Authors:	Tibubos, Ana N. Otten, Daniëlle Zöller, Daniela Binder, Harald Wild, Philipp S. Fleischer, Toni Johar, Hamimatunnisa Atasoy, Seryan Schulze, Lara Ladwig, Karl-Heinz Schomerus, Georg Linkohr, Birgit Grabe, Hans J. Kruse, Johannes Schmidt, Carsten-Oliver Münzel, Thomas König, Jochem Brähler, Elmar Beutel, Manfred E.
Title:	Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9 : sex-sensitive assessment of depressive symptoms in three representative German cohort studies
Online publication date:	6-Jul-2022
Year of first publication:	2021
Language:	english
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.
DDC:	610 Medizin 610 Medical sciences
Institution:	Johannes Gutenberg-Universität Mainz
Department:	FB 04 Medizin
Place:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-7317
Version:	Published version
Publication type:	Zeitschriftenaufsatz
License:	CC BY
Information on rights of use:	https://creativecommons.org/licenses/by/4.0/
Journal:	BMC psychiatry 21
Pages or article number:	238
Publisher:	BioMed Central
Publisher place:	London
Issue date:	2021
ISSN:	1471-244X
Publisher DOI:	10.1186/s12888-021-03234-x
Appears in collections:	JGU-Publikationen