Is Treatment Working? Detecting Real Change in the Treatment of Child and Adolescent Depression

J Am Acad Child Adolesc Psychiatry. 2019 Dec;58(12):1157-1164. doi: 10.1016/j.jaac.2019.02.011. Epub 2019 Feb 27.


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.

Keywords: PHQ-9A; SMFQ; child and adolescent depression; measurement-based care (MBC); reliable change index (RCI).

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Validation Study

MeSH terms

  • Adolescent
  • Child
  • Depression / diagnosis*
  • Depression / therapy
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / therapy
  • Female
  • Humans
  • Male
  • Psychiatric Status Rating Scales / standards*
  • Psychometrics / statistics & numerical data
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Treatment Outcome