> ## Documentation Index
> Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt
> Use this file to discover all available pages before exploring further.
# PHQ-A — depression screening for teens
> The PHQ-9 adapted for adolescents 11-17, with an adolescent-specific cutoff and a built-in self-harm flag.
The PHQ-A is what you reach for when a teenage client walks in and you
want a quick, validated read on depression severity. It's the adolescent
version of the PHQ-9 — same nine symptom items, written for younger
clients, plus a functional-impairment question and four suicidality
items the adult PHQ-9 doesn't carry.
## What it measures
Nine DSM-aligned depression symptoms over the past two weeks (anhedonia,
mood, sleep, appetite, energy, self-worth, concentration, psychomotor
change, and suicidal ideation). The wording is adolescent-appropriate —
"feeling down, depressed, **irritable**, or hopeless" includes the
irritability presentation that's common in teens — and the prompts about
school work, family, and friends keep it grounded in a young client's
day-to-day.
A tenth item captures functional impairment ("how difficult have these
problems made it for you to do your work, take care of things at home,
or get along with other people"). Four more items ask directly about
past-month suicidal thoughts, lifetime attempts, past-year attempts, and
past-month attempts.
## When to use it
* Intake with any client ages 11-17 where depression is on the table
* Routine progress tracking through a course of treatment
* A check-in any time mood symptoms shift or a parent raises a concern
* Anywhere you'd use the PHQ-9 in an adult — this is the adolescent
equivalent
## How clients fill it out
Two to three minutes in-session, on the practitioner's device or the
client's phone. Quiet enough that you can read it aloud if a younger
client prefers, but most 13+ clients complete it independently.
## Scoring and severity cutoffs
Sum of items 1-9, range 0-27. The functional-impairment item and the
four suicidality items don't add to the depression total — they surface
separately.
| Total | Band |
| ----- | ----------------------------------------------------------- |
| 0-4 | Minimal |
| 5-9 | Mild |
| 10 | Approaching adolescent cutoff |
| 11-14 | Moderate — clinically significant depression in adolescents |
| 15-19 | Moderately severe |
| 20-27 | Severe |
**The adolescent cutoff is ≥11**, not the ≥10 used for adults. Richardson
et al. (2010) validated that the adolescent-specific threshold for
clinically significant depression sits one point higher.
**Item 9** (thoughts of being better off dead or hurting yourself) and
**items 11-14** (the suicidality probe) carry a sensitive flag.
Any endorsement triggers a separate signal regardless of the total
score — follow up clinically in the same session. A "minimal" total
with a positive Item 9 is still a clinical event.
## Tracking over time
The PHQ-A trends week-over-week the same way the PHQ-9 does for adults.
A drop of 5 or more points across sessions is a meaningful clinical
change. Use it to anchor the conversation about whether the treatment
plan is working, especially with a young client who may have trouble
articulating change in their own words.
## PHQ-A vs PHQ-9
Same nine symptoms, rewritten for adolescents, plus two items on
functional impairment and a direct question about serious thoughts of
ending life. The important difference is the threshold: the adolescent
cutoff is **11**, not the adult **10**, which came out of validation work
in adolescent primary care.
Use the PHQ-A for ages 11 to 17 and the
[PHQ-9](/clinical-templates/screening/phq-9) from 18. Running the adult
version with a fifteen-year-old will usually still detect depression, but
you'd be reading it against a threshold that wasn't set for them.
If anxiety or broader difficulties are also in the picture, the
[RCADS](/clinical-templates/child/rcads-parent) covers depression and five
anxiety disorders in one parent-report instrument, and the
[SDQ](/clinical-templates/child/sdq-self) gives a broad screen across
conduct, hyperactivity and peer relationships as well as mood.
## Is it free to use?
**Yes.** The PHQ-A falls under Pfizer's 2010 free-public release of the PHQ family.
## Citation
Johnson, J. G., Harris, E. S., Spitzer, R. L., & Williams, J. B. W.
(2002). The Patient Health Questionnaire for Adolescents: Validation of
an instrument for the assessment of mental disorders among adolescent
primary care patients. *Journal of Adolescent Health,* 30(3), 196-204.
Adolescent cutoff: Richardson, L. P., McCauley, E., Grossman, D. C.,
McCarty, C. A., Richards, J., Russo, J. E., Rockhill, C., & Katon, W.
(2010). Evaluation of the Patient Health Questionnaire-9 Item for
detecting major depression among adolescents. *Pediatrics,* 126(6),
1117-1123.
The PHQ family is copyright Pfizer Inc., released for free public use
without restriction.
## Related articles
The adult depression measure. Same structure, ≥10 cutoff, no
adolescent-specific wording.
Broader adolescent mental-health screen — emotional symptoms,
conduct, hyperactivity, peers, prosocial.
How sensitive items surface in the conversation and what to do with the
signal.