Background: Depression symptom screening scales are often used to determine a clinical diagnosis of major depressive disorder (MDD) in prevention research. The aim of this review is to systematically examine the reliability, validity and diagnostic utility of commonly used screening scales in depression prevention research among children and adolescents. Methods: We conducted a systematic review of the electronic databases PsycINFO, PsycEXTRA and Medline examining the reliability, validity and diagnostic utility of four commonly used depression symptom rating scales among children and adolescents: the Children׳s Depression Inventory (CDI), Beck Depression Inventory (BDI), Center for Epidemiologic Studies – Depression Scale (CES-D) and the Reynolds Adolescent Depression Scale (RADS). We used univariate and bivariate random effects models to pool data and conducted metaregression to identify and explain causes of heterogeneity. Results: We identified 54 studies (66 data points, 34,542 participants). Across the four scales, internal reliability was ‘good’ (pooled estimate: 0.89, 95% Confidence Interval (CI): 0.86–0.92). Sensitivity and specificity were ‘moderate’ (sensitivity: 0.80, 95% CI: 0.76–0.84; specificity: 0.78, 95% CI: 0.74–0.83). For studies that used a diagnostic interview to determine a diagnosis of MDD, positive predictive power for identifying true cases was mostly poor. Psychometric properties did not differ on the basis of study quality, sample type (clinical vs. nonclinical) or sample age (child vs. adolescent). Limitations: Some analyses may have been underpowered to identify conditions in which test performance may vary, due to low numbers of studies with adequate data. Conclusions: Commonly used depression symptom rating scales are reliable measures of depressive symptoms among adolescents; however, using cutoff scores to indicate clinical levels of depression may result in many false positives.

Background: Anxiety and depression are common during pregnancy and associated with adverse outcomes for the mother and infant if left untreated. Despite the need to improve treatment accessibility and uptake in this population, no studies have investigated internet-delivered cognitive behavioural therapy (iCBT) for antenatal anxiety and depression. In a randomised controlled trial, we examined the efficacy and acceptability of a brief, unguided iCBT intervention – the MUMentum Pregnancy program – in pregnant women with anxiety and/or depression. Methods: Participants meeting clinical threshold on validated self-report measures of generalised anxiety and/or depression were recruited online and randomised to iCBT (n=43) or a treatment as usual (TAU) control (n=44). Outcomes were assessed at baseline, post-treatment and four-week follow-up; and included anxiety, depression, psychological distress, antenatal bonding, quality of life, and treatment acceptability. Results: Of the 36 women who started iCBT, 26 completed all three lessons of treatment (76% adherence rate). iCBT produced moderate to large effect size reductions for anxiety on the GAD-7 (Hedges’ g=0.76) and psychological distress on the Kessler-10 (g=0.88) that were superior to TAU. Only small nonsignificant differences were found for depression outcomes (g=<0.35). Participants reported that iCBT was an acceptable treatment for antenatal anxiety and/or depression. Limitations: Lack of an active control condition and long-term postpartum follow-up. Conclusions: This is the first study to evaluate brief unguided iCBT for antenatal anxiety and depression. While our findings are promising, particularly for anxiety reduction, additional RCTs are required to establish treatment efficacy.

Background: Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11–13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being. Method: Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit. Results: In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life. Conclusions: This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.

Background: Old age respondents may differ systemically in their responses to measures of psychological distress over and above their actual latent distress levels when compared to younger respondents. The current study aimed to investigate the potential for age-related bias(es) in the Kessler 6 Psychological Distress Scale (K6) items. Methods: Data from the 2007 Australian National Survey of Mental Health and Wellbeing were analyzed using Item Response Theory to detect the presence of item bias in each of the K6 items. The potential for item bias was assessed by systematically comparing respondents classed as young (16–34 years), middle aged (35–64 years), and old aged (65–85 years). The significance and magnitude of the item bias between the age groups was assessed using the log-likelihood ratio method of differential item functioning. Results: After statistical adjustment, there were no biases of significant magnitude influencing the endorsement of K6 items between young and middle-aged respondents or between middle-aged and old age respondents. There was a bias of significant magnitude present in the endorsement of the K6 item addressing levels of fatigue between young and old age respondents. Conclusions: Despite the identification of significant item bias in the endorsement of K6 items between the age groups, the magnitude and influence of the bias on total K6 scores is likely to have little influence on the overall interpretation of group data when comparing psychological distress across the lifespan. Researchers should be cautious, however, when examining individual levels of fatigue related to psychological distress in older individuals.

The burden attributable to late-life Generalized Anxiety Disorder (GAD) is set to increase alongside the ageing population. Yet, the psychogeriatric workforce is limited in size and few studies have focused on the treatment of GAD among older patients. Internet-delivered cognitive behavioral therapy (iCBT) could be integrated into existing infrastructure and scale the psychogeriatric workforce, if shown to be effective across the adult lifespan. This study examined age-related differences in presentation, adherence and effects of iCBT for GAD among patients in routine clinical care (N = 942; 18–29 years (n = 267); 30–39 years (n = 260); 40–49 years (n = 180); 50–59 years (n = 124); and 60+ years (n = 111)). Compared to younger patients, older patients were less likely to present with probable GAD and MDD diagnoses (<60 years vs. 60+ years) and more likely to complete treatment (<50 years vs. 50+ years). iCBT produced moderate to large effect size reductions in symptom severity, distress and impairment independent of age. iCBT is therefore an effective treatment for GAD across the adult lifespan, which can be delivered in routine clinical care. Continuing to integrate iCBT into existing services has the potential to improve the capacity of the existing workforce to manage those seeking help for GAD particularly as the population ages.

Clinician-guided internet-delivered cognitive behavioral therapy (iCBT) is an effective treatment for depression and anxiety disorders. However, few studies have examined the effectiveness of completely unguided iCBT. The current research investigated adherence to, and the effects of two brief unguided iCBT programs on depression and anxiety symptom severity, and psychological distress. Study 1 evaluated a four-lesson transdiagnostic iCBT program for anxiety and depression (N = 927). Study 2 then evaluated a three-lesson version of the same program (N = 5107) in order to determine whether reducing the duration of treatment would influence adherence and treatment effects. Cross-tabulations and independent t-tests were used to examine the extent to which users adhered and remitted with treatment. Linear mixed models were used to evaluate the effects of treatment in the entire sample, and stratified by gender and completer-type (e.g., users who completed some but not all lessons vs. those who completed all lessons of treatment). Among those who began treatment, 13.83% completed all four lessons in Study 1. Shortening the course to three lessons did not improve adherence (e.g., 13.11% in Study 2). In both studies, users, on average, experienced moderate to large effect size reductions in anxiety and depressive symptom severity, as well as psychological distress. This pattern of results was robust across gender and for those who did and did not complete treatment. Approximately two-thirds of those who completed treatment experienced remission. These data show that unguided iCBT programs, which have the capacity to attract large numbers of individuals with clinically significant symptoms of depression and anxiety, and psychological distress, can produce significant improvements in wellbeing.

Background: The burden attributable to late-life depression is set to increase with the ageing population. The size of the workforce trained to deliver psychogeriatric medicine is limited. Internet-delivered cognitive behavioral therapy (iCBT) is an efficacious and scalable treatment option for depression. Yet older adults are underrepresented in iCBT research. This study examines the effects of iCBT for depression across the adult lifespan among patients seeking help in routine clinical care (N = 1288). Methods: Regression analyses were used to examine the relationship between age group (e.g., 18-24years (n = 141); 25-34years (n = 289); 35-44years (n = 320); 45-54years (n = 289); 55-64years (n = 180); 65 +years (n = 69)) and presenting demographic and clinical characteristics, adherence to treatment, and rates of remission, recovery and reliable improvement. Linear mixed models were used to examine whether reductions in symptom severity, distress and impairment varied as a function of age. Results: Patients aged 65+ years were more likely to be male compared to those aged 18–34 years and have been prescribed iCBT by their GP compared to those aged 55–64 years. Patients experiencing late-life depression experienced moderate to large effect size reductions in depressive symptom severity, psychological distress, and impairment, as did all other age groups. Rates of remission, recovery or reliable improvement were comparable across the adult lifespan. Conclusions: iCBT is an effective treatment option for depression including in later life, and can be used to scale evidenced-based medicine in routine clinical care. Limitations: No follow-up data were collected. The long-term effects of treatment, particularly for those who did not experience remission, are unclear.

Major depressive disorder (MDD) is a common disorder with a lifetime risk around 35%. It is a significant cause of mortality and the second leading cause of years lived with disability worldwide. At many levels, the similarities between MDD and the anxiety disorders are much stronger than the differences. For instance, these disorders share genetic, temperamental and environmental risk factors, frequently co-occur, and cognitive behavior therapy (CBT) and antidepressant drugs are recommended as principal treatments for both. It will therefore be very difficult to locate pathologies and treatments that are specific to subtypes of depression without considering their relationship with anxiety. As a result, we broaden our comment on Perlis’ proposal to reduce personalized (or non-evidence based) medicine in favor of precise (evidence-based) medicine to include both depression and anxiety.

Objectives: To describe the frequency, type and quality of mental health treatment among Australian adults with past-year affective and/or anxiety disorders. Design, setting and participants: Retrospective analysis of data for 8831 adults aged 16–85 years interviewed for the 2007 National Survey of Mental Health and Wellbeing, of whom 17% (n = 1517) met International Classification of Diseases, 10th revision (ICD-10) criteria for a past-year affective and/or anxiety disorder. Main outcome measures: Three levels of mental health treatment received in the past year: (1) any consultation with a health professional for mental health; (2) any evidence-based intervention (antidepressant medication, mood stabiliser medication, cognitive behaviour therapy and/or psychotherapy); and (3) minimally adequate treatment (a “dose” of an evidence-based intervention above a minimum threshold, consistent with treatment guidelines). Results: Of participants with past-year affective and/or anxiety disorders, 39% sought professional help for mental health, 26% received an evidence-based treatment, and 16% received minimally adequate treatment. After controlling for clinical factors including type and severity of disorder, the odds of all levels of treatment were lower among younger adults (16–29 years) compared with middle-aged adults, and the odds of receiving an evidence-based treatment or minimally adequate treatment were lower among people who consulted a general practitioner only compared with a mental health professional. Conclusions: Closing the gap in treatment quality requires strategies to increase the use of evidence-based interventions, and to ensure these are delivered in sufficient doses. Research to elucidate why some patients are at increased risk of inadequate treatment, and the aspects of treatment that contribute to inadequate care, is indicated.

Objective: Options for revising the DSM-IV Generalized Anxiety Disorder (GAD) diagnostic criteria have been made by the DSM-5 Anxiety, Obsessive-Compulsive, Post-traumatic and Dissociative Disorders Work Group. It has been proposed that renaming the disorder Generalized Worry Disorder, clarifying criterion A to emphasize the primacy of worry, reducing the duration required, altering the list of associated symptoms to reflect the concomitants of worry that are specific to GAD, and adding behavioural criteria could clarify the concept of chronic worry for clinicians and enhance the reliability of the diagnosis. The influence of the proposed changes on the prevalence and severity of cases is examined. Method: Data from a national survey and from a clinical data set were used to quantify the effect of the proposed changes. Results: Reducing the duration from 6 to 3 months and removing the clinical significance criterion raised the prevalence of GAD, whereas revising the associated symptoms and adding behavioural symptoms reduced the prevalence. With all the new options implemented, although the prevalence of the diagnosis rose by 9%, it was associated with similar levels of distress and impairment as DSM-IV cases. Conclusions: There is preliminary evidence that the proposals may increase the prevalence of GAD but may not influence the severity of cases. The clinical utility, reliability and validity of the diagnosis remains to be established.