TABLE 4.
Stoplight Model for Examples of Screening Cases
| Exemplars | Pretest Prob | Score Profile | DLR | Posttest Prob |
|---|---|---|---|---|
| 6th-Grade Boy | Concurrent: 2.0% | CDI: 15 (Hi) | Concurrent: 3.34 | Concurrent: 6.4% |
| Prospective: 16.0% | CRSQ: 29 (Med) | Prospective: 0.88 | Prospective: 14.4% | |
| FLED: 10.3% | ACSQ: 98 (Med) | FLED: 1.85 | FLED: 17.1% | |
| rMDD: 9.4% | rMDD: 2.36 | rMDD: 18.9% | ||
| 6th-Grade Girl | Concurrent: 3.4% | CDI: 15 (Hi) | Concurrent: 3.34 | Concurrent: 9.4% |
| Prospective: 26.6% | CRSQ: 26 (Med) | Prospective: 6.67 | Prospective: 70.1% | |
| FLED: 26.2% | ACSQ: 124 (Hi) | FLED: 1.85 | FLED: 40.0% | |
| rMDD: 15.0% | rMDD: 2.36 | rMDD: 29.4% | ||
| 9th-Grade Boy | Concurrent: 6.3% | CDI: 15 (Hi) | Concurrent: 3.34 | Concurrent: 17.6% |
| Prospective: 30.1% | CRSQ: 29 (Hi) | Prospective: 6.67 | Prospective: 74.1% | |
| FLED: 16.9% | ACSQ: 92 (Med) | FLED: 1.85 | FLED: 27.5% | |
| rMDD: 16.1% | rMDD: 2.98 | rMDD: 56.8% | ||
| 9th-Grade Girl | Concurrent: 6.6% | CDI: 14 (Med) | Concurrent: 0.66 | Concurrent: 4.7% |
| Prospective: 45.5% | CRSQ: 23 (Med) | Prospective: 0.88 | Prospective: 42.8% | |
| FLED: 33.8% | ACSQ: 131 (Hi) | FLED: 1.00 | FLED: 33.8% | |
| rMDD: 33.3% | rMDD: 2.98 | rMDD: 59.8% | ||
| Interpretation | ||||
| 6th-Grade Boy | Yellow Zone: Despite an elevated DLR for a concurrent episode, the likelihood of presenting with a current episode are still quite low based on the post-test probability. Absent any critical symptoms, an immediate referral for a full assessment is not necessary due to the low risk of a current or future episode. At the same time, the elevated risk for rMDD and FLED warrants routine monitoring, and potentially even increased monitoring in the coming years. | |||
| 6th-grade Girl | Red Zone: An assessment for a full mental health assessment is warranted and any available preventative services should be initiated immediately based on these screening scores. It is particularly alarming that early adolescent girls with this scoring profile have an over 70% likelihood of developing a depressive episode in the upcoming 3 years despite the fact that less than 10% with this profile will be currently depressed. | |||
| 9th-Grade Boy | Red Zone: Middle adolescent boys with this scoring profile should immediately be referred for a mental health assessment and preventative services should be delivered. These youth are nearly three times more likely to be experiencing a concurrent depressive episode than the base rate, and are at significant risk for a prospective episode. The heightened risk for rMDD is another reason that an immediate referral is warranted. | |||
| 9th-Grade Girl | Yellow Zone: Middle adolescent girls with this profile should be closely monitored, but a referral for a full assessment may not be imminent. Compared to their peers, youth with this scoring profile are at decreased or equivalent risk for current, future, and FLED depression outcomes. Yet, increased monitoring is warranted despite a subthreshold CDI score (14) due to these youth’s heightened risk for rMDD. Increased monitoring may help identify risk for this pattern earlier allowing for an opportunity to prevent a chronic depression course. | |||
Note: Exemplars = examples of scoring profiles based on demographic data and the scoring profile; Pretest Prob = percentage chance of each depression outcome based on sex and age; Score Profile = sample scores on significant, unique indicators; DLR = diagnostic likelihood ratio; Posttest Prob = (prevalence/ (1-prevelance) × DLR) / ((prevalence/(1 – prevelance)) + 1) (Straus et al., 2011); Concurrent = current depression diagnosis at baseline; Prospective = experiencing a depressive episode during the follow-up period; FLED = first lifetime episode of depression (i.e., episode of depression during 36 months with no lifetime history); rMDD = recurrent major depression disorder (i.e., more than one episode of depression over the lifetime); Rumination = total score on the Children’s Response Style Questionnaire–Rumination subscale (Abela et al., 2004); Attributional style = total score on the Adolescent Cognitive Style Questionnaire (Hankin & Abramson, 2002); Depressive symptoms = total score on the Children’s Depression Inventory (Kovacs, 1992); Hi = high tertile; Med = medium tertile; Yellow Zone = increased monitoring; Red Zone = refer for mental health services.