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Kristófersdóttir KH, Kristjánsdóttir H, Asgeirsdottir RL, Karlsson T, Vésteinsdóttir V, Thorsdottir F. Investigating the PHQ-9 With Mokken Scale Analysis and Cognitive Interviews. Assessment 2024; 31:1332-1355. [PMID: 38159031 DOI: 10.1177/10731911231216961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Scores on the Patient Health Questionnaire-9 (PHQ-9) are frequently used to assess depression both in research and in clinical practice. The aim was to examine the validity of the PHQ-9 sum score by using Mokken scale analysis (Study I) and cognitive interviews (Study II) on the Icelandic version of PHQ-9. A primary care sample of 618 individuals was used in Study I. The results indicate that the PHQ-9 items are not close enough to perfectly unidimensional for their sum score to accurately order people on the depression severity dimension. In Study II, the sample consisted of 53 individuals, with 28 having a history of depression and 25 not. The findings reveal a number of issues concerning respondents' use of the PHQ-9. No systematic differences were found in the results of the two groups. The PHQ-9 sum score should thus be interpreted and used with great care. We provide scale revision recommendations to improve the quality of PHQ-9.
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Euteneuer F, Salzmann S, Süssenbach P. Income rank and depressive symptoms among employees in Germany - A 5-year cross-lagged panel analysis. Int J Clin Health Psychol 2024; 24:100485. [PMID: 39101052 PMCID: PMC11296231 DOI: 10.1016/j.ijchp.2024.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
Background/Objective Socioeconomic disparities in mental health are well-established. Previous research suggests that relative income rank is associated with depressive symptoms above and beyond absolute income. This study aimed to investigate the predictive value of income rank for future depressive symptoms while accounting for absolute income. Exploring potential reverse pathways from depressive symptoms to income rank was a secondary objective. Method A two-wave cross-lagged panel design with a 5-year follow-up was used to analyze data for income rank, absolute income, and two dimensions of depressive symptoms (i.e., cognitive-affective and somatic symptoms) from initially 4,201 employees. Income rank was calculated for reference groups, based on the same gender, the same 5-year age band, and the same occupational skill level. Results Lower income rank at baseline predicted a higher severity of cognitive-affective depressive symptoms at five-year follow-up, even after adjusting for absolute income. In contrast, income rank did not demonstrate a significant unique longitudinal association with somatic depressive symptoms when simultaneously taking absolute income into account. There was no evidence for the assumption that depressive symptoms are predictive for future income rank (i.e., reverse pathway). Conclusions Cognitive-affective symptoms of depression might be particularly responsive to social comparisons and a relatively low social rank.
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Affiliation(s)
- Frank Euteneuer
- Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
- Division of Translational Clinical Stress Research, Institute of Neuroscience and Biopsychology for Clinical Application, Medical School Berlin, Berlin, Germany
| | - Stefan Salzmann
- Medical Psychology, Department of Medicine, Health and Medical University, Erfurt, Germany
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Philipp Süssenbach
- Fachhochschule des Mittelstands (FHM) Bielefeld–University of Applied Sciences, Bielefeld, Germany
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Hanson CL, Magnusson BM, Crandall AA, Barnes MD, McFarland E, Smith M. Life experience pathways to college student emotional and mental health: A structural equation model. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:826-833. [PMID: 35471936 DOI: 10.1080/07448481.2022.2058328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
Objective: Previous research suggests that both adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and current life experiences are associated with emotional wellbeing and mental health. The purpose of this study was to explore the influence of these life experience and coping processes on college student emotional and mental health. Participants: College students (N = 555) were recruited from a large western university. Methods: Participants completed an online cross-sectional survey measuring early and current life experiences, cognitive and emotional coping efforts, and emotional and mental health outcomes. Data were analyzed using structural equation modeling. Results: There was an indirect effect of PCEs on emotional and mental health through cognitive and emotional coping efforts. No association was observed between ACEs and mental health. Conclusions: Increases in PCEs are protective, enhance coping efforts, and strengthen emotional and mental health outcomes among college students.
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Affiliation(s)
- Carl L Hanson
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | | | | | - Michael D Barnes
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - Emily McFarland
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - McKaylee Smith
- Department of Public Health, Brigham Young University, Provo, Utah, USA
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Rufino JV, Rodrigues R, Birolim MM, Girotto E, Mesas AE, Martínez-Vizcaíno V, Guidoni CM. Analysis of the dimensional structure of the Patient Health Questionnaire-9 (PHQ-9) in undergraduate students at a public university in Brazil. J Affect Disord 2024; 349:158-164. [PMID: 38199387 DOI: 10.1016/j.jad.2024.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND The prevalence of mental health-related problems has increased in recent years, especially among young adults, such as university students. Several measurement instruments have been developed to identify individuals at risk for depression, such as the Patient Health Questionnaire-9 (PHQ-9). However, different dimensional structures of the PHQ-9 can make it difficult to interpret and compare research results. To analyze the dimensional structure and convergent validity of the PHQ-9 in university students. METHODS This is a cross-sectional study developed with 3163 students enrolled in different courses at a university in southern Brazil. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to identify the most parsimonious and best-fitting model. Convergent validity was verified through the significant relationship (p < 0.05) between theoretically related constructs (sleep quality, alcohol consumption, and physical activity practice). RESULTS The EFA resulted in two models (unidimensional and two-dimensional), with better indices for the two-dimensional model. In the CFA, both the unidimensional and the two-dimensional models presented satisfactory fit indices that were higher for the unidimensional model. LIMITATIONS The analysis of convergent validity is limited by the absence of a gold standard for comparison. CONCLUSIONS This study provided support for the unidimensional structure of the PHQ-9, with adequate convergent validity, among university students.
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Affiliation(s)
- Jessica Vertuan Rufino
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Departamento de Saúde Coletiva, Londrina, PR, Brazil
| | - Renne Rodrigues
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Departamento de Saúde Coletiva, Londrina, PR, Brazil
| | - Marcela Maria Birolim
- Faculdade Guairacá, Departamento de Enfermagem e Odontologia, Guarapuava, PR, Brazil
| | - Edmarlon Girotto
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Departamento de Ciências Farmacêuticas, Londrina, PR, Brazil
| | - Arthur Eumann Mesas
- Universidad de Castilla-La Mancha, Facultad de Enfermería de Cuenca, Centro Estudios Sociosanitarios, Cuenca, Spain.
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Facultad de Enfermería de Cuenca, Centro Estudios Sociosanitarios, Cuenca, Spain; Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | - Camilo Molino Guidoni
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Departamento de Ciências Farmacêuticas, Londrina, PR, Brazil
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Tseng VWS, Tharp JA, Reiter JE, Ferrer W, Hong DS, Doraiswamy PM, Nickels S. Identifying a stable and generalizable factor structure of major depressive disorder across three large longitudinal cohorts. Psychiatry Res 2024; 333:115702. [PMID: 38219346 DOI: 10.1016/j.psychres.2023.115702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024]
Abstract
The Patient Health Questionnaire 9 (PHQ-9) is the current standard outpatient screening tool for measuring and tracking the nine symptoms of major depressive disorder (MDD). While the PHQ-9 was originally conceptualized as a unidimensional measure, it has become clear that MDD is not a monolithic construct, as evidenced by high comorbidities with other theoretically distinct diagnoses and common symptom overlap between depression and other diagnoses. Therefore, identifying reliable and temporally stable subfactors of depressive symptoms could allow research and care to be tailored to different depression phenotypes. This study improved on previous factor analysis studies of the PHQ-9 by leveraging samples that were clinical (participants with depression only), large (N = 1483 depressed individuals in total), longitudinal (up to 5 years), and from three diverse (matching racial distribution of the United States) datasets. By refraining from assuming the number of factors or item loadings a priori, and thus utilizing a solely data-driven approach, we identified a ranked list of best-fitting models, with the parsimonious one achieving good model fit across studies at most timepoints (average TLI >= 0.90). This model categorizes the PHQ-9 items into four factors: (1) Affective (Anhedonia + Depressed Mood), (2) Somatic (Sleep + Fatigue + Appetite), (3) Internalizing (Worth/Guilt + Suicidality), (4) Sensorimotor (Concentration + Psychomotor), which may be used to further precision psychiatry by testing factor-specific interventions in research and clinical settings.
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Affiliation(s)
- Vincent W S Tseng
- Verily Life Sciences LLC, 269 E Grand Ave, South San Francisco, CA, USA.
| | - Jordan A Tharp
- Verily Life Sciences LLC, 269 E Grand Ave, South San Francisco, CA, USA
| | - Jacob E Reiter
- Verily Life Sciences LLC, 269 E Grand Ave, South San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA
| | - Weston Ferrer
- Verily Life Sciences LLC, 269 E Grand Ave, South San Francisco, CA, USA
| | - David S Hong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA
| | - P Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Institute for Brain Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Stefanie Nickels
- Verily Life Sciences LLC, 269 E Grand Ave, South San Francisco, CA, USA
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Cosci F, Christensen KS, Ceccatelli S, Patierno C, Carrozzino D. Patient Health Questionnaire-9: A clinimetric analysis. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2024; 46:e20233449. [PMID: 38281157 PMCID: PMC11302993 DOI: 10.47626/1516-4446-2023-3449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE The Patient Health Questionnaire-9 (PHQ-9) is a widely used self-report measure of depression whose psychometric properties were found to be merely acceptable. Insufficient attention has been devoted to its clinimetric validity, while its clinical utility is still debated, particularly for assessing depression severity. This is the first study to test the PHQ-9 construct validity and clinical utility based on clinimetric principles. METHODS An online survey of 3,398 participants was conducted. Item response theory models (Rasch and Mokken analyses) were used to assess the PHQ-9 validity and determine its clinical utility. RESULTS Fit to the Rasch model was achieved after adjusting the sample size. Items 2, 4, 6, and 9 over-discriminated, while items 1, 5, and 7 under-discriminated. Local dependency between items 2 and 6 was indicated. The PHQ-9 was not unidimensional. A Loevinger's coefficient of 0.49 was found, indicating an acceptable level of scalability. CONCLUSION The PHQ-9 is an instrument with potential clinical utility as an overall index of depression, mainly for screening purposes. Substantial revision, particularly in the wording of over- and under-discriminating items, is needed.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
- International Lab of Clinical Measurements, University of Florence, Florence, Italy
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Kaj Sparle Christensen
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Sara Ceccatelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chiara Patierno
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Danilo Carrozzino
- Department of Psychology Renzo Canestrari, University of Bologna, Bologna, Italy
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Doyle E, Carey E, Rossouw J, Booth A, Rickwood D, O'Reilly A. Examining the psychometric properties of the headspace Youth (mental health) Service Satisfaction Scale in a mental health service in Ireland. Child Care Health Dev 2024; 50:e13220. [PMID: 38265133 DOI: 10.1111/cch.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 10/05/2023] [Accepted: 11/21/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Evaluating service quality and satisfaction is central to the provision of accessible and developmentally appropriate youth mental health services. However, there are limited suitable measures and a lack of published evidence on the psychometric properties of measures to assess young people's satisfaction with youth mental health services. The headspace Youth (Mental Health) Service Satisfaction Scale (YSSS) was designed and implemented to assess young people's satisfaction with headspace mental health services in Australia. This study examined the reliability and factor structure of the YSSS in a youth mental health service in Ireland. METHODS The sample comprised 1449 young people (66.2% female) aged 12-25 years (M = 16.48, SD = 2.97). Participants completed the YSSS after their final brief intervention session through Jigsaw-The National Centre for Youth Mental Health. Confirmatory factor analysis (CFA) was performed on one- and four-factor models to test findings from previous studies. Reliability was also examined. RESULTS CFA supported a single-factor structure of the YSSS, and all items were suitable for inclusion. The internal consistency of the measure was deemed acceptable (α = 0.89). CONCLUSIONS Findings suggest that the YSSS is a reliable measure for monitoring satisfaction with youth mental health services in an Irish context. The measure demonstrated a unidimensional construct of satisfaction. These findings support the broader application of the YSSS and add to existing knowledge on measuring satisfaction within youth mental health services.
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Affiliation(s)
- Elizabeth Doyle
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Eleanor Carey
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Johannes Rossouw
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Ailbhe Booth
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- headspace National Youth Mental Health Foundation, Melbourne, Victoria, Australia
| | - Aileen O'Reilly
- UCD School of Psychology, University College Dublin, Dublin, Ireland
- ALONE, Dublin, Ireland
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Fonseca-Pedrero E, Díez-Gómez A, Pérez-Albéniz A, Al-Halabí S, Lucas-Molina B, Debbané M. Youth screening depression: Validation of the Patient Health Questionnaire-9 (PHQ-9) in a representative sample of adolescents. Psychiatry Res 2023; 328:115486. [PMID: 37738682 DOI: 10.1016/j.psychres.2023.115486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Depression symptoms and mood disorders constitute one of the major public health challenges among youths. Thus, early prevention and intervention for depression should be a priority. The main goal of the present study was to validate the Patient Health Questionnaire-9 (PHQ-9) scores in a school-based sample of non-clinical adolescents. METHOD Stratified random sampling was conducted. Participants were 2235 students (M = 14.49, SD =1.76, range= 12-18 years), 52.9 % were female, from 34 secondary schools in Spain. Several previously validated self-reported questionnaires of mental health and psychopathology were administrated. RESULTS The unidimensional factorial model of the PHQ-9 items showed adequate goodness of fit indices. Strong measurement invariance across gender was found. Omega for the PHQ-9 total score was 0.87. The PHQ-9 total score was positively associated with anxiety symptoms and emotional and behavioral problems, and negatively associated with prosocial behavior and quality of life. CONCLUSIONS The PHQ-9 is a brief, easy, and reliable tool for assessing self-reported depressive symptoms in both clinical and school settings. PHQ-9 may be used as a screening tool for universal early detection and monitorization of depression symptoms during adolescence.
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Affiliation(s)
| | | | | | | | | | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
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Blake JJ, Gracey F, Whitmore S, Broomfield NM. Comparing the Symptomatology of Post-stroke Depression with Depression in the General Population: A Systematic Review. Neuropsychol Rev 2023:10.1007/s11065-023-09611-5. [PMID: 37667057 DOI: 10.1007/s11065-023-09611-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/12/2023] [Indexed: 09/06/2023]
Abstract
Previous research into the phenomenological differences of post-stroke depression (PSD) has typically focused on comparisons of symptom profiles between stroke and non-stroke population controls. This systematic review aimed to synthesize these findings with results from other methodological approaches that contribute to an understanding of phenomenological differences. Articles were identified via a systematic search of seven databases and additional manual searching. A narrative synthesis approach was adopted because of the high methodological heterogeneity. Twelve articles comparing the symptomatology of depression between stroke and non-stroke controls were included. Three distinct methodological approaches, relevant to the aim, were identified: comparisons of profiles among groups with similar overall depression severity, comparisons of the strengths of correlations between a symptom and depression, and comparisons of latent symptom severity. The symptomatology of depression was generally similar between the groups, including somatic symptoms, despite the hypothesized interference of comorbid physical stroke effects. Despite high heterogeneity, there was a tentative indication that post-stroke depression manifests with comparatively less severe/prevalent anhedonia. Possible mechanisms for the observed similarities and differences are explored, including suggestions for future research.
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Affiliation(s)
- J J Blake
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - F Gracey
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - S Whitmore
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - N M Broomfield
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
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Gómez-Gómez I, Benítez I, Bellón J, Moreno-Peral P, Oliván-Blázquez B, Clavería A, Zabaleta-del-Olmo E, Llobera J, Serrano-Ripoll MJ, Tamayo-Morales O, Motrico E. Utility of PHQ-2, PHQ-8 and PHQ-9 for detecting major depression in primary health care: a validation study in Spain. Psychol Med 2023; 53:5625-5635. [PMID: 36258639 PMCID: PMC10482708 DOI: 10.1017/s0033291722002835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/22/2022] [Accepted: 08/19/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Primary health care (PHC) professionals may play a crucial role in improving early diagnosis of depressive disorders. However, only 50% of cases are detected in PHC. The most widely used screening instrument for major depression is the Patient Health Questionnaire (PHQ), including the two-, eight- and nine-item versions. Surprisingly, there is neither enough evidence about the validity of PHQ in PHC patients in Spain nor indications about how to interpret the total scores. This study aimed to gather validity evidence to support the use of the three PHQ versions to screen for major depression in PHC in Spain. Additionally, the present study provided information for helping professionals to choose the best PHQ version according to the context. METHODS The sample was composed of 2579 participants from 22 Spanish PHC centers participating in the EIRA-3 study. The reliability and validity of the three PHQ versions for Spanish PHC patients were assessed based on responses to the questionnaire. RESULTS The PHQ-8 and PHQ-9 showed high internal consistency. The results obtained confirm the theoretically expected relationship between PHQ results and anxiety, social support and health-related QoL. A single-factor solution was confirmed. Regarding to the level of agreement with the CIDI interview (used as the criterion), our results indicate that the PHQ has a good discrimination power. The optimal cut-off values were: ⩾2 for PHQ-2, ⩾7 for PHQ-8 and ⩾8 for PHQ-9. CONCLUSIONS PHQ is a good and valuable tool for detecting major depression in PHC patients in Spain.
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Affiliation(s)
- Irene Gómez-Gómez
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Seville, Spain
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Isabel Benítez
- Department of Methodology of Behavioral Sciences, Universidad de Granada, Granada, Spain
| | - Juan Bellón
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
- El Palo Health Centre, Andalusian Health Service (SAS), Málaga, Spain
- Department of Public Health and Psychiatry, University of Málaga (UMA), Málaga, Spain
| | - Patricia Moreno-Peral
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Bárbara Oliván-Blázquez
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
- Institute for Health Research Aragón (IISA), Zaragoza, Spain
| | - Ana Clavería
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Primary Care Research Unit, Área de Vigo, SERGAS, Vigo, Spain
- I-Saúde Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Edurne Zabaleta-del-Olmo
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Atenció Primària Barcelona Ciutat, Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Nursing department, Faculty of Nursing, Universitat de Girona, Girona, Spain
| | - Joan Llobera
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Maria J. Serrano-Ripoll
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Olaya Tamayo-Morales
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Seville, Spain
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
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Lee EH, Kang EH, Kang HJ, Lee HY. Measurement invariance of the patient health questionnaire-9 depression scale in a nationally representative population-based sample. Front Psychol 2023; 14:1217038. [PMID: 37720651 PMCID: PMC10500305 DOI: 10.3389/fpsyg.2023.1217038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
The Patient Health Questionnaire-9 (PHQ-9) is widely used to measure the severity of depressive symptoms and to screen for depressive disorder, but its measurement invariance has received little research attention. The aim of this study was to assess the measurement invariance of the PHQ-9 across various sociodemographic and medical-condition groups. The structural validity and internal consistency of the PHQ-9 were also assessed as the prerequisite properties for measurement invariance. This study was conducted using data from the Korea National Health and Nutrition Examination Survey. The included participants comprised 5,347 people older than 19 years. Exploratory graph analysis (EGA) and confirmatory factor analysis (CFA) were performed to determine structural validity, and the omega coefficient (ω ) was used to determine internal consistency. Measurement invariance (configural, metric, and scalar invariance) was evaluated using multigroup confirmatory factor analysis (MGCFA). The single structural model of the PHQ-9 that was validated by EGA was also satisfactory with fit indices of χ2 = 770.765 (p < 0.001), CFI = 0.944, SRMR = 0.040, and RMSEA = 0.076 (90% CI = 0.072-0.081). The ω of the PHQ-9 was 0.812, implying satisfactory internal consistency. The one-factor PHQ-9 had equivalent overall structure, factor loadings, and item intercepts across age groups, suggesting invariance across ages. Partial scalar invariance was demonstrated across sex and marital-status groups. Partial metric and scalar invariance were supported across education groups. Scalar invariance was supported among all of the medical-condition (hypertension, diabetes, cancer, arthritis, asthma, and heart disease) groups. Overall, the measurement invariance of the one-factor PHQ-9 was empirically supported across sociodemographic and medical-condition groups. The PHQ-9 can be reliably used to compare the severity of depressive symptoms across these groups in research and practice.
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Affiliation(s)
- Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea
| | - Eun Hee Kang
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea
| | - Hyun-Jung Kang
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea
| | - Hyun Young Lee
- Clinical Trial Center, Ajou University Hospital, Suwon, Republic of Korea
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12
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González-Sánchez A, Ortega-Moreno R, Villegas-Barahona G, Carazo-Vargas E, Arias-LeClaire H, Vicente-Galindo P. New cut-off points of PHQ-9 and its variants, in Costa Rica: a nationwide observational study. Sci Rep 2023; 13:14295. [PMID: 37652965 PMCID: PMC10471633 DOI: 10.1038/s41598-023-41560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023] Open
Abstract
The PHQ-9 questionnaire is a screening test worldwide used to measure depression. But it cannot be used in Costa Rica, due to the fact that it has not previously been validated for its population. The present study aims to show the validation of the PHQ-9 questionnaire and its variants (PHQ-2, PHQ-4, PHQ-8) in a population sample of adults residing in Costa Rica. A sample was collected (n = 1162) using a self-administered questionnaire. Confirmatory Factor Analysis (CFA), Receiver Operating Characteristic (ROC) curve, and Multiple Group Confirmatory Factor Analysis (MGCFA) were tested. One factor was found that explained 73.33% of the variance with excellent internal consistency (α = 0.928). Goodness-of-fit measures were adequate (RMSEA = 0.107; CFI = 0.948), as was diagnostic power at a cut-off of 10 (78.60 for Sensitivity and 27.95 for 1-Specificity). External validation indices were good (r = 0.843 with GAD-7, r = - 0.647 with RS14, and r = 0.301 with FCV19S), and the model showed invariance by sex (∆χ2 = 27.90; df = 27; p < 0.001). Additionally, new cut-off points were proposed for PHQ-9 and its variants for Costa Rican male, female, and general populations. The PHQ-9 and its variants (PHQ-2, 4, and 8) are valid tools for detecting depression (and anxiety for PHQ-4) in Costa Rican population. In addition, new cut-off points differentiated by sex are proposed.
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Affiliation(s)
- Armando González-Sánchez
- Department of Statistics and Operative Research, University of Salamanca, Campus Miguel de Unamuno. C/ Alfonso X El Sabio, S/N, 37007, Salamanca, Spain.
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Virgen de la Vega, 10ª Planta, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain.
| | - Raúl Ortega-Moreno
- Psychology School, National University, Costa Rica (UNA), Heredia, Costa Rica
| | | | | | | | - Purificación Vicente-Galindo
- Department of Statistics and Operative Research, University of Salamanca, Campus Miguel de Unamuno. C/ Alfonso X El Sabio, S/N, 37007, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Virgen de la Vega, 10ª Planta, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
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13
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Dagher D, Samaha S, Mhanna M, Azzi R, Mina A, Soufia M, Hallit S, Obeid S, Haddad G. Depressive symptoms among a sample of Lebanese adolescents: Scale validation and correlates with disordered eating. Arch Pediatr 2023:S0929-693X(23)00094-5. [PMID: 37336697 DOI: 10.1016/j.arcped.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/16/2022] [Accepted: 04/29/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Adolescence is a transitional phase that brings many psychological and physiological challenges that increase emotional vulnerability and threaten the adolescent's mental well-being. Indeed, mental illnesses, such as depression and eating disorders, show an alarming increase in prevalence after puberty. Adolescent depression is particularly concerning owing to the fact that it is a principal cause of disability among adolescents, an important risk factor for suicidality, and is associated with higher risks of present and subsequent morbidity. Our study aimed at (1) examining the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) and (2) evaluating the correlation between depression, eating disorders, stress, and other variables in a sample of Lebanese adolescents. METHODS This cross-sectional research enlisted 555 Lebanese teenagers (15-18 years) from all Lebanese governorates (May-June 2020). The confirmatory factor analysis of the PHQ-9 scale items was carried out using the SPSS AMOS program v.24. The relative chi-square, the root mean square error of approximation (RMSEA), Tucker Lewis Index (TLI) and the comparative fit index (CFI) were all utilized as goodness-of-fit indexes. RESULTS The median age of the participants was 16.66 ± 1.00 years, with 75.7% females. Among these 555 adolescents, 62.9% had mild-to-moderate depression and 14% reported moderately severe-to-severe depression, while only 23.1% were classified as not suffering from depression. Confirmatory factor analysis of the PHQ-9 scale was conducted using the one-factor structure that is described in the literature; the fit indices obtained were acceptable as follows: χ2/df= 136.26/27 =5.05, CFI=0.92, TLI=0.90 and RMSEA=0.085 [0.072-0.100]. However, the modification indices between items 6 and 9 were high; after correlating these two items, the fit indices improved more as follows: χ2/df= 105.59/26=4.06, CFI=0.94, TLI=0.92 and RMSEA=0.074 [0.060-0.089]. The multivariable analysis results showed that more stress (β=0.59), female sex (β=1.54), and more binge eating (β=0.16) were significantly associated with more depression. CONCLUSION This study supports the validity of the PHQ-9, which presents as a reliable tool for the evaluation of depression in future epidemiological studies of Lebanese adolescents. It also elucidates the high level of depression among this age group and its correlation with modifiable and unmodifiable factors.
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Affiliation(s)
- Dina Dagher
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Serena Samaha
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Mariam Mhanna
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Reine Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Anthony Mina
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon; Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia; Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; Applied Science Research Center, Applied Science Private University, Amman, Jordan.
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Georges Haddad
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon; Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
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14
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Gabarrell-Pascuet A, Domènech-Abella J, Rod NH, Varga TV. Variations in sociodemographic and health-related factors are linked to distinct clusters of individuals with depression based on the PHQ-9 instrument: NHANES 2007-2018. J Affect Disord 2023; 335:95-104. [PMID: 37156277 DOI: 10.1016/j.jad.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Depression is a heterogeneous disease. Identification of latent depression subgroups and differential associations across these putative groups and sociodemographic and health-related factors might pave the way toward targeted treatment of individuals. METHODS We used model-based clustering to identify relevant subgroups of 2900 individuals with moderate to severe depression (defined as scores ≥10 on the PHQ-9 instrument) from the NHANES cross-sectional survey. We used ANOVA and chi-squared tests to assess associations between cluster membership and sociodemographics, health-related variables, and prescription medication use. RESULTS We identified six latent clusters of individuals, three based on depression severity and three differentially loaded by somatic and mental components of the PHQ-9. The Severe mental depression cluster had the most individuals with low education and income (P < 0.05). We observed differences in the prevalence of numerous health conditions, with the Severe mental depression cluster showing the worst overall physical health. We observed marked differences between the clusters regarding prescription medication use: the Severe mental depression cluster had the highest use of cardiovascular and metabolic agents, while the Uniform severe depression cluster showed the highest use of central nervous system and psychotherapeutic agents. LIMITATIONS Due to the cross-sectional design we cannot make conclusions about causal relationships. We used self-reported data. We did not have access to a replication cohort. CONCLUSIONS We show that socioeconomic factors, somatic diseases, and prescription medication use are differentially associated with distinct and clinically relevant clusters of individuals with moderate to severe depression.
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Affiliation(s)
- Aina Gabarrell-Pascuet
- Epidemiology of Mental Health Disorders and Ageing Research Group, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain; Research, Teaching, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Joan Domènech-Abella
- Epidemiology of Mental Health Disorders and Ageing Research Group, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain; Research, Teaching, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Naja H Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tibor V Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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15
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Saunders R, Moinian D, Stott J, Delamain H, Naqvi SA, Singh S, Wheatley J, Pilling S, Buckman JEJ. Measurement invariance of the PHQ-9 and GAD-7 across males and females seeking treatment for common mental health disorders. BMC Psychiatry 2023; 23:298. [PMID: 37118684 PMCID: PMC10148535 DOI: 10.1186/s12888-023-04804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalised Anxiety Disorder scale (GAD-7) scales are routinely used in research and clinical practice. Whilst measurement invariance of these measures across gender has been demonstrated individually in general population studies and clinical samples, less is known about invariance of the distinct but correlated latent factors ('depression' and 'anxiety'). The current study assessed measurement invariance of these constructs across males and females seeking treatment for common mental health disorders. METHODS Data were provided from eight psychological treatment services in London, England. Data from initial assessments with the services where individual items on the PHQ-9 and GAD-7 were available were included in analyses. Measurement invariance was explored across self-identified genders, with 'male' and 'female' categories available in the dataset. Sensitivity analyses were conducted using propensity score matching on sociodemographic and clinical variables. RESULTS Data were available for 165,872 patients (110,833 females, 55,039 males). There was evidence of measurement invariance between males and females in both the full sample and a propensity score matched sample (n = 46,249 in each group). CONCLUSIONS Measurement invariance of the correlated depression and anxiety factors of PHQ-9 and GAD-7 were indicated in this sample of individuals seeking psychological treatment for CMHDs. These results support the use of these measures in routine clinical practice for both males and females. This is of particular importance for assessing the prevalence of clinically significant levels of symptoms as well as comparing treatment outcomes across genders.
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Affiliation(s)
- Rob Saunders
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, UK.
| | - Delilah Moinian
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua Stott
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Henry Delamain
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Syed Ali Naqvi
- Barking & Dagenham and Havering IAPT Services, North East London NHS Foundation Trust, London, UK
| | - Satwant Singh
- Waltham Forest Talking Therapies, North East London NHS Foundation Trust, London, UK
| | - Jon Wheatley
- Talk Changes: City & Hackney IAPT Service, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Stephen Pilling
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Joshua E J Buckman
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
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16
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Wang Y, Liang L, Sun Z, Liu R, Wei Y, Qi S, Ke Q, Wang F. Factor structure of the patient health questionnaire-9 and measurement invariance across gender and age among Chinese university students. Medicine (Baltimore) 2023; 102:e32590. [PMID: 36607886 PMCID: PMC9829284 DOI: 10.1097/md.0000000000032590] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The Patient Health Questionnaire-9 (PHQ-9) has been widely used to screen depression symptoms. The present research aimed to assess the reliability and validity of PHQ-9, besides measurement invariance of the PHQ-9 across gender and age among Chinese university students. A total of 12,957 Chinese college students from 2 universities in Henan and Hainan provinces (China) completed the questionnaires via WeChat. This research reported the psychometric properties of PHQ-9 and measurement invariance of the PHQ-9 across gender and age among Chinese university students. Compared with 1-factor model, the 2-factor (affective factor and somatic factor) model of PHQ-9 showed a better fit index in Chinese university students. Without the last 2 items, the 2-factor model of the PHQ-9 showed satisfactory reliability, validity, and good fit index (e.g., Root mean square error of approximation = 0.060, Goodness-of-fit index = 0.982, Comparative fit index = 0.986, and Tucker-Lewis index = 0.974). The Cronbach's alpha of PHQ-9 was 0.874. Multi-group analysis across gender and age demonstrated that measurement equivalency for the 2-factor model of the PHQ-9 was established (e.g., Root mean square error of approximation < 0.08, Comparative fit index > 0.90 and Tucker-Lewis index > 0.90). The 2-factor model of the PHQ-9 without the items of "movement" and "desire to die" showed a better fit index in Chinese university students. The measurement equivalence across gender and age for the 2-factor model of the PHQ-9 can be established among Chinese university students.
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Affiliation(s)
- Yang Wang
- Psychology Institute, Inner Mongolia Normal University, Hohhot, Inner Mongolia, P.R. China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Lijuan Liang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute, Nanjing Medical University, Nanjing, P.R. China
- Laboratory of Psychology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, P.R. China
| | | | - Rongxun Liu
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute, Nanjing Medical University, Nanjing, P.R. China
- College of Medical Engineering, Xinxiang Medical University, Xinxiang, Henan, P.R. China
| | - Yange Wei
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute, Nanjing Medical University, Nanjing, P.R. China
| | - Shisan Qi
- Psychology Institute, Inner Mongolia Normal University, Hohhot, Inner Mongolia, P.R. China
| | - Qiao Ke
- Graduate School, Medical University Nanjing, Nanjing, P.R. China
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute, Nanjing Medical University, Nanjing, P.R. China
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Tele AK, Carvajal-Velez L, Nyongesa V, Ahs JW, Mwaniga S, Kathono J, Yator O, Njuguna S, Kanyanya I, Amin N, Kohrt B, Wambua GN, Kumar M. Validation of the English and Swahili Adaptation of the Patient Health Questionnaire-9 for Use Among Adolescents in Kenya. J Adolesc Health 2023; 72:S61-S70. [PMID: 36376148 DOI: 10.1016/j.jadohealth.2022.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/25/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Our study aimed to validate culturally adapted English and Swahili versions of the Patient Health Questionnaire-9 (PHQ-9) for use with adolescents in Kenya. Criterion validity was determined with clinician-administered diagnostic interviews using the Kiddie Schedule of Affective Disorders and Schizophrenia. METHODS A total of 250 adolescents comprising 148 (59.2%) females and 102 (40.8%) males aged 10-19 years (mean = 14.76; standard deviation = 2.78) were recruited. The PHQ-9 was administered to all respondents concurrently in English and Swahili. Adolescents were later interviewed by clinicians using Kiddie Schedule of Affective Disorders and Schizophrenia to determine the presence or absence of current symptoms of major depressive disorder. Sensitivity specificity, positive predictive value (PPV) and negative predictive value (NPV), and likelihood ratios for various cut-off scores for PHQ-9 were analyzed using receiver operating characteristic curves. RESULTS The internal consistency (Cronbach's α) for PHQ-9 was 0.862 for the English version and 0.834 for Swahili version. The area under the curve was 0.89 (95% confidence interval, 0.84-0.92) and 0.87 (95% confidence interval, 0.82-0.90) for English and Swahili version, respectively, on receiver operating characteristic analysis. A cut-off of ≥ 9 on the English-language version had a sensitivity of 95.0%, specificity of 73.0%, PPV of 0.23, and NPV of 0.99; a cut-off of ≥ 9 on the Swahili version yielded a sensitivity of 89.0%, specificity of 70.0%, PPV of 0.20, and NPV of 0.90. DISCUSSION Psychometric properties were comparable across both English-adapted and Swahili-adapted version of the PHQ-9, are reliable, and valid instrument to detect major depressive disorder among adolescents which can be used in resource-limited settings for early identification of adolescents in need of mental health support.
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Affiliation(s)
- Albert Kimtai Tele
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands.
| | - Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Jill W Ahs
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Swedish Red Cross University, Stockholm, Sweden
| | | | | | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Simon Njuguna
- Department of Mental Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Ian Kanyanya
- Department of Mental Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nabila Amin
- Mathare National Referral and Teaching Hospital, Nairobi, Kenya
| | - Brandon Kohrt
- Department of Psychiatry, George Washington University, Washington, DC
| | - Grace Nduku Wambua
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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Moreno-Agostino D, Chua KC, Peters TJ, Scazufca M, Araya R. Psychometric properties of the PHQ-9 measure of depression among Brazilian older adults. Aging Ment Health 2022; 26:2285-2290. [PMID: 34409909 DOI: 10.1080/13607863.2021.1963951] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objectives: To obtain evidence on the psychometric properties of the Patient Health Questionnaire - 9 (PHQ-9, one of the most extensively used tools for assessing depression) in the Brazilian older population.Method: Data on 3,356 Brazilian adults aged 60+ years living in Guarulhos, São Paulo state were used. The factor structure of the questionnaire was analysed using a factor analysis approach. The questionnaire's measurement equivalence was tested across gender, age, personal income, and education level groups. The scores were compared across groups based on the highest level of equivalence achieved. The questionnaire's internal consistency was analysed considering its factor structure.Results: A one-factor solution was identified as the most adequate factor structure, with the factor explaining 57.6% of the items' variance. The correlation of the resulting latent score with the overall raw sum score in the PHQ-9 was r = 0.96. Measurement equivalence regarding thresholds and loadings was achieved for all tested groups. On average, women, older, less educated, and poorer people had higher latent scores on the depression factor. The measure showed a good internal consistency with Revelle's omega total ωt=0.92.Conclusion: The results suggest that, among Brazilian older adults living in Guarulhos, São Paulo state, the PHQ-9 measures depressive symptomatology equivalently across different sociodemographic subgroups. Moreover, it can be scored using the raw sum of the item scores to adequately reflect different levels of depressive symptomatology.
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Affiliation(s)
- Darío Moreno-Agostino
- Department of Health Service and Population Research; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Kia-Chong Chua
- Department of Health Service and Population Research; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tim J Peters
- Population Health Sciences; Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcia Scazufca
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Araya
- Department of Health Service and Population Research; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Kawilapat S, Maneeton B, Maneeton N, Prasitwattanaseree S, Kongsuk T, Arunpongpaisal S, Leejongpermpoon J, Sukhawaha S, Traisathit P. Comparison of unweighted and item response theory-based weighted sum scoring for the Nine-Questions Depression-Rating Scale in the Northern Thai Dialect. BMC Med Res Methodol 2022; 22:268. [PMID: 36224520 PMCID: PMC9555165 DOI: 10.1186/s12874-022-01744-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Nine-Questions Depression-Rating Scale (9Q) has been developed as an alternative assessment tool for assessing the severity of depressive symptoms in Thai adults. The traditional unweighted sum scoring approach does not account for differences in the loadings of the items on the actual severity. Therefore, we developed an Item Response Theory (IRT)-based weighted sum scoring approach to provide a scoring method that is more precise than the unweighted sum score. Methods Secondary data from a study on the criterion-related validity of the 9Q in the northern Thai dialect was used in this study. All participants were interviewed to obtain demographic data and screened/evaluated for major depressive disorder and the severity of the associated depressive symptoms, followed by diagnosis by a psychiatrist for major depressive disorder. IRT models were used to estimate the discrimination and threshold parameters. Differential item functioning (DIF) of responses to each item between males and females was compared using likelihood-ratio tests. The IRT-based weighed sum scores of the individual items are defined as the linear combination of individual response weighted with the discrimination and threshold parameters divided by the plausible maximum score based on the graded-response model (GRM) for the 9Q score (9Q-GRM) or the nominal-response model (NRM) for categorical combinations of the intensity and frequency of symptoms from the 9Q responses (9QSF-NRM). The performances of the two scoring procedures were compared using relative precision. Results Of the 1,355 participants, 1,000 and 355 participants were randomly selected for the developmental and validation group for the IRT-based weighted scoring, respectively. the gender-related DIF were presented for items 2 and 5 for the 9Q-GRM, while most items (except for items 3 and 6) for the 9QSF-NRM, which could be used to separately estimate the parameters between genders. The 9Q-GRM model accounting for DIF had a higher precision (16.7%) than the unweighted sum-score approach. Discussion Our findings suggest that weighted sum scoring with the IRT parameters can improve the scoring when using 9Q to measure the severity of the depressive symptoms in Thai adults. Accounting for DIF between the genders resulted in higher precision for IRT-based weighted scoring. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01744-0.
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Affiliation(s)
- Suttipong Kawilapat
- Department of Statistics, Faculty of Science, Chiang Mai University, 239 Huaykaew Road, Suthep, Muang, 50200, Chiang Mai, Thailand.,Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sukon Prasitwattanaseree
- Department of Statistics, Faculty of Science, Chiang Mai University, 239 Huaykaew Road, Suthep, Muang, 50200, Chiang Mai, Thailand
| | - Thoranin Kongsuk
- Prasrimahabhodi Psychiatric Hospital, Ubon Ratchathani, Thailand.,Somdet Chaopraya Institute of Psychiatry, Bangkok, Thailand
| | - Suwanna Arunpongpaisal
- Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, 239 Huaykaew Road, Suthep, Muang, 50200, Chiang Mai, Thailand. .,Research Center in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Chiang Mai, Thailand. .,Department of Statistics, Faculty of Science, Data Science Research Center, Chiang Mai University, Chiang Mai, Thailand.
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Measurement invariance of six language versions of the post-traumatic stress disorder checklist for DSM-5 in civilians after traumatic brain injury. Sci Rep 2022; 12:16571. [PMID: 36195725 PMCID: PMC9532419 DOI: 10.1038/s41598-022-20170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/09/2022] [Indexed: 11/08/2022] Open
Abstract
Traumatic brain injury (TBI) is frequently associated with neuropsychiatric impairments such as symptoms of post-traumatic stress disorder (PTSD), which can be screened using self-report instruments such as the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). The current study aims to inspect the factorial validity and cross-linguistic equivalence of the PCL-5 in individuals after TBI with differential severity. Data for six language groups (n ≥ 200; Dutch, English, Finnish, Italian, Norwegian, Spanish) were extracted from the CENTER-TBI study database. Factorial validity of PTSD was evaluated using confirmatory factor analyses (CFA), and compared between four concurrent structural models. A multi-group CFA approach was utilized to investigate the measurement invariance (MI) of the PCL-5 across languages. All structural models showed satisfactory goodness-of-fit with small between-model variation. The original DSM-5 model for PTSD provided solid evidence of MI across the language groups. The current study underlines the validity of the clinical DSM-5 conceptualization of PTSD and demonstrates the comparability of PCL-5 symptom scores between language versions in individuals after TBI. Future studies should apply MI methods to other sociodemographic (e.g., age, gender) and injury-related (e.g., TBI severity) characteristics to improve the monitoring and clinical care of individuals suffering from PTSD symptoms after TBI.
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Mohamadian R, Khazaie H, Ahmadi SM, Fatmizade M, Ghahremani S, Sadeghi H, Ansari Z, Ahmadi A, Zare S. The Psychometric Properties of the Persian Versions of the Patient Health Questionnaires 9 and 2 as Screening Tools for Detecting Depression among University Students. Int J Prev Med 2022; 13:116. [PMID: 36276890 PMCID: PMC9580551 DOI: 10.4103/ijpvm.ijpvm_213_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/06/2021] [Indexed: 11/11/2022] Open
Abstract
Background Among the common mental disorders in societies, depression is one of the most common mental disorders that affects all groups and classes of society. Students are among the groups with the highest rates of depression. Therefore, the need for a short and effective tool for screening and early detection of depression is felt. The aim of this research is to determine validity, reliability and the best cut-off point of the patient health questionnaires-9 (PHQ-9) and patient health questionnaires-2 (PHQ-2) in university students. Methods This cross-sectional study was conducted on 246 students of Kermanshah University of medical science in Kermanshah province of Iran. They completed the PHQ-2, PHQ-9, and the Beck Depression Inventory-II (BDI-II). A structured interview was used to diagnose depression. To analyze the data, Cronbach's alpha for internal consistency, the intra-class correlation (ICC) for test-retest reliability, confirmatory factor analysis for construct validity, Pearson Correlation for Convergent validity, and receiver-operating characteristic (ROC) curve for Criterion validity was used. Results The mean age of the participants was 20.43 ± 2.29. Cronbach's alpha coefficient for PHQ-9 and PHQ-2 was 0.82 and 0.80, respectively. The test-retest reliability based on intra-class correlation (ICC) for PHQ-9 and PHQ-2 after two weeks was 0.81 and 0.73, respectively (P < 0.001). The correlation coefficient between the PHQ-9 and PHQ-2 with the BDI-II was 0.74 and 0.64, respectively (P < 0.001). Confirmatory factor analysis showed that two-factor model and one factor model had good model fit. The best cut-off point score for the PHQ-9 was 10 with a sensitivity of 0.90 and specificity of 0.93, and the best cut-off point score for the PHQ-2 was 3 with the sensitivity of 0.71 and specificity of 0.92. Conclusions The PHQ-9 and PHQ-2 are suitable tools to screen depression in the university students in Iran.
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Affiliation(s)
- Rasoul Mohamadian
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Seyed Mojtaba Ahmadi
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran,Address for correspondence: Dr. Seyed Mojtaba Ahmadi, Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. E-mail:
| | - Mehdi Fatmizade
- Department of Clinical Psychology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Susan Ghahremani
- Department of Clinical Psychology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Sadeghi
- Department of Clinical Psychology, School of Medicine, Ghazvin University of Medical Sciences, Ghazvin, Iran
| | - Zohreh Ansari
- Department of Clinical Psychology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Ahmadi
- Medical Department, School of Medicine, Jondishahpour University of Medical Sciences, Ahvaz, Iran
| | - Sadighe Zare
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
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Validity and reliability of the Patient Health Questionnaire scale (PHQ-9) among university students of Bangladesh. PLoS One 2022; 17:e0269634. [PMID: 35675375 PMCID: PMC9176811 DOI: 10.1371/journal.pone.0269634] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/24/2022] [Indexed: 01/05/2023] Open
Abstract
This study investigated the reliability and factorial validity of Patient Health Questionnaire-9 (PHQ-9) in the context of university students in Bangladesh. The research aimed to assess whether the original one-dimensional model or a model containing both somatic and cognitive-emotional factors is appropriate in the case of a sample of university students. A repeated cross-sectional survey design based on convenience sampling was used to collect data from 677 university students from both public and private universities. The factor structure of the PHQ-9 was assessed using confirmatory factor analysis (CFA). Measurement invariances were assessed across gender, type of university, level of education and victim of domestic violence. Its convergent validity was determined by investigating its correlations with Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS). Results showed excellent reliability of PHQ-9 as measured by both Cronbach's α and McDonald's ω. CFA suggested that a modified one-factor model where the error variances between item-3 ('sleeping difficulties') and item-6 ('feeling as a failure'), item-6 and item-9 ('suicidal thoughts'), item-4 ('feeling tired') and item-9, item-3 and item-9 were allowed to covary is appropriate for the sample. This model provided high values of comparative fit index (CFI), goodness of fit index (GFI), and Tucker Lewis Index (TLI), low value of standardized root mean square residual (SRMR) and a non-significant root mean square error of approximation (RMSEA) as well as a high Factor Determinacy Score Coefficient. Correlation between PHQ-9 and GAD-7 was 0.751 and 0.934 between PHQ-9 and PHQ-ADS. Finally, the model is strictly invariant across gender and university type. Overall, the study provided support for modified unidimensional structure for PHQ-9 and showed high internal consistency along with good convergent validity.
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23
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López-Guerra VM, López-Núñez C, Vaca-Gallegos SL, Torres-Carrión PV. Psychometric Properties and Factor Structure of the Patient Health Questionnaire-9 as a Screening Tool for Depression Among Ecuadorian College Students. Front Psychol 2022; 13:813894. [PMID: 35572338 PMCID: PMC9105228 DOI: 10.3389/fpsyg.2022.813894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/12/2022] [Indexed: 12/26/2022] Open
Abstract
Background The Patient Health Questionnaire-9 (PHQ-9) is the most well-known self-report measure to screen for depressive symptomatology, although discerning which is the factor structure that represents the best fit remains a challenge. Objective The aim of this study was to analyze the psychometric properties and factorial structure of the Spanish version of the PHQ-9 in a large sample of Ecuadorian college students. Methods A total of 5,394 students (M = 22.03 years; SD = 3.05; 54.8% female) from three Ecuadorian universities were surveyed using a computerized questionnaire within a 4-week assessment period. The PHQ-9 was tested for factorial structure, reliability, and correlations with other mental health-related measures. Results The hierarchical model that included a general factor and three nested factors had a better fit, and such a hierarchical structure remained invariant across sex and age. Total omega value (ω) was 0.90 for the total scale and hierarchical omega values (ωh) were 0.68 for the general factor, as well as 0.34, 0.38, and 0.44 for the respective nested factors (somatic, cognitive/affective, concentration/motor). Moreover, PHQ-9 scores were significantly higher among women, although effect sizes of comparison of those sex differences were very small. Finally, the PHQ-9 scores correlated with multiple mental health indicators (psychological inflexibility, loneliness, stress, and satisfaction with life). Discussion The Spanish version of the PHQ-9 showed good psychometric properties among Ecuadorian college students. The hierarchical structure showed the best fit for the data, including not only a dominant general factor, but also the somatic, cognitive/affective and concentration/motor subcomponents. In conclusion, the PHQ-9 tool seems to represent an easy-to-implement screening questionnaire to design preventive programs for those Ecuadorian college students at risk of developing depressive disorders.
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Affiliation(s)
| | - Carla López-Núñez
- Department of Personality, Assessment and Psychological Treatments, School of Psychology, University of Seville, Seville, Spain
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24
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Stojanovski K, King EJ, Amico KR, Eisenberg MC, Geronimus AT, Baros S, Schmidt AJ. Stigmatizing Policies Interact with Mental Health and Sexual Behaviours to Structurally Induce HIV Diagnoses Among European Men Who Have Sex with Men. AIDS Behav 2022; 26:3400-3410. [PMID: 35434774 PMCID: PMC9556380 DOI: 10.1007/s10461-022-03683-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/18/2022]
Abstract
Structural stigma shapes men who have sex with men's (MSM's) mental health and sexual behaviours. The aim of this study was to examine how stigmatizing policies interact with downstream anxiety/depression and sexual behaviours to structurally pattern HIV disparities among European MSM. We conducted a secondary data analysis of the European Men-who-have-sex-with-men Internet Survey (EMIS) from 2017. We included a total of 98,600 participants living in 39 European countries. We used the Rainbow Index, a score given to countries based on their sexual and gender minority policies as the predictor of HIV diagnosis. We conducted adjusted random intercept and slope multi-level logistic regressions. In adjusted models, higher Rainbow Index scores was associated with lower predictive probabilities of diagnosed HIV, regardless of the number of condomless intercourse partners. The predictive probability of HIV diagnosis was also lower, regardless of severity of anxiety/depression, where the Rainbow Index score was better. Country-level policies interact with downstream sexual behaviours and anxiety/depression to structurally influence HIV diagnosis among MSM in Europe.
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Affiliation(s)
- Kristefer Stojanovski
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Elizabeth J King
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marisa C Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Mathematics, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Arline T Geronimus
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Population Studies Centre, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Sladjana Baros
- Department for HIV, STI, Viral Hepatitis, and Tuberculosis, Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Axel J Schmidt
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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25
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Identifying Depression-Related Behavior on Facebook—An Experimental Study. SOCIAL SCIENCES-BASEL 2022. [DOI: 10.3390/socsci11030135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Depression is one of the major mental health problems in the world and the leading cause of disability worldwide. As people leave more and more digital traces in the online world, it becomes possible to detect depression-related behavior based on people’s online activities. We use a novel Facebook study to identify possible non-textual elements of depression-related behavior in a social media environment. This study focuses on the relationship between depression and the volume and composition of Facebook friendship networks and the volume and temporal variability of Facebook activities. We also tried to establish a link between depression and the interest categories of the participants. The significant predictors were partly different for cognitive-affective depression and somatic depression. Earlier studies found that depressed people have a smaller online social network. We found the same pattern in the case of cognitive-affective depression. We also found that they posted less in others’ timelines, but we did not find that they posted more in their own timeline. Our study was the first to use the Facebook ads interest data to predict depression. Those who were classified into the less interest category by Facebook had higher depression levels on both scales.
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Shevlin M, Butter S, McBride O, Murphy J, Gibson-Miller J, Hartman TK, Levita L, Mason L, Martinez AP, McKay R, Stocks TVA, Bennett KM, Hyland P, Vallieres F, Valiente C, Vazquez C, Contreras A, Peinado V, Trucharte A, Bertamini M, Panzeri A, Bruno G, Granziol U, Mignemi G, Spoto A, Vidotto G, Bentall RP. Measurement invariance of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) across four European countries during the COVID-19 pandemic. BMC Psychiatry 2022; 22:154. [PMID: 35232409 PMCID: PMC8886334 DOI: 10.1186/s12888-022-03787-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) are self-report measures of major depressive disorder and generalised anxiety disorder. The primary aim of this study was to test for differential item functioning (DIF) on the PHQ-9 and GAD-7 items based on age, sex (males and females), and country. METHOD Data from nationally representative surveys in UK, Ireland, Spain, and Italy (combined N = 6,054) were used to fit confirmatory factor analytic and multiple-indictor multiple-causes models. RESULTS Spain and Italy had higher latent variable means than the UK and Ireland for both anxiety and depression, but there was no evidence for differential items functioning. CONCLUSIONS The PHQ-9 and GAD-7 scores were found to be unidimensional, reliable, and largely free of DIF in data from four large nationally representative samples of the general population in the UK, Ireland, Italy and Spain.
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Affiliation(s)
- Mark Shevlin
- grid.12641.300000000105519715Ulster University, Coleraine, Northern Ireland
| | - Sarah Butter
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, S1 2LT, Sheffield, England.
| | - Orla McBride
- grid.12641.300000000105519715Ulster University, Coleraine, Northern Ireland
| | - Jamie Murphy
- grid.12641.300000000105519715Ulster University, Coleraine, Northern Ireland
| | - Jilly Gibson-Miller
- grid.11835.3e0000 0004 1936 9262Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, S1 2LT Sheffield, England
| | - Todd K. Hartman
- grid.5379.80000000121662407University of Manchester, Manchester, England
| | - Liat Levita
- grid.11835.3e0000 0004 1936 9262Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, S1 2LT Sheffield, England
| | - Liam Mason
- grid.83440.3b0000000121901201University College London, London, England
| | - Anton P. Martinez
- grid.11835.3e0000 0004 1936 9262Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, S1 2LT Sheffield, England
| | - Ryan McKay
- grid.4464.20000 0001 2161 2573Royal Holloway, University of London, Egham, England
| | - Thomas VA Stocks
- grid.11835.3e0000 0004 1936 9262Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, S1 2LT Sheffield, England
| | - Kate M Bennett
- grid.10025.360000 0004 1936 8470University of Liverpool, Liverpool, England
| | - Philip Hyland
- grid.95004.380000 0000 9331 9029Maynooth University, Maynooth, Ireland
| | | | - Carmen Valiente
- grid.4795.f0000 0001 2157 7667Complutense University of Madrid, Madrid, Spain
| | - Carmelo Vazquez
- grid.4795.f0000 0001 2157 7667Complutense University of Madrid, Madrid, Spain
| | - Alba Contreras
- grid.4795.f0000 0001 2157 7667Complutense University of Madrid, Madrid, Spain
| | - Vanesa Peinado
- grid.4795.f0000 0001 2157 7667Complutense University of Madrid, Madrid, Spain
| | - Almudena Trucharte
- grid.4795.f0000 0001 2157 7667Complutense University of Madrid, Madrid, Spain
| | - Marco Bertamini
- grid.10025.360000 0004 1936 8470University of Liverpool, Liverpool, England
| | - Anna Panzeri
- grid.5608.b0000 0004 1757 3470University of Padua, Padua, Italy
| | - Giovanni Bruno
- grid.5608.b0000 0004 1757 3470University of Padua, Padua, Italy
| | | | | | - Andrea Spoto
- grid.5608.b0000 0004 1757 3470University of Padua, Padua, Italy
| | - Giulio Vidotto
- grid.5608.b0000 0004 1757 3470University of Padua, Padua, Italy
| | - Richard P. Bentall
- grid.11835.3e0000 0004 1936 9262Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, S1 2LT Sheffield, England
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Wesson PD, Lippman SA, Neilands TB, Ahern J, Kahn K, Pettifor A. Evaluating the Validity and Reliability of the Gender Equitable Men's Scale Using a Longitudinal Cohort of Adolescent Girls and Young Women in South Africa. AIDS Behav 2022; 26:775-785. [PMID: 34426864 PMCID: PMC8840910 DOI: 10.1007/s10461-021-03436-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Abstract
Inequitable gender norms and beliefs contribute to increased sexual risk behavior, and, among adolescent girls and young women (AGYW), risk of HIV acquisition. We investigated the longitudinal measurement properties of the Gender Equitable Men's Scale (GEMS) when applied to a cohort of AGYW in rural South Africa (2011-2015). We used item response theory [Person-Item maps, Differential Item Functioning (DIF)] and measurement invariance confirmatory factor analysis models to assess the validity and reliability of the GEMS instrument. Item difficulty and endorsement of gender equitable beliefs both shifted over time. DIF analysis identified item bias for over half of the items; influenced by age, pregnancy, sexual debut, and intimate partner violence. Measurement invariance models revealed strong longitudinal invariance properties. GEMS is a reliable longitudinal measurement of gender equitable beliefs, with notable bias for specific items when administered to subgroups. Additional items specific to the adolescent experience are warranted for a more stable assessment of gender equitable beliefs in a population facing shifting norms as they mature.
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Affiliation(s)
- Paul D. Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St., 3rd Floor, UCSF Box 0886, San Francisco, CA 94143 USA
| | - Sheri A. Lippman
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St., 3rd Floor, San Francisco, CA USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St., 3rd Floor, San Francisco, CA USA
| | - Jennifer Ahern
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
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Pranckeviciene A, Saudargiene A, Gecaite-Stonciene J, Liaugaudaite V, Griskova-Bulanova I, Simkute D, Naginiene R, Dainauskas LL, Ceidaite G, Burkauskas J. Validation of the patient health questionnaire-9 and the generalized anxiety disorder-7 in Lithuanian student sample. PLoS One 2022; 17:e0263027. [PMID: 35085349 PMCID: PMC8794093 DOI: 10.1371/journal.pone.0263027] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Questionnaire- 7 (GAD-7) are short screening instruments used for detection of depression and anxiety symptoms in various settings, including general and mental health care as well as the general population. The aim of this study is to evaluate psychometric properties and factorial structure of the PHQ-9 and the GAD-7 in a sample of Lithuanian university students. METHODS 1368 students (mean age 22.5±4.8) completed the PHQ-9 and the GAD-7 questionnaires online; after the completion of the survey, students were asked to provide phone contact for an additional interview. Eligible students were approached later by trained interviewers and completed The Clinical Interview Schedule-Revised for assessment of depressive and anxiety disorders. RESULTS Results showed that the PHQ-9 and the GAD-7 are reliable screening tools for depression and anxiety (Cronbach alpha 0.86 and 0.91, respectively). The one-factor structure of the PHQ-9 and the GAD-7 was confirmed by the Confirmatory Factor Analysis. A cut-off of ≥10 for the PHQ-9 resulted in 71% sensitivity and 66% specificity recognizing students with increased risk for mood or anxiety disorder. For the GAD-7, a cut-off ≥9 resulted in 73% sensitivity and 70% specificity recognizing students at risk. The PHQ-9 was sensitive but not specific in recognizing students with depressive disorders. The sensitivity and specificity of the GAD-7 in differentiating students with generalized anxiety disorders were low. CONCLUSIONS The PHQ-9 and the GAD-7 have sufficient formal psychometric properties, but their clinical utility as diagnostic tools for recognition of depressive and anxiety disorders in students is limited. Due to low specificity and high false positive rates, both scales are recommended only as an initial screening tool for recognition of subjects with increased risk of mental disorders, however positive cases should be later assessed using more comprehensive instruments.
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Affiliation(s)
- Aiste Pranckeviciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
| | - Ausra Saudargiene
- Laboratory of Biophysics and Bioinformatics, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Informatics, Vytautas Magnus University, Kaunas, Lithuania
| | - Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
| | - Vilma Liaugaudaite
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
| | - Inga Griskova-Bulanova
- Department of Neurobiology and Biophysics, Institute of Biosciences, Vilnius University, Vilnius, Lithuania
| | - Dovile Simkute
- Department of Neurobiology and Biophysics, Institute of Biosciences, Vilnius University, Vilnius, Lithuania
| | - Rima Naginiene
- Laboratory of Toxicology, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laurynas Linas Dainauskas
- Laboratory of Biophysics and Bioinformatics, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gintare Ceidaite
- Department of Informatics, Vytautas Magnus University, Kaunas, Lithuania
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
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Measurement invariance testing of the patient health questionnaire-9 (PHQ-9) across people with and without diabetes mellitus from the NHANES, EMHS and UK Biobank datasets. J Affect Disord 2021; 292:311-318. [PMID: 34139403 DOI: 10.1016/j.jad.2021.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The prevalence of depression is higher among those with diabetes than in the general population. The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but measurement invariance of the PHQ-9 across groups of people with and without diabetes has not yet been investigated. METHODS Data from three independent cohorts from the USA (n=1,886 with diabetes, n=4,153 without diabetes), Quebec, Canada (n= 800 with diabetes, n= 2,411 without diabetes), and the UK (n=4,981 with diabetes, n=145,570 without diabetes), were used to examine measurement invariance between adults with and without diabetes. A series of multiple group confirmatory factor analyses were performed, with increasingly stringent model constraints applied to assess configural, equal thresholds, and equal thresholds and loadings invariance, respectively. One-factor and two-factor (somatic and cognitive-affective items) models were examined. RESULTS Results demonstrated that the most stringent models, testing equal loadings and thresholds, had satisfactory model fit in the three cohorts for one-factor models (RMSEA = .063 or below and CFI = .978 or above) and two-factor models (RMSEA = .042 or below and CFI = .989 or above). LIMITATIONS Data were from Western countries only and we could not distinguish between type of diabetes. CONCLUSIONS Results provide support for measurement invariance between groups of people with and without diabetes, using either a one-factor or a two-factor model. While the two-factor solution has a slightly better fit, the one-factor solution is more parsimonious. Depending on research or clinical needs, both factor structures can be used.
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Moehring A, Guertler D, Krause K, Bischof G, Rumpf HJ, Batra A, Wurm S, John U, Meyer C. Longitudinal measurement invariance of the patient health questionnaire in a German sample. BMC Psychiatry 2021; 21:386. [PMID: 34348669 PMCID: PMC8335884 DOI: 10.1186/s12888-021-03390-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Patient Health Questionnaire-8 (PHQ-8) is a screening questionnaire of depressive symptoms. However, it is unknown whether it is equivalent across time and between groups of individuals. The aim of our paper was to test whether the PHQ-8 has the same meaning in two groups of individuals over time. METHODS Primary care patients were proactively recruited from three German cities. PHQ-8 data from a baseline assessment (n = 588), two assessments during the intervention (n = 246/225), and a six (n = 437) and 12 months (n = 447) follow-up assessment were first used to examine the factor structure of the PHQ-8 by confirmatory factor analysis (CFA). The best fitting factor solution was then used to test longitudinal invariance across time and between intervention and control group by Multiple Group CFA. RESULTS A two-factor structure consistently showed the best model fit. Only configural longitudinal invariance was evidenced when the baseline assessment was included in the analysis. Without the baseline assessment, strict longitudinal invariance was shown across the intervention and the follow-up assessments. Scalar invariance was established between the intervention and control group for the baseline assessment and strict invariance between groups and across the 6- and 12-month follow-up assessments. CONCLUSIONS The lack of longitudinal invariance might be attributed to various differences between the baseline assessments and all following assessments, e.g., assessment mode (iPad vs telephone), potential changes in symptom perception, and setting. TRIAL REGISTRATION DRKS0001163 5, date of trial registration: 20.01.2017; DRKS00011637 , date of trial registration: 25.01.2017.
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Affiliation(s)
- Anne Moehring
- Department of Social Medicine and Prevention, Institute of Community Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany. .,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.
| | - Diana Guertler
- grid.5603.0Department of Social Medicine and Prevention, Institute of Community Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Kristian Krause
- grid.5603.0Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
| | - Gallus Bischof
- grid.4562.50000 0001 0057 2672Department of Psychiatry and Psychotherapy, Research Group S:TEP, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Hans-Juergen Rumpf
- grid.4562.50000 0001 0057 2672Department of Psychiatry and Psychotherapy, Research Group S:TEP, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Anil Batra
- grid.411544.10000 0001 0196 8249Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwer Str. 14, 72076 Tuebingen, Germany
| | - Susanne Wurm
- grid.5603.0Department of Social Medicine and Prevention, Institute of Community Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
| | - Ulrich John
- grid.5603.0Department of Social Medicine and Prevention, Institute of Community Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Christian Meyer
- grid.5603.0Department of Social Medicine and Prevention, Institute of Community Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
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Socio-demographic, behavioural and psycho-social factors associated with depression in two Russian cities. J Affect Disord 2021; 290:202-210. [PMID: 34004402 PMCID: PMC8626563 DOI: 10.1016/j.jad.2021.04.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/11/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Russia has a high burden of suicide and alcohol-attributable mortality. However there have been few studies of the epidemiology of depression. METHODS The study population was 5077 men and women aged 35-69 years from a cross-sectional population based survey in the cities of Arkhangelsk and Novosibirsk (2015-17). Moderate depression was defined as Patient Health Questionnaire-9 (PHQ-9) score≥10. Risk factors considered were socio-demographic factors (age, sex, marital status, living alone, education, employment status, financial constraints); health behaviours (smoking, alcohol use) and psycho-social factors (life events and social support). RESULTS After mutual adjustment for all other factors, there was evidence that PHQ-9≥10 was associated with sex (higher in women), financial constraints, employment status, being a non-drinker, problem drinking, smoking, not having enough people to confide in and the number of life events in the past 6 months. Employment status was more strongly associated in men (OR 1.84 (95%CI 1.17, 2.88)) than women (OR 1.15 95% CI 0.86, 1.55). The effect size was particularly striking for financial constraints (odd ratio over 3 times higher in those with not enough money for food and clothes compared to no financial constraints), problem drinking (OR 1.72 (1.12, 2.65) among drinkers with CAGE score of 2 and 2.25 (95% CI 1.42, 3.57) in those with score ≥3 compared to zero) and life events (85% higher odds in those experiencing one life event and over 4 times higher odds in those experiencing 3 or more life events) all of which demonstrated a dose-response with PHQ-9>=10. LIMITATIONS The study was cross-sectional in nature therefore temporal relationships could not be assessed. CONCLUSIONS We have identified here a range of risk factors for depression among the Russian general population consistent with findings from other populations. The strikingly strong association with financial constraints indicates the importance of social inequality for the burden of depression.
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De Man J, Absetz P, Sathish T, Desloge A, Haregu T, Oldenburg B, Johnson LCM, Thankappan KR, Williams ED. Are the PHQ-9 and GAD-7 Suitable for Use in India? A Psychometric Analysis. Front Psychol 2021; 12:676398. [PMID: 34054677 PMCID: PMC8155718 DOI: 10.3389/fpsyg.2021.676398] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/16/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cross-cultural evidence on the factorial structure and invariance of the PHQ-9 and the GAD-7 is lacking for South Asia. Recommendations on the use of unit-weighted scores of these scales (the sum of items' scores) are not well-founded. This study aims to address these contextual and methodological gaps using data from a rural Indian population. METHODS The study surveyed 1,209 participants of the Kerala Diabetes Prevention Program aged 30-60 years (n at risk of diabetes = 1,007 and n with diabetes = 202). 1,007 participants were surveyed over 2 years using the PHQ-9 and the GAD-7. Bifactor-(S - 1) modeling and multigroup confirmatory factor analysis were used. RESULTS Factor analysis supported the existence of a somatic and cognitive/affective subcomponent for both scales, but less explicitly for the GAD-7. Hierarchical omega values were 0.72 for the PHQ-9 and 0.76 for the GAD-7. Both scales showed full scalar invariance and full or partial residual invariance across age, gender, education, status of diabetes and over time. Effect sizes between categories measured by unit-weighted scores versus latent means followed a similar trend but were systematically higher for the latent means. For both disorders, female gender and lower education were associated with higher symptom severity scores, which corresponds with regional and global trends. CONCLUSIONS For both scales, psychometric properties were comparable to studies in western settings. Distinct clinical profiles (somatic-cognitive) were supported for depression, and to a lesser extent for anxiety. Unit-weighted scores of the full scales should be used with caution, while scoring subscales is not recommended. The stability of these scales supports their use and allows for meaningful comparison across tested subgroups. CLINICAL TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336603&isReview=true.
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Affiliation(s)
- Jeroen De Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Tampere University, Tampere, Finland
- University of Eastern Finland, Kuopio, Finland
| | | | - Allissa Desloge
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tilahun Haregu
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Leslie C. M. Johnson
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Emily D. Williams
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
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Harry ML, Coley RY, Waring SC, Simon GE. Evaluating the Cross-Cultural Measurement Invariance of the PHQ-9 between American Indian/Alaska Native Adults and Diverse Racial and Ethnic Groups. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100121. [PMID: 34142103 PMCID: PMC8208497 DOI: 10.1016/j.jadr.2021.100121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Patient Health Questionnaire-9 (PHQ-9), a self-reported depression screening instrument for measurement-based care (MBC), may have cross-cultural measurement invariance (MI) with a regional group of American Indian/Alaska Native (AI/AN) and non-Hispanic White adults. However, to ensure health equity, research was needed on the cross-cultural MI of the PHQ-9 between other groups of AI/AN peoples and diverse populations. METHODS We assessed the MI of the one-factor PHQ-9 model and five previously identified two-factor models between non-Hispanic AI/AN adults (ages 18-64) from healthcare systems A (n=1,759) and B (n=2,701) using secondary data and robust maximum likelihood estimation. We then tested either fully or partially invariant models for MI between either combined or separate AI/AN groups, respectively, and Hispanic (n=7,974), White (n=7,974), Asian (n=6,988), Black (n=6,213), and Native Hawaiian/Pacific Islander (n=1,370) adults from healthcare system B. All had mental health or substance use disorder diagnoses and were seen in behavioral health or primary care from 1/1/2009-9/30/2017. RESULTS The one-factor PHQ-9 model was partially invariant, with two-factor models partially, or in one case fully, invariant between AI/AN groups. The one-factor model and three two-factor models were partially invariant between all seven groups, while a two-factor model was fully invariant and another partially invariant between a combined AI/AN group and other racial and ethnic groups. CONCLUSIONS Achieving health equity in MBC requires ensuring the cross-cultural validity of measurement tools. Before comparing mean scores, PHQ-9 models should be assessed for individual racial and ethnic group fit for adults with mental health or substance use disorders.
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Affiliation(s)
- Melissa L. Harry
- Essentia Health, Essentia Institute of Rural Health, 502 East Second Street, Duluth, MN 55805
| | - R. Yates Coley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466
| | - Stephen C. Waring
- Essentia Health, Essentia Institute of Rural Health, 502 East Second Street, Duluth, MN 55805
| | - Gregory E. Simon
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466
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Cheng Y, Meng J. The association between depression and problematic smartphone behaviors through smartphone use in a clinical sample. HUMAN BEHAVIOR AND EMERGING TECHNOLOGIES 2021. [DOI: 10.1002/hbe2.258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ying Cheng
- Department of Management California State University San Bernardino California USA
| | - Jingbo Meng
- Department of Communication Michigan State University East Lansing Michigan USA
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Cano-Vindel A, Muñoz-Navarro R, Moriana JA, Ruiz-Rodríguez P, Medrano LA, González-Blanch C. Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: the results of the PsicAP randomized controlled trial. Psychol Med 2021; 52:1-13. [PMID: 33550995 PMCID: PMC9772911 DOI: 10.1017/s0033291720005498] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/28/2020] [Accepted: 12/30/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Emotional disorders are highly prevalent in primary care. We aimed to determine whether a transdiagnostic psychological therapy plus treatment-as-usual (TAU) is more efficacious than TAU alone in primary care adult patients. METHODS A randomized, two-arm, single-blind clinical trial was conducted in 22 primary care centres in Spain. A total of 1061 adult patients with emotional disorders were enrolled. The transdiagnostic protocol (n = 527) consisted of seven 90-min sessions (8-10 patients) delivered over a 12-14-week period. TAU (n = 534) consisted of regular consultations with a general practitioner. Primary outcome measures were self-reported symptoms of anxiety, depression, and somatizations. Secondary outcome measures were functioning and quality of life. Patients were assessed at baseline, post-treatment, and at 3, 6, and 12 months. Intention-to-treat and per-protocol analyses were performed. RESULTS Post-treatment primary outcomes were significantly better in the transdiagnostic group compared to TAU (anxiety: p < 0.001; Morris's d = -0.65; depression: p < 0.001; d = -0.58, and somatic symptoms: p < 0.001; d = -0.40). These effects were sustained at the 12-month follow-up (anxiety: p < 0.001; d = -0.44; depression: p < 0.001; d = -0.36 and somatic symptoms: p < 0.001; d = -0.32). The transdiagnostic group also had significantly better outcomes on functioning (d = 0.16-0.33) and quality of life domains (d = 0.24-0.42), with sustained improvement at the 12-month follow-up in functioning (d = 0.25-0.39) and quality of life (d = 0.58-0.72). Reliable recovery rates showed large between-group effect sizes (d > 0.80) in favour of the transdiagnostic group after treatment and at the 12-month follow-up. CONCLUSIONS Adding a brief transdiagnostic psychological intervention to TAU may significantly improve outcomes in emotional disorders treated in primary care. TRIAL REGISTRATION isrctn.org identifier: ISRCTN58437086.
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Affiliation(s)
- Antonio Cano-Vindel
- Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223 Madrid, Spain
| | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Social and Human Sciences, University of Zaragoza, C/Cdad. Escolar, S/N, 44003, Teruel, Spain
| | - Juan A. Moriana
- Department of Psychology, University of Córdoba/ Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC/Reina Sofía University Hospital, Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain
| | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Calle Teruel, 4, 28941 Fuenlabrada, Madrid, Spain
| | | | - César González-Blanch
- Mental Health Centre, University Hospital “Marqués de Valdecilla”- IDIVAL, Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain
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The factor structure of major depressive symptoms in a sample of Chinese earthquake survivors. BMC Psychiatry 2021; 21:59. [PMID: 33509157 PMCID: PMC7841918 DOI: 10.1186/s12888-020-02993-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/30/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Experiencing natural disasters is associated with common mental disorders including major depressive disorder (MDD). However, the latent structure of MDD is widely debated, and few studies tested the MDD factor structure in Chinese natural disaster survivors. Therefore, the aim of the current study was to evaluate the factorial validity of the Patient Health Questionnaire-9 (PHQ-9) for DSM-5 major depressive disorder (MDD) symptoms in Chinese earthquake survivors. METHOD Participants were 1058 Chinese earthquake survivors. Self-reported measures included the PHQ-9 and the Short-Form Health Survey (SF-36). Confirmatory factor analysis (CFA) and structural equation modelling (SEM) was used to examine the latent structure of MDD and the associations between latent factors of MDD and different domains of health-related quality of life (HRQoL), respectively. RESULTS In the current sample, the model consisted of somatic and cognitive/affective (non-somatic) factors demonstrated significantly better fit than the other competing MDD models (χ2 = 173.89, df = 26, CFI = 0.986, TLI = 0.981, RMSEA = 0.073, BIC = 18,091.13). Further SEM analyses indicated that the non-somatic factor was significantly related to both physical (β = - 0.362, p < .01) and psychosocial HRQoL (β = - 0.773, p < .01), while the somatic factor was a uniquely predictor of physical HRQoL (β = - 0.336, p < .01). Furthermore, we found the somatic factor partially mediated the relationship between the cognitive/affective factor and physical HRQoL (all ps < .05). CONCLUSIONS The MDD symptoms was best captured by a two-factor model comprised of somatic and cognitive/affective factors in Chinese natural disaster survivors. The two MDD factors were differentially associated with physical and psychosocial HRQoL, and the cognitive/affective factor associated physical HRQoL partially through the somatic factor. The current findings increase our understanding of latent structure of MDD symptoms, and carry implications for assessment and intervention of post-disaster mental health problems.
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Wisting L, Johnson SU, Bulik CM, Andreassen OA, Rø Ø, Bang L. Psychometric properties of the Norwegian version of the Patient Health Questionnaire-9 (PHQ-9) in a large female sample of adults with and without eating disorders. BMC Psychiatry 2021; 21:6. [PMID: 33402149 PMCID: PMC7786911 DOI: 10.1186/s12888-020-03013-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Internationally, the Patient Health Questionnaire-9 (PHQ-9) is commonly used to assess the frequency and severity of depressive symptoms. However, psychometric properties of the Norwegian version of the PHQ-9 have only been assessed in adolescents. We present normative data for women and an evaluation of the psychometric properties (internal consistency, convergent validity, and factor structure) of the Norwegian PHQ-9 among women with and without eating disorders (ED). METHODS In this case-control study, a total of 793 females aged 18-78 years (mean 30.39; SD 9.83) completed an online self-report assessment. Measures included the ED100K and Eating Disorder Examination Questionnaire (EDE-Q) to assess ED psychopathology, and the Generalized Anxiety Disorder (GAD) scale and Difficulties in Emotion Regulation Scale Short Form (DERS-SF) to assess symptoms of anxiety and emotion regulation deficits. Participants were categorized into three groups, i.e., previous ED (19.7%, n = 148), current ED (36.3%, n = 272), and no history of ED (44.0%, n = 330), based on self-reported scores on the ED 100 K and the EDE-Q. RESULTS Mean PHQ-9 total score for those with a previous history of ED was 10.67 (SD 6.33), for those with a current ED 16.61 (SD 5.84), and for those with no lifetime history of ED 6.83 (SD 5.58). Excellent internal consistency was demonstrated by Cronbach's alpha's for individuals with a previous ED (.88), for individuals with a current ED (.86), and for individuals with no history of ED (.88). Acceptable convergent validity was indicated based on significant correlations between the PHQ-9 and GAD-7 and DERS-SF. Confirmatory Factor Analyses revealed a mediocre fit for a one-factor structure of the PHQ-9, regardless of diagnostic status. CONCLUSIONS The psychometric properties of the Norwegian version of the PHQ-9 are acceptable across females with and without ED, and the PHQ-9 can be recommended for use in clinical ED settings and for people without mental disorders.
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Affiliation(s)
- Line Wisting
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway.
| | - Sverre Urnes Johnson
- grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Oslo, Norway ,Modum Bad Psychiatric Center, Vikersund, Norway
| | - Cynthia M. Bulik
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ,grid.10698.360000000122483208Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.10698.360000000122483208Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Ole A. Andreassen
- grid.55325.340000 0004 0389 8485NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Øyvind Rø
- grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, Mental Health and Addiction, University of Oslo, Oslo, Norway
| | - Lasse Bang
- grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
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Stochl J, Fried EI, Fritz J, Croudace TJ, Russo DA, Knight C, Jones PB, Perez J. On Dimensionality, Measurement Invariance, and Suitability of Sum Scores for the PHQ-9 and the GAD-7. Assessment 2020; 29:355-366. [PMID: 33269612 DOI: 10.1177/1073191120976863] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In psychiatry, severity of mental health conditions and their change over time are usually measured via sum scores of items on psychometric scales. However, inferences from such scores can be biased if psychometric properties such as unidimensionality and temporal measurement invariance for instruments are not met. Here, we aimed to evaluate these properties for common measures of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder Assessment-7) in a large clinical sample (N = 22,362) undergoing psychotherapy. In addition, we tested consistency in dimensionality results across different methods (parallel analysis, factor analysis, explained common variance, the partial credit model, and the Mokken model). Results showed that while both Patient Health Questionnaire-9 and Generalized Anxiety Disorder Assessment-7 are multidimensional instruments with highly correlated factors, there is justification for sum scores as measures of severity. Temporal measurement invariance across 10 therapy sessions was evaluated. Strict temporal measurement invariance was established in both scales, allowing researchers to compare sum scores as severity measures across time.
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Affiliation(s)
- Jan Stochl
- University of Cambridge, Cambridge, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, UK.,Charles University, Prague, Czech Republic
| | - Eiko I Fried
- Leiden University, Leiden, Zuid-Holland, Netherlands
| | | | | | | | | | - Peter B Jones
- University of Cambridge, Cambridge, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, UK
| | - Jesus Perez
- University of Cambridge, Cambridge, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, UK
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Mwangi P, Nyongesa MK, Koot HM, Cuijpers P, Newton CR, Abubakar A. Validation of a Swahili version of the 9-item Patient Health Questionnaire (PHQ-9) among adults living with HIV compared to a community sample from Kilifi, Kenya. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020; 1:100013. [PMID: 33313580 PMCID: PMC7714257 DOI: 10.1016/j.jadr.2020.100013] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 01/04/2023] Open
Abstract
Comparison of tool psychometrics between HIV-infected adults and community controls Internal consistency and test-retest reliability of the adapted Swahili PHQ-9 is good Swahili PHQ-9 is unidimensional overall, in HIV-infected adults and community sample Swahili PHQ-9 is invariant across group (HIV-infected vs controls), sex and age-group Swahili PHQ-9 exhibited good discriminant validity between the two participant groups
Background Depression remains under-investigated in people living with HIV in sub-Saharan Africa due to paucity of adequately validated measures. This study aimed to validate an adapted version of the 9-item Patient Health Questionnaire (PHQ-9) among adults living with HIV compared to those from the community in Kilifi, Kenya. Methods Analysis of data from 450 adults living with HIV and 337 adults from the community was conducted examining the reliability, factorial structure, measurement invariance and discriminant validity of interviewer-administered PHQ-9, Swahili version. Results Internal consistency of the Swahili PHQ-9 was good overall, in adults living with HIV and those from the community (Macdonald's omega > 0.80). The two-week test-retest reliability was acceptable among adults living with HIV (ICC = 0.64). A one-factor confirmatory factor analysis (CFA) model indicated the Swahili PHQ-9 was unidimensional in the overall sample, in adults living with HIV and those from the community. Multi-group CFA substantiated measurement invariance of this unidimensional scale across participant group (adults living with HIV vs. community), sex (females vs. males) and age category (young, middle-age and elderly adults). The Swahili PHQ-9 exhibited good discriminant validity between the two participant groups. Limitations No diagnostic interview for mental disorders was administered in the original studies limiting analysis of sensitivity and specificity of the Swahili PHQ-9. Conclusion The Swahili PHQ-9 is a reliable and valid unidimensional scale. It appears a valuable tool for assessing depressive symptoms that can be generalized across different demographic groups, in primary HIV clinics and the general community within this and similar settings.
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Affiliation(s)
- Paul Mwangi
- Department of Biostatistics, University of Hasselt, Hasselt, Belgium
| | - Moses K. Nyongesa
- Neurosciences Group, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Corresponding author at: Neurosciences Group, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya.
| | - Hans M. Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Charles R.J.C. Newton
- Neurosciences Group, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Neurosciences Group, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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Smarr KL, Keefer AL. Measures of Depression and Depressive Symptoms. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:608-629. [PMID: 33091258 DOI: 10.1002/acr.24191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/17/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Karen L Smarr
- Harry S. Truman Memorial Veterans' Hospital and University of Missouri School of Medicine, Columbia
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Lamela D, Soreira C, Matos P, Morais A. Systematic review of the factor structure and measurement invariance of the patient health questionnaire-9 (PHQ-9) and validation of the Portuguese version in community settings. J Affect Disord 2020; 276:220-233. [PMID: 32697702 DOI: 10.1016/j.jad.2020.06.066] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/19/2020] [Accepted: 06/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND This research sought to review studies that examined the factor structure of the PHQ-9 using a confirmatory factor analysis approach (Study 1); to review studies that tested the measurement invariance of the PHQ-9 (Study 2); to examine the psychometric properties of the European Portuguese version in the general population (Study 3). METHODS Using PRISMA guidelines, a search was performed on Web of Science, PsycINFO, and Scopus from 2001 to August 2019. Assessment of eligibility criteria and data extraction were conducted by two independent researchers (Studies 1 and 2). In Study 3, data were collected from 1479 Portuguese adults, using a cross-sectional design. The BDI-II and the GDS-15 were administered to examine convergent validity. RESULTS The systematic review identified four-factor models of the PHQ-9 (Study 1). Nineteen studies supported a one-factor model, whereas 12 found evidence for a two-factor model. Both models were supported in general, clinical, psychiatric, and international samples. Study 2 identified ten studies that examined PHQ-9 measurement invariance across 18 groups. The PHQ-9 measurement invariance was fully supported across studies. Study 3 revealed that a two-factor model showed a close fit to data in the European Portuguese version of the PHQ-9. Measurement invariance, reliability, and convergent and divergent validity were also established. LIMITATIONS Study 3 did not include a gold standard measure of depression to evaluate PHQ-9 diagnostic properties. CONCLUSIONS Conceptual implications of the findings are discussed, and recommendations for using the Portuguese version of the PHQ-9 as a screening measure in community settings are also highlighted.
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Affiliation(s)
- Diogo Lamela
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal.
| | - Cátia Soreira
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal
| | - Paula Matos
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal
| | - Ana Morais
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal
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Carroll HA, Hook K, Perez OFR, Denckla C, Vince CC, Ghebrehiwet S, Ando K, Touma M, Borba CPC, Fricchione GL, Henderson DC. Establishing reliability and validity for mental health screening instruments in resource-constrained settings: Systematic review of the PHQ-9 and key recommendations. Psychiatry Res 2020; 291:113236. [PMID: 32593853 PMCID: PMC7484202 DOI: 10.1016/j.psychres.2020.113236] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 01/28/2023]
Abstract
Mental illness is one of the largest contributors to the global disease burden. The importance of valid and reliable mental health measures is crucial in order to accurately measure said burden, to capture symptom improvement, and to ensure that symptoms are appropriately identified and quantified. This is of particular importance in low and middle-income countries (LMICs), where the burden of mental illness is relatively high, and there is heterogeneity in linguistic, racial, and ethnic groups. Using the PHQ-9 as an illustrative example, this systematic review aims to provide an overview of existing work and highlight common validation and reporting practices. A systematic review of published literature validating the use of the PHQ-9 in LMICs as indexed in the PubMed and PsychInfo databases was conducted. The review included n = 49 articles (reduced from n = 2,349). This manuscript summarizes these results in terms of the frequency of reporting on important procedures and in regards to the types of reliability and validity measured. Then, building off of the existing literature, we provide key recommendations for measure validation in LMICs, which can be generalized for any type of measure used in a setting in which it was not initially developed.
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Affiliation(s)
- Haley A Carroll
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States; Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States
| | - Kimberly Hook
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States; Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States.
| | - Oscar F Rojas Perez
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States; Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States
| | - Christy Denckla
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Senait Ghebrehiwet
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States
| | - Kanako Ando
- Northeastern University, Boston, MA, United States
| | - Mia Touma
- Boston University, Boston, MA, United States
| | - Christina P C Borba
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States; Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States
| | - Gregory L Fricchione
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States; Harvard Medical School, Boston, USA
| | - David C Henderson
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States; Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Peng T, Li ZM, Liu J, Zhang Y. Evaluation of reliability and validity of the Patient Health Questionnaire-9 in patients with acne. Dermatol Ther 2020; 33:e13584. [PMID: 32410322 DOI: 10.1111/dth.13584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Abstract
To evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) in patients with acne. Three hundred acne patients were enrolled from January 2019 to December 2019. PHQ-9 and Hamilton Depression Scale(HAMD) survey was conducted to evaluate their depression status. Cronbach's α coefficient and test-retest reliability after 1 week were used to analyze the reliability of PHQ-9. Factor analysis, Spearman correlation analysis, receiver operating characteristic curve (ROC curve) were used for validity analysis of the PHQ-9.The screening validity was analyzed in different subgroups. Two hundred fifty-eight patients with acne completed the questionnaire. Forty-seven were diagnosed with depressive disorder. The best cut-off point for the PHQ-9 score is 9 points, with a sensitivity of 95.7%,a specificity of 88.6% and the area under the ROC curve(AUC) of 0.973.In validity analysis, the correlation coefficient between the total score of PHQ-9 and HAMD was 0.766,the kappa value was 0.530.Factor analysis revealed two common factors (cognitive-affective factor and somatic symptom factor),which explained 65.52% of the total variances. In reliability analysis, the Cronbach's α coefficient of the PHQ-9 was 0.851,the test-retest reliability value was 0.824.The time to complete the PHQ-9 was significantly less than the time to complete HAMD (P < .001).The PHQ-9 shows good reliability and validity for the diagnosis of depression in patients with acne, and can be used for preliminary screening of depression.
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Affiliation(s)
- Tianli Peng
- Department of Dermatology, The First Affiliated Hospital of WenZhou Medical University, WenZhou, China
| | - Zhi-Ming Li
- Department of Dermatology, The First Affiliated Hospital of WenZhou Medical University, WenZhou, China
| | - Jinjin Liu
- Department of Dermatology, The First Affiliated Hospital of WenZhou Medical University, WenZhou, China
| | - Yi Zhang
- Department of Dermatology, The First Affiliated Hospital of WenZhou Medical University, WenZhou, China
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Validation of the patient health Questionnaire-9 (PHQ-9) for detecting depression among pregnant women in Lima, Peru. CURRENT PSYCHOLOGY 2020; 41:3797-3805. [DOI: 10.1007/s12144-020-00882-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Heterogeneous association patterns of depressive subfactors in suicidality: The 2014 and 2016 Korea National Health and Nutrition Examination Surveys. J Affect Disord 2020; 272:183-190. [PMID: 32379614 DOI: 10.1016/j.jad.2020.04.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/20/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The heterogeneity of depressive symptoms in suicidality is poorly understood. This study examines the heterogeneous association between subfactors of depressive symptoms in suicidality. METHODS The data of 5742 participants aged 19 and older were taken from the 2014 and 2016 Korean National Health and Nutrition Examination Surveys and analyzed. Subfactors of depressive symptoms were identified utilizing factor analyses that yielded two groups (typical- and other-depressive factors). Multivariable logistic regression models were used to estimate the association between each factor and suicidality after adjusting for covariates. RESULTS Typical depressive factors included cardinal and somatic symptoms, whereas other depressive factors contained cognitive and other symptoms. The typical factors were associated with each suicidality in succession, however, others depressive factors were not. The heterogeneity of subfactors made the greatest impact on suicide attempts, controlling for all covariates, followed by suicide plans, with a robust coefficient of typical depressive factors. These differential patterns of subfactors existed especially in females and younger people, suggesting the importance of concerning typical depressive factors for those groups. LIMITATIONS Although a confirmatory factor analysis was performed, depressive subfactors need validation and reliability tests. CONCLUSIONS Our study findings may help to explain why an improved understanding of the typical depressive factors including cardinal and somatic symptoms is important to prevent suicidality, especially in females and younger people.
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Huarcaya-Victoria J, Villarreal-Zegarra D, Podestà A, Luna-Cuadros MA. Psychometric Properties of a Spanish Version of the Fear of COVID-19 Scale in General Population of Lima, Peru. Int J Ment Health Addict 2020; 20:249-262. [PMID: 32837434 PMCID: PMC7307940 DOI: 10.1007/s11469-020-00354-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The current pandemic of the novel coronavirus COVID-19 has increased the anxiety and fear experienced by many. The main objective of this study was to analyze the psychometric properties of the Spanish-translated version of the Fear of COVID-19 Scale (FCV-19S) using a sample of population in Peru. This is a cross-sectional instrumental study. Data were collected by a convenience sampling method, resulting in a total of 832 participants, and the collection took place over 1 week, April 17–23, 2020. The original version of the FCV-19S was translated from English into Spanish. The results support a bifactor model consisting of one general factor and two specific factors—one of emotional fear reactions and another of somatic expressions of fear of COVID-19 (CFI = 0.988, RMSEA = 0.075). Invariance between healthcare workers and age groups was reached (ΔCFI < 0.01), but the invariance between men and women was not met (ΔCFI = 0.02). Convergent validity was found with depressive, anxious, and posttraumatic stress symptoms. The general factor of the fear of COVID-19 and two specific factors had an optimal level of internal consistency (ω > 0.89 and α > 0.83). The study found the Spanish-translated version of the FCV-19S has good psychometric properties and presents evidence of validity and reliability.
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Affiliation(s)
- Jeff Huarcaya-Victoria
- Facultad de Medicina, Centro de Investigación en Salud Pública, Universidad de San Martín de Porres, Lima, Peru
| | - David Villarreal-Zegarra
- Instituto Peruano de Orientación Psicológica, Lima, Peru.,CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Investigación, Universidad Católica los Ángeles de Chimbote, Chimbote, Peru
| | - Angela Podestà
- Hospital Nacional Guillermo Almenara Irigoyen, EsSalud. Departamento de Psiquiatría, Unidad de Psiquiatría de Enlace, Lima, Peru
| | - María Alejandra Luna-Cuadros
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA USA
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Wang HY, Cheng C. Psychometric Evaluation and Comparison of Two Gaming Disorder Measures Derived From the DSM-5 and ICD-11 Frameworks. Front Psychiatry 2020; 11:577366. [PMID: 33391047 PMCID: PMC7773660 DOI: 10.3389/fpsyt.2020.577366] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/27/2020] [Indexed: 12/28/2022] Open
Abstract
Gaming disorder was listed as a condition for further study in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, and measures of the disorder have mushroomed in the years since. The Gaming Disorder Test (GDT) was developed after gaming disorder was officially included in the 11th Revision of the International Classification of Diseases (ICD-11) in 2018. However, it remains unknown whether the GDT, which is based on the ICD-11 framework, is psychometrically similar to or different from the popular nine-item Internet Gaming Disorder Scale-Short Form (IGDS9-SF) based on the DSM-5 framework. To address this important but unexplored issue, the present study evaluated and compared the psychometric properties of the GDT and IGDS9-SF in a sample of 544 adult gamers (56.2% men; mean age = 28.8, SD = 8.55). The results revealed both measures to have good reliability, structural validity, and criterion validity, with the exception of one IGDS9-SF item with a low factor loading. Moreover, the IGDS9-SF exhibited scalar measurement invariance for gender and age but only partial metric invariance for employment status, whereas the GDT exhibited scalar measurement invariance for all three demographic characteristics. Finally, the GDT displayed incremental validity over the IGDS9-SF in explaining gaming time, but not social anxiety and depressive symptoms. This study thus contributes to the literature by comparing measures derived from distinct gaming disorder diagnostic frameworks empirically. Recommendations for the selection of gaming disorder measures by researchers and practitioners are discussed.
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Affiliation(s)
- Hsin-Yi Wang
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Cecilia Cheng
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong
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Denovan A, Dagnall N. Development and Evaluation of the Chronic Time Pressure Inventory. Front Psychol 2019; 10:2717. [PMID: 31866906 PMCID: PMC6904346 DOI: 10.3389/fpsyg.2019.02717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
The negative effects of chronic time pressure (i.e., time shortage and feelings of being rushed) are pervasive within modern society. Noting this, and the absence of an established self-report measure, the present paper developed and evaluated the Chronic Time Pressure Inventory (CTPI). Established theory informed the generation of items, resulting in an initial 15-item measure. Study 1, using parallel analysis, exploratory factor analysis and confirmatory factor analysis, examined CTPI factorial structure within a sample of 401 respondents. Additionally, reliability (omega and alpha) and convergent validity testing occurred by correlating the CTPI with the Perceived Stress Scale (PSS-10). Study 2 replicated the emergent, superior factor model in an independent sample of 163 respondents and assessed measurement invariance. Analysis further examined reliability (omega and alpha) and convergent validity. Across the two studies, results supported a bifactor solution, where a general overarching factor encompassed two discrete, but overlapping temporal factors (i.e., Feeling Harried and Cognitive Awareness of Time Shortage). Invariance testing indicated invariance of form, factor loadings, item intercepts and residuals across Study 1 and 2. The CTPI also demonstrated good internal reliability and satisfactory convergent validity with the PSS-10. Findings supported Szollos’ (2009) theoretical conceptualization of chronic time pressure and established the CTPI as a psychometrically sound, theoretically aligned measure of the construct. Indeed, results advocate the CTPI as a promising instrument for conducting survey-based research into chronic time pressure.
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Affiliation(s)
- Andrew Denovan
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Neil Dagnall
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
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Maroufizadeh S, Omani-Samani R, Almasi-Hashiani A, Amini P, Sepidarkish M. The reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility. Reprod Health 2019; 16:137. [PMID: 31500644 PMCID: PMC6734346 DOI: 10.1186/s12978-019-0802-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/02/2019] [Indexed: 01/17/2023] Open
Abstract
Background Depression in patients with infertility often goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) and its ultra-brief version (i.e. PHQ-2) are widely used measures of depressive symptoms. These scales have not been validated in patients with infertility. The aim of the present study was to examine the reliability and validity of the PHQ-9 and PHQ-2 in patients with infertility. Methods In this cross-sectional study, a total of 539 patients with infertility from a referral infertility clinic in Tehran, Iran completed the PHQ-9, along with other relevant scales: the WHO-five Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder-7 (GAD-7). Factor structure and internal consistency of PHQ-9 were examined via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was evaluated by relationship with WHO-5, HADS and GAD-7. Results The mean total PHQ-9 and PHQ-2 scores were 8.47 ± 6.17 and 2.42 ± 1.86, respectively, and using a cut-off value of 10 (for PHQ-9) and 3 (for PHQ-2), the prevalence of depressive symptoms was 38.6 and 43.6%, respectively. The Cronbach’s alphas for PHQ-9 and PHQ-2 were, respectively, 0.851 and 0.767, indicating good internal consistency. The CFA results confirmed the one-factor model of the PHQ-9 (χ2/df = 4.29; CFI = 0.98; RMSEA = 0.078 and SRMR = 0.044). Both PHQ-9 and PHQ-2 showed moderate to strong correlation with the measures of WHO-5, HADS-depression, HADS-anxiety, and the GAD-7, confirming convergent validity. In univariate analysis, female sex, long infertility duration, and unsuccessful treatment were significantly associated with depression symptoms. Conclusion Both PHQ-9 and PHQ-2 are brief and easy to use measures of depressive symptoms with good psychometric properties that appear suitable for routine use in patients with infertility.
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Affiliation(s)
- Saman Maroufizadeh
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Omani-Samani
- Department of Medical Ethics and Law, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Payam Amini
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran
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Valid group comparisons can be made with the Patient Health Questionnaire (PHQ-9): A measurement invariance study across groups by demographic characteristics. PLoS One 2019; 14:e0221717. [PMID: 31498796 PMCID: PMC6733536 DOI: 10.1371/journal.pone.0221717] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022] Open
Abstract
Objective Analyze the measurement invariance and the factor structure of the Patient Health Questionnaire-9 (PHQ-9) in the Peruvian population. Method Secondary data analysis performed using cross-sectional data from the Health Questionnaire of the Demographic and Health Survey in Peru. Variables of interest were the PHQ-9 and demographic characteristics (sex, age group, level of education, socioeconomic status, marital status, and area of residence). Factor structure was evaluated by standard confirmatory factor analysis (CFA), and measurement invariance by multi-group CFA, using standard goodness-of-fit indices criteria for interpreting results from both CFAs. Analysis of the internal consistency (α and ω) was also pursued. Results Data from 30,449 study participants were analyzed, 56.7% were women, average age was 40.5 years (standard deviation (SD) = 16.3), 65.9% lived in urban areas, 74.6% were married, and had 9 years of education on average (SD = 4.6). From standard CFA, a one-dimensional model presented the best fit (CFI = 0.936; RMSEA = 0.089; SRMR = 0.039). From multi-group CFA, all progressively restricted models had ΔCFI<0.01 across almost all groups by demographic characteristics. PHQ-9 reliability was optimal (α = ω = 0.87). Conclusions The evidence presents support for the one-dimensional model and measurement invariance of the PHQ-9 measure, allowing for reliable comparisons between sex, age groups, education level, socioeconomic status, marital status, and residence area, and recommends its use within the Peruvian population.
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