Free PHQ-A — Adolescent Depression Self-Check

Your PHQ-A score in context

The PHQ-A is a snapshot of how the past two weeks have felt across thirteen specific items, not a fixed measurement of who you are as a person or what your future looks like. Adolescent mental health is dynamic — mood, sleep, identity, relationships, family dynamics, school context, and physiological development all shift across weeks and months, and screens like the PHQ-A move with them. A score on a single administration tells you about the past two weeks; a pattern across serial administrations tells you about a trajectory. GLAD-PC recommends repeat screening in the standard well-visit cadence (annually for adolescents in pediatric primary care, more often for adolescents in active treatment for depression) because the trajectory matters more than any single number.

One important distinction: items 1–9 are the only items that contribute to the scored total. Items 10–13 are deliberately scored separately. Item 10 (past-year depressed mood) screens for dysthymia or persistent depressive disorder — a separate condition from major depression that the items-1–9 total does not capture cleanly because the recall window differs (two weeks for items 1–9, one year for item 10). Item 11 (functional impairment) captures how much the items are interfering with day-to-day life and is often more useful for tracking progress over time than the items-1–9 total alone. Items 12 (recent serious ideation) and 13 (lifetime attempt) are the GLAD-PC safety items — per the GLAD-PC scoring rule, any endorsement of either is treated as a positive screen on its own, independent of the items-1–9 score. That rule exists because the items-1–9 total alone can miss the safety picture: an adolescent with low overall mood symptoms but recent serious ideation or a prior attempt is at elevated risk regardless of what the total looks like.

On the items-1–9 cutoffs: the Kroenke 2001 PHQ-9 cutoffs (0–4 minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe) were originally validated in adults. GLAD-PC found that these cutoffs perform at clinically meaningful sensitivity and specificity in adolescents too — re-calibration was not needed. The cutoffs are widely used in adolescent pediatric primary care, in school-based health, and in adolescent mental-health research. GLAD-PC identifies 10 as the threshold above which clinical evaluation and active treatment planning are typically recommended in primary care, rather than the watchful-waiting approach used at lower scores. 15+ typically prompts consideration of pharmacotherapy alongside psychotherapy; 20+ typically prompts prompt evaluation and explicit safety planning.

When you retake the PHQ-A, the change is often more informative than any single number. The PHQ-9 does not have a formally established minimum clinically important difference in adolescents; the adult literature cites approximately a 5-point change as clinically meaningful and this is generally treated as inheritable pending more adolescent-specific evidence. Progress is best described in terms of band shift (severe → moderately severe → moderate → mild → minimal) or sustained directional change across several administrations rather than a fixed point-change threshold. If you are working with a clinician, they will typically look at PHQ-A scores across multiple administrations rather than making decisions off a single result.

How to bring this to a clinician — and to a parent or guardian

The PHQ-A is the standard adolescent depression screen in pediatric primary care and is recommended by GLAD-PC, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry. Most pediatricians, family physicians, adolescent-medicine specialists, and adolescent therapists will recognize it by name or by format. You do not need to explain the instrument in detail; bringing the score gives the conversation a concrete starting point that descriptions of how you've been feeling can otherwise lack.

A note about telling a parent or guardian first: adolescent treatment usually involves a parent for consent, logistics (transportation, payment, scheduling), and often clinically (family-based interventions improve outcomes). Telling a parent can be the hardest single step of this process, particularly when the depression itself makes everything feel harder than it should be, when family dynamics are part of what's been hard, or when family acceptance of identity (sexuality, gender, faith, values) is uncertain. A few framings that other teens have found useful: "I took a screen for depression and the score said I should talk to a doctor — can you help me set that up?"; "I've been having a hard time for a while and I want to talk to a counselor or doctor about it"; "I'm not in immediate danger but I want some help." If telling a parent feels unsafe — particularly around LGBTQ+ identity in a non-affirming family — a school counselor, a relative, a coach, or a trusted teacher can help bridge that conversation, and the Trevor Project (1-866-488-7386) specifically supports LGBTQ+ teens in this situation.

What to bring to the clinical appointment:

• The items 1–9 total (0–27)
• The items 10–13 answers — particularly any answer above the lowest on items 12 or 13
• Which items felt heaviest — the pattern often tells a clinician about whether the picture is more about mood (items 1, 2), sleep (item 3), energy and fatigue (items 4, 5), self-worth (item 6), school and concentration (item 7), psychomotor (item 8), or safety (items 9, 12, 13)
• How long the picture at this level has been present (best guess in weeks) — adolescent depression can be acute or chronic, and the timing matters
• Items 9, 12, and 13 specifically — be ready to talk about them directly. Clinicians at this band ask explicitly; preparing yourself to answer is reasonable
• Any history of self-harm behaviors (cutting, burning, hitting yourself, scratching to the point of injury) — distinct from suicidal thoughts but worth raising
• Personal or family history of mood, anxiety, ADHD, eating, OCD, bipolar, or psychotic disorders — particularly bipolar disorder, because adolescent mood episodes can present as depression and later shift, and the treatment plan differs
• Any trauma — bullying, harassment, family conflict, violence, sexual harm, peer loss, family rejection around identity. These are common in adolescents and warrant explicit attention regardless of the PHQ-A band
• School context (attendance, grades, friendships, any 504 plan or IEP)
• Substance use — including alcohol, cannabis, vaping/nicotine, prescription medications you're not prescribed, and anything else
• Online environment — social media use, online harassment or bullying, content that's been hard to put down
• What support you currently have (parents, siblings, friends, mentors, coaches, online community) and what you specifically need help with
• Any current psychiatric medication — do not stop or change without a clinical conversation

A short opening you can use as-is:

I took the PHQ-A at home and scored [X] on items 1–9 (the PHQ-9 part), which is in the [band] range. I also answered [your item 12 / 13 answers]. The items that felt heaviest were [item descriptions]. I'd like to talk about what to do next.

A pediatrician or adolescent-medicine clinician will commonly follow up by taking a structured adolescent mental-health history, screening for conditions the PHQ-A does not directly capture (anxiety, ADHD, eating disorders, trauma, substance use), assessing impact on school, peer, and family functioning, discussing items 9, 12, and 13 specifically, and in some cases building or updating a safety plan with you. They may also check labs (TSH, free T4, CBC, vitamin D, mononucleosis if relevant) and review any current medications. Treatment options will be discussed and individualized; first-line treatment for adolescent depression at moderate or higher severity typically includes psychotherapy (CBT and IPT-A have strong adolescent-specific evidence) and, in many cases, pharmacotherapy (fluoxetine and escitalopram are the two adolescent-FDA-approved SSRIs for major depression). You can print this page or save it as PDF using your browser's print menu — the result, score, and item pattern all carry through.

If you're reading this with a teen or young adult in your life

If you are a parent, guardian, relative, sibling, friend, coach, teacher, school counselor, or other support person reading this result alongside a teen, this section is addressed to you. Adolescent mental-health symptoms are often carried quietly — by the time someone takes a PHQ-A, they may have been managing the picture for weeks or months without making it fully visible to the people around them. Adolescent developmental norms around privacy, autonomy, and peer-orientation make it especially hard for teens to describe depression to adults. The score gives you a concrete starting point for a conversation that can otherwise be hard to begin. Ask them directly what they want from you before drawing your own conclusions from the number.

Three things that consistently help: showing up steady and present, without trying to fix the whole picture in one conversation. Adolescent depression does not respond to "snap out of it," "every teenager feels this way," "you have so much to be happy about," or "have you tried [obvious wellness suggestion]" even when those statements are well-intentioned; they tend to land as dismissive of the actual lived experience and they teach the teen that talking honestly leads to being misunderstood. Practical help with the logistics that depression has made harder — making the doctor appointment, driving them there, taking on some household tasks that have backed up, advocating with the school for an accommodation, sitting with them while they reach out to a friend or a counselor — often meets the moment in a way words cannot, because depression directly compresses the daily capacity that being a teen demands. And asking calmly what kind of support feels most useful right now: a quiet presence, help thinking through a specific decision, going somewhere together, just knowing you are available.

Three things that tend not to help: minimizing the picture ("all teens are like this," "hormones will settle," "it'll pass") — adolescent depression at PHQ-A items-1–9 totals above 10 is not a developmental phase, and the GLAD-PC guidelines exist precisely because it does not reliably remit on its own; offering have-you-tried suggestions for routines, supplements, apps, or sleep tricks the teen has almost certainly already considered or tried; and pressing them to make big decisions about school, social life, identity, or the future in the moment, when capacity is already compressed by the depression itself. Most teens in the moderate-or-higher PHQ-A band have spent considerable mental energy on their own picture; the help that lands tends to be smaller, more concrete, more present, and less prescriptive than the help that tries to fix the whole picture.

Things you may have noticed that the teen cannot self-observe or self-name: changes in eating, sleeping (sleeping much more or much less), screen-time patterns or withdrawal from contact, irritability or rage that feels disproportionate, expressions of hopelessness or worthlessness in passing, changes in friendships, dropping grades or school absences, loss of interest in things that used to matter, new or returning self-harm marks, changes in substance use, changes in online behavior. These are valuable observations precisely because they are hard to self-track during adolescent depression. Sharing them — calmly, factually, not as an accusation or as a diagnosis — with the teen and, if possible, with their clinician shortens the path to a useful conversation. Be aware that adolescent depression often presents as irritability rather than sadness, particularly in family contexts, which is one of the most commonly missed presentations.

One situation calls for specific care: if they mention thoughts of self-harm or ending their life — even passively (not wanting to be here, wishing they could just stop, thoughts that people would be better off without them) — that is information to take seriously rather than redirect away from. Suicide is one of the leading causes of death in US adolescents (CDC 2022 ranked it second for ages 10–14 and third for ages 15–24); crisis lines for teens exist precisely because this is a known clinical reality. The most useful response is to stay calm, ask gently whether they have any specific plans or means (asking about it does not put the idea in their head — that is a well-documented myth in adolescent mental-health research), and help them connect with support today: suggest they call or text 988 (US Suicide and Crisis Lifeline) or text HOME to 741741 (Crisis Text Line — used heavily by teens) while you sit with them, or call 1-866-488-7386 (the Trevor Project — 24/7, LGBTQ+ youth specific). If they have any access to lethal means at home (firearms, medications, anything else), means-restriction counseling is one of the highest-leverage safety interventions in adolescent depression — temporarily securing or removing those means saves lives, and pediatricians and emergency departments can help guide this. If they feel unsafe or you feel they may not stay safe in the next hours, an emergency department visit is appropriate.

If the picture has reached a point where it's meaningfully compressing daily life — school attendance dropping, basic self-care slipping, friendships compressed, expressions of hopelessness, sleep severely disrupted, eating significantly shifted — helping schedule and keep the first clinical appointment is one of the most concrete, high-leverage things you can do. Getting to the room (or to the telehealth visit) is often the hardest single step in adolescent depression, because the depression itself compresses the bandwidth required to handle logistics. The PHQ-A items-1–9 thresholds at 10 (moderate), 15 (moderately severe), and 20 (severe) are GLAD-PC clinical decision points and warrant prompt clinical contact regardless of how the teen feels in the moment.

One last note for LGBTQ+ teens and the adults supporting them: family acceptance is one of the strongest protective factors in queer and trans adolescent mental health. Family rejection is one of the strongest risk factors. If sexuality, gender, or identity is part of what's been hard, the Trevor Project (1-866-488-7386, text START to 678678) specializes in this and the resources at thetrevorproject.org for both teens and supportive adults are excellent.

Other screens you might also take

The PHQ-A is an adolescent-specific depression screen — a focused 13-item view calibrated to detect adolescent depression while explicitly addressing safety. Several patterns commonly co-occur with elevated PHQ-A scores, and a more targeted second screen often clarifies the larger picture. The screens below are working tools that pair naturally with the PHQ-A for context, not as replacements.