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Factorial validity and invariance of the Patient Health Questionnaire (PHQ)-9 among clinical and non-clinical populations

Author

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  • Satomi Doi
  • Masaya Ito
  • Yoshitake Takebayashi
  • Kumiko Muramatsu
  • Masaru Horikoshi

Abstract

The Patient Health Questionnaire-9 (PHQ-9) is commonly used to screen for depressive disorder and for monitoring depressive symptoms. However, there are mixed findings regarding its factor structure (i.e., whether it has a unidimensional, two-dimensional, or bi-factor structure). Furthermore, its measurement invariance between non-clinical and clinical populations and that between patients with major depressive disorder (MDD) and MDD with comorbid anxiety disorder (AD) is unknown. Japanese adults with MDD (n = 406), MDD with AD (n = 636), and no psychiatric disorders (non-clinical population; n = 1,163) answered this questionnaire on the Internet. Confirmatory factor analyses showed that the bi-factor model had a better fit than the unidimensional and two-dimensional factor models did. The results of a multi-group confirmatory factor analysis indicated scalar invariance between the non-clinical and only MDD groups, and that between the only MDD and MDD with AD groups. In conclusion, the bi-factor model with two specific factors was supported among the non-clinical, only MDD, and MDD with AD groups. The scalar measurement invariance model was supported between the groups, which indicated the total or sub-scale scores were comparable between groups.

Suggested Citation

  • Satomi Doi & Masaya Ito & Yoshitake Takebayashi & Kumiko Muramatsu & Masaru Horikoshi, 2018. "Factorial validity and invariance of the Patient Health Questionnaire (PHQ)-9 among clinical and non-clinical populations," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-9, July.
    • Handle: RePEc:plo:pone00:0199235
    DOI: 10.1371/journal.pone.0199235
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    References listed on IDEAS

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    1. Yiu-Fai Yung & David Thissen & Lori McLeod, 1999. "On the relationship between the higher-order factor model and the hierarchical factor model," Psychometrika, Springer;The Psychometric Society, vol. 64(2), pages 113-128, June.
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    1. David Villarreal-Zegarra & Anthony Copez-Lonzoy & Antonio Bernabé-Ortiz & G J Melendez-Torres & Juan Carlos Bazo-Alvarez, 2019. "Valid group comparisons can be made with the Patient Health Questionnaire (PHQ-9): A measurement invariance study across groups by demographic characteristics," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-15, September.
    2. Nicolas Barrantes & Jhonatan Clausen, 2022. "Does Multidimensional Poverty Affect Depression? Evidence from Peru," Progress in Development Studies, , vol. 22(2), pages 107-129, April.
    3. Carl B. Becker & Yozo Taniyama & Noriko Sasaki & Megumi Kondo-Arita & Shinya Yamada & Kayoko Yamamoto, 2022. "Mourners’ Dissatisfaction with Funerals May Influence Their Subsequent Medical/Welfare Expenses—A Nationwide Survey in Japan," IJERPH, MDPI, vol. 19(1), pages 1-12, January.

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