Diagnostic accuracy of the Montgomery–Åsberg Depression Rating Scale parent report among adolescent psychiatric outpatients

Abstract

Background: The diagnostic accuracy of the parent report of the Montgomery–Åsberg Depression Rating Scale (MADRS-P) for the screening of major depressive disorder (MDD) in adolescents has not been evaluated.

Aim: The aim was to explore the psychometric properties and diagnostic accuracy of the MADRS-P in general child and adolescent psychiatric outpatient services in Sweden.

Method: The study was a validation and a diagnostic accuracy study. Consecutive adolescent psychiatric patients (n = 101, 45 males, mean age 15 years) were assessed with a diagnostic interview, the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime version (K-SADS-PL), as a reference test. Thereafter, their parents reported on the MADRS-P. Both categorical MDD diagnoses and dimensional MDD symptom severity scores were obtained from the K-SADS-PL.

Results: The internal consistency of the MADRS-P, measured with Cronbach’s alpha, was 0.846. The concurrent validity, assessed by Spearman’s rho as a correlation between the K-SADS MDD symptom severity score and the MADRS-P score, was 0.580. The area under the curve in a receiver operating characteristic analysis for all participants was 0.786 (95% confidence interval 0.694–0.877, p < .001). At a cut-off of 10, sensitivity was 0.86, specificity 0.54, positive predictive value 0.59 and negative predictive value 0.84.

Conclusions: The parent-rated MADRS-P showed similar psychometric properties as previously shown for the self-rated MADRS-S in adults. Although the MADRS-P has acceptable diagnostic accuracy for screening for MDD in adolescents in a general psychiatric setting, it cannot be used alone for diagnosing MDD.

Keywords:

• Depression
• questionnaire
• validation study
• adolescents
• parents

Acknowledgements

We would like to thank Professor Marie Åsberg for allowing us to validate a parent version of the MADRS-S, all patients and parents for their participation, as well as all clinical staff for help with the research logistics in the psychiatric clinics of Sala and Västerås, which made this study possible. We are grateful to Mattias Rehn for excellent data management.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This work was supported by the County Council of Västmanland (LTV-473811, LTV-466871, LTV-398781, LTV-379991, LTV-375811, LTV-369201, LTV-353451) and the Uppsala-Örebro Regional Research Council (RFR-475881, RFR-376361).