System of Empirically Based Assessment (ASEBA; Achenbach & Rescorla, 2001) and the Children's Depression Inventory (CDI; Kovacs, 2003) provide self-, parent-, and teacher-report versions. As examples of the plethora of instruments available for use with clients of all ages during the past 20 years in counseling outcome research, Table 1 presents 25 diverse depression inventories and associated characteristics.

Counseling outcome research includes articles published in counseling, psychology, and medical journals that explore the effectiveness and staying power of counseling and psychotherapy interventions. Counseling outcome research does not include medication-only trials. Barkham et al. (1998), Moran and Mohr (2005), and A. B. Shafer (2006) identified the most widely used depression scales in counseling outcome research. For participants of all ages, these included the Hamilton Rating Scale for Depression (HAM-D; Hamilton, 1960), which is an interview protocol completed by the clinician, and the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) and the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977), both of which are self-report instruments. Erford et al. (2011) confirmed the popularity of these outcome instruments, specifically among clinical trials of school-age youth, indicating that the BDI-II was used in 13 of the 42 (31%) clinical trials, the HAM-D in 12 of the 42 (29%) clinical trials, and the CES-D in eight of the 42 (19%) clinical trials selected into the meta-analysis (see Table 2). Erford et al. reported three additional instruments commonly found among the 42 selected studies of treatment of depression in school-age youth, including 17 clinical trials (40%) that used the self-report CDI, 10 clinical trials (24%) that used the mother-report Child Behavior Checklist Internalizing scale (CBCL-M-I; Achenbach & Rescorla, 2001), and five clinical trials (12%) that used the self-report Reynolds Adolescent Depression Scale-Second Edition (RADS-2; W. M. Reynolds, 2002).

The Erford et al. (2011) meta-analysis was conducted to determine the effectiveness of counseling interventions at posttest and upon follow-up with school-age youth, both inside and outside of the school setting, from 42 articles published from 1990 to 2009. These articles did not include medication trials. A side benefit of that meta-analysis was the identification of the published outcome measures (used as dependent variables) used most frequently, allowing comparisons between effect sizes derived from various clinical trials on various outcome measures. The purpose of this article is to review the practical and technical characteristics of these six most commonly used depression scales and, using effect size estimates from Erford et al., compare each scale's ability to measure treatment outcomes among school-age youth. These six depression instruments were selected for review because of their prominence in the outcome research literature for school-age youth over the past 20 years and because each met high standards of technical adequacy. Readers are referred to Table 1 for additional measures of depression used in outcome studies with participants of all ages.


The CDI was originally published in 1992, based on items from the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), and is designed to assess depressive symptoms in children 7 to 17 years old. …


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