Development and validation of a comprehensive risk warning indicator system for depression in Chinese children and adolescents: A cross-sectional observational study

Depression among children and adolescents has reached epidemic proportions globally, necessitating systematic early detection approaches. Existing screening instruments demonstrate variable accuracy across populations and lack comprehensive and culturally appropriate frameworks for Chinese pediatric populations. This study developed and validated a comprehensive risk warning indicator system for depression detection in Chinese children and adolescents. A mixed-methods approach integrated a systematic literature review, expert consensus methodology, and empirical validation. Twenty distinguished experts from 8 tertiary psychiatric hospitals across 6 provinces participated in 2-round Delphi consultations to refine indicator selection. Psychometric validation employed data from 386 children and adolescents diagnosed with depression (ages 11-18) attending outpatient services. Analytic hierarchy process methodology determined hierarchical indicator weights, while comprehensive reliability and content validity assessments evaluated system performance. The expert consultation achieved 100% response rates with authority coefficients of 0.808 and 0.868 across rounds. The coordination coefficients demonstrated significant consensus (W = 0.131 and 0.142, both P < .001). The final system comprised 5 primary domains with 38 secondary indicators: language indicators (weight = 0.347), emotional indicators (0.251), behavioral indicators (0.190), stress event indicators (0.144), and history/genetic history (0.068). Psychometric validation revealed robust reliability (overall Kuder-Richardson Formula 20 = 0.811; split-half = 0.745; test-retest ICC = 0.832) and exceptional content validity (Item-Level Content Validity Index: 0.881-1.000; Scale-Level Content Validity Index Average = 0.995; Scale-Level Content Validity Index Universal Agreement = 0.832). This scientifically rigorous, culturally appropriate indicator system demonstrates excellent psychometric properties and practical applicability for early depression detection across clinical, educational, and community settings, potentially improving prevention and intervention outcomes in vulnerable youth populations.