PHQ-A Scoring Guide · Adolescent Depression Screener

The PHQ-A depression screen is a 9-item questionnaire adapted from the PHQ-9 to screen for depression in adolescents.

Totals run 0–27, with no validated adolescent severity bands. Item 9 screens for suicidal ideation.

What does the PHQ-A measure?

The PHQ-A (Patient Health Questionnaire, Adolescent) depression screen is a 9-item self-report questionnaire adapted from the PHQ-9 for use with adolescents. It uses the same nine DSM criterion symptoms as the adult PHQ-9 with age-appropriate language and an additional question about functional impairment.

The name comes from the Patient Health Questionnaire for Adolescents, a self-administered tool that assesses anxiety, eating, mood and substance use disorders ^[1]. This page covers the 9-item depression screen. A separate study evaluated the standard adult PHQ-9 in adolescents ^[2].

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How do you give the PHQ-A?

Each of the 9 items asks how often the adolescent has been bothered by a symptom over the past 2 weeks, rated from 0 (Not at all) to 3 (Nearly every day). Total scores range from 0 to 27; higher scores indicate more depressive symptoms.

Item 9 asks specifically about thoughts of self-harm or suicide. Any positive response (score ≥1) requires immediate clinical attention regardless of total score.

How do you score and interpret the PHQ-A?

Sum the 9 items for a total of 0–27. No adolescent severity bands have been validated for the PHQ-A total in its cited sources.

• Original study. The PHQ-A was scored with diagnostic algorithms rather than score bands ^[1], and the adult PHQ-9 severity bands were not validated for this version.
• Nearest evidence. A cut point of 11 was optimal on the standard PHQ-9 in youth aged 13–17 ^[2] (see Psychometric properties).

Use the total to track change over time and as a prompt for clinical interview, not as a severity label.

Item 9 (suicidal ideation) always requires clinical review regardless of total score.

Item 9: suicidal ideation

Any positive response to Item 9 ("Thoughts that you would be better off dead or of hurting yourself in some way") requires immediate clinical evaluation, regardless of total score. Follow your organization's suicide risk protocol; in Canada and the US, 988 is the Suicide Crisis Helpline.

Psychometric properties

• Original PHQ-A. In 403 adolescents from primary care clinics and school nurses' offices in four US states, compared against a semi-structured clinical interview by psychologists blind to PHQ-A results, the PHQ-A showed satisfactory sensitivity, specificity, diagnostic agreement and overall diagnostic accuracy. Adolescents with PHQ-A diagnoses had significantly poorer functioning and overall health ^[1].
• PHQ-9 in adolescents. In 442 youth aged 13–17, compared against the DISC-IV structured interview, a score of 11 or more had a sensitivity of 89.5% and a specificity of 77.5% for major depression, with an area under the ROC curve of 0.88. The optimal cut point was higher among adolescents than in adults, with similar sensitivity and specificity ^[2].

Limitations

• Screening, not diagnosis. A positive screen calls for a clinical interview; the PHQ-A cannot diagnose depression on its own.
• Item 9 is not a risk assessment. Any endorsement requires a structured suicide risk evaluation, whatever the total score.
• Self-report. Adolescents may under- or over-report symptoms depending on privacy, who is present, and trust in the clinician.
• No validated severity bands. Adult PHQ-9 bands do not transfer automatically; in youth aged 13–17, a cut point of 11 was optimal on the standard PHQ-9, higher than in adults ^[2].
• Two meanings of "PHQ-A". The validated PHQ-A is a multi-disorder questionnaire ^[1]; evidence for the 9-item depression screen on its own is limited.

Billing the PHQ-A (CPT 96127)

PHQ-A administration qualifies for reimbursement under CPT code 96127 (brief emotional/behavioural assessment). Medicare's Medically Unlikely Edit caps 96127 at 4 units per date of service; commercial payer limits vary, so confirm your contract.

Each unit is one validated scale administered, scored and documented. When co-administered with SCARED or CRAFFT in the same encounter, each scale bills as a separate 96127 unit.