The Montgomery and Åsberg Depression Rating Scale - self-assessment for use in adolescents : an evaluation of psychometric and diagnostic accuracy

Background: The Montgomery–Åsberg Depression Rating Scale – Self Assessment (MADRS-S) is used to assess symptom severity in major depressive disorder (MDD) among adolescents, but its psychometric properties and diagnostic accuracy are unclear. Aim: The aim of this study was to explore psychometric properties, including diagnostic accuracy, of the MADRS-S in adolescent psychiatric outpatients. Method: Adolescent psychiatric outpatients (N = 105, mean age 16 years, 46 boys) completed the MADRS-S and were interviewed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). Results: In principal component analysis, two components with eigenvalues of 4.6 and 1.3 explained 51.1% and 14.4% of the variance, respectively. On the first component loaded items assessing Mood, Feelings of unease, Appetite, Initiative, Pessimism, and Zest for life. On the second component loaded items assessing Sleep, Ability to concentrate, and Emotional involvement. Cronbach’s alpha (internal consistency) for all items was 0.87. Spearman’s rho was 0.68 for concurrent validity (correlation between total MADRS-S-score and K-SADS MDD severity score). In receiver-operating characteristic analysis, the area under the curve was 0.86 (95% confidence interval 0.78–0.93, p < .001). For all the participants, the highest combined sensitivity and specificity were reached using cut-offs of 15 and 16 (sensitivity 0.82, specificity 0.86). Optimizing sensitivity for MDD, with specificity still ≥0.5, cut off for all was 9, for boys 7 and for girls 10. Conclusion: Psychometric properties of MADRS-S showed good reliability and validity as well as satisfying diagnostic accuracy, indicating good to excellent properties for MDD screening of adolescent psychiatric patients.