Level 2: Mid-level evidence

The United States Preventive Services Task Force (USPSTF) recommends (Grade B Recommendation) depression screening in adolescents aged 12-18 years when systems for diagnosis, treatment, and follow-up are in place (Pediatrics. 2009;123:1223-1228), but screening can be time-consuming. The Two-Question Patient Health Questionnaire (PHQ-2), which includes two questions from the nine-question PHQ-9, is a commonly used and highly sensitive instrument in adults and elderly patients (J Am Geriatr Soc. 2007;55:596-602). A recent cohort study with 2,291 patients aged 13-17 years suggests that it can also be helpful as an initial screening tool in adolescents. Patients were asked how often in the past two weeks they had experienced a depressed mood and how often they had a lack of pleasure in usual activities. The score ranged from 0 for “not at all” to 3 for “nearly every day.” A total score of ≥3 was considered a positive screening for depression and was found in 12% of the patients. A subgroup of 271 screened-positive and 228 screened-negative adolescents completed formal diagnostic interviews, and 19 participants met DSM-IV criteria for major depression. The PHQ-2 with a cutoff value of 3 points had 74% sensitivity, 75% specificity, 12% positive predictive value, and 99% negative predictive value for major depression (Pediatrics. 2010;125:e1097-1103).