Internal consistency and test retest reliability.

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.

青少年抑郁是一项全球性公共卫生关切议题，在南非亦同样存在，这凸显了开发可靠抑郁筛查工具的迫切需求。患者健康问卷青少年版（Patient Health Questionnaire Adolescent, PHQ-A）与流调中心用儿童抑郁量表（Center for Epidemiologic Studies - Depression Scale for Children, CES-DC）是青少年群体中常用的心理健康筛查工具，但二者在南非人群中的心理测量学特征尚未得到充分研究。本研究旨在填补这一研究空白，针对南非10~14岁青少年群体，探究PHQ-A与CES-DC的心理测量学性能。首先，研究招募42名10~14岁青少年开展认知访谈焦点小组，以明确其对抑郁筛查工具条目内容的理解程度；其次，从10所学校招募500名青少年完成平板问卷调查，内容涵盖社会人口学信息与改编版抑郁筛查工具；随后，选取123名青少年仅接受MINI-KID抑郁模块的临床诊断访谈；两周后，对其中145名青少年再次施测初始平板问卷，以评估重测信度。本研究以MINI-KID为金标准，采用受试者工作特征（Receiver Operating Characteristic, ROC）曲线分析检验效标效度。在500名受访青少年中，女性占比59.2%，平均年龄为12岁（标准差SD=1.42）。PHQ-A展现出良好的内部一致性信度（克朗巴赫α系数=0.82）与中等程度的重测信度（组内相关系数Intraclass Correlation Coefficient, ICC=0.56）；CES-DC同样具备良好的内部一致性信度（α=0.86）与中等重测信度（ICC=0.68）。PHQ-A的灵敏度为85.7%，特异度为61.8%，尤登指数（Youden’s index）提示其理想截断值为7.5分；CES-DC的灵敏度为95.2%，特异度为56.9%，尤登指数为21。PHQ-A的因子结构包含1个覆盖9个条目的因子与3个覆盖8个条目的因子；而CES-DC的因子结构包含3个因子。本研究结果表明PHQ-A与CES-DC具备良好的心理测量学性能，为非洲年轻青少年心理健康评估工具的有限研究提供了有益补充。针对该人群开展PHQ-A与CES-DC的心理测量学特征验证，有助于提升精神疾病的早期识别与干预水平。