The Heterogeneity of Youth Depression Scales

Depression is a leading mental health concern among children and adolescents, —90% of whom live in developing countries. Accurate measurement of depression in this population is a crucial step toward effective research, diagnosis, and intervention. Although rating scales for children and adolescents are widely used by researchers, clinicians, and large-scale surveys, their heterogeneity in developing contexts has been largely overlooked. To fill the gap, we analyzed the content of 27 Chinese depression scales and self-report data from four commonly used scales (N = 12,764). Our content analysis identified 84 unique symptoms across the 27 scales and low rate of overlap (mean = 0.19, range: 0.09–0.25), suggesting that instruments often assumed to be comparable capture distinct symptom domains. Moreover, few scales included cultural- or age-specific symptoms, suggesting a lack of cultural- or age-adaptation. Analyses of self-report data showed that the four scales produced different detection rates and each identified unique cases. Exploratory Graph Analysis revealed that their items clustered into three distinct symptom communities rather than a unified construct. These findings indicate that depression scales for children and adolescents are not interchangeable and highlight the need for harmonization efforts. Achieving a balance between standardization and contextual adaptation is essential for improving the validity and comparability of depression measurement in global mental health research.