PHQ-A Scoring: PHQ-9 Modified for Teens Scorer and Guide

The GLAD-PC scoring sheet defines a positive answer as a 2 or 3 on items 1 to 8, or a 1, 2 or 3 on item 9, and says all positive answers should be followed up by interview. The scorer above lists the positive items so you can see which ones to follow up.

The sheet also says a total of 10 or more has a good sensitivity and specificity for major depressive disorder. Separately, a study of the standard PHQ-9 in 442 youth aged 13 to 17 found that a cut point of 11 or more worked best for detecting major depression (sensitivity 89.5%, specificity 77.5%). Neither threshold is a diagnosis: use the cut point your setting has adopted and name it in the note.

The sheet goes on to describe how the answers can support a diagnostic evaluation for major depressive disorder and for dysthymia, using the difficulty question and the past-year question. That evaluation is the clinician's, so the scorer does not apply it.

Item 9 asks about thoughts of death or self-harm, and two of the added questions ask about serious suicidal thoughts in the past month and suicide attempts at any time. The GLAD-PC scoring sheet says all positive answers to item 9 and to the two additional suicide items must be followed up by a clinical interview. Item 9 is added into the total, so a low total can still include a positive item 9, and the two added questions are not part of the total at all.

When any of them is positive, complete and document a suicide risk assessment under your setting's protocol, and record each answer on its own line. See how to document a C-SSRS screen for the structure, and where needed, build a safety plan with the client. The scorer shows a prompt as soon as one of these answers is positive. This page does not set out a triage procedure.

The scoring is the same: nine items scored 0 to 3, a total of 0 to 27, and cut points at 5, 10, 15 and 20. The differences are in the wording and the added questions. The toolkit says the GLAD-PC team modified the PHQ-9 to better represent adolescent depression by adding irritability and changing work to schoolwork, and added previously validated questions on suicide attempts and adolescent dysthymia. For adult clients, use the PHQ-9 scorer.

Choose the response the adolescent marked for each of the nine items. Each response is worth 0 (not at all), 1 (several days), 2 (more than half the days) or 3 (nearly every day). Once all nine are answered, the scorer shows the total out of 27, the severity band from the GLAD-PC scoring sheet, the positive items to follow up, and a plain sentence you can paste into the note and edit. You can also record the difficulty question and the three yes or no questions, which go into the sentence but never into the total.

The scorer follows the item order of the 2018 GLAD-PC form: interest or pleasure, low or irritable mood, sleep, energy, appetite, self-view, concentration, movement, and thoughts of death or self-harm. An earlier printing from the American Academy of Pediatrics (2010) lists the same nine items with low mood first and appetite before energy. Enter each answer under its matching topic: the total and the item 9 check are the same with either printing.

It does not show a total until every item is answered, because a partial sum is not a PHQ-A score. It is deterministic: the same answers always give the same result. It runs entirely in your browser, and nothing you enter is sent, stored or tracked. It is a screening aid, not a diagnosis.

The GLAD-PC guidelines, reprinted in the toolkit from Pediatrics (2018), recommend that adolescent patients ages 12 years and older be screened annually for depression with a formal self-report screening tool, on paper or electronically. They also remind clinicians to interview an adolescent alone. Your agency or payer may set its own schedule, and repeat administrations during treatment are usually set in the treatment plan, such as the depression treatment plan.

The PHQ instructions say all the measures in the PHQ family, including the PHQ-A, are in the public domain and that no permission is required to reproduce, translate, display or distribute them.

The PHQ-9 Modified for Teens is a GLAD-PC adaptation. Each page of the 2018 toolkit carries "© 2018 The REACH Institute" and says the form was modified with permission from the PHQ-9, the revised PHQ-A and the CDS, and the toolkit names a REACH Institute contact for permission for use. Download the form from the toolkit, and check with the REACH Institute before reprinting it. WellNotes does not reproduce the questions, and the scorer on this page uses short topic labels, not the item wording.