Depression Screening Tools for Adults and Adolescents
For adults 18 years and older, use the Patient Health Questionnaire-2 (PHQ-2) as an initial screen, followed by the PHQ-9 if positive; for adolescents ages 12-17, use the PHQ-9 Modified for Teens (PHQ-9-M) as the primary screening tool. 1, 2, 3
Adults (18 years and older)
Recommended Screening Approach
The USPSTF endorses universal screening for depression in all adults regardless of risk factors 1. The most practical and evidence-based approach uses a two-step process:
Step 1: PHQ-2 (Initial Screen)
- Ask two simple questions: "Over the past 2 weeks, have you felt down, depressed, or hopeless?" and "Over the past 2 weeks, have you felt little interest or pleasure in doing things?"
- Score ≥1 out of 7 warrants further evaluation 4
- Sensitivity comparable to PHQ-9, though specificity is lower (78-92% vs 91-94%) 3
Step 2: PHQ-9 (Confirmatory Screen)
- Administer if PHQ-2 is positive
- Cut-point ≥10 out of 27 provides optimal balance (sensitivity 91-94%, specificity 91-94%) 3, 4
- A positive screen requires clinical diagnostic interview using DSM-5 criteria—screening alone does not establish diagnosis 1, 5
Population-Specific Tools
Older Adults (65+ years):
- Geriatric Depression Scale is specifically validated for this population 1, 3
- Alternative: PHQ-9 remains appropriate 3
Pregnant and Postpartum Women:
- Edinburgh Postnatal Depression Scale is the gold standard 1, 3
- Alternative: PHQ-2 or PHQ-9 are acceptable 3
Hospital Anxiety and Depression Scales can be used in general adult populations but are less commonly employed in primary care 1
Critical Implementation Caveat
Screening should only be implemented when adequate systems exist for accurate diagnosis, effective treatment, and appropriate follow-up 1, 5. Without these supports in place, screening provides minimal benefit and may cause harm through false positives, labeling, and stigma 5.
Adolescents (12-17 years)
Recommended Screening Approach
The PHQ-9 Modified for Teens (PHQ-9-M) is the primary recommended tool for universal annual screening of all adolescents ages 12 and older 2, 6, 7.
Key Implementation Points:
- Screen annually at well-visits starting at age 12 2
- Cut-point ≥11 provides sensitivity 89.5% and specificity 77.5% for major depressive disorder 2
- Also screen at sick visits—adolescents presenting for acute care are more likely to endorse depressive symptoms than those at well-visits 8
Alternative Adolescent Tools
PHQ-2 for Adolescents:
- Can serve as initial brief screen
- Cut-point ≥3 has sensitivity 73.7% and specificity 75.2% 2
- Must follow positive results with PHQ-9-M or clinical interview
Other validated options (though less commonly used):
- Mood and Feelings Questionnaire
- Columbia Depression Scale
- Center for Epidemiologic Studies Depression Scale (CES-D) for youth ≥12 years 9
Targeted Screening for High-Risk Adolescents
Beyond universal screening, systematically monitor adolescents with these risk factors using formal depression instruments 2:
- Previous or family history of depression, bipolar disorder, suicide attempts, substance use, or other psychiatric illness
- Significant psychosocial stressors (family crises, abuse, neglect, trauma)
- Frequent somatic complaints
- Foster care or adoption status
Critical Adolescent-Specific Caveats
Positive screens require diagnostic confirmation: A high score indicates need for full clinical assessment using DSM-5 criteria, not automatic diagnosis 2
Low positive predictive value: In primary care populations, only 15.2% of positive PHQ-9 screens represent true major depressive disorder 2. However, many screen-positive adolescents have other depressive disorders or subthreshold depression warranting intervention 2
Collateral information is essential: Interview both adolescent and parent/caregiver separately, as agreement between parent and youth reports is poor (κ=0.15) 2
Assess suicide risk: Always evaluate suicidality in screen-positive adolescents, as 7.19% of screened adolescents endorse suicidal ideation 7
Systems of care required: Like adults, adolescent screening only benefits patients when linked to effective treatment pathways and mental health referral systems 2
Screening Interval
Adults: Optimal interval unknown; pragmatic approach is to screen all adults at least once, then use clinical judgment based on risk factors and life events for repeat screening 1, 10
Adolescents: Annual screening at well-visits 2
Recurrent screening is most productive in patients with depression history, unexplained somatic symptoms, comorbid psychological conditions, substance abuse, or chronic pain 10.