Table 3.

Diagnostic Likelihood Ratios for Significant Predictors and Stoplight Model for Examples of Screening Cases.

Diagnostic Likelihood Ratios
Model	Low DLR	Medium DLR	High DLR
CDI	0.77	1.40	2.51
SadPeak	0.27	0.59	2.39
CDRS-R	0.19	0.73	1.70
Examples of Screening Cases
	Pre-Test Probability	Scoring Profile	Post-Test Probability
(1) 8 year-old female	10.78%	CDI: 15 SadPeak: 0.38	CDI Alone: 23.27% CDI; SadPeak: 7.46%
(2) 8 year-old male	6.25%	CDI: 14 SadPeak: 0.79	CDI Alone: 8.53% CDI; SadPeak: 18.03%
(3) 14 year-old female	15.38%	CDI: 14 SadPeak: 0.79	CDI Alone: 20.28% CDI; SadPeak: 37.83%
(4) 14 year-old male	11.77%	CDI: 14 SadPeak: 0.38	CDI Alone: 15.74% CDI; SadPeak: 4.80%
Interpretation
(1) 8 year-old female	Yellow: Despite an above threshold CDI score, a low score for pupil dilation leads to a slightly lower likelihood of experiencing depression onset than someone in the general population. As the CDI score is elevated, continued monitoring is warranted but others with above threshold CDI scores and pupil dilation should be prioritized for services.
(2) 8 year-old male	Red: Just relying on CDI scores one would potentially would be missing out on someone who is nearly 3-times more likely to experience depression onset. This child should be immediately referred for a mental health assessment, and any preventative services should be made readily available.
(3) 14 year-old female	Red: The subthreshold CDI score confers that this individual is slightly more at risk to develop depression. The above threshold pupil dilation score together with the subthreshold CDI score, however, suggests that this person is nearly three times as likely to experience depression onset.
(4) 14 year-old male	Green: Despite presenting with a CDI score near the threshold, this individual is actually at little risk for experiencing a depressive episode over the next two years. Specifically, low scores on pupil dilation together with subthreshold scores on the CDI suggest that this individual is approximately 300% less likely to experience a first lifetime episode of depression compared to his pre-test probability.

Note: CDI= Child self-report score on the Children’s Depression Inventory (CDI; Kovacs, 1992); CDRS-R=Combined child self-report and parent reported scores on the Children’s Depression Rating Scale-Revised (CDRS-R; Poznanski & Mokros, 1996); SadPeak=Child’s peak pupil dilation to faces during the highest level of sadness intensity; DLR = Diagnostic Likelihood Ratio; Low DLR: CDI = < 7; SadPeak= < .45; CDRS-R= < 18; Medium DLR: CDI= 7–14; SadPeak=.45-.71; CDRS-R=18–19; High DLR: CDI= ≥15; SadPeak= ≥ .72; CDRS-R = ≥ 20. Pre-Test Probability = The percentage chance of each depression outcome based on sex and age; Post-Test Probability = (prevalence/(1-prevelance)* DLR)/((prevalence/(1-prevelance)) + 1) (Straus et al., 2011); Green Zone=standard screening approach; Yellow Zone = increased monitoring; Red Zone = implement brief intervention (or prioritize for mental health services in settings now equipped to implement mental health services).