{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:31:20Z","timestamp":1785432680822,"version":"3.56.0"},"reference-count":69,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>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\u201314-year-olds in South Africa. First, a sample of 42 adolescents aged 10\u201314 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\u2009=\u20091.42). The PHQ-A demonstrated good internal consistency (alpha\u2009=\u20090.82) and moderate test-retest reliability (ICC\u2009=\u20090.56). The CES-DC showed good internal consistency (alpha\u2009=\u20090.86) and moderate test-retest reliability (ICC\u2009=\u20090.68). The PHQ-A displayed good sensitivity (85.7%) and specificity (61.8%). Youden\u2019s 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\u2019s 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.<\/jats:p>","DOI":"10.1371\/journal.pone.0334658","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T18:38:53Z","timestamp":1763404733000},"page":"e0334658","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Investigating the psychometric properties of the Patient Health Questionnaire for Adolescents (PHQ-A) and Center for Epidemiologic Studies - Depression Scale for Children (CES-DC) among young adolescents in South Africa"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6416-5395","authenticated-orcid":true,"given":"Mirriam","family":"Mkhize","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"van der Westhuizen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Sorsdahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"issue":"4","key":"pone.0334658.ref001","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232007","article-title":"Common mental disorders prevalence in adolescents: A systematic review and meta-analyses","volume":"15","author":"SA Silva","year":"2020","journal-title":"PLoS One"},{"issue":"9569","key":"pone.0334658.ref002","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1016\/S0140-6736(07)60368-7","article-title":"Mental health of young people: a global public-health challenge","volume":"369","author":"V Patel","year":"2007","journal-title":"Lancet"},{"issue":"7","key":"pone.0334658.ref003","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1017\/S0033291714002888","article-title":"A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth","volume":"45","author":"HE Erskine","year":"2015","journal-title":"Psychol Med"},{"issue":"1","key":"pone.0334658.ref004","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2989\/JCAMH.2008.20.1.6.491","article-title":"The prevalence of anxiety and depression symptoms and syndromes in Kenyan children and adolescents","volume":"20","author":"DM Ndetei","year":"2008","journal-title":"J Child Adolesc Ment Health"},{"key":"pone.0334658.ref005","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1472-698X-13-19","article-title":"Prevalence and risk factors of depression in childhood and adolescence as seen in four districts of North-Eastern Uganda","volume":"13","author":"E Kinyanda","year":"2013","journal-title":"BMC Int Health Hum Rights"},{"issue":"7","key":"pone.0334658.ref006","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1007\/s00127-018-1511-4","article-title":"Mental health problems and their association to violence and maltreatment in a nationally representative sample of Tanzanian secondary school students","volume":"53","author":"M Nkuba","year":"2018","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"pone.0334658.ref007","doi-asserted-by":"crossref","first-page":"152476","DOI":"10.1016\/j.comppsych.2024.152476","article-title":"An investigation into symptoms of depression and anxiety and emotion regulation among older adolescents from low-income settings in South Africa","volume":"132","author":"C Ward-Smith","year":"2024","journal-title":"Compr Psychiatry"},{"issue":"5","key":"pone.0334658.ref008","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1007\/s10826-019-01646-8","article-title":"Depression and Anxiety Symptoms, Social Support, and Demographic Factors Among Kenyan High School Students","volume":"29","author":"TL Osborn","year":"2019","journal-title":"J Child Fam Stud"},{"issue":"5","key":"pone.0334658.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0251689","article-title":"The prevalence of mental health problems in sub-Saharan adolescents: A systematic review","volume":"16","author":"A J\u00f6rns-Presentati","year":"2021","journal-title":"PLoS One"},{"key":"pone.0334658.ref010","unstructured":"Osborn TL, Venturo-Conerly KE, Wasil A, Schleider JL, Weisz J. 2019."},{"key":"pone.0334658.ref011","doi-asserted-by":"crossref","first-page":"152469","DOI":"10.1016\/j.comppsych.2024.152469","article-title":"Prevalence and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa","volume":"131","author":"M Mkhize","year":"2024","journal-title":"Compr Psychiatry"},{"key":"pone.0334658.ref012","unstructured":"WHO. 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