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Open Access 01-12-2021 | Mood Disorders | Research

Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies

Authors: 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

Published in: BMC Psychiatry | Issue 1/2021

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.

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Title: Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies
Authors: 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
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Mood Disorders
Affective Disorder
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03234-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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