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Factor structure and measurement invariance across various demographic groups and over time for the PHQ-9 in primary care patients in Spain.

ABSTRACT: The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study) and a subsample of 218 patients who participated in a follow-up assessment at 3 months. Confirmatory factor analysis (CFA) was used to test one- and two-factor structures identified in previous studies. Analyses of multiple-group invariance were conducted to determine the extent to which the factor structure is comparable across various demographic groups (i.e., gender, age, marital status, level of education, and employment situation) and over time. Both one-factor and two-factor re-specified models met all the pre-established fit criteria. However, because the factors identified in the two-factor model were highly correlated (r = .86), the one-factor model was preferred for its parsimony. Multi-group CFA indicated measurement invariance across different demographic groups and across time. The present findings suggest that physicians in Spain can use the PHQ-9 to obtain a global score for depression severity in different demographic groups and to reliably monitor changes over time in the primary care setting.

SUBMITTER: Gonzalez-Blanch C

PROVIDER: S-EPMC5825085 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Factor structure and measurement invariance across various demographic groups and over time for the PHQ-9 in primary care patients in Spain.

González-Blanch César C Medrano Leonardo Adrián LA Muñoz-Navarro Roger R Ruíz-Rodríguez Paloma P Moriana Juan Antonio JA Limonero Joaquín T JT Schmitz Florian F Cano-Vindel Antonio A

PloS one 20180223 2

The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study) and a subsample of 218 patients who partici ...[more]

PMID: 29474410

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Project description:AimTo investigate whether items of the SF-12, widely used to assess health outcome in clinical practice and public health research, provide unbiased measurements of underlying constructs in different demographic groups regarding gender, age, educational level and ethnicity.MethodsWe included 23,146 men and women aged 18-70 of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, or Moroccan origin from the HELIUS study. Both multiple group confirmatory factor analyses (MGCFA), with increasingly stringent model constraints (i.e. assessing Configural, Metric, Strong and Strict measurement invariance (MI)), and regression analysis were conducted to establish comparability of SF-12 items across demographic groups.ResultsMI regarding gender, age and education was tested in the ethnic Dutch group (N = 4,615). In each subsequent step of testing MI, change in goodness-of-fit measures did not exceed 0.010 (RMSEA) or 0.004 (CFI). Moreover, goodness-of-fit indices showed good fit for strict invariance models: RMSEA<0.055; CFI>0.97. Regarding ethnicity, RMSEA values of metric and subsequent models fell above 0.055, indicating violation of measurement invariance in factor loadings, thresholds and residual variances. Regression analysis revealed possible age-, education- and ethnicity-related DIF. Adjustment for this DIF had little impact on the magnitude of age and educational differences in physical and mental health, but ethnic inequalities in physical health-and to a lesser extent mental health-were reduced after DIF adjustment.ConclusionsWe found no evidence of violation of measurement invariance of the SF-12 regarding gender, age and educational level. If minor DIF would remain undetected in our MGCFA analyses, we showed that this would have negligible effect on the magnitude of demographic health inequalities. Regarding ethnicity, the SF-12 was not measurement invariant. After accounting for DIF, we observed a reduction of ethnic inequalities in health, in particular in physical health. Caution is warranted when comparing SF-12 scores across population groups with various ethnic backgrounds.

Dataset Information

Factor structure and measurement invariance across various demographic groups and over time for the PHQ-9 in primary care patients in Spain.

Publications

Factor structure and measurement invariance across various demographic groups and over time for the PHQ-9 in primary care patients in Spain.

Similar Datasets

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