Depression and Anxiety Screening in Adolescents

Depression Screening

• The American Academy of Pediatrics recommends using the Patient Health Questionnaire-9 (PHQ-9) or PHQ-9 Modified for Teens for depression screening in 12-year-olds, with a cutoff score of 11 providing optimal sensitivity (89.5%) and specificity (77.5%) for major depressive disorder 1
• A cutoff score of ≥11 on the PHQ-9 yields sensitivity of 89.5% and specificity of 77.5% for major depressive disorder, with a negative predictive value of 99.4% 1
• The PHQ-9 consists of 9 items directly corresponding to DSM-IV criteria for major depressive disorder 2
• The PHQ-2 (brief version) can be used as a rapid initial screen, with a cutoff score of ≥3 providing sensitivity of 73.7% and specificity of 75.2% 1
• The Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item scale validated for youth as young as 12 years, with scores ≥16 suggesting moderate to severe depressive symptoms 3, 2
• The Mood and Feelings Questionnaire is a validated standalone depression-specific scale for adolescents 1

Critical Safety Consideration

• The American Academy of Pediatrics emphasizes the importance of never omitting the suicidal ideation question (item 9 on PHQ-9), as skipping it artificially lowers risk detection and misses critical safety information 4, 5
• Any endorsement of self-harm ideation requires immediate referral for emergency psychiatric evaluation regardless of total score 4, 5

Anxiety Screening

• The Screen for Child Anxiety Related Disorders-5 (SCARED-5) can be used as a brief anxiety-specific screen that can be incorporated into broader behavioral health screening 1

Practical Implementation Considerations

• The American Academy of Pediatrics recommends avoiding overwhelming clinicians with too much information from multidimensional screening packets, as positive depression or anxiety findings may be overlooked in the "morass of issues" 1
• Before attributing symptoms to psychiatric causes, it is essential to rule out medical causes including uncontrolled pain, fatigue, delirium from infection or electrolyte imbalance, thyroid disorders, and medication side effects 3, 4, 5