To assess different methodologies for adolescent mental health screening, investigators from multiple institutions compared the psychometric properties of 2 separate screening instruments, and evaluated whether these instruments were best completed by adolescents, their parents, or both. Study participants included adolescents 11–17 years old and their parents recruited from both a community sample in Manheim, Germany, and a clinic sample from a child and adolescent psychiatric service in Zurich, Switzerland. Participants at both sites completed the Strengths and Difficulties Questionnaire (SDQ) and the Development and Well-Being Assessment (DAWBA). The SDQ covers 20 items tied to emotional symptoms, disruptive behavior, hyperactivity, and peer problems. DAWBA is executed through structured interview sections and a loosely structured section designed to evoke open-ended descriptions from respondents about areas of concern. For the analyses, both dimensional scales and dichotomous classifications from the SDQ and DAWBA were determined based on youth-only responses, parent-only responses, or combined youth and parent responses. The gold standard for a psychiatric diagnosis was based on expert review of open-ended responses on the DAWBA. With the dimensional scales, receiver operator characteristic curves were generated, and areas under the curve (AUCs) calculated. For dichotomous measures, the sensitivity and specificity of each screening method as predictive of a psychiatric diagnosis was determined. The utility of youth-only, parent-only, or combined screening with each screening methodology was assessed.
Among the study population, 21 of the 252 participants (8.3%) in the community sample and 62 of 86 adolescents (72.1%) in the clinic sample were classified as having at least one psychiatric diagnosis based on expert review of DAWBA screening. With all screening measures, information derived from the adolescent was less discriminatory than that provided by his or her parents. However, a combination of parent and adolescent self-reports had the highest utility based on comparison of AUCs and sensitivities and specificities of the various measures. The results also built on those findings, showing that this hierarchy was true across a variety of approaches, from short questionnaires to in-depth assessments.
The authors conclude that combined adolescent and parent screening for mental health issues is optimal. In cases where only parents or youth can be evaluated in order to identify adolescent psychopathology, the researchers conclude that parents are the better source of information.
Dr. Wong has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Mental illness often emerges in adolescence, and its prevalence among youth is on the rise.1,2 Over the last decade, visits for treatment of adolescent mental health conditions have increased in the inpatient and emergency department settings.2 While pediatric primary care clinics are well positioned to perform routine mental health screening, screening adolescents for mental illness...