Validity of the PHQ-9A as a self-report screener for major depressive disorder in youth ages 10–12 years

Approximately 2 % of preadolescents in the United States have Major Depressive Disorder (MDD) which is associated with long-term morbidity; however, they are frequently underrecognized and undertreated. Guided by the need for self-report depression screening instruments in children below 13 years of age, this study sought to establish the psychometric properties of the Patient Health Questionnaire for Adolescents (PHQ-9A) as a dimensional measure and obtain a categorical cut-point using a structured interview-based diagnosis of current MDD in preadolescents. Preadolescent participants (10–12-year-olds; n = 470) were drawn from the Texas Childhood Trauma Research Network, a longitudinal registry of youth with trauma exposure. Diagnoses were assessed with the Mini-International Neuropsychiatric Interview for Children and Adolescents. Self-reported assessments included PHQ-9A and other psychosocial scales. The two-factor model separating cognitive/affective and somatic symptoms showed a good fit. High correlations (0.84) between factors and strong internal reliability (α = 0.83) support the use of a total score. Test-retest latent variable correlations were 0.68 over one month. Fit was invariant for sex and age (compared to 13–14-year-olds). PHQ-9A scores were correlated with related constructs. At the Youden Index optimal cut-point of 5, sensitivity was 0.93 and specificity was 0.60, against MDD diagnosis. Those above this cut-point who did not get an MDD diagnosis had significant impairment with indicators of high risk for future MDD. Alternative cut-points with different ratios for specificity and sensitivity are offered. Our study supports the PHQ-9A as a brief and free screening tool for preadolescent youth in clinical and research settings.