Depression Assessment Scales for Teenagers
The Patient Health Questionnaire-9 Modified for Teens (PHQ-9M) is the most validated and recommended screening tool for assessing depression in adolescents, with a sensitivity of 89.5% and specificity of 77.5% at a cutoff score of 11 for detecting major depressive disorder. 1
Primary Recommended Scales
PHQ-9 Modified for Teens (PHQ-9M)
- Optimal cutoff score: 11 (higher than adult version) 1
- Psychometric properties: Strong internal consistency (Cronbach's α = 0.83-0.88) 2
- Advantages: Brief, easy to administer, free, validated in school and clinical settings 3
- Administration time: Less than 5 minutes
- Age range: Validated for ages 13-18 years
- Format: Self-report questionnaire
Beck Depression Inventory (BDI)
- Sensitivity: 84-90%, Specificity: 81-86% at cutoff score of 11 4
- Domains assessed: Behavioral, cognitive, and somatic components of depression including suicidal ideation 4
- Age range: Validated for adolescents
- Format: 21-item self-report scale
Additional Validated Scales
Center for Epidemiologic Studies Depression Scale (CES-D)
- Description: 20-item scale (also available in 10-item short form) 4
- Cutoff score: ≥16 suggests moderate to severe depressive symptoms 4
- Advantage: Relatively unaffected by presence of physical symptoms 4
- Domains: Negative affect/mood, positive mood/well-being, somatic symptoms, interpersonal issues
PHQ-2
- Description: Ultra-brief 2-question screen 4
- Sensitivity: 73.7%, Specificity: 75.2% at cutoff score of 3 4
- Usage: Can be used as initial screen before administering longer instruments
- Limitation: Less sensitive than PHQ-9M but still performs adequately 5
Implementation Considerations
Age-Specific Recommendations
- For younger adolescents (12-14 years): PHQ-9M with clinician follow-up
- For older adolescents (15-18 years): PHQ-9M or BDI
- For children under 12: Limited validation data exists for depression screening tools 4
Screening Protocol
- Universal screening: All adolescents 12 years and older should be screened annually for depression 4
- Targeted screening: More frequent screening for those with risk factors:
- Previous depression history
- Family history of depression
- Substance use
- Trauma history
- Psychosocial adversity
- Frequent somatic complaints 4
Clinical Pathway
- Initial screening: Use PHQ-9M or PHQ-2
- Positive screen follow-up: All positive screens require full diagnostic interviews using standard diagnostic criteria (DSM-5) 4
- Assessment of severity: Use PHQ-9M score to determine depression severity:
- Mild: 5-6 symptoms that are mild in severity
- Moderate: Between mild and severe
- Severe: All 9 symptoms or severe functional impairment 4
Important Caveats
- False positives: Screening tools have good sensitivity but moderate specificity, resulting in false positives 4
- Comprehensive assessment: Screening tools should never replace clinical judgment or comprehensive evaluation
- Suicide risk: Always assess for suicide risk in adolescents who screen positive for depression 4
- Follow-up systems: Clinical practices that screen for depression should have systems in place to ensure positive screens are followed by accurate diagnosis, effective treatment, and follow-up 4
- Cultural considerations: Limited data exists on how these scales perform across different cultural and ethnic groups
Special Considerations for Primary Care
- The PHQ-9M has been specifically validated in pediatric primary care settings, making it particularly suitable for this context 5, 1
- Brief screening questions about mood and anhedonia may be as effective as longer instruments in busy primary care settings 4
- Screening alone without appropriate follow-up and treatment resources does not improve outcomes 4
Remember that while these scales are valuable screening tools, they are not diagnostic instruments. Positive screens should always be followed by a comprehensive clinical assessment to confirm the presence of depression and determine appropriate treatment.