Objective

Despite advances in evidence-based treatments for youth depression in recent decades, overall treatment effects are modest at best, with 30% to 50% of youth being nonresponders. Practice parameters consistently recommend systematic assessment and routine monitoring of depressive symptoms, or measurement-based care (MBC), to enhance youth depression treatment. However, the literature offers few guidelines on how to use assessment results to inform care decisions or to detect real and clinically meaningful change. Thus the current study produced reliable change indices (RCIs) per Jacobson and Truax for two commonly used standardized assessments of youth depression (ie, Patient Health Questionnaire−9 items, Modified for Adolescents [PHQ-9A], the Short Moods and Feelings Questionnaire [SMFQ]).

Method

The study sample (N = 1,738) consisted of youths 6 to 18 years old seen in a child and adolescent psychiatry clinic of a regional pediatric medical center who completed at least one of the target depression measures. We examined the factor structure and internal reliability for the PHQ-9A, and calculated RCIs for patients with a depression-related diagnosis for both measures.

Results

Analyses confirmed a one-factor solution and adequate internal consistency (α = .86) for the PHQ-9A. All measures yielded acceptable test-retest reliabilities (r > 0.75) and RCIs that equate to clinical practice recommendations of using reliable changes scores of 7, 6, and 8 for the PHQ-9A, the SMFQ−Child Report, and the SMFQ−Parent Report, respectively.

Conclusion

Psychometric validation of the PHQ-9A and these RCIs are timely and significant contributions to the treatment of youth depression, by facilitating effective use of MBC—a critical evidence-based strategy for improving treatment outcomes.

中文翻译：

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治疗有效吗？在儿童和青少年抑郁症的治疗中发现真正的变化。

客观的

尽管近几十年来在针对青年抑郁症的循证治疗方面取得了进步，但总体治疗效果至多适中，其中30％至50％的青年没有反应。实践参数始终建议对抑郁症状或评估为基础的护理（MBC）进行系统评估和常规监测，以增强青年抑郁症的治疗水平。但是，文献中很少提供有关如何使用评估结果为护理决策提供信息或检测实际和临床上有意义的变化的指南。因此，当前的研究针对两种常用的青年抑郁症标准化评估（即患者健康问卷-9项，针对青少年的修订版[PHQ-9A]，《短期情绪和情感问卷》 []为每位Jacobson和Truax得出了可靠的变化指数（RCI）。 SMFQ]）。

方法

研究样本（N = 1,738）由在地区儿童医学中心的儿童和青少年精神病诊所看过的至少6至18岁的年轻人组成，他们至少完成了一项目标抑郁措施。我们检查了PHQ-9A的因素结构和内部可靠性，并通过两种方法计算了患有抑郁相关诊断的患者的RCI。

结果

分析确认了PHQ-9A的单因素解决方案和足够的内部一致性（α= .86）。所有措施均产生可接受的重测信度（r > 0.75）和RCI，等同于对PHQ-9A，SMFQ-Child报告和SMFQ-Parent使用可靠的变化评分7、6和8的临床实践建议分别报告。

结论

PHQ-9A和这些RCI的心理计量学验证通过促进有效使用MBC（一种重要的循证策略，改善治疗效果），是对青年抑郁症治疗的及时而重要的贡献。