Many of the scales demonstrated weak psychometrics in at least one of the following ways: (a) lack of psychometric data [i.e., reliability and / or validity; e.g., HFQ, MASC, PBS, Social Adjustment Scale - Self - Report (SAS - SR) and all perceived self - esteem and self - concept scales], (b) items that fall on more than one subscale (e.g., CBCL - 1991 version), (c) low alpha coefficients (e.g., below.60) for some subscales, which calls into question the utility of using these subscales in research and clinical work (e.g., HFQ, MMPI - A, CBCL - 1991 version, BASC, PSPCSAYC), (d)
high correlations between subscales (e.g., PANAS - C), (e) lack of clarity regarding clinically - relevant cut - off
scores, yielding
high false positive and false negative rates (e.g., CES - D, CDI) and an inability to distinguish between minor (i.e., subclinical) and major (i.e., clinical) «cases» of a disorder (e.g.,
depression; CDI, BDI), (f) lack of correspondence between items and DSM criteria (e.g., CBCL - 1991 version, CDI, BDI, CES - D, (g) a factor structure that lacks clarity across studies (e.g., PSPCSAYC, CASI; although the factor structure is often difficult to assess in studies of pediatric populations, given the small sample sizes), (h) low inter-rater reliability for interview and observational methods (e.g., CGAS), (i) low correlations between respondents such as child, parent, teacher [e.g., BASC, PSPCSAYC, CSI, FSSC - R, SCARED, Connors Ratings Scales - Revised (CRS - R)-RSB-, (j) the inclusion of somatic or physical symptom items on mental health subscales (e.g., CBCL), which is a problem
when conducting studies of children with pediatric physical conditions because physical symptoms may be a feature of the condition rather than an indicator of a mental health problem, (k)
high correlations with measures of social desirability, which is particularly problematic for the self - related rating scales and for child - report scales more generally, and (l) content validity problems (e.g., the RCMAS is a measure of anxiety, but contains items that tap mood, attention, peer interactions, and impulsivity).
This cutoff point corresponds to 80th percentile
scores for community samples and has a 95 % sensitivity for diagnosing major depressive disorder (MDD) among low - income women, although the specificity and positive predictive value for MDD are low (70 % and 0.28, respectively).29, 30 The cutoff point of 16 has been used by many investigators assessing depressive symptoms in a variety of cohorts, including pregnant women.28 — 33
When studying depressive symptoms during pregnancy, some investigators chose to use a
higher CES - D cutoff point (eg, the 90th percentile) to account for the possibility that symptoms of normal pregnancy may overlap with symptoms of
depression.9, 18 There is no evidence that this approach is more accurate or preferable to using the cutoff point of 16, and the use of
higher cutoff points increases specificity but decreases sensitivity for MDD.28 We used a consistent cutoff point of 16 to define depressive symptoms before and after parturition.