Published in PLOS One on 2025-11-17, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Mirriam Mkhize, Claire van der Westhuizen, Katherine Sorsdahl
Source: PLOS One • DOI 10.1371/journal.pone.0334658
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
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.
1. Introduction
The prevalence of mental health conditions among adolescents is high worldwide, particularly in Africa. Between 10% to 20% of adolescents experience a mental health condition [1,2], contributing 5% of disability-adjusted life years (DALYs) and represent a quarter of all years lived with disability (YLDs) among adolescents aged 10–19 [3]. Despite the limited prevalence research in Africa, reported prevalence of depression and anxiety ranges from 5% to 50% [4–9], but most studies focus on high-risk or older adolescents aged 15 and higher [6,7,10], with studies focusing on younger adolescents underrepresented Data from phase 1 of this study, a recent cross-sectional study of 621 adolescents aged 10–14 years in school settings in South Africa found that 33.5% reported experiencing symptoms of depression [11]. While these studies offer valuable insight into symptoms of depression and anxiety among this population, a major limitation is the use of tools that have not been assessed for reliability and validity within the context.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Mirriam Mkhize, Claire van der Westhuizen, Katherine Sorsdahl. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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