Validated self-administered screening tools to identify depression among young adults (18 to 25-years-old) in East Asia and the Pacific Region low-and-middle income countries (LMICs): A systematic review

Abstract

This systematic review evaluates the validity, reliability, and diagnostic accuracy of self-administered screening tools for symptoms of depression among young adults (18 to 25 years old) in East Asia and the Pacific. A total of 22 studies with 24,069 participants were included, covering both clinical and non-clinical populations. Nine self-administered screening tools were identified, with Patient Health Questionnaire-9 (PHQ-9), Patient Health Questionnaire-2 PHQ-2, and Centre for Epidemiological Studies Depression (CES-D) being the most frequently studied. PHQ-9 demonstrated moderate to excellent internal consistency reliability, with Cronbach’s alpha ranging from 0.67 to 0.92, and a pooled AUC of 0.86, indicating strong screening accuracy. PHQ-2, showed an Area Under the Curve (AUC) of 0.85, high sensitivity (0.96), and moderate specificity (0.80). CES-D exhibited an AUC of 0.87, good sensitivity (0.81), and specificity (0.78), with high heterogeneity (I² = 74.70 %–86.69 %). The meta-analysis revealed substantial variability in sensitivity and specificity across settings, with differences in study methodologies, cutoff scores, and reference standards contributing to high heterogeneity. Additionally, 95.5 % of studies had a moderate risk of bias in patient selection, affecting generalizability. Despite these limitations, PHQ-9, PHQ-2, and CES-D remain valuable tools for identifying symptoms of depression among young adults. The accessibility, ease of administration, and strong psychometric properties of these tests support their continued use in resource-limited settings, though standardization of methodologies and expanded regional validation are needed to improve screening accuracy and applicability