Noemi Baumgartner1, Isabelle Häberling2, Sophie Emery2, Michael Strumberger3, Kristin Nalani4, Suzanne Erb5, Silke Bachmann6, Lars Wöckel7, Ulrich Müller-Knapp8, Bruno Rhiner9, Brigitte Contin-Waldvogel10, Klaus Schmeck3, Susanne Walitza11, Gregor Berger2. 1. Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Switzerland. Electronic address: noemi.baumgartner@uzh.ch. 2. Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Switzerland. 3. Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Switzerland. 4. Clinic for Psychosomatic Medicine and Psychiatry, Zurich, Switzerland. 5. Child and Adolescent Psychiatric Services St. Gallen, St. Gallen, Switzerland. 6. Clienia Littenheid AG, Littenheid, Switzerland; University Clinic of the Martin-Luther University Halle - Wittenberg's Medical Faculty, Switzerland. 7. Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Switzerland; Clienia Littenheid AG, Littenheid, Switzerland. 8. Child and Adolescent Psychiatry Klinik Sonnenhof, Ganterschwil, Switzerland. 9. Child and Adolescent Psychiatry Thurgau, Weinfelden, Switzerland. 10. Child and Adolescent Psychiatric Services Baselland, Liestal, Switzerland. 11. Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland; Center for Integrative Human Physiology Zurich, University of Zurich, Switzerland.
Abstract
BACKGROUND: Parents and their children often disagree on the existence and severity of psychopathological symptoms, especially in major depressive disorder (MDD). Discrepant estimations pose a problem for the validity of diagnoses and illness severity with major implications for treatment evaluation. METHODS: 118 adolescents aged 13-18 years and their parents were interviewed and their reports were compared regarding the presence of a MDD diagnosis. In addition, severity ratings of depression symptoms reported in the Children's Depression Rating Scale-Revised (CDRS-R) were compared between parents and their offspring using multivariate analyses and polynomial regressions. The association between borderline features, functional impairment, and treatment history variables with parent-child agreement was assessed. RESULTS: In 38% of the cases, parents and adolescents agreed on DSM-IV diagnostic MDD criteria, while in 53%, only the adolescent endorsed criteria for a MDD. A MDD that was endorsed by parents and adolescents was characterized by higher depression severity, higher number of previous treatments, and higher functional impairment. Using a polynomial approach, neither age nor borderline tendencies were associated with agreement. LIMITATIONS: We did not differentiate between mother's versus father's reports and borderline features were assessed by self-report only. CONCLUSIONS: Adolescents and their parents gave differing reports of the existence and severity of depressive symptoms. The high discrepancy levels combined with the uncertainty of previously published findings due to methodological challenges are concerning. Clinicians and researchers need to consider discrepancies in agreement in relation to diagnosis and illness severity in the context of their clinical and research decisions.
BACKGROUND: Parents and their children often disagree on the existence and severity of psychopathological symptoms, especially in major depressive disorder (MDD). Discrepant estimations pose a problem for the validity of diagnoses and illness severity with major implications for treatment evaluation. METHODS: 118 adolescents aged 13-18 years and their parents were interviewed and their reports were compared regarding the presence of a MDD diagnosis. In addition, severity ratings of depression symptoms reported in the Children's Depression Rating Scale-Revised (CDRS-R) were compared between parents and their offspring using multivariate analyses and polynomial regressions. The association between borderline features, functional impairment, and treatment history variables with parent-child agreement was assessed. RESULTS: In 38% of the cases, parents and adolescents agreed on DSM-IV diagnostic MDD criteria, while in 53%, only the adolescent endorsed criteria for a MDD. A MDD that was endorsed by parents and adolescents was characterized by higher depression severity, higher number of previous treatments, and higher functional impairment. Using a polynomial approach, neither age nor borderline tendencies were associated with agreement. LIMITATIONS: We did not differentiate between mother's versus father's reports and borderline features were assessed by self-report only. CONCLUSIONS: Adolescents and their parents gave differing reports of the existence and severity of depressive symptoms. The high discrepancy levels combined with the uncertainty of previously published findings due to methodological challenges are concerning. Clinicians and researchers need to consider discrepancies in agreement in relation to diagnosis and illness severity in the context of their clinical and research decisions.
Authors: Reem M A Shafi; Paul A Nakonezny; Keith A Miller; Jinal Desai; Ammar G Almorsy; Anna N Ligezka; Brooke A Morath; Magdalena Romanowicz; Paul E Croarkin Journal: Psychiatry Res Date: 2021-05-19 Impact factor: 11.225