The PHQ-A is the PHQ-9 modified for teens 11 to 17. A teen rates nine symptoms over the past two weeks, for a total from 0 to 27 with the same bands as the PHQ-9, then answers extra questions on the past year, daily life, and suicide. See how to score it, what each band means, and what to do when a safety question is positive, then record the result with the free template. The official form comes free in the GLAD-PC toolkit.
PHQ-A result template
FreePHQ-A TEEN DEPRESSION SCREEN Date: [Date] Teen: [Name or ID; age in years, 11 to 17] Visit: [Annual check-up, sports physical, acute visit, or follow-up of known depression] Setting: [Clinic, school-based health center, or telehealth] HOW IT WAS DONE Form: [Paper, tablet, or portal; language of the form] Completed by: [Teen alone, or read aloud by staff; interpreter if used] Time alone with the teen: [Yes or no; who stepped out of the room] Confidentiality explained: [What stays private, and that safety concerns are shared] SCORE Items 1 to 9: [Score for each item, 0 to 3] Total: [0 to 27; cutoff used, 10 or 11] Severity: [None or minimal, mild, moderate, moderately severe, or severe] Past year, sad most days: [Yes or no] Difficulty with school, home, or friends: [Not difficult at all, somewhat, very, or extremely difficult] SAFETY QUESTIONS Item 9: [Score 0 to 3] Serious thoughts of ending their life, past month: [Yes or no] Suicide attempt, ever: [Yes or no; when and how, if known] Same-day assessment: [Who did it; ideation, plan, intent, self-harm, access to means, protective factors; or not needed] Risk level: [Low, moderate, or high, with the reasoning] TALKING WITH THE TEEN In their own words: [What the teen said about mood, sleep, school, friends, and home] Psychosocial history: [HEEADSSS findings that bear on mood, such as bullying, substance use, or conflict at home] Other causes considered: [Substance use, thyroid, sleep, grief, trauma, past mania] Impression: [Working diagnosis or screen result] PARENT OR CAREGIVER Involved: [Who, and what was shared with the teen's agreement] Home safety steps: [Firearms locked or stored away, medicines locked up, who will check in] PLAN Decision: [Watch and rescreen, therapy, medication, or urgent mental health assessment] Safety plan: [Written with the teen and given to them, or not needed] Crisis contacts: [988 by call or text, and local services] Follow-up: [Date, and when the PHQ-A will be repeated] Clinician: [Name, credentials]
Use it for
Teens answer more openly when they fill in the form alone, after you explain what stays private.
Avoid: Handing the form to the parent to fill in, or letting the teen answer with a parent reading over their shoulder.
Add the nine symptom items, each 0 to 3, for a total from 0 to 27. Then read the four questions below them on their own.
Avoid: Scoring the PHQ-A only as a number. The safety answers matter more than the total.
Item 9 and the two extra suicide questions each need a same-day interview if positive, whatever the total.
Avoid: Letting the teen leave before the clinician has seen the safety answers. Check them while the teen is still in the room.
The band gives the likely severity. The interview with the teen, and a parent where possible, confirms it.
Avoid: Diagnosing depression from the total, or ruling it out because the teen seems cheerful in the room.
Repeat the PHQ-A at each follow-up visit to see whether support or treatment is working.
Each one follows the recording template. Use them to judge how much to write.
Pediatric practice, annual check-up, form filled in on a tablet while her mother waited outside
15-year-old girl. English form on a tablet, filled in alone. Confidentiality and its safety limit explained to her and her mother together before her mother stepped out.
Items 1 to 9: 2, 2, 2, 1, 2, 2, 1, 0, 1. Total 13, moderate, above the practice cutoff of 10. Past year sad most days: no. Difficulty: very difficult. Mood and interest both at 2, with six positive symptoms counting item 9.
Item 9: 1, several days. Serious thoughts of ending her life in the past month: no. Attempt ever: no. Same-day assessment by the pediatrician: some nights she wishes she could fall asleep and not wake up. No plan, intent, self-harm, or past attempts. Her father keeps a hunting rifle in a locked safe; prescription pain pills from her mother’s surgery are in the bathroom cabinet. Protective factors: close to her older sister, plays in the school band, wants to study nursing. Risk level: low, passive thoughts with no plan or intent.
Low and snappy since a breakup and a falling-out with her friend group in August. Sleeps poorly, skips lunch, and her grades have dropped from As to Cs. Drinks at parties about once a month; no other substance use. No past episodes of mania, no family history of bipolar disorder. Impression: major depressive disorder, single episode, moderate.
With her agreement, her mother joined at the end. Shared that she is depressed, that she has had passive thoughts, and the safety plan; the details about her friends stayed private. Her mother will move the rifle to her uncle’s house this week and lock up the pain pills tonight.
Safety plan written with her, with her sister and 988 as contacts. Referral to the practice’s behavioral health clinician for CBT, first session booked for next week. Discussed an SSRI; she wants to try therapy first. Phone check-in in 1 week, visit and repeat PHQ-A in 4 weeks; return sooner if her thoughts change.
School-based health center, visit for headaches, on a paper form
13-year-old boy in grade 8, seen for headaches twice a week since September. Paper form in English, filled in alone in the exam room. His father joined by phone at the start and the end.
Items 1 to 9: 1, 1, 2, 0, 1, 0, 1, 0, 0. Total 6, mild, below the cutoff. Past year sad most days: no. Difficulty: somewhat difficult.
Item 9: 0. Serious thoughts of ending his life in the past month: no. Attempt ever: no. Same-day assessment not needed.
Moved here in the summer and misses his old friends. On his phone in bed until about 1 a.m. on school nights, so he sleeps about 6 hours; the headaches come on in the afternoon. Still plays basketball on weekends and enjoys it. No substance use, no bullying. Neurological exam normal. Impression: mild depressive symptoms with an adjustment to the move, and tension-type headaches linked to short sleep.
With his agreement, shared the sleep plan and the headache diary with his father, and that his mood is a little low after the move. His father will charge the phone in the kitchen overnight.
Watch and support: phone out of the bedroom, lights out by 10:30, and a try-out for the school basketball team. With his agreement, a check-in with the school counselor. Headache diary for 4 weeks. Repeat PHQ-A at the visit in 6 weeks; come back sooner if his mood drops or the headaches get worse.
Teens often hold back with a parent beside them. Give them time alone with the form, after explaining what stays private.
The two extra suicide questions can be positive when item 9 is 0. A past attempt, years ago, still needs the same-day interview.
Only items 1 to 9 count. The past-year, difficulty, and suicide questions are read on their own.
A teen who scores high on irritability and low on sadness can still be depressed. Read the item scores, not only the total.
Share what keeps the teen safe and what they agree to, and tell them first. Leaving the parent out when the risk is real puts the safety plan at risk.
Vero Scribe records the PHQ-A result in your template from the visit, with consent, or from your dictation: the total, the safety questions, what the teen agreed to share, and the plan. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
Each of the nine symptom items scores 0 to 3, by how often it happened in the past two weeks. Add them for a total from 0 to 27. The four questions below the items, on the past year, daily difficulty, and suicide, are not added; read each on its own.
The bands are 0 to 4 none or minimal, 5 to 9 mild, 10 to 14 moderate, 15 to 19 moderately severe, and 20 to 27 severe. Many clinics use 10 or more as a positive screen, and a 2010 study in teens found 11 or more gave the best balance. The diagnosis comes from an interview with the teen.
Item 9 above 0, or a yes to the past-month or lifetime suicide question, needs a clinical interview the same day, before the teen leaves. Ask about thoughts, plans, intent, self-harm, past attempts, and access to firearms and medicines. Write a safety plan with the teen and involve a parent in keeping them safe. The 988 crisis line takes calls and texts.
The PHQ-A keeps the PHQ-9’s nine symptoms, scoring, and bands, with wording changed for teens: irritability is added to the mood item, schoolwork to the concentration item, and weight loss to the appetite item. It also adds a question on feeling sad most days in the past year and two suicide questions, one on the past month and one on any attempt ever.
The form is for teens 11 to 17. From 18, use the adult PHQ-9. GLAD-PC, the guidelines the form comes from, recommends screening every teen 12 and over for depression once a year.
Explain at the start that the answers stay between the teen and the clinician unless their safety is at risk. Share the result with a parent when the teen agrees, and whenever a safety concern means the parent needs to help, telling the teen first what you will share.
Front desk staff, nurses, or medical assistants can hand it out, and teens fill it in themselves. A clinician scores it, reads the safety answers before the teen leaves, and makes the diagnosis in an interview.
The GLAD-PC toolkit from The REACH Institute lists it among its free screens and gives it, with a scoring sheet, in English and 12 other languages. The toolkit is copyrighted, so get the form there and keep its attribution line. The recording template on this page is free to copy or download.
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The adult version, with all 9 questions and a scoring calculator.
The teen psychosocial interview that puts the PHQ-A result in context.
For a positive safety question: warning signs, people to call, and means out of reach.
Pediatric visit notes drafted from the visit, for your review.
Every tool, by area, with what its scores mean.
Vero records scores, findings, and plans in the templates you choose, so you review instead of type.
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