Identifying clinically relevant anhedonia in young people aged 16–25: a provisional screening threshold for the Anhedonia Scale for Adolescents

BackgroundAnhedonia is a core symptom of depression and is associated with greater illness severity and poorer outcomes in young people. The Anhedonia Scale for Adolescents (ASA) is a validated 14-item multidimensional measure, but no empirically derived screening threshold exists for the original English-language scale.AimsTo derive a provisional ASA screening threshold in older adolescents and young adults.MethodIn 1199 participants aged 16–25 years recruited in the UK, receiver operating characteristic (ROC) analyses evaluated the ASA against three reference criteria: depressive symptom caseness (Mood and Feelings Questionnaire [MFQ] ≥27), self-reported clinician diagnosis of depression (n = 709) and anhedonia caseness on the Snaith–Hamilton Pleasure Scale (SHAPS; n = 433). Optimal thresholds were identified using the Youden index, and performance was compared across age groups and gender and in a 5-month follow-up subsample (n = 332).ResultsThe ASA had excellent discrimination against MFQ caseness (AUC = 0.89, 95% CI 0.87–0.91; optimal threshold 16.5, sensitivity 86%, specificity 77%). Optimal thresholds were 15.5 against both clinician diagnosis (AUC = 0.74, 95% CI 0.70–0.79; sensitivity 88%, specificity 47%) and SHAPS caseness (AUC = 0.83, 95% CI 0.79–0.87). Discrimination did not differ by age group or gender. At follow-up, discrimination was outstanding (AUC = 0.94, 95% CI 0.91–0.96), although the optimal threshold was higher (19.5).ConclusionsThresholds converged at 15.5–16.5 across reference criteria, supporting a provisional screening threshold of ≥17 for identifying clinically relevant anhedonia in young people. Replication against structured clinical assessment is needed before this threshold is used diagnostically.