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Depression Screening in Trauma-Exposed Youth: Multi-Informant Algorithms for the Child Welfare Setting

Fri, March 22, 7:45 to 9:15am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Routine depression screening is recommended beginning at age 12 by the United States Preventative Services Task Force and professional organizations (e.g., the American Academy of Pediatrics; Zuckerbrot et al., 2018). The development of targeted depression screening may be most needed within settings that serve trauma-exposed youth. The risk for depressive symptom profiles during adolescence is influenced by childhood exposure to trauma (McCutcheon et al., 2009). Yet, formal recommendations for best screening practices are elusive. The Achenbach System of Empirically Based Assessment (AESBA) represents a widely used protocol for mental and behavioral health screening in youth (MacMillan & Sisselman-Borgia, 2018). Importantly, the multi-informant battery is a valid measure of internalizing and externalizing symptoms in trauma-exposed youth (Woods et al., 2014), and is routinely used within the child welfare context (e.g., Garcia et al., 2014). However, methodological limitations including reliance on the parent report, only examining internalizing subscales, focusing solely on current or prospective depression, and a lack of attention on incremental validity (Garb, 2003) have led to inconsistent recommendations for depression screening using the AESBA. Thus, the goal of the present study was to use an evidence-based medicine (EBM) quantitative framework to develop explicit recommendations for assessing concurrent and prospective depression risk with the ASEBA among adolescents in the child welfare system.

1056 youth and 1056 caregivers participated in the National Survey of Child and Adolescent Well-Being (NSCAW-II). Data from the baseline, 18-month, and 36-month follow up visits were used for the current study. The youth ranged in age from 11-17 years old at baseline (AgeM=13.72) and were balanced in terms of sex (54.5% female). Youth and caregivers independently completed the Youth Self Report and the Child Behavior Checklist, respectively (Achenbach & Rescola, 2001). Youth also completed the Children’s Depression Inventory (Kovacs, 1992). We used state-of-the-science methodology that incorporated area under the curve (AUC) and reclassification analyses. AUC approaches generate empirically-informed cutoffs that can be used in clinical decision making (Youngstrom, 2014). Reclassification analyses are used to quantify the costs and benefits of including an additional prognostic marker within screening protocols (Leening, Vedder, Witteman, Pencina, & Steyerberg, 2014).

Youth-reported internalizing and externalizing, and parent-reported social problems subscales demonstrated incremental validity for concurrent depressive outcomes (AUC: 0.9326, X2 = 19.237, df = 8, p-value = 0.01364). Youth-reported anxious/depressed symptoms and aggressive behavior, in addition to parent-reported withdrawn symptoms and somatic complaints, yielded incremental validity for prospective depressive outcomes (AUC: 0.8702, X2 = 8.8115 , df = 8 , p-value = 0.3584).

Our findings suggest leveraging the multi-informant and multi-symptom strengths of the AESBA may be necessary to adequately assess depression risk. Specifically, we found that while self-reported internalizing symptoms explained most of the variance in current depression outcomes, a myriad of symptoms and informants was necessary for prospective depression. These findings are consistent with past research which suggests behavioral dysregulation, including avoidant and externalizing behaviors, are risk factors for adolescent depression. Findings are contextualized with past research on the ASEBA and our contribution to an EBM approach for depression screening in vulnerable adolescents is discussed.


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