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
Although multiple studies of adolescents have examined the association of depression with individual health risk behaviors such as obesity or smoking, this is one of the few studies that examined the association between depression and multiple risk behaviors.
Methods
A brief mail questionnaire, which screened for age, gender, weight, height, sedentary behaviors, physical activity, perception of general health, functional impairment and depressive symptoms, was completed by a sample of 2291 youth (60.7% response rate) aged 13–17 enrolled in a health care plan. A subset of youth who screened positive on the two-item depression screen and a random sample of those screening negative were approached to participate in a telephone interview with more in-depth information obtained on smoking and at-risk behaviors associated with drug and alcohol use.
Results
Youth screening positive for high levels of depressive symptoms compared to those with few or no depressive symptoms were significantly more likely to meet criteria for obesity, had a poorer perception of health, spent more time on the computer, got along less well with parents and friends, had more problems completing school work and were more likely to have experimented with smoking and a wide array of behaviors associated with drug and alcohol use.
Conclusions
Because many adverse health behaviors that develop in adolescence continue into adulthood, the association of depressive symptoms with multiple risk behaviors and poor functioning suggest that early interventions are needed at an individual, school, community and primary care level.
Key PointsQuestionCan low-intensity outreach programs, based on effective clinical interventions but delivered primarily online, prevent self-harm or suicidal behavior among outpatients reporting frequent suicidal ideation?FindingsIn this pragmatic randomized clinical trial that included 18 882 outpatients with frequent suicidal ideation, the percentage with nonfatal or fatal self-harm over 18 months was 3.3% among those offered care management, 3.9% among those offered online dialectical behavior therapy skills training, and 3.1% among those receiving usual care, respectively. Compared with usual care, the risk of self-harm was not significantly different for care management but was significantly increased for those offered skills training.MeaningCompared with usual care, offering care management did not significantly reduce the risk of self-harm, and offering brief online dialectical behavior therapy skills training increased the risk of self-harm among at-risk adults.
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