Original articleThe patient health questionnaire for adolescents: Validation of an instrument for the assessment of mental disorders among adolescent primary care patients
Section snippets
Development of the PHQ-A
The two components of the original PRIME-MD (the patient questionnaire and the clinical evaluation guide) were combined into a 6-page, 67-item questionnaire that can be entirely self-administered by the patient in 5 minutes or less. The clinician scans the completed questionnaire and applies diagnostic algorithms that are printed in abbreviated form at the bottom of each page. In this study, the data from the PHQ-A were entered into a computer program that applied the diagnostic algorithms
Research questions
The present study investigated the validity of the PHQ-A in a multisite sample of adolescent patients in a range of primary care settings, by focusing on the following questions: (a) “Are diagnoses made with the PHQ-A as accurate as diagnoses made with the original PRIME-MD interview, using independent diagnoses made by mental health professionals (MHPs) as the criterion standard?”; (b) “Is the prevalence of mental disorders identified using the PHQ-A comparable to that obtained from MHP
Sample
The sample consisted of 403 English-speaking adolescent primary care patients (36.7% male, 63.3% female) between the ages of 13 and 18 years (mean age = 15.90 years, SD =1.24) who showed no evidence of mental retardation or organic mental disorder and had at least 9 years of education. The composition of the sample was 77.2% white, 4.2% African-American, 12.4% Hispanic, 2.2% Asian or Pacific Islander, 1.5% Native American and 2.2% Other. A total of 254 participants were recruited from the
Diagnostic results of PHQ-A evaluations
As Table 1 indicates, 20.8% of the participants were diagnosed with psychiatric disorders using the PHQ-A, while 19.6% of the participants were diagnosed with psychiatric disorders by the mental health professionals. Thirty-three patients (8.2%) were diagnosed with one psychiatric disorder, while 51 (12.7%) were diagnosed with two or more disorders. There were 16 co-occurring anxiety and depressive disorders, 12 co-occurring depressive and substance use disorders, 3 cases with depressive
Discussion
The present findings indicate that the diagnostic validity of the PHQ-A is comparable to that of the original PRIME-MD interview and the adult PHQ. The diagnostic validity of the PHQ-A was demonstrated by agreement with an independent interview by a mental health professional (criterion validity) and by the association of PHQ-A diagnoses with indices of impaired functioning, distress, and poor health (construct validity). Compared with the findings of the MHP interview, the PHQ-A demonstrated
Acknowledgements
This research was supported by a grant from the Aaron Diamond Foundation to Jeffrey G. Johnson, Ph.D. and grants from the Hibbard E. Williams Research Fund, University of California, Davis School of Medicine to Emily S. Harris, M.D. The development of the PHQ was underwritten by an educational grant from Pfizer US Pharmaceuticals, Inc., New York, NY. PRIME-MD is a trademark of Pfizer Inc. Copyright held by Pfizer Inc.
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