211 - Lowering the Bar and Raising Detection: Re-evaluating the PHQ-A Flagging Threshold in Adolescent Depression Screening

Publication Number: 2203.211

Alix Paredes Molina, Brown University School of Public Health, Providence, RI, United States; Violet J.. Landrum, Brown University School of Public Health, Providence, RI, United States; Tracy Gladstone, Brown University, Providence, RI, United States

Background: Adolescent depression often develops gradually, making early identification of depressive episode risk critical for prevention and support. Universal screening in primary care and school settings has strong potential to improve detection and treatment, offering an opportunity to intervene before depressive symptoms escalate. Patient Health Questionnaire for Adolescents (PHQ-A) scores of ≥10 are widely used as the standard threshold to identify youth at risk of experiencing a depressive episode. This cutoff may be too conservative, leaving youth with an emerging or subthreshold depressive episode to be undetected and unsupported until their symptoms become more severe.

Objective: Mood Check is a universal, school-based screening program focused on early prevention of adolescent depression through proactive identification and support of at-risk youth. Leveraging longitudinal Mood Check data, the current study examines whether lowering the PHQ-A flagging threshold from ≥10 to ≥8 could improve the identification of depressive episode risk in adolescents.

Design/Methods: Data were collected from 683 adolescents (ages 11–15) in the class of 2028 across three northeastern U.S. school districts, who completed the PHQ-A in 7th and 9th grade as part of the Mood Check program. To evaluate whether the standard cutoff of ≥10 may overlook youth at emerging risk, analyses focused on students with baseline PHQ-A scores of 8-9 (N=37, mild symptomology) and 10-14 (N=36, moderate symptomology). Descriptive and inferential analyses compared depressive symptom patterns across these groups from 7th to 9th grade.

Results: An independent t-test comparing the change in PHQ-A scores from 7th to 9th grade showed no significant difference between students with baseline scores of 8–9 and those with scores of 10–14 (p = 0.262), indicating similar trajectories of depressive symptoms across both groups. A Pearson Chi-Square test revealed no significant difference in the proportion of students from either group who met the standard clinical threshold for moderate depression (PHQ-A ≥ 10) at 9th-grade follow-up (χ²=3.33, df=1, p = 0.07).

Conclusion(s): Adolescents with baseline PHQ-A scores of 8–9 showed comparable risk patterns to those with scores of 10–14. Findings support that lowering the PHQ-A flagging threshold to ≥8 may improve early detection of youth at risk for depressive episodes, allowing intervention before symptoms escalate. Further validation in larger, diverse samples is warranted to confirm that this adjustment would meaningfully increase identification of at-risk youth without inflating false positives.