Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies
Abstract Background The Patient Health Questionnaire-9 (PHQ-9) has been proposed as a reliable and valid screening instrument for depressive symptoms with one latent factor. However, studies explicitly testing alternative model structures found support for a two-dimensional structure reflecting a so...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | BMC Psychiatry |
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| Online Access: | https://doi.org/10.1186/s12888-021-03234-x |
| _version_ | 1830307294847434752 |
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| author | Ana N. Tibubos Daniëlle Otten Daniela Zöller Harald Binder Philipp S. Wild Toni Fleischer Hamimatunnisa Johar Seryan Atasoy Lara Schulze Karl-Heinz Ladwig Georg Schomerus Birgit Linkohr Hans J. Grabe Johannes Kruse Carsten-Oliver Schmidt Thomas Münzel Jochem König Elmar Brähler Manfred E. Beutel |
| author_facet | Ana N. Tibubos Daniëlle Otten Daniela Zöller Harald Binder Philipp S. Wild Toni Fleischer Hamimatunnisa Johar Seryan Atasoy Lara Schulze Karl-Heinz Ladwig Georg Schomerus Birgit Linkohr Hans J. Grabe Johannes Kruse Carsten-Oliver Schmidt Thomas Münzel Jochem König Elmar Brähler Manfred E. Beutel |
| author_sort | Ana N. Tibubos |
| collection | DOAJ |
| description | Abstract Background The Patient Health Questionnaire-9 (PHQ-9) has been proposed as a reliable and valid screening instrument for depressive symptoms with one latent factor. However, studies explicitly testing alternative model structures found support for a two-dimensional structure reflecting a somatic and a cognitive-affective dimension. We investigated the bidimensional structure of the PHQ-9, with a somatic (sleeping problems, fatigability, appetitive problems, and psychomotor retardation) and a cognitive-affective dimension (lack of interest, depressed mood, negative feelings about self, concentration problems, and suicidal ideation), and tested for sex- and regional-differences. Methods We have included data from the GEnder-Sensitive Analyses of mental health trajectories and implications for prevention: A multi-cohort consortium (GESA). Privacy-preserving analyses to provide information on the overall population and cohort-specific information and analyses of variance to compare depressive, somatic and cognitive-affective symptoms between sexes and cohorts were executed in DataSHIELD. In order to determine the dimensionality and measurement invariance of the PHQ-9 we tested three models (1 factor, 2 correlated factors, and bifactor) via confirmatory analyses and performed multi-group confirmatory factor analysis. Results Differences between sex and cohorts exist for PHQ-9 and for both of its dimensions. Women reported depressive symptoms in general as well as somatic and cognitive-affective symptoms more frequently. For all tested models an acceptable to excellent fit was found, consistently indicating a better model fit for the two-factor and bifactor model. Scalar measurement invariance was established between women and men, the three cohorts, and their interaction. Conclusions The two facets of depression should be taken into account when using PHQ-9, while data also render support to a general factor. Somatic and cognitive-affective symptoms assessed by the PHQ-9 can be considered equivalent across women and men and between different German populations from different regions. |
| first_indexed | 2024-12-19T10:29:01Z |
| format | Article |
| id | doaj.art-1556e73148dd473f8cbfe39ccbfb726e |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-19T10:29:01Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-1556e73148dd473f8cbfe39ccbfb726e2022-12-21T20:25:49ZengBMCBMC Psychiatry1471-244X2021-05-0121111310.1186/s12888-021-03234-xBidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studiesAna N. Tibubos0Daniëlle Otten1Daniela Zöller2Harald Binder3Philipp S. Wild4Toni Fleischer5Hamimatunnisa Johar6Seryan Atasoy7Lara Schulze8Karl-Heinz Ladwig9Georg Schomerus10Birgit Linkohr11Hans J. Grabe12Johannes Kruse13Carsten-Oliver Schmidt14Thomas Münzel15Jochem König16Elmar Brähler17Manfred E. Beutel18Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University MainzDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University MainzFreiburg Center of Data Analysis and Modelling, Mathematical Institute – Faculty of Mathematics and Physics, University of FreiburgFreiburg Center of Data Analysis and Modelling, Mathematical Institute – Faculty of Mathematics and Physics, University of FreiburgPreventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center, Johannes Gutenberg-University MainzDepartment of Psychiatry and Psychotherapy, University Medicine GreifswaldDepartment of Psychosomatic Medicine and Psychotherapy, University of Gieβen and MarburgDepartment of Psychosomatic Medicine and Psychotherapy, University of Gieβen and MarburgDepartment of Psychiatry and Psychotherapy, University Medicine GreifswaldDepartment of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität MünchenDepartment of Psychiatry and Psychotherapy, Leipzig University Medical CenterHelmholtz Zentrum München, German Research Center for Environmental Health, Institute of EpidemiologyDepartment of Psychiatry and Psychotherapy, University Medicine GreifswaldDepartment of Psychosomatic Medicine and Psychotherapy, University of Gieβen and MarburgInstitute for Community Management, University Medicine GreifswaldDZHK (German Center for Cardiovascular Research), Partner Site Rhine-MainInstitute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg-University MainzDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University MainzDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University MainzAbstract Background The Patient Health Questionnaire-9 (PHQ-9) has been proposed as a reliable and valid screening instrument for depressive symptoms with one latent factor. However, studies explicitly testing alternative model structures found support for a two-dimensional structure reflecting a somatic and a cognitive-affective dimension. We investigated the bidimensional structure of the PHQ-9, with a somatic (sleeping problems, fatigability, appetitive problems, and psychomotor retardation) and a cognitive-affective dimension (lack of interest, depressed mood, negative feelings about self, concentration problems, and suicidal ideation), and tested for sex- and regional-differences. Methods We have included data from the GEnder-Sensitive Analyses of mental health trajectories and implications for prevention: A multi-cohort consortium (GESA). Privacy-preserving analyses to provide information on the overall population and cohort-specific information and analyses of variance to compare depressive, somatic and cognitive-affective symptoms between sexes and cohorts were executed in DataSHIELD. In order to determine the dimensionality and measurement invariance of the PHQ-9 we tested three models (1 factor, 2 correlated factors, and bifactor) via confirmatory analyses and performed multi-group confirmatory factor analysis. Results Differences between sex and cohorts exist for PHQ-9 and for both of its dimensions. Women reported depressive symptoms in general as well as somatic and cognitive-affective symptoms more frequently. For all tested models an acceptable to excellent fit was found, consistently indicating a better model fit for the two-factor and bifactor model. Scalar measurement invariance was established between women and men, the three cohorts, and their interaction. Conclusions The two facets of depression should be taken into account when using PHQ-9, while data also render support to a general factor. Somatic and cognitive-affective symptoms assessed by the PHQ-9 can be considered equivalent across women and men and between different German populations from different regions.https://doi.org/10.1186/s12888-021-03234-xDepressionSomatic dimensionCognitive-affective dimensionSex-differencesRegional differences |
| spellingShingle | Ana N. Tibubos Daniëlle Otten Daniela Zöller Harald Binder Philipp S. Wild Toni Fleischer Hamimatunnisa Johar Seryan Atasoy Lara Schulze Karl-Heinz Ladwig Georg Schomerus Birgit Linkohr Hans J. Grabe Johannes Kruse Carsten-Oliver Schmidt Thomas Münzel Jochem König Elmar Brähler Manfred E. Beutel Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies BMC Psychiatry Depression Somatic dimension Cognitive-affective dimension Sex-differences Regional differences |
| title | Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies |
| title_full | Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies |
| title_fullStr | Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies |
| title_full_unstemmed | Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies |
| title_short | Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies |
| title_sort | bidimensional structure and measurement equivalence of the patient health questionnaire 9 sex sensitive assessment of depressive symptoms in three representative german cohort studies |
| topic | Depression Somatic dimension Cognitive-affective dimension Sex-differences Regional differences |
| url | https://doi.org/10.1186/s12888-021-03234-x |
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