Establishing the measurement precision of the patient health questionnaire in an adolescent sample
Abstract
Background Technically sound measures are necessary for accurately identifying youth at risk for depression, but many studies rely on classical test theory metrics or adult samples to evaluate measures. This study examined the use of the PHQ-8, a common and freely available pediatric depression screener, in an adolescent sample using item response theory (IRT).Methods Secondary analyses were conducted on data from a study conducted in Midwestern middle schools in which 1224 youth completed the PHQ-8 as part of a battery of surveys. Polytomous IRT analyses (a Graded Response Model) were used to evaluate the PHQ-8. Items were examined for their ability to distinguish between respondents of different latent depression severity and for differential item functioning (DIF) across demographic categories.Results All PHQ-8 items had adequate discriminative abilities. Items measuring anhedonia and psychomotor disturbances performed relatively poorly, and items measuring somatic symptoms (appetite and sleep) were most informative when respondents endorsed extreme response options ("not at all" or "nearly every day"). No DIF was found across grade level or race, but several items were flagged for DIF by gender and student income level.Limitations These results might not be generalizable to a broader youth population due to administration setting and the unique demographic characteristics of this sample (76.0 % African American).Conclusions Tools such as the PHQ-8 are appropriate to quickly screen for depression in adolescents, but further scrutiny of adolescent response patterns is warranted. Future research should examine items measuring anhedonia and psychomotor and somatic disturbances in adolescents.
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The PHQ-8 has demonstrated good reliability and validity with adolescent populations.
“The PHQ-8 [36] has demonstrated good reliability and validity with adolescent populations [44].”
From A Virtual Reality–Based Cognitive Defusion Application for Youth Depression and Anxiety: Mixed Methods Experimental Study. (2025) · cites this paper as [44]
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Vilela-Estrada, A. L., Villarreal‐Zegarra, D., Toyama, M., Carbonel, A., Fung, C., Carbonetti, F. L., Hidalgo-Padilla, L., Sureshkumar, D. S., Uribe-Restrepo, J. M., Olivar, N., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.02.088 · Cited by 15 · see citing works
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“…that VR was “probably a little bit more effective” (participant 44; female; aged 21 y) because it enabled them to be “totally involved” (participant 44; female; aged 21 y), whereas “during the audio, I still had like random thoughts coming to mind and you know, partly focusing on that, partly…”
InfluentialIdentifying Caregiving Youth and Associated Mental Health Concerns in a Medical Clinic Setting
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“28 The reliability in the current study was also satisfactory (Cronbach ’ s alpha: α = 0.92).”
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“This is a widely used measure for assessing depressive symptoms, and has been validated with young adolescents (e.g., Danzo et al., 2024; Hodgson et al., 2023).”
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“Research has shown that the PHQ-8 has adequate discriminative abilities in adolescent samples (e.g., Hodgson et al., 2023).”
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“The PHQ-8 has been used with youth samples [45], and was selected for this study as it omits an item on suicidal or self-injurious thoughts, while still being a valid measure of depressive symptoms [44].”
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“Since there is some indication about limited measurement precision among adolescents for some response options [79], we will use item response theory (IRT) or similar methods to take into account separate probabilities for response option of each item.”
Vaughn, R., Prakash, K., Tomlinson, C. S., Mair, P., Yu, L., Kolko, D. J., Pilkonis, P. A., & Lindhiem, O. J. (2026) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-026-10300-9
“…Major Depressive Disorder symptoms such as anhedonia and psychomotor disturbances may be more difficult for female youth to endorse compared to male youth on screening measures implemented nearly universally in the U.S. pediatric care system (Patient Health Questionnaire-8; Hodgson et al., 2023).”
Exploring perfectionism in youth with Vocal Cord Dyskinesia
Fisher, K., Bauman, N. M., Mudd, P. A., Long, C., Behzadpour, H. K., & Andrew, L. M. (2026) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2026.112955
- Authors
- Hodgson, C. G., Bonifay, W., Yang, W., & Herman, K. C.
- Affiliations
- Nationwide Children's Hospital (US)
- University of Missouri (US)
- Corresponding author
- Yang, Wenxi
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2023-12
- Volume
- 342
- Pages
- 76-84
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W4386648266
- Cited by
- 13
- References
- 61
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 1
- FWCI
- 2.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Institute of Education Sciences (R305A130143)
- University of Missouri
- U.S. Department of Education
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- 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
- Keywords
- PHQ-8, Patient Health Questionnaire, adolescent depression, depression screening, measurement precision, item response theory, graded response model, differential item functioning, anhedonia, psychomotor disorders, somatic symptoms, gender differences, socioeconomic status, junior high school students
- MeSH terms
- Patient Health Questionnaire, Adolescent, Adult, Child, Depression, Humans, Psychometrics, Surveys and Questionnaires, Anhedonia
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