The Children's Depression Inventory: error in cutoff scores for screening purposes

The Children's Depression Inventory (CDI) is used to screen for depression in school-age children. Such screening uses the manual's reported information on suggested cutoff scores. These cutoff scores are based on an erroneous base-rate calculation and an inadequate methodology. Data are provided showing that for the suggested cutoff scores of 13 or 20, the CDI has poor receiver-operating characteristics. Indeed, for the cutoff score of 20, suggested as being suitable for screening in the general population (e.g., schools), clinicians will miss 86% of depressed children. In conclusion, it is recommended that the CDI is better suited as a continuous measure of mood and that cutoff scores should not be used to screen for the likely presence or absence of depression.