Validation of the Thai Version of the Patient Health Questionnaire for Adolescents (PHQ-A) in adolescent psychiatric patients Validation of the Thai version of the PHQ-A

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Wimonwan Panyawong
Chosita Pavasuthipaisit
Rattanasak Santitadakul


A basic screening tool for depression for adolescents was insufficient in Thailand. Thus, Patient
Health Questionnaire for Adolescents (PHQ-A) was translated into Thai. This study aimed to examine
the psychometric properties of the Thai version of the PHQ-A. Samples were 11-20 year old patients
who attended 12 child and adolescent psychiatric clinics across Thailand. Of 272 adolescent patients,
172 patients had depression and 100 patients did not have depression. To evaluate criterion validity,
the PHQ-A scores were compared with the clinical diagnosis. Internal consistency and exploratory
factor analysis (EFA) were also conducted for item and factor analysis Convergent validity was calculated
from correlations between the PHQ-A and the Children’s Depression Inventory (CDI) and the Centre for
Epidemiologic Studies-Depression Scale (CES-D). The internal consistency coefficient of the Thai version
of the PHQ-A was 0.92. EFA suggested that one-factor structure of depressive symptoms was suitable
for the PHQ-A. The area under the curve of the PHQ-A total score against professional diagnosis was
0.88. The results indicated an optimal cut-off point with acceptable sensitivity and specificity of 8.
Moreover, the PHQ-A score of 10 was useful for differentiating between patients without depression and
those with moderate to severe major depressive disorder (MDD). Convergent validity was good with high
correlations for both the CDI and the CES-D (r=0.83 and 0.87, respectively). The Thai version of the
PHQ-A is a valid and reliable measurement. The tool is simple and easy to use for screening and monitoring
the severity of depressive symptoms in children and adolescents in both clinical and community

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How to Cite
Panyawong, W., Pavasuthipaisit, C., & Santitadakul, R. (2020). Validation of the Thai Version of the Patient Health Questionnaire for Adolescents (PHQ-A) in adolescent psychiatric patients: Validation of the Thai version of the PHQ-A. International Journal of Child Development and Mental Health, 8(1), 30–40. Retrieved from
Original Articles


Baranne, M. L., & Falissard, B. (2018). Global burden of mental disorders among children aged 5–14 years. Child and adolescent psychiatry and mental health, 12(1), 19.

Beard, C., Hsu, K., Rifkin, L., Busch, A., & Björgvinsson, T. (2016). Validation of the PHQ-9 in a psychiatric sample. Journal of Affective Disorders, 193, 267-273.

Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186-3191.

Bhatta, S., Champion, J. D., Young, C., & Loika, E. (2018). Outcomes of depression screening among adolescents accessing school-based pediatric primary care clinic services. Journal of Pediatric Nursing, 38, 8-14.

Birmaher, B., & Brent, D. (2007). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 46(11), 1503-1526.

Boothroyd, L., Dagnan, D., & Muncer, S. (2019). PHQ-9: One factor or two? Psychiatry Research, 271, 532-534.

Brown, A., Rice, S. M., Rickwood, D. J., & Parker, A. G. (2015). Systematic review of barriers and facilitators to accessing and engaging with mental health care among at-risk young people. Asia-Pacific Psychiatry, 8(1), 3-22.

Busner, J., & Targum, S. D. (2007). The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont), 4(7), 29-37.

Cappelli, M., Clulow, M. K., Goodman, J. T., Davidson, S. I., Feder, S. H., Baron, P., ... & McGrath, P. J. (1995). Identifying depressed and suicidal adolescents in a teen health clinic. Journal of Adolescent Health, 16(1), 64-70.

Charernboon, T. (2011). Measures and screening tests for depression in Thailand: A user’s guide. Thammasat Medical Journal, 11(4), 667-676. (In Thai)

Ekasawin, S., Phothisut, C., & Chomcheun, R. (2016). The prevalence of psychiatric disorders in Thai students aged 13-17 years. Journal of Mental Health of Thailand, 24(3), 141-153.

Ganguly, S., Samanta, M., Roy, P., Chatterjee, S., Kaplan, D. W., & Basu, B. (2013). Patient health questionnaire-9 as an effective tool for screening of depression among Indian adolescents. Journal of Adolescent Health, 52(5), 546-551.

Guo, B., Kaylor-Hughes, C., Garland, A., Nixon, N., Sweeney, T., Simpson, S., … Morriss, R. (2017). Factor structure and longitudinal measurement invariance of PHQ-9 for specialist mental health care patients with persistent major depressive disorder: Exploratory structural equation modelling. Journal of Affective Disorders, 219, 1-8.

Jirapramukpitak, T. (2017). Mental health gap and related economic burden: a longitudinal community survey. Retrieved from: (In Thai)

Johnson, J. G., Harris, E. S., Spitzer, R. L., & Williams, J. B. (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.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606-613.

Lewandowski, R. E., O’Connor, B., Bertagnolli, A., Beck, A., Tinoco, A., Gardner, W. P., ... & Brace, N. E. (2016). Screening for and diagnosis of depression among adolescents in a large health maintenance organization. Psychiatric Services, 67(6), 636-641.

Lotrakul, M., Sumrithe, S., & Saipanish, R. (2008). Reliability and validity of the Thai version of the PHQ-9. BMC psychiatry, 8(1), 46.

Manea, L., Gilbody, S., & McMillan, D. (2011). Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): A meta-analysis. Canadian Medical Association Journal, 184(3), E191-E196.

McDermott, B., Baigent, M., Chanen, A., Fraser, L., Graetz, B., Hayman, N., ... & Smalley, T. (2010). Clinical practice guidelines: Depression in adolescents and young adults. Melbourne: beyondblue: the national depression initiative.

National Collaborating Centre for Mental Health. (2005). Depression in children and young people: identification and management in primary, community and secondary care. In Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. Centre for Reviews and Dissemination (UK).

Naveed, S., Waqas, A., Memon, A.R., Jabeen, M., & Sheikh, M.H. (2019). Cross-cultural validation of the Urdu translation of the Patient Health Questionnaire for Adolescents among children and adolescents at a Pakistani school. Public Health, 168, 59-66.

Richardson, L. P., McCauley, E., Grossman, D. C., McCarty, C. A., Richards, J., Russo, J. E., … Katon, W. (2010). Evaluation of the patient health questionnaire-9 item for detecting major depression among adolescents. Pediatrics, 126(6), 1117-1123.

Siu, A. L. (2016). Screening for depression in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics, 137(3), e20154467

Trangkasombat, U. & Liknapichitkul, D. (1996). Depression in children: study by using the Children’s Depression Inventory. Journal of the Psychiatric Association of Thailand, 41, 221-230. (In Thai)

Trangkasombat, U., Larpboosarb, V., & Havanont, P. (1997). Using CES-D for screening depression in adolescents. Journal of the Psychiatric Association of Thailand, 42. (In Thai)

Udomratn, P. (2009). How Thailand has modified the section on mental disorders in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD‐10). Asia‐Pacific Psychiatry, 1(2), 88-89.

US Preventive Services Task Force. (2009). Screening and treatment for major depressive disorder in children and adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics, 123(4), 1223-1228.

Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., ... & Coggeshall, M. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1545-1602.

Williams, S. B., O'Connor, E. A., Eder, M., & Whitlock, E. P. (2009). Screening for child and adolescent depression in primary care settings: a systematic evidence review for the US Preventive Services Task Force. Pediatrics, 123(4), e716-e735.

Wongpiromsarn, Y., Wipulakorn, P., Nuanmanee, S., Woener, W., & Mongkol, A. (2011). Strengths and Diffi culties Questionnaire (SDQ) Thai improved version: change and administration. Journal of Mental Health of Thailand, 19(2), 128-134. (In Thai)

World Health Organization (WHO) (2014). Health for the world’s adolescents: a second chance in the second decade. Geneva: World Health Organization.

World Health Organization (WHO) (2016). International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). Retrieved from

World Health Organization (WHO) (2017a). Depression and other common mental disorders: global health estimates. Retrieved from

World Health Organization (WHO) (2017b). Mental health status of adolescents in south-east Asia: evidence for action. New Delhi: World Health Organization, Regional Office for South-East Asia. Retrieved from

Zhang, Y. L., Liang, W., Chen, Z. M., Zhang, H. M., Zhang, J. H., Weng, X. Q., ... & Zhang, Y. L. (2013). Validity and reliability of P atient H ealth Q uestionnaire‐9 and P atient H ealth Q uestionnaire‐2 to screen for depression among college students in C hina. Asia‐Pacific Psychiatry, 5(4), 268-275.