Predicting Future Risk of Depressive Episode in Adolescents

The Chicago Adolescent Depression Risk Assessment (CADRA)

The Chicago Adolescent Depression Risk Assessment (CADRA) is designed to help primary care physicians predict depression in adolescents a year in advance, enabling families and doctors to intervene appropriately with kids even mildly at risk for onset of the disorder.

Depression in teens and young adults is a significant problem, with 24 percent of those under age 24 suffering an episode that may cause functional impairment, and the start a lifelong pattern of depression and increase risk of suicide. A "valid and practical" prediction index doctors could use in primary care could enable physicians to provide appropriate intervention, heading off development of the disorder. This study sought to create such a tool by analyzing risk factors in data from a national survey of adolescent health in 1995 that included a one-year follow-up in 1996. The final sample of nearly 5,000 boys and girls included a diverse group of U.S. youth.

Key Findings:

  • The study determined the top 20 variables predictive of depression in adolescents one year later.
  • The 20-item index was able to anticipate a depressive episode one year later with greater than 75 percent sensitivity and specificity and had excellent positive and negative predictive values.
  • The predictive index was able to accurately determine where each individual fell within five levels of risk.
  • Items that were determined to be predictive included mood, adverse events and social vulnerability and were consistent with current thoughts on how depression develops.

This study shows it is feasible for primary care physicians, using an in-office tool, to identify youths even mildly at risk for depression. Determining the level of risk is important for doctors to determine appropriate types of intervention. The CADRA questionnaire is suitable for use by physicians on a personal computer and is being adapted for use on handheld devices.