CSP 636

Clinical Tool Critique:

Children's Depression Inventory 2
(CDI 2)

by Lahee An, Anwen Buu, Lucy Tran

 Purpose of CDI 2
CDI 2 is a self-report assessment tool to measure presence and severity
of depressive symptoms in the last 2 weeks of youth aged 7-17 years.

NOT diagnostic of a depressive disorder.

Only serves to supplement data obtained through interviews and

discussions with child and informants to gain a comprehensive view.
Cannot serve as a substitute for direct clinical observation.

Provides valuable information that can be used for treatment and

intervention planning and measuring mental health outcomes.
Administration
2 versions: paper-and-pencil and computerized format
Full-length version (28 items)
Assesses a range of symptoms associated with MDD &
DD
Items reflect developmentally appropriate manifestations
of depressive symptoms
3 choices per item, simple sentence structure, low reading
level
reflects severity of target symptom
0 (none) to 2 (definite)
Parent (17 items) & Teacher (12 items) Forms
Measures observable aspects of depression
4-point Likert type scale
0 (not at all) - 3 (much or most of the time)
Short-version (12 items)
 Things to Know When
Administering CDI 2
NOT recomended for use with some
youth:
those unwilling to respond to a
questionnaire
those who are disoriented,
severely impaired, or not proficient
in English (or language of CDI 2
translation)
Recommended for
administrators of CDI 2 to
read assessment items
aloud (while respondent is
reading along) to ensure
comprehension for youth (7-
9 y.o.) and youth with poor
reading skills (regardless of
age)
 Main Uses for CDI 2
Assessing
Depressive Symptoms
Facilitates diagnostic
decisions
Guide treatment
planning
Allows clinician to
compare the child to
a normative group
Screening Evaluating
a Group of Youth an Intervention
Observe impact of an
Short ver. CDI 2 (12
intervention on
items) permits
depressive symptoms
screening a group of of youth
youth Results can be collected
Select specific cutoff at several points during
based on goals and intervention to evaluate
scope of screening effects
Sensitivity & specificity Helping in supporting
future decisions on an
intervention
 Standardization
Self-Report Teacher-Rated Parent-Rated
Standardization

n= 1,100 boys and girls, 631 teacher 1,187 parent

aged 7 to 17 evaluations (339 boys evaluations (591 boys
Sample

Stratified to match age, and 292 girls) + 206 and 596 girls + 272
sex, race/ethnicity, and additional additional
geography of
population

n= 319 boys and girls, No new clinical cases No new clinical cases
aged 7 to 17 were collected were collected
Sample
Clinical

Included children with

various DSM-5
diagnoses (MDD,
ADHD, CD/ODD, GAD)
 Scores and Scoring Algorithms

Total Score
TOTAL
SCALES

Emotional Problems Functional Problems

SUBSCALES

Negative Mood/ Negative Interpersonal

Ineffectiveness
Physical Symptoms Self-Esteem Problems
 The Effects of Age and Sex
Self-Report
No significant effect of sex was
observed in either full- or short-
length version
Age impacted several scores on
full- and short-length forms
Teacher-Rated Parent-Rated
Sex significantly affected the Total No significant effects
Score and Functional Problems on sex or age
scale score (decreasing
symptomatic tendencies in boys
with age; the reverse for girls)
Teachers rated younger students
as more symptomatic than older
students on the Emotional Problem
scale
 Reliability
Internal Test-Retest Standard Error of
Consistency Reliability Measurement
measures the consistency of
when all items measure how much measured
results when you repeat the
the same construct test scores are spread
same test on the same
around a "true" score
sample at a different point in
Cronbach's alpha value
time
Self-Report: .82 SEM = SD x √(1-⍺),
Full-Length SR: .91 where SD represents
assessed using a subgroup of
TR: .82-.89 79 children from the population
PR: .79-.88 standardization sample taken standard deviation and
twice with a 2-4 week time gap test's reliability
CDI 2:SR, CDI 2: SR(S), estimate
and CDI:P have
exceptional short-term
temporal stability and
acceptable long-term
temporal stability
 Validity of CDI 2

Discriminative Validity Convergent Validity

Tests how well CDI 2 can
distinguish children with a
diagnosis of major depressive
disorder from children without a
diagnosis of MDD
Refers to the extent to which
responses on a test scores
correlate from other relevant
measures - depression
 2 Approaches to Discriminative Validity
1st approach:
Goal: Assess potential differences in the self-report
scores between different diagnostic group & control
cases
Clinical sample: children with different DSM-IV
diagnoses (generalized anxiety, conduct/ oppositional
defiant disorder, attention deficit hyperactivity disorder
Control cases: standardization sample (selected based
on age, sex, and race/ ethnicity with diagnoses of MDD)
Conclusion: Utilizing univariate and multivariate
analyses of covariates (ANCOVA & MANCOVA), MDD
group scored higher compared to all other groups
EXCEPT for generalized anxiety groups
anxiety and depression has high level of occurrence
and exhibit similar kinds of impairments
2nd approach:
Goal: Discriminant function analyses (DFA)
used to examine whether self- report CDI 2
scores could differentiate MDD cases from
matched controls and clinical cases with other
diagnoses
Controlled variables: youth's demographic
characteristics, including age, sex, and race
Conclusion:
Accuracy of classifying MDD and mach
control cases: 78.3% for the full-length
total & 80.8% for the short total scores
Accuracy of classifying MDD from other
diagnoses: 72.6% for the full-length total
score & 70.3% for the short total score
 Convergent Validity

Results
Overall sample:
266 youths Scores were strong between CDI 2 scores and the
scores from the Connors Comprehensive Behavior
Rating Scales
both test utilizes the comprehensive coverage of
the symptoms of MDD
214 youths 52 youths Scores were moderate between CDI 2 scores and the
(standardization (clinical sample) Beck Youth Inventory
sample) Youth version of the BDI only has partial coverage
of the symptoms of major depression and
dysthymia
 Conclusion and Recommendations
Pros
Aids in the early
identification of depressive
symptoms
Features specific scales for
Emotional and Functional
problems along with sub-
scales
Overall, good reliability and
validity
Cons
Translations of CDI 2 present a
potential inequity issue
The samples were only
selected within the United
States
Does not accurately
represent other countries
with different social and
cultural backgrounds
Limitation of self-reported data
Thank You!