Psychometric Properties of the Patient Health Questionnaire-9 Modified for Major Depressive Disorder in Adolescents

Abstract

Objectives: The Patient Health Questionnaire-9 Modified (PHQ-9M) is a self-report tool used to assess the presence and severity of depressive symptoms in teenagers. Despite widespread use in primary care clinics and psychiatric settings, the PHQ-9M has not been validated nor are its psychometric properties adequately understood for the adolescent population. This study sought to examine the psychometrics of the PHQ-9M in treatment-seeking, depressed adolescents at a psychiatric psychopharmacology clinic who were concurrently assessed with the Children's Depression Rating Scale Revised (CDRS-R) and Quick Inventory of Depressive Symptomatology-Adolescent (17-item) Self-Report (QIDS-A17-SR). Methods: Adolescents (N = 160) aged 13 through 18 years with a diagnosis of major depressive disorder, determined on the basis of a clinical interview and semi-structured interview using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, were assessed for severity of depressive symptoms with the PHQ-9M, CDRS-R (adolescent interview only), and QIDS-A17-SR assessments at baseline, 4, and 8 weeks. Classical test theory analysis was used to evaluate the internal consistency and dimensionality of the PHQ-9M. Convergent validity was evaluated via intraclass correlations of the PHQ-9M with the CDRS-R and QIDS-A17-SR. Sensitivity to treatment response was also evaluated. Results: The internal consistency (Cronbach's coefficient a) at baseline, 4, and 8 weeks was 0.879, 0.859, and 0.827 for the PHQ-9M; 0.739, 0.835, and 0.867 for CDRS-R; and 0.712, 0.777, and 0.804 for QIDS-A17-SR, respectively. The PHQ-9M had moderate convergent validity with the CDRS-R but good convergent validity with the QIDS-A17-SR. The PHQ-9M was less sensitive to changes in symptom severity than the CDRS-R and QIDS-A17-SR. Conclusions: The PHQ-9M appears to be a valid and reliable assessment tool for the severity of depressive symptoms in a psychiatric clinic setting. However, its utility as a treatment outcome measure may be limited compared with other available rating scales.

Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: A quality improvement project

“…Patients ages 12 to 17 years old were screened with the Patient Health Questionnaire 9‐Item—Modified for Adolescents (PHQ9A). This differs minimally from published guidelines, 5 which recommends PHQ9 (adult version), only in that the item that asks about “trouble concentrating” refers to “school work and reading” instead of “reading the newspaper.” The PHQ9A was recently validated in two separate studies and found to be psychometrically sound for detecting depression among 12 to 18 years old 12,13 . Patients 18 years and older were screened with the standard version of the PHQ9.…”

Quasi‐Experimental Single‐Subject Design: Comparing Seeking Safety and Canine‐Assisted Therapy Interventions Among Mentally Ill Female Inmates

“…Example items include “Feeling down, depressed, or hopeless,” “Feeling tired or having little energy,” and “Feeling bad about yourself or that you are a failure or have let yourself or your family down.” Research supports the factor structure and demonstrates strong factorial invariance between the treatment groups and across time (Guo et al, ). Also, several studies indicate strong evidence supporting the PHQ‐9 as a unidimensional measure of depression with internal consistency ranging from .83 to .88 (Nandakumar et al, ). Additionally, the PHQ‐9 demonstrates moderate to good convergent validity (Nandakumar et al, ).…”

“…Also, several studies indicate strong evidence supporting the PHQ‐9 as a unidimensional measure of depression with internal consistency ranging from .83 to .88 (Nandakumar et al, ). Additionally, the PHQ‐9 demonstrates moderate to good convergent validity (Nandakumar et al, ). Test‐retest validity is measured at .86 (Kroenke, Spitzer, & Williams, ).…”

A pediatrician‐friendly review of three common behavioral health screeners in pediatric practice: Findings and recommendations

“…In 2009, the Academy of Pediatrics recommended universal depression screening for young patients ages 12–18 years old 33,46‐48 . The PHQ‐9 is a short 9‐item screening tool that can be used in both primary care and pediatric hospital settings for detecting depressive symptomology in adolescents 26,34,35,49 . The brief screener takes about 5 to 10 minutes to complete and it assesses the presence as well as the severity of depressive symptoms.…”

“…Consequently, the present work focuses on the PSC‐17, PHQ‐9, and SCARED for several reasons. First, all three measures are reviewed and recommended in previous large scale authoritative scholarly articles 33‐36 . Second, they all possess sound psychometric properties 16,26,37‐43 .…”