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Development of the Thai version of the Patient Health Questionnaire for Adolescents (PHQ-A)


                    Background  The Patient Health Questionnaire for Adolescents (PHQ-A) is a simple and

                    widely used as a basic screening for depression. This study aimed to develop the Thai version
                    of the PHQ-A and to determine reliability and validity of the Thai version of the PHQ-A.

                    Methods          Samples were 11-20 year-old patients who attended 12 child and adolescent
                    psychiatric clinics across Thailand. 272 adolescent patients consisted of 172 patients with
                    depressive disorder and 100 patients with no depressive disorder. To evaluate criterion

                    validity, the PHQ-A scores were compared with the clinical diagnosis by the certified child
                    and adolescent psychiatrists. Convergent validity were calculated from correlations between
                    the PHQ-A and the CDI or the CES-D. Internal consistency was also examined for reliability

                    and item analysis.

                    Results          The results illustrated satisfactory reliability and validity of the Thai version

                    of the PHQ-A. Internal consistency was excellent (Alpha coefficient = 0.92). Means of the PHQ-A
                    total score were gradually increased following severities of depressive disorder. ROC analysis
                    of the total score against professional diagnosis showed an area under curve of 0.88.

                    An optimal cut-off point with acceptable sensitivity and specificity was 8 (sensitivity 76%,
                    specificity 81%) . This study found that  the interval category of the PHQ-A score divided by
                    severity of depressive disorder (0-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately

                    severe, and ≥20 severe) was useful for differentiating patients without depression from
                    moderate to severe major depressive disorder (MDD). However, this study found scattered
                    total scores among patients with mild MDD and other depressive disorder. Convergent

                    validity was also good with high correlations for both the CDI and the CES-D (r=0.83 and 0.87,

                    Conclusions  The Thai version of the PHQ-A was proven to be a simple and validated
                    depression questionnaire specifically for adolescent group (11-20 years old). It is suitable

                    for not only screening, but also monitoring severity of depression. The tool can be used in
                    variety of setting including clinic, school, and community settings.

                    Key words: depression, adolescents, screening, PHQ-A

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