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Indian J Psychol Med. 2017 Nov-Dec; 39(6): 831–833.
PMCID: PMC5733444

Overestimation of Depression Prevalence among Adolescent Students

Sir,

I read with interest the study on the prevalence of depression among adolescent students by Jha et al.[1] in May–June issue of 2017. The authors have used a Hindi translation of Beck Depression Inventory II (BDI-II) to screen 1485 adolescents (of which 1412 responded) aged 14–18 years and reported a point prevalence of any depression to be 49.2%. Guilty feeling, pessimism, sadness, and past failure were the most common self-reported symptoms, which the authors have wrongly interpreted as factors responsible for depression. The factors associated with self-reported depression in their study included “school factors” such as an inability to cope, teasing and physical punishment at school, and “family factors” such as parental conflict and financial constraints.

The reported rates of depression vary according to the instrument used for screening. In a meta-analysis of the studies on Iranian adolescents,[2] the mean prevalence of depression was 43.55% using the BDI, 15.87% using Symptom Checklist 90, and 13.05% using Children's Depression Inventory. Similar to the study by Jha et al.,[1] several others Indian studies[3,4,5,6] using BDI/BDI-II have reported high prevalence rates of depression among adolescents. One study from Mangalore[7] on college students estimated a prevalence of depression up to 80% using BDI-II screening.

Studies using a two-stage method, where screening is followed by confirmation using structured interviews, give more reliable estimates of depression. In a study from Sweden,[8] 88% of adolescents scored >16 on BDI; however, only 13% of low scorers had depression diagnosis following structured interview. The study by Sarkar et al.[9] using Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-Present and Lifetime) found a prevalence of the depressive disorder among students from standard I–VII to be 3.13%. Similarly,[10] screening with BDI followed by K-SADS-Epidemiological version 5 in Nigerian adolescents aged 13–18 years resulted in 6.9% prevalence of depression.

In the meta-analysis by Jane Costello et al.,[11] the prevalence estimate for depression under 13 years of age was 2.8% (standard error [SE] 0.5%) and for 13–18 years it was 5.6% (SE 0.3%). They concluded that there is no increase in the prevalence of child, and adolescent depression and the concerns regarding the epidemic of depression are not true. Nevertheless, a recent study in the USA reported an increase in the 12-month prevalence of major depressive episodes from 8.7% in 2005 to 11.3% in 2014 in adolescents.[12]

Although the authors assert that the Hindi translation of BDI-II was extensively piloted, they have not stated the psychometric properties of the translated scale. Another instrument, Patient Health Questionnaire 9, has been well validated as a screening tool[13] and has a Hindi version for use in India, could have been used in the study. Furthermore, the cutoff score of 13 may overestimate depression; hence, a score of 23 for screening has been suggested based on Youden's index.[14]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

1. Jha KK, Singh SK, Nirala SK, Kumar C, Kumar P, Aggrawal N. Prevalence of Depression among School-going Adolescents in an Urban Area of Bihar, India. Indian J Psychol Med. 2017;39:287–92. [PMC free article] [PubMed]
2. Sajjadi H, Mohaqeqi Kamal SH, Rafiey H, Vameghi M, Forouzan AS, Rezaei M. A systematic review of the prevalence and risk factors of depression among Iranian adolescents. Glob J Health Sci. 2013;5:16–27. [PMC free article] [PubMed]
3. Nagendra K, Sanjay D, Gouli C, Kalappanavar NK, VinodKumar CS. Prevalence and association of depression and suicidal tendency among adolescent students. Int J Biomed Adv Res. 2012;3:714–9.
4. Malik M, Khanna P, Rohilla R, Mehta B, Goyal A. Prevalence of depression among school going adolescents in an Urban area of Haryana, India. Int J Community Med Public Health. 2015;2:624–6.
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8. Olsson G, von Knorring AL. Beck's Depression Inventory as a screening instrument for adolescent depression in Sweden: Gender differences. Acta Psychiatr Scand. 1997;95:277–82. [PubMed]
9. Sarkar S, Sinha VK, Praharaj SK. Depressive disorders in school children of Suburban India: An epidemiological study. Soc Psychiatry Psychiatr Epidemiol. 2012;47:783–8. [PubMed]
10. Adewuya AO, Ola BA, Aloba OO. Prevalence of major depressive disorders and a validation of the Beck Depression Inventory among Nigerian adolescents. Eur Child Adolesc Psychiatry. 2007;16:287–92. [PubMed]
11. Jane Costello E, Erkanli A, Angold A. Is there an epidemic of child or adolescent depression? J Child Psychol Psychiatry. 2006;47:1263–71. [PubMed]
12. Mojtabai R, Olfson M, Han B. National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics. 2016;138 pii: E20161878. [PMC free article] [PubMed]
13. Ganguly S, Samanta M, Roy P, Chatterjee S, Kaplan DW, Basu B. Patient health questionnaire-9 as an effective tool for screening of depression among Indian adolescents. J Adolesc Health. 2013;52:546–51. [PubMed]
14. Dolle K, Schulte-Körne G, O’Leary AM, von Hofacker N, Izat Y, Allgaier AK. The Beck Depression Inventory-II in adolescent mental health patients: Cut-off scores for detecting depression and rating severity. Psychiatry Res. 2012;200:843–8. [PubMed]

Articles from Indian Journal of Psychological Medicine are provided here courtesy of Wolters Kluwer -- Medknow Publications