Measuring symptoms of depression in children and adolescents with and without a chronic condition

Children and adolescents with chronic medical conditions show higher rates of depression, but symptoms such as fatigue, sleep problems, and appetite changes are common to both depression and chronic illness. Measurement invariance is important to establish in depression screening tools across chronic health groups to determine whether they accurately assess depressive symptoms and not chronic health symptoms. This study examined whether the depression subscale of the Revised Children's Anxiety and Depression Scale (RCADS) functioned equivalently across those with and without a chronic condition.

A nationally representative sample of 11-19-year-olds in Northern Ireland (N = 1,299) completed the scale. Demographic information, such as age, sex, and urbanicity, and health diagnoses, were also collected. The present study included physical health conditions recognized as being chronic or long-term in nature.

Confirmatory factor analysis supported the original one-factor model of depression (χ2(35) = 370.03, p < .001; comparative fit index = .971; Tucker-Lewis index = .963; root mean square error of approximation = .090, 90% confidence interval, .082-.098; standardized root mean square residual = .035) and strong measurement invariance was established using Multi-Group Confirmatory Factor Analysis. Those with a chronic condition scored moderately higher on depression (Cohen's d = .41).

These findings indicate that the RCADS is a valid and reliable tool to screen for depression across health groups, supporting valid comparisons between them.