How should we screen for depression following a natural disaster? An ROC approach to post-disaster screening in adolescents and adults.

BACKGROUND: The present study's aim was to provide the foundation for an efficient, empirically based protocol for depression screening following a natural disaster. Utilizing a Receiver Operating Characteristic (ROC) analytic approach, the study tested a) what specific disaster-related stressors (i.e., property damage, loss of basic services) and individual-related constructs (i.e., PTSD symptoms, trauma history, social support) conveyed the greatest risk for post-natural disaster depression, b) specific cutoff scores across these measures, and c) whether the significance or cutoff scores for each construct varied between adolescents and adults.

METHODS: Structured phone-based clinical interviews were conducted with 2000 adolescents who lived through a tornado and 1543 adults who survived a hurricane.

RESULTS: Findings suggested that in both adolescents and adults, individual-related constructs forecasted greater risk for depressive symptoms following a natural disaster compared to disaster-related stressors. Furthermore, trauma history and PTSD symptoms were particularly strong indicators for adolescent depressive symptoms compared to adult depressive symptoms. Adolescents and adults who reported vulnerable scores for social support, trauma history, and lifetime PTSD symptoms were approximately twice as likely to present as depressed following the natural disaster.

LIMITATIONS: Findings from the present study were limited to post-disaster assessments and based on self-reported functioning 6-12 months following the natural disaster.

CONCLUSIONS: The present study synthesizes the extensive body of research on post-disaster functioning by providing a clear framework for which questions may be most important to ask when screening for depression following a natural disaster.