Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study
Background: Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifact...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2018-06-01
|
| Series: | Frontiers in Psychiatry |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fpsyt.2018.00240/full |
| _version_ | 1818410453875818496 |
|---|---|
| author | Rainer Leonhart Lars de Vroege Lars de Vroege Lan Zhang Yang Liu Zaiquan Dong Rainer Schaefert Rainer Schaefert Rainer Schaefert Sandra Nolte Sandra Nolte Felix Fischer Kurt Fritzsche Christina M. van der Feltz-Cornelis Christina M. van der Feltz-Cornelis |
| author_facet | Rainer Leonhart Lars de Vroege Lars de Vroege Lan Zhang Yang Liu Zaiquan Dong Rainer Schaefert Rainer Schaefert Rainer Schaefert Sandra Nolte Sandra Nolte Felix Fischer Kurt Fritzsche Christina M. van der Feltz-Cornelis Christina M. van der Feltz-Cornelis |
| author_sort | Rainer Leonhart |
| collection | DOAJ |
| description | Background: Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China.Method: Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed.Results: The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples.Conclusion: The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted to a bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China. |
| first_indexed | 2024-12-14T10:15:46Z |
| format | Article |
| id | doaj.art-506745e1c5194af6aa64025d8a0aee47 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-14T10:15:46Z |
| publishDate | 2018-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-506745e1c5194af6aa64025d8a0aee472022-12-21T23:06:51ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402018-06-01910.3389/fpsyt.2018.00240379437Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) StudyRainer Leonhart0Lars de Vroege1Lars de Vroege2Lan Zhang3Yang Liu4Zaiquan Dong5Rainer Schaefert6Rainer Schaefert7Rainer Schaefert8Sandra Nolte9Sandra Nolte10Felix Fischer11Kurt Fritzsche12Christina M. van der Feltz-Cornelis13Christina M. van der Feltz-Cornelis14Department Social Psychology and Methodology, Institute of Psychology, University of Freiburg, Freiburg, GermanyClinical Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, NetherlandsDepartment Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, NetherlandsMental Health Center, West China Hospital of Sichuan University, Chengdu, ChinaMental Health Center, West China Hospital of Sichuan University, Chengdu, ChinaMental Health Center, West China Hospital of Sichuan University, Chengdu, ChinaDivision of Internal Medicine, Department of Psychosomatic Medicine, University Hospital Basel, Basel, SwitzerlandDepartment of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, GermanyFaculty of Medicine, University of Basel, Basel, SwitzerlandDepartment of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyPopulation Health Strategic Research Centre, School of Health and Social Development, Deakin University, Burwood, VIC, AustraliaDepartment of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany0Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, GermanyClinical Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, NetherlandsDepartment Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, NetherlandsBackground: Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China.Method: Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed.Results: The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples.Conclusion: The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted to a bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.https://www.frontiersin.org/article/10.3389/fpsyt.2018.00240/fullsomatic symptomspatient health questionnaire-15factor structurestructural equation modeling (SEM)transcultural |
| spellingShingle | Rainer Leonhart Lars de Vroege Lars de Vroege Lan Zhang Yang Liu Zaiquan Dong Rainer Schaefert Rainer Schaefert Rainer Schaefert Sandra Nolte Sandra Nolte Felix Fischer Kurt Fritzsche Christina M. van der Feltz-Cornelis Christina M. van der Feltz-Cornelis Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study Frontiers in Psychiatry somatic symptoms patient health questionnaire-15 factor structure structural equation modeling (SEM) transcultural |
| title | Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study |
| title_full | Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study |
| title_fullStr | Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study |
| title_full_unstemmed | Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study |
| title_short | Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study |
| title_sort | comparison of the factor structure of the patient health questionnaire for somatic symptoms phq 15 in germany the netherlands and china a transcultural structural equation modeling sem study |
| topic | somatic symptoms patient health questionnaire-15 factor structure structural equation modeling (SEM) transcultural |
| url | https://www.frontiersin.org/article/10.3389/fpsyt.2018.00240/full |
| work_keys_str_mv | AT rainerleonhart comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT larsdevroege comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT larsdevroege comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT lanzhang comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT yangliu comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT zaiquandong comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT rainerschaefert comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT rainerschaefert comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT rainerschaefert comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT sandranolte comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT sandranolte comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT felixfischer comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT kurtfritzsche comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT christinamvanderfeltzcornelis comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy AT christinamvanderfeltzcornelis comparisonofthefactorstructureofthepatienthealthquestionnaireforsomaticsymptomsphq15ingermanythenetherlandsandchinaatransculturalstructuralequationmodelingsemstudy |