SCREENING FOR DEPRESSION IN ADOLESCENTS: VALIDITY OF THE PATIENT HEALTH QUESTIONNAIRE IN PEDIATRIC CARE: Research Article: Validity of the PHQ in Pediatric Care
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BACKGROUND: This study examines the criterion validity of the Patient Health Questionnaire 9-item (PHQ-9) and 2-item (PHQ-2) version as a depression-screening instrument for adolescents. METHODS: Three hundred twenty-two adolescents aged 13-16 were recruited from pediatric hospitals. Criterion validity of the PHQ-9 and PHQ-2 was assessed against diagnoses of any depressive disorder provided by a structured diagnostic interview. Areas under the receiver operating characteristics curve (AUCs) and sensitivities and specificities at optimal cutoff points were computed for both versions of the PHQ. Besides the dimensional algorithm, a categorical algorithm was applied for the PHQ-9. Validity measures of both scoring procedures of the PHQ-9 as well as PHQ-2 were compared statistically. In addition, unaided clinical depression diagnoses by the attending pediatricians were evaluated. RESULTS: Using the dimensional algorithm, the AUCof the PHQ-9 (93.2%) was significantly higher than that of the PHQ-2 (87.2%). At optimal cutoffs, there was no significant difference in sensitivity (PHQ-9: 90.0%, PHQ-2: 85.0%), but in specificity (PHQ-9: 86.5%, PHQ-2: 79.4%). Although the categorical algorithm of the PHQ-9 was most specific (94.7%), sensitivity was just above chance (52.5%). The unaided clinical diagnoses yielded a sensitivity of 12.5% and a specificity of 96.0%. CONCLUSIONS: The dimensional algorithm of the PHQ-9 demonstrated high criterion validity, whereas the categorical algorithm should not be applied due to its low sensitivity. Even though the PHQ-2 performed well, validity of the PHQ-9 was still superior. Hence, the PHQ-9 can be recommended as depression screener for adolescents to improve recognition rates in pediatric care.
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The PHQ-2 can be used as a rapid screen with remaining items given if positive, but the full PHQ-9 performs better in adolescents.
“There is a PHQ-2 that can serve as a “rapid screen” with the remaining questions administered if positive, although the full PHQ-9 performs better in the adolescent population [65].”
From Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death (2022) · cites this paper as [65]
The Discussion (page not provided) describes the PHQ-2 as a possible ultra-short screening compromise and says the PHQ-9 outperformed it in adolescents. The Measures section identifies the PHQ-2 as the first two PHQ-9 items, but the paper does not say to administer the remaining items after a positive PHQ-2 result; its Discussion instead calls for extensive clinical exploration after a positive screen. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe PHQ-9 is a 9-item depression screen validated in adults and adolescents that includes a suicidal thoughts question.
“The Patient Health Questionnaire-9 (PHQ-9), a 9-item screening instrument for depression, is validated in adults and adolescents and has a question specifically inquiring about suicidal thoughts.”
From Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death (2022) · cites this paper as [65]
The PHQ-9 is a commonly used evidence-based depression screening instrument.
“A commonly used evidence-based depression screening instrument is the Patient Health Questionnaire PHQ-9.36-37”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [36]
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- Authors
- Allgaier, A.-K., Pietsch, K., Frühe, B., Sigl-Glöckner, J., & Schulte-Körne, G.
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- Department of Child and Adolescent Psychiatry; Psychosomatics and Psychotherapy; Ludwig-Maximilians-University Munich; Munich; Germany
- Corresponding author
- Allgaier, Antje-Kathrin
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2012-07-02
- Volume
- 29
- Issue
- 10
- Pages
- 906-913
- ISSN
- 1091-4269 (ISSN-L)
- OpenAlex
- W1545597343
- Cited by
- 235
- References
- 39
- Citations by year
- 2026: 12 · 2025: 12 · 2024: 34 · 2023: 10 · 2022: 26 · 2021: 30 · 2020: 17 · 2019: 38 · 2018: 8 · 2017: 8 · 2016: 15 · 2015: 8 · 2014: 10 · 2013: 6 · 2012: 1
- FWCI
- 10.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- adolescent depression, depression screening, Patient Health Questionnaire, PHQ-9, PHQ-2, criterion validity, pediatric care, sensitivity and specificity
- MeSH terms
- Adolescent, Adolescent Psychiatry, Depressive Disorder, Female, Hospitals, Pediatric, Humans, Male, Mass Screening, Pediatrics, Primary Health Care, Surveys and Questionnaires, Sensitivity and Specificity, Reproducibility of Results
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