Cohort profile: BioMD-Y (biopsychosocial factors of major depression in youth) - a biobank study on the molecular genetics and environmental factors of depression in children and adolescents in Munich.

PURPOSE: BioMD-Y is a comprehensive biobank study of children and adolescents with major depression (MD) and their healthy peers in Germany, collecting a host of both biological and psychosocial information from the participants and their parents with the aim of exploring genetic and environmental risk and protective factors for MD in children and adolescents. PARTICIPANTS: Children and adolescents aged 8-18 years are recruited to either the clinical case group (MD, diagnosis of MD disorder) or the typically developing control group (absence of any psychiatric condition). FINDINGS TO DATE: To date, four publications on both genetic and environmental risk and resilience factors (including FKBP5, glucocorticoid receptor activation, polygenic risk scores, psychosocial and sociodemographic risk and resilience factors) have been published based on the BioMD-Y sample. FUTURE PLANS: Data collection is currently scheduled to continue into 2026. Research questions will be further addressed using available measures.

Prevalence of depression and depressive symptoms in women with previous miscarriages or stillbirths - A systematic review.

Women who have had miscarriages or stillbirths are known to have an elevated risk for depression. However, the prevalence of depressive disorders and/or symptoms in this group is unclear. Therefore, our aim was to estimate the corresponding prevalence of depression and depressive symptoms. A systematic literature search of the databases MEDLINE, psycINFO and PSYNDEX was conducted to consider all studies published between 2000 and 2022 in English or German on the prevalence of depression or depressive symptoms in women following miscarriages or stillbirths. Studies using valid psychiatric diagnoses or validated assessment methods regarding depression were included in the systematic review. The PRISMA guidelines were followed. Data concerning depressive symptoms were extracted from 14 studies. The range regarding prevalence of depressive symptoms in women with previous miscarriages or stillbirths was very wide (5%-91.2%). All longitudinal studies demonstrate a reduction of depressive symptoms over time. The prevalence of depressive disorders had a range of 5.4 (only for minor depression according to DSM-IV) - 18.6% (for depressive disorders according to ICD-10). The included studies are very heterogeneous considering the investigated groups, the length of pregnancies and time passed since the occurrence of miscarriages or stillbirths. Women with miscarriages or stillbirths have an elevated risk for depressive symptoms and disorders. In most affected women, depressive symptoms are most pronounced in the first months after the pregnancy loss and diminish over time.

Suicide rates during and after the first COVID-19 lockdown in Germany in 2020.

The impact of the COVID-19 pandemic and of measures implemented to curb the spread of the virus on suicidal behavior has been investigated in different regions of the world, but does not yet allow to draw conclusions for Germany. Especially lockdowns might have effects on suicide rates via impact on mental disorders, changes in the choice of suicide method, a decrease in help seeking behavior, or a deterioration in the quality of medical care for people with mental disorders. The following research questions were addressed: i) did suicide rates in Germany in 2020 change during lockdown and non-lockdown periods when compared to a ten-year baseline? ii) was there a change in the proportion of suicide methods during the lockdown compared to baseline? An interrupted time-series analysis based on a linear regression was used. For the comparisons of predicted and observed suicide rates, excess suicide mortality rates (ESMR) were chosen among others. Changes in the choice of method were analyzed by comparing the rates of different methods to those at baseline. Although the mean suicide rate in 2020 was not significantly different from baseline, the weekly analysis of suicide rates revealed a significant difference (χ2 = 64.16; df = 39; p = 0.007), with some weeks showing higher and others lower rates than previous years. The effects for separate weeks were attenuated to non-significance after correction for multiple testing. Suicide mortality during the first lockdown in 2020 was significantly lower than expected (ESMR = 0.933; 95% CI: 0.890; 0.985) whereas, in the post-lockdown period, the registered suicide mortality was not significantly different from the expected one (ESMR = 1.024; 95% CI: 0.997; 1.051). During lockdown, there was a significant increase of the percentage of the suicide method categories jumping and 'other methods' and a decrease of poisoning and lying in front of a moving object. Being able to determine whether the choice of more or less lethal methods during lockdown versus non-lockdown periods partly explains this finding would require a representative assessment of attempted suicides.

Evaluation of an information booklet for adolescents on depression: evidence from a randomized controlled study.

BACKGROUND: Adolescents with depression often show barriers to seek treatment offers due to various reasons, including limited knowledge about the manifestation of the disorder, its treatment options, or fear of stigmatization. Psychoeducational approaches might reduce these barriers by increasing depression literacy. The aim of the present randomized controlled study was to evaluate whether an innovative and age-appropriate evidence-based information booklet about youth depression increases depression-specific knowledge in adolescents with depression and is also appealing to the target group. METHODS: 50 adolescents with a history of depression (current/remitted) aged 12-18 years participated in the study including a pre-, post- and follow-up assessment. Participants were randomly assigned to one of two groups. The experimental group received a target group-specific information booklet about youth depression including seven subdomains. The active control group received an information booklet about asthma in youth that was highly comparable to the depression booklet in terms of format and length. Before and after reading, and at a four-week follow-up, we assessed knowledge about youth depression based on a questionnaire. Furthermore, participants evaluated the acceptability of the information booklets. RESULTS: Unlike the active control group, the experimental group showed a significant increase in depression-specific knowledge from pre to post and from pre to follow-up across all subdomains. This increase was evident in four subdomains ("symptoms", "treatment", "antidepressants", and "causes"). The overall reception of the information booklet about depression was positive and participants stated that they would recommend the information booklet about depression to their peers. CONCLUSION: This is the first randomized controlled study to demonstrate that an information booklet about youth depression effectively imparts depression-specific knowledge to participants with a history of depression and shows high acceptance. Information booklets that are appealing and increase depression-specific knowledge might be a promising low-threshold and cost-effective approach to reduce barriers to treatment and raise awareness.

Munich Alliance Against Depression.

Background: A four-level community-based intervention aiming simultaneously to improve the care for depression and to prevent suicidal behavior has been implemented in the German city Munich. Aims: Changes in suicide rates in Munich during 2009-2014 were analyzed with respect to a 10-year baseline. The same was true for a control region (Cologne) and Germany minus Munich. Method: The interventions included training of primary care providers, a public awareness campaign, training of community facilitators, and support for patients and relatives. Analyses included repeated-measures, generalized linear models. Results: In Munich, the suicide rate significantly decreased during the intervention period compared to baseline (percentage change = -15.0%; p < .001, 198 compared to 222 suicides per year). Differences in the change for Munich and the change for the control locations (Cologne; -1.7%; p = .71) and Germany minus Munich (-6.2%; p = .09) were not significant. Limitations: Data on suicide attempts were unavailable. Conclusion: In Munich, a clinically and statistically significant decrease in suicide rate was found. This change was numerically but not significantly larger than in the control regions. The results are promising, however. Because of low suicide base rates and limited power, no strong conclusions can be drawn concerning suicide preventive effects of the intervention.

Effects of Four Different EEG-Neurofeedback Reinforcement Types in Healthy Individuals - A Pilot Study.

EEG neurofeedback (EEG-NFB) is a promising tool for the treatment of depressive disorders. However, many methods for the presentation of neurobiological reactions are available and it is widely unknown which of these feedback options are preferrable. Moreover, the influence of motivation on NFB training success is insufficiently studied. This study analyzed the efficacy of a novel EEG protocol (FC3/Pz) based on findings for NFB in depression. The role of four feedback options (Rumination, Anxiety, Meditation Master, Moving Art) from the NFB software "Brain Assistant" and motivation in EEG-based NFB performance was studied. Regarding "Anxiety" and "Rumination" visual feedback was used to evoke emotions; reinforcement (both negative and positive operant conditioning) was continuous. Regarding "Meditation Master" visual feedback was combined with continuous positive reinforcement. Regarding "Moving Art" 20-min calm nature films with neutral character were used; both visual and auditive feedback were applied. The reinforcement was positive and continuous. 13 healthy participants completed 15 EEG sessions over four months combining simultaneous frontal (aims: reduction of theta-, alpha- and high beta-activity, increase of low and mid beta-activity) and parietal training (aims: reduction of theta-, alpha 1-, mid and high beta-activity, increase of alpha 2- and low beta-activity). We observed significantly more pronounced percentage change in the expected direction for Anxiety than Moving Art (mean difference = 3.32; p = 0.003). The association between motivation and performance was non-significant. Based on these results we conclude that feedback with both negative and positive operant conditioning and emotion evoking effects should be preferred.

Grief in women with previous miscarriage or stillbirth: a systematic review of cross-sectional and longitudinal prospective studies.

Background: Women who have had miscarriages or stillbirths are known to have a high risk for enduring grief. However, the course and frequency of enduring grief in this subgroup are not fully understood. Objective: Our aims were to assess the intensity of grief and its course in women with miscarriages or stillbirths and to estimate the frequency of severe grief reactions in this population. Additionally, we compared subgroups with miscarriages versus stillbirths and with single versus recurrent pregnancy loss. Method: A systematic literature search of the databases MEDLINE, psycINFO and PSYNDEX was conducted to consider all studies published between 2000 and 31 March 2022 in English or German on the prevalence and intensity of grief in women who had miscarriages or stillbirths. Studies that used validated assessment methods were included in this systematic review. The PRISMA guidelines were followed. Results: Study characteristics and grief data were extracted independently by two investigators from 13 cross-sectional and eight longitudinal studies from 11 countries (N = 2597). All studies used self-reporting instruments. According to 17 of 21 studies (81%), grief is markedly elevated in women after miscarriages or stillbirths. The studies are very heterogeneous regarding the samples, the length of pregnancies and the time of assessment regarding grief after miscarriages. Most studies document intense grief and frequent severe grief reactions - with a decrease over time - in women who have had miscarriages or stillbirths. Clear conclusions regarding corresponding differences between women with miscarriages and stillbirths or single and recurrent pregnancy losses cannot be drawn. Conclusions: Pronounced grief is frequent in women who had miscarriages or stillbirths. More longitudinal studies are needed to examine the course of grief in this group and to identify those women who develop prolonged grief disorder, depression or other mental-health problems.

Antecedentes: Se sabe que las mujeres que han tenido abortos espontáneos o mortinatos tienen un alto riesgo de sufrir un duelo persistente. Sin embargo, el curso y la frecuencia del duelo persistente en este subgrupo no se conocen del todo.Objetivo: Nuestros objetivos fueron evaluar la intensidad del duelo y su curso en mujeres con abortos espontáneos o mortinatos y estimar la frecuencia de las reacciones de duelo graves en esta población. Además, comparamos subgrupos con abortos espontáneos frente a mortinatos y con pérdidas de embarazo únicas frente a recurrentes.Método: Se realizó una búsqueda bibliográfica sistemática en las bases de datos MEDLINE, psycINFO y PSYNDEX para considerar todos los estudios publicados entre el año 2000 y el 31 de marzo de 2022 en inglés o alemán sobre la prevalencia e intensidad del duelo en mujeres que tuvieron abortos espontáneos o mortinatos. Se incluyeron en esta revisión sistemática los estudios que utilizaron métodos de evaluación validados. Se siguieron las directrices PRISMA.Resultados: Dos investigadores extrajeron de forma independiente las características de los estudios y los datos sobre el duelo de 13 estudios transversales y ocho longitudinales de once países (N=2597). Todos los estudios utilizaron instrumentos de autorreporte. Según 17 de 21 estudios (81%), el duelo es muy elevado en las mujeres después de un aborto espontáneo o un mortinato. Los estudios son muy heterogéneos en cuanto a las muestras, la duración de los embarazos y el momento de la evaluación del duelo tras los abortos espontáneos. La mayoría de los estudios documentan un duelo intenso y frecuentes reacciones de duelo severas -con una disminución en el tiempo- en mujeres que han tenido abortos espontáneos o mortinatos. No se pueden extraer conclusiones claras sobre las diferencias correspondientes entre las mujeres con abortos espontáneos y mortinatos o con pérdidas de embarazos únicos y recurrentes.Conclusiones: El duelo prolongado es frecuente en las mujeres que han tenido abortos espontáneos o mortinatos. Se necesitan más estudios longitudinales para examinar el curso del duelo en este grupo e identificar a las mujeres que desarrollan un trastorno de duelo prolongado, depresión u otros problemas de salud mental.

The effect of depressive symptomatology on the association of vitamin D and sleep.

BACKGROUND: Sleep disorders and vitamin D deficiency are highly prevalent health problems. Few studies examined the effect of vitamin D concentrations on objectively measured sleep with high methodological quality and temporal proximity. Previous analysis within the LIFE-Adult-Study suggested that a lower concentration of serum vitamin D was associated with both shorter and later night sleep. However, no conclusion about underlying mechanisms could be drawn. We addressed the question whether this relationship is explained by the presence of depressive syndromes, which are linked to both vitamin D deficiency and sleep disturbances. METHODS: It was investigated whether the association of vitamin D concentrations and night sleep parameters is mediated or moderated by depressive symptomatology. We investigated a subset (n = 1252) of the community sample from the LIFE-Adult-Study, in which sleep parameters had been objectively assessed using actigraphy, based on which two sleep parameters were calculated: night sleep duration and midsleep time. Serum 25(OH) D concentrations were measured using an electrochemiluminescence immunoassay. Depressive symptomatology was evaluated with the Centre for Epidemiological Studies Depression Scale. The mediation effect was analyzed by using Hayes' PROCESS macro tool for SPSS for Windows. RESULTS: The depressive symptomatology was neither significantly associated with night sleep duration nor midsleep time. The associations between vitamin D concentrations and night sleep duration/midsleep time through mediation by depressive symptomatology were not significant. Corresponding moderator analyses were also non-significant. CONCLUSION: The associations between vitamin D concentrations and night sleep parameters (sleep duration and midsleep time) seem to be neither mediated nor moderated by depressive symptomatology.

Psychosocial stressors and protective factors for major depression in youth: evidence from a case-control study.

BACKGROUND: Severe adverse life events, such as traumatic experiences, are well-known stressors implicated in (youth) major depression (MD). However, to date, far less is known about the role of more common psychosocial stressors in the context of MD, which are part of everyday life during youth. In addition, it is not well-understood whether and how distinct stressors interact with protective factors in youths diagnosed with MD. Thus, the present study aimed at examining several specific psychosocial stressors implicated in a first-episode juvenile MD and addressed the question whether protective factors might moderate the relationship between stressors and a diagnosis of MD. METHODS: One-hundred male and female youths with MD and 101 typically developing (TD) controls (10-18 years) were included. A large number of qualitatively different psychosocial stressors occurring in various areas of life were assessed via self-report. Moreover, we also investigated sociodemographic and pre- and postnatal stressors, as well as the presence of familial affective disorders via parental-report. Social support and a positive family climate were conceptualized as protective factors and were assessed via self-report. RESULTS: Results showed that the proportion of youths experiencing specific psychosocial stressors was higher in the MD than in the TD group. In particular, the proportion of youths indicating changes at home or at school, experiences of violence, delinquent behavior, as well as the proportion of youths who were exposed to sociodemographic stressors was higher in the MD than in the TD group. Moreover, the percentage of youths with a family history of an affective disorder, or whose mothers experienced psychological burdens during/after pregnancy was elevated in the MD group. Youths with MD experienced less social support and a less positive family climate than their TD peers. These factors, however, did not buffer the influence of specific stressors on MD. CONCLUSION: We could show that next to more severe adverse life events, more common psychosocial stressors are linked to youth MD. Importantly, by identifying distinct stressors in youth MD, our results can increase treatment and prevention efforts aiming to improve the outcomes in youths affected by MD or in at-risk individuals.

Interactions between FKBP5 variation and environmental stressors in adolescent Major Depression.

OBJECTIVE: Major Depression (MD) results from a complex interplay between environmental stressors and biological factors. Previous studies in adults have shown that adverse life events interact with genetic variation in FKBP5, a gene implicated in the stress-response system, to predict depressive symptoms and MD. This is the first study to investigate interactions between FKBP5 variants and a range of environmental stressors in adolescents with a clinical diagnosis of MD. METHOD: 148 male and female adolescents with MD and 143 typically developing (TD) controls (13-18 years) were included in the present study. For self-reported environmental stressors, subjective severity was assessed to allow a classification of these factors as mild, moderate and severe. Sociodemographic stressors were assessed via parental-report. RESULTS: With a heightened number of sociodemographic, moderate and total number of stressors, participants carrying at least one copy of the FKBP5 CATT haplotype or at least one minor allele of various FKBP5 SNPs had the highest risk for being in the MD group. No genetic main effects were found. Sociodemographic stressors as well as self-reported mild, moderate, and severe stressors were more common in depressed than in TD adolescents. CONCLUSION: This is the first study to show interactions between genetic variation in FKBP5 and environmental stressors in a sample of clinically depressed adolescents. The current study provides important starting-points for preventive efforts and highlights the need for a fine-grained analysis of different forms and severities of environmental stressors and their interplay with genetic variation for understanding the complex etiology of (youth) MD.

Polygenic Risk: Predicting Depression Outcomes in Clinical and Epidemiological Cohorts of Youths.

OBJECTIVE: Identifying risk factors for major depression and depressive symptoms in youths could have important implications for prevention efforts. This study examined the association of polygenic risk scores (PRSs) for a broad depression phenotype derived from a large-scale genome-wide association study (GWAS) in adults, and its interaction with childhood abuse, with clinically relevant depression outcomes in clinical and epidemiological youth cohorts. METHODS: The clinical cohort comprised 279 youths with major depression (mean age=14.76 years [SD=2.00], 68% female) and 187 healthy control subjects (mean age=14.67 years [SD=2.45], 63% female). The first epidemiological cohort included 1,450 youths (mean age=13.99 years [SD=0.92], 63% female). Of those, 694 who were not clinically depressed at baseline underwent follow-ups at 6, 12, and 24 months. The replication epidemiological cohort comprised children assessed at ages 8 (N=184; 49.2% female) and 11 (N=317; 46.7% female) years. All cohorts were genome-wide genotyped and completed measures for major depression, depressive symptoms, and/or childhood abuse. Summary statistics from the largest GWAS to date on depression were used to calculate the depression PRS. RESULTS: In the clinical cohort, the depression PRS predicted case-control status (odds ratio=1.560, 95% CI=1.230-1.980), depression severity (ß=0.177, SE=0.069), and age at onset (ß=-0.375, SE=0.160). In the first epidemiological cohort, the depression PRS predicted baseline depressive symptoms (ß=0.557, SE=0.200) and prospectively predicted onset of moderate to severe depressive symptoms (hazard ratio=1.202, 95% CI=1.045-1.383). The associations with depressive symptoms were replicated in the second epidemiological cohort. Evidence was found for an additive, but not an interactive, effect of the depression PRS and childhood abuse on depression outcomes. CONCLUSIONS: Depression PRSs derived from adults generalize to depression outcomes in youths and may serve as an early indicator of clinically significant levels of depression.

One-year follow-up of a randomized controlled trial of sertraline and cognitive behavior group therapy in depressed primary care patients (MIND study).

BACKGROUND: The long-term course of symptoms in patients with mild-to-moderate depression is not well understood. A 12-month-follow-up analysis was performed on those participants from a randomized controlled 10-week trial (RCT, MIND-study), who had received either treatment with an antidepressant (sertraline) or a psychotherapeutic intervention (group cognitive-behavioral therapy (CBT)). METHODS: The longitudinal interval follow-up evaluation (LIFE) was applied to 77 patients with mild-to moderate depression. The primary outcome was the number of weeks in the one-year follow-up period spent completely recovered from all depressive symptoms. Functional outcome was measured with the Global Assessment of Functioning (GAF) scale. Further outcomes were relapse and remission rates based on weekly psychiatric rating scales (PSR) and the number of weeks in the follow-up period during which patients had a depressive disorder or subthreshold symptoms of depression. RESULTS: Patients with acute treatment (10 weeks) with SSRI and those with acute treatment with CBT (also 10 weeks) did not differ significantly concerning the number of weeks in the follow-up period in which they were completely recovered (primary outcome) (SSRI: 31.6 weeks (standard deviation (SD): 23.7), CBT: 27.8 weeks (SD: 24.3)). Sertraline was superior to CBT regarding GAF scores by trend (p = 0.06). LIMITATIONS: The generalizability of the findings is limited by the moderate sample size and missing values (LIFE). CONCLUSIONS: Sertraline and group CBT have similar anti-depressive effects in the long-term course of mild-to-moderate depression. Regarding long-term global functioning, sertraline seems to be slightly superior to CBT.

The Depression Screener for Teenagers (DesTeen): a valid instrument for early detection of adolescent depression in mental health care.

OBJECTIVE: Diagnosis of comorbid depressive disorder is challenging, even in mental health care. Screening instruments could be economic tools in indicating depression. For the first time, the current study investigates the validity of the newly developed Depression Screener for Teenagers (DesTeen) and its abbreviated five-item form DesTeen-a in a mental health setting. METHODS: A total of 88 patients aged 13-16 years were recruited in institutions specialized in child and adolescent psychiatry, psychotherapy or psychosomatic medicine. DSM-IV-TR diagnoses of major depression or dysthymia based on a structured diagnostic interview served as the gold standard for validation. For assessing the criterion validity of the DesTeen and the DesTeen-a, areas under the receiver operating characteristic curve (AUC) were calculated. Specificity and sensitivity were computed for optimal cut-off scores according to the Youden Index. RESULTS: Point prevalence of depression was 27.3%. Diagnostic accuracy of the DesTeen was high (AUC=.94). Using a cut-off score of ≥ 18, sensitivity was .96 and specificity was .86. The DesTeen-a showed no loss in validity (AUC=.94). At a cut-off point of ≥ 6, sensitivity remained excellent (.96), while specificity was slightly lower (.80). LIMITATIONS: The limited representativeness and the small sample size restrict the generalizability of the findings. CONCLUSIONS: The DesTeen and its abbreviated version are valid instruments to screen for adolescent depression in mental health care. Since structured interviews to diagnose comorbid mental disorders are rarely applied, the DesTeen and the DesTeen-a can support mental health specialists in making the diagnostic process more efficient, thus facilitating effective treatment planning.

Improving early detection of childhood depression in mental health care: the Children׳s Depression Screener (ChilD-S).

Diagnosing childhood depression can pose a challenge, even for mental health specialists. Screening tools can aid clinicians within the initial step of the diagnostic process. For the first time, the Children׳s Depression Screener (ChilD-S) is validated in a mental health setting as a novel field of application beyond the previously examined pediatric setting. Based on a structured interview, DSM-IV-TR diagnoses of depression were made for 79 psychiatric patients aged 9-12, serving as the gold standard for validation. For assessing criterion validity, receiver operating characteristic (ROC) curves were calculated. Point prevalence of major depression and dysthymia was 28%. Diagnostic accuracy in terms of the area under the ROC curve was high (0.97). At the optimal cut-off point ≥12 according to the Youden׳s index, sensitivity was 0.91 and specificity was 0.81. The findings suggest that the ChilD-S is not only a valid screening instrument for childhood depression in pediatric care but also in mental health settings. As a brief tool it can easily be implemented into daily clinical practice of mental health professionals facilitating the diagnostic process, especially in case of comorbid depression.

Increasing knowledge about depression in adolescents: effects of an information booklet.

PURPOSE: This study evaluates a newly developed information booklet about depression among adolescents. The aim was to examine the enhancement of knowledge through the booklet with the objective of reducing stigma and facilitating awareness of own treatment needs. METHODS: 628 German ninth graders were enrolled in a pre-post-follow-up study using study-specific questionnaires to investigate knowledge enhancement in seven depression-related topics. Exploratively, knowledge enhancement was calculated with respect to education level and gender. Additionally, the students assessed the booklet's layout, content and utility. Knowledge enhancement was analyzed using repeated measures ANOVA for index values of the booklet's topics. The effect size partial eta square (η²) was computed. RESULTS: The pre-post-follow-up comparison yielded significant knowledge enhancement for all seven index values (p < 0.001). The associated effect sizes were medium to large. The strongest effects were achieved for the categories "Antidepressants" (η² = 0.56), "Symptoms" (η² = 0.45) and "Treatment" (η² = 0.17) of depression as well as for "Suicidality" (η² = 0.36). Although baseline knowledge was high in all students, knowledge enhancement was greater in better educated than in less educated students. Overall assessment of the booklet was good (mean = 2.15 on a rating scale from "very good" (1) to "fail" (6)). CONCLUSIONS: The information booklet as a low-threshold educational approach can significantly enhance depression-specific knowledge in students. Hence, it helps adolescents to acknowledge their own symptoms and treatment needs as well as to recognize these specific mental health problems in their peers. Thus, the booklet can contribute to the reduction of stigma and treatment barriers in adolescents.

Beside the Geriatric Depression Scale: the WHO-Five Well-being Index as a valid screening tool for depression in nursing homes.

OBJECTIVE: The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. METHODS: Data from 92 residents aged 65-97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. RESULTS: Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 (0.92) at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 (0.69) at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression (0.92), whereas the GDS-15 was sensitive only for major depression (0.85), but not for minor depression (0.54). For specificity, there was no significant difference between WHO-5 (0.79) and GDS-15 (0.88), but both instruments outperformed the GDS-4 (0.53). CONCLUSIONS: The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents.

Screening for adolescent depression in paediatric care: validity of a new brief version of the Center for Epidemiological Studies Depression Scale.

BACKGROUND: The study assessed the criterion validity of the 15-item version of the Center for Epidemiological Studies Depression Scale (CES-D-15) as a screening instrument in paediatric care. METHOD: A total of 327 patients (13-16 years) completed the CES-D-15 and a diagnostic interview serving as gold standard diagnosis for validation. RESULTS: Receiver operating characteristics yielded an overall accuracy of area under the curve (AUC) = .90 (95% CI [.85, .95]) for the detection of any depressive disorder. At the optimal cut-off point of 14, sensitivity (.85) and specificity (.84) were good. CONCLUSIONS: The CES-D-15 is a promising tool for paediatricians to enhance the recognition rate of juvenile depression.

[Agreement of clinical diagnosis, structured interviews, and self-report questionnaires for depression in children and adolescents]. / Übereinstimmung von klinischer Diagnose, strukturierten Interviews und Selbstbeurteilungsfragebögen bei Depression im Kindes- und Jugendalter.

OBJECTIVE: The present study examines the agreement of structured child and parent interviews as well as clinical diagnosis for depressive episodes in children and adolescents. Moreover, it compares the accuracy and optimal cutoff scores of self-report questionnaires with reference to each of these diagnostic assessments. METHOD: 81 children (9-12 years) and 88 adolescents (13-16 years) in psychiatric care and their parents completed the structured diagnostic interview Kinder-DIPS. The children answered the German Children's Depression Inventory (CDI), and the adolescents answered the German Center for Epidemiologic Studies Depression Scale (CES-D). Kappa coefficients quantified the agreement. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff scores, sensitivity, specificity, as well as positive and negative predictive values. RESULTS: The agreement between the child and parent interviews as well as between the interviews and clinical diagnosis was low to moderate. Clinicians diagnosed depressive episodes more frequently than the interviews. Cutoff scores and measures of accuracy varied between the reference standards, with less favorable results for clinical diagnosis. CONCLUSIONS: Clinicians may profit from conducting structured interviews. Strategies for dealing with conflicting information from children and parents should be tested empirically and described in detail.