Investigating the psychometric properties of the Patient Health Questionnaire for Adolescents (PHQ-A) and Center for Epidemiologic Studies - Depression Scale for Children (CES-DC) among young adolescents in South Africa.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Psychometrics*/methods ; Depression*/diagnosis ; Depression*/epidemiology ; Depression*/psychology ; Patient Health Questionnaire*; Humans ; Adolescent ; South Africa/epidemiology ; Female ; Male ; Child ; Reproducibility of Results ; Surveys and Questionnaires ; Mass Screening ; Psychiatric Status Rating Scales

Depression among adolescents is a global concern, including in South Africa, emphasizing the need for reliable screening tools. While the the Patient Health Questionnaire Adolescent (PHQ-A) and Center for Epidemiologic Studies - Depression Scale for Children (CES-DC) are commonly used mental health screening tools among adolescents, their psychometric properties in South Africa are not well-studied. This study aims to fill this gap by examining the psychometric properties of the PHQ-A and CES-DC among adolescents aged 10-14-year-olds in South Africa. First, a sample of 42 adolescents aged 10-14 years were recruited to participate in cognitive testing focus groups to determine their comprehension of the depression screening tool items. Secondly, a sample of 500 adolescents from 10 schools completed a tablet-based survey including socio-demographic information and the adapted depression screening tools. A subset of 123 adolescents underwent clinical diagnostic interview with the MINI-KID depression modules only. After two weeks, a subset of 145 adolescents had the initial tablet-based survey re-administered for test-retest reliability. Criterion validity was examined using ROC analysis, with the MINI-KID as the reference standard. Of the 500 adolescents surveyed, the majority were female (59.2%), with an average age of 12 years (SD = 1.42). The PHQ-A demonstrated good internal consistency (alpha = 0.82) and moderate test-retest reliability (ICC = 0.56). The CES-DC showed good internal consistency (alpha = 0.86) and moderate test-retest reliability (ICC = 0.68). The PHQ-A displayed good sensitivity (85.7%) and specificity (61.8%). Youden's index indicated 7.5 as the ideal cutoff score for the PHQ-A. The CES-DC has a sensitivity of 95.2% and specificity of 56.9% and Youden's index of 21. Factor structure for the PHQ-A included one factor loading for 9 items and 3 factor loading for 8 items; while for the CES-DC factor structure consisted of o three factor loadings. The findings show good psychometric properties of the PHQ-A and CES-DC and contributes to the limited research on mental health assessment tools for younger adolescents in Africa. Testing the psychometric properties of the PHQ-A and CES-DC for this population could help improve early detection and intervention for mental health conditions.
(Copyright: © 2025 Mkhize et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The authors have declared that no competing interests exist.

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Date Created: 20251117 Date Completed: 20251117 Latest Revision: 20251123

20251123

PMC12622798

10.1371/journal.pone.0334658

41248167