PHQ-A (Patient Health Questionnaire — Adolescent): Take It, Score It, Understand Your Results
The PHQ-A (Patient Health Questionnaire for Adolescents) is a depression screening questionnaire designed for use with teenagers, typically ages 11-17. It exists in two forms: the original Johnson et al. 2002 PHQ-A multi-module instrument, and the more commonly used PHQ-9 modified for adolescents (validated by Richardson et al. in 2010, who confirmed the instrument's reliability in pediatric primary care). The 9-item adolescent form uses the same scoring (0-27 total) as the adult PHQ-9, but the recommended clinical cutoff is ≥11 (one point higher than the adult ≥10). The U.S. Preventive Services Task Force recommends depression screening for adolescents aged 12-18 (Grade B). The PHQ-A is a screening tool, not a diagnosis — any positive screen, especially any non-zero response to item 9 (thoughts of self-harm), should be reviewed promptly by a qualified clinician.
What is the PHQ-A?
The PHQ-A (Patient Health Questionnaire for Adolescents) is the adolescent adaptation of the PHQ depression family developed by Spitzer, Kroenke, and Williams under a research grant from Pfizer. Two versions exist: (1) the original Johnson et al. 2002 PHQ-A, which is a multi-module instrument covering depression, anxiety, eating disorders, and substance use in adolescents; and (2) the more commonly used PHQ-9 modified for adolescents, validated by Richardson and colleagues in 2010 in a sample of 442 adolescents aged 13-17 in pediatric primary care. The adolescent forms use the same 9 depression items as the adult PHQ-9 but with modified introductory wording and an adolescent-specific cutoff. The PHQ-A is in the public domain and is one of the most widely used adolescent depression screening tools in pediatric primary care and adolescent mental health.
What the PHQ-A measures
The PHQ-A measures the same 9 DSM symptoms of a major depressive episode as the adult PHQ-9: low mood, loss of interest, sleep disturbance, low energy, appetite changes, feelings of failure, difficulty concentrating, slowed or restless behavior, and thoughts of self-harm. The recall window is the past two weeks. Item 9, which asks about thoughts of self-harm or being better off dead, is a non-negotiable safety surface — any non-zero response warrants immediate clinical follow-up regardless of the total score, particularly important in adolescents because of their elevated risk for suicide attempts. The instrument also asks about how much these symptoms have interfered with daily life — school, family, friendships — to capture functional impact alongside symptom count.
How the PHQ-A is administered
The PHQ-A is a self-report questionnaire that takes about 3 to 5 minutes for adolescents to complete. Each item asks how often the symptom has been present over the past two weeks, with four response options scored 0 (not at all), 1 (several days), 2 (more than half the days), and 3 (nearly every day). The total score is the sum of all 9 items, range 0 to 27. The questionnaire can be completed on paper, on a screen, or read aloud by a clinician. Many pediatric clinics include the PHQ-A in pre-visit electronic intake. Parents or guardians are typically NOT asked to complete the screener on behalf of the adolescent — the score reflects the adolescent's own self-report, which is the validated approach. Caregivers play a critical supporting role around interpretation and next steps.
Who uses the PHQ-A
The PHQ-A is used routinely in pediatric primary care, adolescent mental health services, school-based health centers, integrated behavioral health programs, and adolescent depression research worldwide. The American Academy of Pediatrics recommends annual depression screening for adolescents in primary care starting at age 12, and the PHQ-A is one of the most commonly used instruments to do so. The U.S. Preventive Services Task Force recommends depression screening for adolescents aged 12-18 when adequate follow-up systems are available (Grade B), while noting insufficient evidence for routine suicide-risk screening in children and adolescents (Grade I). Many electronic health records prompt pediatricians to administer the PHQ-A at routine well-child and sports physical visits.
PHQ-A is a screening tool, not a diagnosis
The PHQ-A is a screening instrument designed for adolescents — it can indicate whether further evaluation for depression is warranted, but it cannot diagnose depression on its own. The adolescent-specific cutoff (≥11) is one point higher than the adult ≥10 cutoff, reflecting validation research in pediatric populations. A high score warrants a follow-up conversation with a clinician who can take the adolescent's full history, family context, school functioning, and any safety concerns into account. A low score does not rule out depression or other mental health conditions; if a teenager is concerned about their mental health, they should talk to a trusted adult — a parent, school counselor, pediatrician, or mental health professional — regardless of their score. Item 9 (self-harm) is taken seriously regardless of total score. If you or your teen is in crisis, call or text 988 (U.S. Suicide & Crisis Lifeline) — available 24/7, including chat at 988lifeline.org/chat.
How to score and interpret your results
Scoring the PHQ-A is straightforward arithmetic. The interpretation step is where the adolescent version diverges from the adult PHQ-9. Add the four response options (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day) across all 9 items for a total between 0 and 27. That total maps onto the severity bands customarily inherited from the adult PHQ-9 family, with one critical adolescent-specific adjustment at the clinical-action threshold.
Severity bands and the adolescent threshold:
| Score | Severity band | Adolescent clinical action |
|---|---|---|
| 0–4 | Minimal | Routine monitoring; rescreen at next well-visit |
| 5–9 | Mild | Watchful waiting and supportive follow-up |
| 10–14 | Moderate | Clinical evaluation; ≥11 crosses the adolescent action threshold |
| 15–19 | Moderately severe | Active treatment planning with a clinician |
| 20–27 | Severe | Immediate clinical evaluation |
The cell to focus on is the moderate band. Richardson and colleagues (2010) found that a cutoff of ≥11 produced the best balance of sensitivity (89.5%) and specificity (77.5%) for detecting major depression in adolescents aged 13–17. The area under the curve was 0.88 (95% CI 0.82–0.94). That is one point higher than the adult ≥10 cutoff, and the difference matters. An adolescent scoring 10 sits just below the validated action threshold for their age group, while a 10 in an adult would already prompt evaluation.
What the score does and does not tell you
A PHQ-A total is a snapshot of how a teen felt over the past two weeks — it is a screening signal, not a diagnosis. Two teens with the same score can have very different clinical pictures depending on item 9 responses, functional impairment, family history, and context. A low total does not rule out depression, and a high total does not by itself confirm major depressive disorder. The score is the start of a conversation with a clinician, not the end of one.
The 9 PHQ-A items and adolescent-specific framing
The 9 depression items map onto the same DSM symptom criteria used in adult depression screening. But the lived experience for a teen often shows up in school-, sleep-, and peer-context ways that look different from adult presentations.
How teen depression symptoms commonly present
- Low mood or hopelessness — sustained sadness, emptiness, or irritability that does not lift, lasting day after day rather than a passing bad mood
- Loss of interest — dropping activities, sports, or social groups that used to matter, including reduced peer contact
- Sleep changes — insomnia or hypersomnia; oversleeping on weekends with school-week exhaustion is a common pattern
- Low energy or fatigue — running on empty through the school day, sometimes paired with memory complaints
- Appetite or weight changes — eating noticeably more or less than usual, sometimes with visible weight change
- Feelings of failure or worthlessness — harsh self-talk, guilt, and a sense of letting family down
- Concentration difficulties — declining grades, trouble focusing in class, unfinished homework
- Psychomotor changes — slowed movement and speech, or restlessness and agitation noticeable to others
- Thoughts of self-harm or being better off dead — the item-9 safety surface, addressed in its own section below
Teen depression often shows up through irritability and anger rather than the classic sadness adults describe. Headaches, stomachaches, social withdrawal, and substance use as coping are common adolescent-specific signals. These may not appear directly on the screener but matter for the clinical conversation. The PHQ-A also asks the teen to rate how much symptoms have interfered with school, family, and friendships — this functional-impairment item carries weight independent of the symptom count.
The PHQ-A is a screening tool, not a diagnosis. The items are best read as prompts for a clinical conversation rather than as labels.
Item 9 (self-harm) — the non-negotiable safety surface for adolescents
Item 9 asks the teen how often, over the past two weeks, they have been bothered by thoughts that they would be better off dead or of hurting themselves in some way. This is the most safety-critical question on the PHQ-A. Any non-zero response — “several days,” “more than half the days,” or “nearly every day” — warrants immediate clinical follow-up regardless of the total score. The American Academy of Child and Adolescent Psychiatry puts the standard plainly: “Take all suicide statements seriously”.
Why item 9 is not a suicide screener
Item 9 is a safety surface, not a validated suicide-risk screener. The U.S. Preventive Services Task Force reviewed the evidence in 2022 and assigned Grade I (insufficient) for suicide-risk screening in all pediatric and adolescent populations — no current instrument has been validated for that purpose. Item 9 surfaces concerning thoughts that need clinical attention; it does not predict suicide risk on its own, and a 0 on item 9 does not mean a teen is safe. Any concern — whether triggered by item 9 or by a parent’s gut feeling — warrants a direct conversation with a clinician.
Crisis resources for teens
If a teen is having thoughts of suicide or self-harm right now, support is available 24/7:
- 988 Suicide & Crisis Lifeline — call or text 988
- Online chat — 988lifeline.org/chat/ (NIMH explicitly confirms 988 supports chat, which many teens prefer over phone calls)
- 911 — for an immediate physical-safety emergency
The chat and text options matter. Many teens are far more comfortable typing about distress than speaking on the phone. NIMH’s teen depression publication specifically surfaces all three modalities — call, text, and chat — to lower the barrier to reach out. Parents and guardians can also use 988 to get guidance on supporting a teen in crisis.
What a positive screen means (and what it doesn’t): the parent and guardian conversation
A score at or above 11 — or any non-zero response to item 9 — is a signal that more conversation is needed, not a verdict. The PHQ-A is a screening tool, not a diagnosis. The next step is a clinician taking the full picture into account: how long symptoms have lasted, family history, school and peer functioning, sleep and substance use context, and safety concerns.
How to start the conversation at home
The American Academy of Child and Adolescent Psychiatry frames the parent and guardian role in three actions: seek professional assessment, facilitate school coordination, and take all suicide statements seriously. MedlinePlus describes a similar pathway for teens: disclose concerns to a trusted adult (parent, teacher, or doctor), get a medical checkup to rule out physical causes, then a psychological evaluation. NIMH encourages teens to talk to a trusted adult — a parent, teacher, school counselor, or doctor — and notes that depression is a real medical condition that responds to treatment.
Treatment landscape: what teens and parents can expect
Evidence-based treatments for adolescent depression include psychotherapy, medication, and combined approaches. Specific psychotherapies with the strongest adolescent evidence include Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT). Antidepressant medication is also used when appropriate, typically with a 3–4 week window before full effectiveness and regular monitoring.
One point parents should discuss with the prescribing clinician: MedlinePlus carries the FDA warning that “teenagers may have an increase in suicidal thoughts” when starting antidepressant medication, and any worsening symptoms should be reported immediately. This is descriptive context, not a recommendation against medication. Antidepressants remain an evidence-based option for adolescents, and the USPSTF lists the FDA black-box warning as a relevant downstream consideration. The right decision is made between the teen, the family, and the clinician.
Depression in teens is common and treatable. More than 1 in 7 teens experience it each year, and pediatric depression diagnoses rose from 4.2% in 2016 to 5.4% in 2021. A positive PHQ-A is the beginning of a treatable problem getting help, not a label.
How accurate is the PHQ-A?
Two large validation studies anchor the accuracy claims for the PHQ-A family. They report slightly different numbers because they tested different instrument variants in different cohorts at different cutoffs. Both sets are legitimate and worth holding side by side.
Validation evidence at a glance
| Study | Instrument variant | Sample | Cutoff | Sensitivity | Specificity |
|---|---|---|---|---|---|
| Richardson 2010 (Pediatrics) | PHQ-9 modified for adolescents | n=442, ages 13–17 | ≥11 | 89.5% | 77.5% |
| USPSTF 2022 review | PHQ-A (adapted for adolescents) | (review-cited) | (review-cited) | 0.73 | 0.94 |
Richardson’s 2010 study of 442 adolescents aged 13–17 used the Diagnostic Interview Schedule for Children (DISC-IV) as the gold standard. At the ≥11 cutoff, the modified PHQ-9 reached sensitivity 89.5% and specificity 77.5%, with an AUC of 0.88 (95% CI 0.82–0.94). It correctly flagged most teens who met DSM-IV major depression criteria, while about 22% without major depression also screened positive.
The USPSTF 2022 evidence review cited PHQ-A figures of sensitivity 0.73 and specificity 0.94 from a different study cohort — a more conservative tradeoff that catches fewer cases but produces fewer false positives. The instrument family also includes Johnson and colleagues’ original 2002 PHQ-A, a multi-module screener covering depression, anxiety, eating, and substance use disorders. It was validated against blinded clinical psychologist interviews in 403 adolescents across four U.S. states and demonstrated “satisfactory sensitivity, specificity, diagnostic agreement, and overall diagnostic accuracy”.
What this means in practice
The takeaway is not which study is “right.” The PHQ-A family is well-validated, with sensitivity and specificity that depend on the exact instrument variant and cutoff. None of the validation work changes the core framing: PHQ-A is a screening tool, not a diagnosis, and a positive score should trigger a clinical evaluation. For a briefer two-item screener often paired with the PHQ-A in primary care, see the PHQ-2 and GAD-2 ultra-brief screening page.
When and how the PHQ-A is used in pediatric care
The PHQ-A typically appears in a teen’s care pathway through one of several routine touchpoints. Knowing where and when it shows up helps families understand what to expect.
Where you might encounter the PHQ-A
- Pre-visit electronic intake for a well-child or annual visit, completed on a tablet or via a patient portal before arriving
- Sports physicals and school-required forms, where pediatricians increasingly fold in mental health screening
- Routine well-child checks from early adolescence onward
- Behavioral health follow-up visits, where the score helps track change over time
- School-based health centers and integrated behavioral health programs
The PHQ-A is in the public domain — no permission is required to reproduce, translate, display, or distribute it, which is one reason it is so widely embedded in pediatric workflows. The instrument was developed by Drs. Spitzer, Williams, and Kroenke at Columbia University with an educational grant from Pfizer Inc..
What happens after the score
The U.S. Preventive Services Task Force’s 2022 recommendation is explicit that screening should happen only where there are “adequate systems and clinical staff” to ensure proper diagnosis, evidence-based treatment, and follow-up. In practice this often takes the form of collaborative care. The pediatrician identifies the positive screen, has the initial conversation with the teen and family, and then coordinates with a behavioral health clinician for evaluation and treatment planning. Pediatricians serve as an “important first resource” for parents concerned about emotional and behavioral health, even when ongoing care will eventually involve specialists.
One workflow point worth flagging: the USPSTF found no evidence on appropriate or recommended screening intervals for depression in adolescents, so cadence varies by practice. Some clinics screen at every well-visit, some annually starting at age 12, and some opportunistically. If your teen has not been screened in a while and you have concerns, asking the pediatrician to administer the PHQ-A is a reasonable request.
When to talk to a clinician (and when to call 988)
The PHQ-A score is one input. A number of situations should prompt a conversation with a clinician or use of crisis services regardless of what the screener shows.
Talk to a pediatrician, school counselor, or mental health clinician if:
- The PHQ-A total score is 11 or higher on the adolescent cutoff
- The total score is between 5 and 10, but symptoms are interfering with school, sleep, friendships, or family life
- The teen has been persistently sad, irritable, or hopeless for more than two weeks, even if the screener is low
- There has been a noticeable academic decline, social withdrawal, or sustained loss of interest in activities the teen used to enjoy
- The teen is using substances as a way of coping with mood
- The teen is an LGBTQIA+ youth without family support — an explicitly recognized risk factor for adolescent depression
- The teen has recently started an antidepressant and is experiencing worsening mood or new suicidal thoughts — report immediately to the prescribing clinician
Call or text 988, or chat at 988lifeline.org/chat/, if:
- The teen has any non-zero response to item 9 (thoughts of self-harm or being better off dead)
- The teen has expressed suicidal thoughts to a parent, friend, or anyone else — take all suicide statements seriously
- A parent or guardian is uncertain how to respond and needs immediate guidance from a trained counselor
- The teen prefers text or chat over a phone call — both are supported 24/7
Call 911 immediately if there is an active medical or safety emergency — for example, a teen who has taken an overdose, has a weapon, or is at imminent risk of harming themselves or someone else.
Depression in teens is treatable, and reaching out — to a trusted adult, a clinician, or a crisis line — is the action that makes the most difference. The PHQ-A is a screening tool, not a diagnosis; what it screens for is treatable.
Frequently asked questions
What is a normal PHQ-A score for a teen?
There is no single “normal” score, but adolescents without depression typically score in the 0–4 (minimal) or 5–9 (mild) range. A total of 11 or higher is the validated clinical-action threshold for adolescents, one point higher than the adult ≥10 cutoff, and warrants follow-up with a clinician.
How is the PHQ-A different from the adult PHQ-9?
The 9 depression items are essentially the same, but the adolescent cutoff is ≥11 instead of the adult ≥10, based on Richardson and colleagues’ 2010 validation in 442 teens aged 13–17. Wording is adjusted for adolescent comprehension, and item 9 is treated as a particularly important safety surface in this age group.
Can a teen take the PHQ-A without a parent?
Yes — the PHQ-A is a self-report instrument that the adolescent completes themselves. The validated approach is for the teen to answer based on their own experience, not for a parent to answer for them. Parents and guardians play a critical role around interpretation and next steps, including helping the teen connect with a clinician.
Is the PHQ-A free to use?
Yes. The PHQ family of screeners is in the public domain. “No permission is required to reproduce, translate, display or distribute” the instruments. They were developed by Spitzer, Williams, and Kroenke at Columbia University with an educational grant from Pfizer Inc..
Does the PHQ-A diagnose depression?
No. The PHQ-A is a screening tool, not a diagnosis. A positive score indicates the need for clinical evaluation. Only a qualified clinician can diagnose depression by taking the full history, ruling out physical causes, and conducting a psychological evaluation.
What if my teen scores high on item 9?
Any non-zero response to item 9 warrants immediate clinical follow-up regardless of the total score. Contact your teen’s pediatrician or mental health clinician. For 24/7 support, call or text 988 or chat at 988lifeline.org/chat/.
Is the PHQ-A a suicide screener?
No. The U.S. Preventive Services Task Force concluded in 2022 that there is insufficient evidence (Grade I) to recommend routine suicide-risk screening in children and adolescents using any current instrument. Item 9 is a safety surface that helps surface concerning thoughts. It is not a validated suicide-risk screener on its own.
What age range is the PHQ-A for?
The PHQ-A is used across adolescence. Validation cohorts range from 13–17 (Richardson 2010) to broader primary care samples. The USPSTF recommends depression screening for adolescents aged 12–18 (Grade B) and notes insufficient evidence for children 11 and younger (Grade I). MedlinePlus uses the 13–17 teen band.