Previously submitted to: JMIR Mental Health (no longer under consideration since Jul 18, 2025)
Date Submitted: Jul 17, 2025
Open Peer Review Period: Jul 18, 2025 - Jul 18, 2025
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Mental Health Screening Tools for Anxiety and Depression in Post-Secondary Students: A Literature Review to Inform Digital Intervention Development
ABSTRACT
Background:
Post-secondary students experience increasingly high rates of mental health challenges. Evidence-supported digital mental health interventions (DMHIs) could form part of an integrated, sustainable prevention and early intervention approach suited for university students. Screening tools like the two- and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9) and the two- and seven-item Generalized Anxiety Disorder questionnaire (GAD-2, GAD-7) could inform individualized signposting to appropriate support resources and services, yet their validation has been largely in general adult populations, raising concerns about their suitability in post-secondary student contexts.
Objective:
To bridge this gap, this literature review aims to summarize the psychometric properties of commonly used screening tools, particularly the PHQ-9, PHQ-2, GAD-7, and GAD-2, across student and general adult populations. Proper use and population specific screening thresholds are critical to develop evidence-based DMHIs that accurately assess, monitor, visualize, and respond to student mental health challenges.
Methods:
Following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, a search of peer-reviewed literature across PubMed, Web of Science, and PsychINFO yielded 82 studies, 49 of which were selected for data extraction and analysis. Studies were clustered into Group 1 (student populations) and Group 2 (general adult populations). This review extracted optimal screening thresholds along with sensitivity, specificity, area under the curve, and predictive values.
Results:
Psychometric properties varied between student and general adult samples. Among students, GAD-2 showed the highest sensitivity (94.2%) and highest specificity (85.2%), while PHQ-2 demonstrated weaker specificity (66.5%). Optimal screening thresholds for student populations were generally equal or lower than those used in general adult settings, especially for the GAD-7 (cut-off: 6 vs. 10). Missing and inconsistent reporting on ethnicity and gender differences limited equity-oriented analysis.
Conclusions:
Applying general adult screening thresholds may compromise accuracy and care equity in student populations. Student-calibrated screening thresholds are important to improve screening precision for DMHI utility and effectiveness.
Citation
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