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

• The findings indicate that the screening tools that we assessed possess high validity and reliability for the assessment of depression symptoms. • Many of the assessed self-administered screening tools (n=5) are robust in diverse clinical and cultural settings and produce valid and reproducible scores of symptoms of depression. • There was high heterogeneity between the accuracy, validity and reliability of the 9 assessed rating scales and there is a moderate risk of bias for all of the assessed scales. • This review has particular applicability to researchers in low- and middle-income countries (LMICs) who have a paucity of validated screening tools for their local environments. Local adaptation and validity testing may be helpful to ensure that the screening tools remain adequately reliable and efficient in new environments. 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 24069 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.