PEDIATRICS Vol. 85 No. 5 May 1990, pp. 813-818
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Screening Adolescents for Depression and Parent-Teenager Conflict in an Ambulatory Medical Setting: A Preliminary Investigation

Howard Schubiner MD1 and Arthur Robin PhD1

1 From the Departments of Pediatrics and Internal Medicine, Wayne State University, and Children's Hospital of Michigan, University Health Center, Detroit, Michigan

Because more than 60% of adolescent visits to physicians last less than 10 minutes, simple screening devices to identify persons at risk for social morbidity are needed. The result of a pilot screening instrument for depression and parent-teenager conflict is described. A seven-item questionnaire (three items for depression and four items for parent-teenager conflict), the Beck Depression Inventory (BDI), and the Conflict Behavior Questionnaire (CBQ), were administered to 226 adolescents at a high-risk adolescent health center. After the visit, the provider rated each patient on a five-point Likert scale for level of depression and parent-teenager conflict. The screening questionnaire and the provider ratings were compared with the BDI and CBQ for sensitivity, specificity, and predictive value. A majority of the subjects (61% for depression and 63% for parent-teenager conflict) had no positive screening responses and, of these, less than 3% were classified as being depressed or having parent-teenager conflict by the BDI or CBQ. There were three or four positive screening responses (three responses for the depression questions and 20 responses for the parent-teenager conflict questions) among 23 adolescents and all of these scored in the abnormal range on the BDI or CBQ. Approximately one third of the subjects had intermediate responses. With one positive response, the predictive value for depression and parent-teenager conflict was 17% and 24%, respectively, whereas with two positive responses the predictive values were 56% and 26%. It was shown by receiver operating characteristic curves that the combined sensitivity and specificity of the screening questionnaire was superior to that of the physician ratings. In this study it was demonstrated that a simple seven-item instrument for depression and parent-teenager conflict can quickly and accurately classify the two thirds of patients with very high or very low scores and provide likelihoods of these problems for the remaining one third of patients who score in the intermediate ranges. This instrument can aid providers in efficient assessment of social morbidity factors in their adolescent patients.

Key Words: assessment • adolescence • parent-teenager conflict • depression • screening

Submitted on November 23, 1988
Accepted on July 2, 1989




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