title: Screening for adolescents' internalizing symptoms in primary care:  item response theory analysis of the behavior health screen depression, anxiety, and suicidal risk scales.
abstract: OBJECTIVE
  To apply a modern psychometric approach to validate the Behavioral Health Screen (BHS) Depression, Anxiety, and Suicidal Risk Scales among adolescents in primary care.
  
  
  METHODS
  Psychometric analyses were conducted using data collected from 426 adolescents aged 12 to 21 years (mean = 15.8, SD = 2.2). Rasch-Masters partial credit models were fit to the data to determine whether items supported the comprehensive measurement of internalizing symptoms with minimal gaps and redundancies.
  
  
  RESULTS
  Scales were reduced to ensure that they measured singular dimensions of generalized anxiety, depressed affect, and suicidal risk both comprehensively and efficiently. Although gender bias was observed for some depression and anxiety items, differential item functioning did not impact overall subscale scores. Future revisions to the BHS should include additional items that assess low-level internalizing symptoms.
  
  
  CONCLUSIONS
  The BHS is an accurate and efficient tool for identifying adolescents with internalizing symptoms in primary care settings. Access to psychometrically sound and cost-effective behavioral health screening tools is essential for meeting the increasing demands for adolescent behavioral health screening in primary/ambulatory care.
authors.affiliation: Division of General Pediatrics, Department of Child and Adolescent Psychiatry, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA 19104-4399, USA. bevans@email.chop.edu
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Bevans
authors.forename: Guy
authors.initials: G
authors.lastname: Diamond
authors.forename: Suzanne
authors.initials: S
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis*; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards; D008603:Mental Health; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics / Q000295:instrumentation* / Q000592:standards; D012306:Risk; D012737:Sex Factors; D013405:Suicide / Q000523:psychology*; D055815:Young Adult