Child Depression Inventory
The Child Depression Inventory (CDI) is a symptom-oriented instrument for assessing depression in children between the ages of seven and 17 years. The basic CDI consists of 27 items, but a 10-item short form is also available for use as a screener.
The CDI was first published by Maria Kovacs in 1992. It was developed because depression in young children is often difficult to diagnose, and also because depression was regarded as an adult disorder until the 1970s. It was thought that children's nervous systems were not sufficiently mature to manifest the neurochemical changes in brain function associated with depression.
In 2002 the National Institute of Mental Health (NIMH) estimated that as many as 2.5% of children and 8.3% of adolescents under the age of 18 in the United States suffer from depression. A study sponsored by the NIMH of 9- to 17-year-olds found that 6% developed depression in a six-month period, with 4.9% diagnosed as having major depression. Research also indicates that children and adolescents experience the onset of depression at earlier ages than previous generations, are more likely to experience recurrences, and are more likely to experience severe depression as adults.
The CDI is intended to detect and evaluate the symptoms of a major depressive disorder or dysthymic disorder in children or adolescents, and to distinguish between children with those disorders and children with other psychiatric conditions. The CDI can be administered repeatedly in order to measure changes in the depression over time and to evaluate the results of treatment for depressive disorders. It is regarded as adequate for assessing the severity of the depressive symptoms.
The CDI has also been used in research studies of the epidemiology of depression in children as well as studies of dissociative symptoms and post-traumatic syndromes in children. It has been rated as having adequate to excellent psychometric properties by research psychologists.
The CDI shares certain drawbacks with other self-report measures used in children, namely that children do not have the same level of ability as adults to understand and report strong internal emotions. On the other hand, children have the same ability as adults to modify their answers on the CDI and similar tests to reflect what they think are the desired answers rather than what they actually feel. This phenomenon is variously known as "faking good" or "faking bad," depending on the bias of the modified answers. Some researchers have also observed that children who do not have age-appropriate reading skills may receive an inaccurate diagnosis on the basis of their CDI score.
Because depressive symptoms fluctuate somewhat in children as well as in adults, the author of the test recommends retesting children who score positive on the CDI, with a two- to four-week interval between the test and the retest. A child who screens positive on the CDI should receive a comprehensive diagnostic evaluation by a licensed mental health professional. The evaluation should include interviews with the child or adolescent; the parents or other caregivers; and, when possible, such other observers as teachers, social service personnel, or the child's primary care physician.
The CDI is self-rated, which means that the child or adolescent being evaluated records their answers to the questions on the test sheet, as distinct from giving verbal answers to questions that are then analyzed and recorded by the examiner. Other self-rated instruments for assessing depression in children include the Beck Depression Inventory (BDI) and the Weinberg Screening Affective Scale (WSAS).
Each question on the CDI consists of three possible responses; the child or adolescent being evaluated selects the response that most closely describes him or her over the preceding two weeks. The CDI is designed to make quantitative measurements of the following symptoms of depression: mood disturbances; capacity for enjoyment; depressed self-evaluation; disturbances in behavior toward other people; and vegetative symptoms, which include fatigue , oversleeping, having difficulty with activities requiring effort, and other symptoms of passivity or inactivity.
The test administrator totals the responses and plots them onto a profile form. A score that falls below a cut-off point, or is 1.0 to 2.0 standard deviations above the mean, is considered to be positive for depression.
"Psychiatric Conditions in Childhood and Adolescence." Section 19, Chapter 274 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
Finch, A. J., and others. "Children's Depression Inventory: Reliability Over Repeated Administrations." Journal of Clinical Child Psychology 16 (1987): 339-341.
Liss, Heidi, Vicky Phares, and Laura Liljequist. "Symptom Endorsement Differences on the Children's Depression Inventory with Children and Adolescents on an Inpatient Unit." Journal of Personality Assessment 76: 396-411.
Michael, Kurt D. "Reliability of Children's Self-Reported Internalizing Symptoms Over Short- to Medium-Length Time Intervals." Journal of the American Academy of Child and Adolescent Psychiatry 37 (February 1998): 205-212.
American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016. (202) 966-7300. <www.aacap.org> .
American Psychological Association. 750 First Street, NE, Washington, DC 20002. (202) 336-5500. <www.apa.org> .
National Depressive and Manic-Depressive Association. 730 North Franklin Street, Suite 501, Chicago, IL 60610-3526. (800) 826-3632. <www.ndmda.org> .
National Institute of Mental Health (NIMH). Depression in Children and Adolescents: A Fact Sheet for Physicians. <www.nimh.nih.gov/publicat/depchildresfact.cfm> .
Texas A & M University at Corpus Christi and the Corpus Christi Independent School District. School Nurse Reference Sheet— Depression. <www.ecdc.tamucc.edu?HELP/depression> .
Rebecca J. Frey, Ph.D.