Objective The purpose of this study was to examine the performance characteristics and validity of the Patient Health Questionnaire - 9 item (PHQ-9) as a screening tool for depression among adolescents. Methods The PHQ-9 was completed by 442 youth (13-17 years) who were enrolled in a large healthcare delivery system and participating in a study on depression outcomes. Criterion validity and performance characteristics were assessed against an independent structured mental health interview (the Child Diagnostic Interview Schedule, DISC-IV). Construct validity was tested by examining associations between the PHQ-9 and a self-report measure of functional impairment, as well as parental reports of child psychosocial impairment and internalizing symptoms. Results A PHQ-9 score ≥11 had a sensitivity of 89.5% and specificity of 77.5% for detecting youth meeting DSM-IV criteria for major depression on the DISC-IV. On ROC analysis the PHQ-9 had an area under the curve of 0.88 (95% CI = 0.82 to 0.94) and the cut point of 11 was optimal for maximizing sensitivity without loss of specificity. Increasing PHQ-9 scores were significantly correlated with increasing levels of functional impairment, as well as parental report of internalizing symptoms and psychosocial problems. Conclusion Although the optimal cut point is higher among adolescents, the sensitivity and specificity of the PHQ-9 are similar to those of adult populations. The brief nature and ease of scoring of this instrument make this tool an excellent choice for providers and researchers seeking to implement depression screening in primary care settings.

Objective To examine the validity of the Patient Health Questionnaire - 2 (PHQ-2), a 2-item depression screening scale among adolescents. Methods After completing a brief depression screen, 499 youth (13–17 years) who were enrolled in an integrated healthcare system were invited to participate in a full assessment including a longer depression screening scale (the Patient Health Questionnaire, PHQ-9), a structured mental health interview (the Child Diagnostic Interview Schedule, DISC-IV). Eighty-nine percent (N=444) completed the assessment. Criterion validity and construct validity were tested by examining associations between the PHQ-2 and other measures of depression and functional impairment. Results A PHQ-2 score ≥3 had a sensitivity of 74% and specificity of 75% for detecting youth meeting DSM-IV criteria for major depression on the DISC-IV, and a sensitivity of 96% and a specificity of 82% for detecting youth who met criteria for probable major depression on the PHQ-9. On ROC analysis the PHQ-2 had an area under the curve of 0.84 (95% CI = 0.75 to 0.92) and the cut point of 3 was optimal for maximizing sensitivity without loss of specificity for detecting major depression. Youth with a PHQ-2 ≥3 had significantly higher functional impairment scores and significantly higher scores for parent-reported internalizing problems than youth with scores <3. Conclusion The PHQ-2 has good sensitivity and specificity for detecting major depression. These properties coupled with the brief nature of the instrument make this tool very promising as a first step for screening for adolescent depression in primary care.

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This Practice Parameter is a revision of a previous Parameter addressing reactive attachment disorder that was published in 2005. It reviews the current status of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DESD) with regard to assessment and treatment. Attachment is a central component of social and emotional development in early childhood, and disordered attachment is defined by specific patterns of abnormal social behavior in the context of "insufficient care" or social neglect. Assessment requires direct observation of the child in the context of his or her relationships with primary caregivers. Treatment requires establishing an attachment relationship for the child when none exists and ameliorating disturbed social relatedness with non-caregivers when evident.