Depression screening in trauma-exposed youth: Multi-informant algorithms for the child welfare setting

Routine depression screening is recommended beginning at age 12 by the United States Preventative Services Task Force and other professional organizations. The development of targeted depression screening initiatives may be most needed within settings that serve trauma-exposed youth. The Achenbach System of Empirically Based Assessment (ASEBA) represents the most widely used protocol for mental and behavioral health screening in the child welfare system. However, methodological limitations for development of screening protocols with the ASEBA include a) reliance on the parent report, b) only examining internalizing subscales, c) focusing solely on current or prospective depression, and d) lack of attention on incremental validity (see Garb, 2003 for a discussion). The goal of the present study was to use an evidence-based medicine (EBM) framework to assess concurrent and prospective depression risk with the ASEBA among adolescents in the child welfare system. Overall, we found that a combination of self-reported internalizing symptoms, attention problems, delinquent behavior, and parent-reported social problems best forecasted concurrent depression status, while self-reported anxious/depressed and externalizing symptoms, in addition to parent-reported somatic complaints and withdrawn symptoms, were necessary to adequately forecast prospective depression outcomes. Using these algorithms, we were able to differentiate and classify youth at minimal risk, moderate risk, and substantial risk for current and future depression symptoms. Overall, our findings suggest leveraging the multi-informant and multi-symptom strengths of the ASEBA may be necessary to adequately assess depression risk. Findings are contextualized with past research on the Achenbach scales and clinical implications for more targeted depression screening are discussed