Mental Health Screening Tools for Anxiety and Depression in Post-Secondary Students: A Literature Review to Inform Digital Intervention Development (Preprint)

<sec> <title>BACKGROUND</title> 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. </sec> <sec> <title>OBJECTIVE</title> 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. </sec> <sec> <title>METHODS</title> 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. </sec> <sec> <title>RESULTS</title> 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. </sec> <sec> <title>CONCLUSIONS</title> 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. </sec>