Research report
Predicting future depression in adolescents using the Short Mood and Feelings Questionnaire: A two-nation study

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Abstract

Background

Adolescence is a key life period for the development of depression. Predicting the development of depression in adolescence through detecting specific early symptoms may aid in the development of timely screening and intervention programmes.

Methods

We administered the Short Mood and Feelings Questionnaire (SMFQ) to 5769 American and Australian students aged 10 to 15 years, at two time points, separated by 12 months. We attempted to predict high levels of depression symptoms at 12 months from symptoms at baseline, using statistical approaches based upon the quality, as well as the quantity, of depression symptoms present. These approaches included classification and regression trees (CART) and logistic regression.

Results

A classification tree employing four SMFQ items, such as feelings of self-hatred and of being unloved, performed almost as well as all 13 SMFQ items at predicting subsequent depression symptomatology.

Limitations

Depression was measured using a self-report instrument, rather than a criterion standard diagnostic interview.

Conclusion

Further validation on other populations of adolescents is required: however the results suggest that several symptoms of depression, especially feelings of self-hatred, and being unloved, are associated with increased levels of self-reported depression at 12 months post baseline. Although screening for depression can be problematic, symptoms such as the ones above should be considered for inclusion in screening tests for adolescents.

Introduction

Experienced by up to 5% of the adolescent population at any one time (Sawyer et al., 2010), depression is associated with many adverse outcomes in adulthood, including lowered educational attainment (Kessler et al., 1995); increased risk of substance use and abuse (McKenzie et al., 2010c, O'Donnell et al., 2006, Patton et al., 2002); and increased risk of suicide (Costello et al., 2003). There has recently been a renewal of interest in the study of this disorder at the level of individual symptoms, particularly in the identification of depression in community settings (Lowe et al., 2010, Rhew et al., 2010). Although few overall studies of depressive symptoms of adolescents exist (Patton et al., 2000), several studies have attempted prediction of later episodes of depression from specific symptoms such as feelings of worthlessness (Pine et al., 1999, van Lang et al., 2007, Van Voorhees et al., 2008, Wilcox and Anthony, 2004). Predicting the development of psychiatric disorders in adolescence by detecting key early symptoms may aid in the screening and treatment of such disorders (McGorry et al., 2000, van Lang et al., 2007).

Unfortunately, few large prospective cohort studies in young people with the scope to examine the predictive value of specific depressive symptoms have been conducted (van Lang et al., 2007). Understanding the development of depressive symptoms in early adolescence requires repetition of symptom measures over critical periods. The findings around predicting depression several years into the future have so far been mixed. For example, prediction of depression at ages 14 and 21, employing symptoms reported at age five, had very limited accuracy (Najman et al., 2008). Symptoms reported in late adolescence, however, were associated with depression in young adulthood, assessed six (van Lang et al., 2007) or seven (Pine et al., 1999) years later. Similarly, symptoms of internalising disorder, such as timidity, sadness, and tiredness, exhibited at ages 13 and 15 were associated with psychiatric disorders, including depression, up to 40 years later (Colman et al., 2007).

Although early adolescence is important for the emergence of depression, there has been little research into using depressive symptoms present in this life stage to predict subsequent depression over shorter time periods (Pine et al., 1999). One recent study found that feelings of sadness and moodiness were highly predictive of adolescent depression 12 months later (Van Voorhees et al., 2008). The present study is concerned with predicting high levels of depressive symptoms in early adolescence, utilising a large sample of Australian and American adolescents, over a 12 month period. We employ approaches based upon the quality or type, as well as the quantity, of depression symptoms present. The former approach makes use of classification and regression trees (CART) (Breiman et al., 1984, Gruenewald et al., 2008, Strobl et al., 2009), as well as logistic regression. Classification trees make few assumptions of the data, are generally readily interpretable by clinicians and researchers (Gruenewald et al., 2008), and can be used to identify salient combinations of symptoms.

Identification of symptom patterns that are predictive of high levels of adolescent depression may aid insight into the underlying aetiology of depression, as well as inform the development of more efficient epidemiological tests for adolescent depression. Such tests can aid in planning prevention and early intervention programmes in school and other settings (Rhew et al., 2010, van Lang et al., 2007).

We hypothesise that the presence of depressive symptoms at the first data collection point will be predictive of high levels of symptoms 12 months later. Our examination of which specific combinations of symptoms are most predictive extends earlier research that concentrated on the total number of symptoms and/or on individual symptoms (Pine et al., 1999, Rhew et al., 2010, van Lang et al., 2007, Wilcox and Anthony, 2004). The purpose of our study is to identify such combinations of symptoms, and compare their predictive performance with that of an approach based upon the number of symptoms. Finally, we discuss how such approaches can be applied to screening for depression.

Section snippets

Recruitment and data collections

We employed a large sample of 5769 students on whom information was collected as part of a binational study of youth development, in the US state of Washington (WA), and the Australian state of Victoria (VIC). In the first stage of a two-stage cluster sampling procedure, schools were randomly selected from a stratified sampling frame of all of the schools in WA (public, private, and alternative) and VIC (Catholic, independent, and government). In the second stage of sampling, single intact

Analysis of individual items

A binary coding of “not true” and “sometimes true” versus “true” is often employed in research involving the SMFQ (Angold et al., 1995). Our initial CART analyses of baseline SMFQ items indicated, however, that the merging of “sometimes true” and “true” was more highly associated (had higher Gini coefficients, described below) with SMFQ caseness at 12 months, than was the merging of “not true” and “sometimes true”. The former coding was therefore employed in all analyses of individual items.

The

Discussion

Our study contributes new information about the utility of early adolescent symptoms in predicting subsequent high levels of depression symptoms. A relatively low level of depression (cut-off of seven or higher on the total SMFQ score, and a subset of four items) can provide efficient prediction of later elevated levels of adolescent depression. The quality or type of symptoms is also important. For example, low self-worth was more predictive of high levels of depression symptomatology at 12 

Role of funding source

Data collection for this research was supported through a grant from the National Institute on Drug Abuse (DA-012140-05), National Institutes of Health, United States Department of Health and Human Services (RF Catalano, Principal Investigator). Data analysis was supported by grants from the Australian Research Council and Australian Health Management. DP McKenzie is supported through a Postdoctoral Public Health Fellowship from the National Health and Medical Research Council of Australia

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgements

We sincerely thank the participants and associated research staff for their participation in the study.

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