PHQ-A: PHQ-9 Modified for Adolescents
The PHQ-A (PHQ-9 Modified for Adolescents), the nine-item self-report depression measure adapted for young people aged 11 to 17, reproduced with its scoring bands, the additional safety and functioning questions described, interpretation notes and licence information.
About this resource
The PHQ-A is the depression module of the Patient Health Questionnaire adapted for adolescents by Johnson, Harris, Spitzer and Williams. The nine symptom items mirror the adult PHQ-9 and the nine DSM criteria for a major depressive episode, with wording adjusted for young people: irritability is added to the depressed mood item, weight loss is added to the appetite item, and the concentration item refers to school work. Each item is rated for frequency over the past two weeks on a 0 to 3 scale, giving a total of 0 to 27. The adolescent version places the depressed mood item first, before the interest and pleasure item.
The published form also includes a functional difficulty question, a question about persistent depressed mood over the past year, and two direct yes/no questions about serious thoughts of ending one's life in the past month and any lifetime suicide attempt. The nine symptom items and the difficulty item are reproduced verbatim below. The three additional yes/no questions are described rather than quoted, because we are not certain of their exact published wording; clinicians should use the official form when these items are needed, which will be in most clinical settings.
The professional version adds the scoring table, notes on the adolescent-specific cut-off, guidance on following up item 9 and the additional safety questions, and limitations, including the need for a clinical interview and, where appropriate, collateral information from a parent or caregiver.
The instrument is reproduced here because Pfizer, the copyright holder, permits reproduction, translation, display and distribution of the PHQ family without permission. Item wording follows the published instrument, with the dashes in items 6 and 8 rendered as plain hyphens.
How to use it
- Give the questionnaire to the adolescent to complete privately, explaining that it asks about mood over the past two weeks and that you will look at it together. Do not have a parent complete it on the young person's behalf.
- Score by summing items 1 to 9. The difficulty item is not added to the total. Use the same severity bands as the adult PHQ-9, and note that a cut-off of 11 has been supported for detecting major depression in adolescents.
- Check item 9 and the safety questions before the session moves on. Any endorsement requires a direct conversation about suicidal thinking, intent, plans, past attempts and protective factors, a risk assessment appropriate to your setting, and a safety plan where indicated.
- Repeat at regular intervals, ideally every session or every other session, and use changes in the total to track response to treatment.
- Treat a high score as a prompt for clinical assessment, including a developmental history, collateral from a parent or caregiver where appropriate, and screening for bipolar features, substance use and bereavement.
References
- Johnson, J. G., Harris, E. S., Spitzer, R. L., & Williams, J. B. W. (2002). The Patient Health Questionnaire for Adolescents: Validation of an instrument for the assessment of mental disorders among adolescent primary care patients. Journal of Adolescent Health, 30(3), 196-204.
- Richardson, L. P., McCauley, E., Grossman, D. C., McCarty, C. A., Richards, J., Russo, J. E., Rockhill, C., & Katon, W. (2010). Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. Pediatrics, 126(6), 1117-1123.
- Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613.
