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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.

ClinicalTrials.gov Identifier: NCT01528020.

Child maltreatment is a robust risk factor for internalizing and externalizing psychopathology in children and adolescents. We examined the role of disruptions in emotion regulation processes as a developmental mechanism linking child maltreatment to the onset of multiple forms of psychopathology in adolescents. Specifically, we examined whether child maltreatment was associated with emotional reactivity and maladaptive cognitive and behavioral responses to distress, including rumination and impulsive behaviors, in two separate samples. We additionally investigated whether each of these components of emotion regulation were associated with internalizing and externalizing psychopathology and mediated the association between child maltreatment and psychopathology. Study 1 included a sample of 167 adolescents recruited based on exposure to physical, sexual, or emotional abuse. Study 2 included a sample of 439 adolescents in a community-based cohort study followed prospectively for 5 years. In both samples, child maltreatment was associated with higher levels of internalizing psychopathology, elevated emotional reactivity, and greater habitual engagement in rumination and impulsive responses to distress. In Study 2, emotional reactivity and maladaptive responses to distress mediated the association between child maltreatment and both internalizing and externalizing psychopathology. These findings provide converging evidence for the role of emotion regulation deficits as a transdiagnostic developmental pathway linking child maltreatment with multiple forms of psychopathology.

IMPORTANCE Up to 20%of adolescents experience an episode of major depression by age 18 years yet few receive evidence-based treatments for their depression. OBJECTIVE To determine whether a collaborative care intervention for adolescents with depression improves depressive outcomes compared with usual care. DESIGN Randomized trial with blinded outcome assessment conducted between April 2010 and April 2013. SETTING Nine primary care clinics in the Group Health system in Washington State. PARTICIPANTS Adolescents (aged 13–17 years) who screened positive for depression (Patient Health Questionnaire 9-item [PHQ-9] score ≥10) on 2 occasions or who screened positive and met criteria for major depression, spoke English, and had telephone access were recruited. Exclusions included alcohol/drug misuse, suicidal plan or recent attempt, bipolar disorder, developmental delay, and seeing a psychiatrist. INTERVENTIONS Twelve-month collaborative care intervention including an initial in-person engagement session and regular follow-up by master’s-level clinicians. Usual care control youth received depression screening results and could access mental health services through Group Health. MAIN OUTCOMES AND MEASURES The primary outcome was change in depressive symptoms on a modified version of the Child Depression Rating Scale–Revised (CDRS-R; score range, 14–94) from baseline to 12 months. Secondary outcomes included change in Columbia Impairment Scale score (CIS), depression response (≥50% decrease on the CDRS-R), and remission (PHQ-9 score <5). RESULTS Intervention youth (n = 50), compared with those randomized to receive usual care (n = 51), had greater decreases in CDRS-R scores such that by 12 months intervention youth had a mean score of 27.5 (95%CI, 23.8–31.1) compared with 34.6 (95%CI, 30.6–38.6) in control youth (overall intervention effect: F2,747.3 = 7.24, P < .001). Both intervention and control youth experienced improvement on the CIS with no significant differences between groups. At 12 months, intervention youth were more likely than control youth to achieve depression response (67.6%vs 38.6%, OR = 3.3, 95%CI, 1.4–8.2; P = .009) and remission (50.4%vs 20.7%, OR = 3.9, 95%CI, 1.5–10.6; P = .007). CONCLUSIONS AND RELEVANCE Among adolescents with depression seen in primary care, a collaborative care intervention resulted in greater improvement in depressive symptoms at 12 months than usual care. These findings suggest that mental health services for adolescents with depression can be integrated into primary care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01140464.

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.

Although parasuicidal behavior in adolescence is poorly understood, evidence suggests that it may be a developmental precursor of borderline personality disorder~BPD!. Current theories of both parasuicide and BPD suggest that emotion dysregulation is the primary precipitant of self-injury, which serves to dampen overwhelmingly negative affect. To date, however, no studies have assessed endophenotypic markers of emotional responding among parasuicidal adolescents. In the present study, we compare parasuicidal adolescent girls~n ϭ 23! with age-matched controls~n ϭ 23! on both psychological and physiological measures of emotion regulation and psychopathology. Adolescents, parents, and teachers completed questionnaires assessing internalizing and externalizing psychopathology, substance use, trait affectivity, and histories of parasuicide. Psychophysiological measures including electrodermal responding~EDR!, respiratory sinus arrhythmia, and cardiac pre-ejection period~PEP! were collected at baseline, during negative mood induction, and during recovery. Compared with controls, parasuicidal adolescents exhibited reduced respiratory sinus arrhythmia~RSA! at baseline, greater RSA reactivity during negative mood induction, and attenuated peripheral serotonin levels. No between-group differences on measures of PEP or EDR were found. These results lend further support to theories of emotion dysregulation and impulsivity in parasuicidal teenage girls.

Purpose-To determine the prevalence of anxiety and depressive disorders in youth with asthma compared to a control sample of youth and to determine the sociodemographic and clinical characteristics associated with having ≥1 anxiety/depressive disorders among youth with asthma.Methods-A telephone interview was offered to all youth aged 11 to 17 with asthma (N=781) and a random sample of similar aged controls (N=598) enrolled in a Health Maintenance Organization (HMO). The C-DISC-4.0 was used to diagnose anxiety and depressive disorders and reliable and valid questionnaires were used to assess severity of anxiety and depressive symptoms. Automated diagnostic, pharmacy and health utilization data were used to measure asthma treatment intensity, asthma severity and non-asthmatic medical comorbidity. One parent was interviewed to assess sociodemographic variables, child/adolescent psychiatric symptoms and to confirm the asthma diagnosis.Results-16.3% of youth with asthma compared to 8.6% of youth without asthma met DSM-IV criteria for ≥1 anxiety and depressive disorders (OR = 1.92, 95% CI 1.13-3.28). Independent factors associated with a significantly higher likelihood of meeting criteria for ≥1 anxiety or depressive disorders included female gender [OR = 1.96 (95% CI 1.27, 3.03)], living in a single parent household, [OR = 1.96 (95% CI 1.26, 3.07)], more parent-reported externalizing behaviors [OR = 1.03 (95% CI 1.01, 1.05)], more recent diagnosis of asthma [OR = 0.94 (95% CI 0.89, 0.98)], and more impairment on the asthma physical health scale [OR = 0.95 (95% CI 0.94, 0.96)].Conclusions-Youth with asthma have an almost two-fold higher prevalence of comorbid DSM-IV anxiety and depressive disorders compared to control youth. Clinical factors associated with meeting criteria for ≥1 anxiety and depressive included more recent asthma diagnosis, more impairment on the asthma physical health scale and increased externalizing behaviors. Medicine, 1959 NE Pacific St., Seattle, WA 98195-6560, PH: 206-543-7177, Fax: 206-221-5414, E-Mail: wkaton@u.washington.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Cross-sectional studies have repeatedly found an increased prevalence of panic disorder among youth with asthma. [1][2][3][4][5] A large family history study also recently reported that first degree relatives of patients with panic disorder had a significantly higher prevalence of asthma and chronic obstructive lung disease compared to a control group without panic disorder. NIH Public Access[6] Recent research suggests that youth with asthma also have a high rate of ot...