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Age-Related Changes in Item Responses to the Patient Health Questionnaire-9: Evidence From the National Health and Nutrition Examination Survey.

ABSTRACT: Background:Epidemiological studies have shown that total scores in depression screening scales change with age, but the mechanism underlying these age-related changes remains unclear. Previous research has indicated that item responses in depression screening scales exhibit characteristic distributions in the general population. We analyzed Patient Health Questionnaire-9 (PHQ-9) data from a representative survey conducted in the USA, to determine how the response pattern for each item changed with age and whether the pattern of responses contributed to age-related changes in total scores. Methods:We analyzed PHQ-9 data for 17,274 participants in the 2011-2016 National Health and Nutrition Examination Survey. The PHQ-9 allows respondents to self-rate the frequency of depressive symptoms using a four-point scale ranging from "not at all" to "nearly every day". Results:The lines for all nine item responses followed the same characteristic pattern across all age groups, which was marked by intersection at a single point between "not at all" and "several days" and parallel patterns between "several days" and "nearly every day" on a logarithmic scale. The probability of "nearly every day" showed a reverse U-shaped pattern, in that it was low from 12-29 years, increased during 30-50 years, and then decreased at ?60 years. The age-related change in the probability of a response of "nearly every day" coincided with the trajectory of the PHQ-9 total scores. Conclusions:This study demonstrated that item responses for the PHQ-9 followed a similar mathematical pattern across the adult lifespan. Moreover, our findings suggested that the probability of a response of "nearly every day" played an important role in age-related changes in PHQ-9 total scores across adulthood.

SUBMITTER: Tomitaka S

PROVIDER: S-EPMC7387704 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Age-Related Changes in Item Responses to the Patient Health Questionnaire-9: Evidence From the National Health and Nutrition Examination Survey.

Tomitaka Shinichiro S Kawasaki Yohei Y Ide Kazuki K Akutagawa Maiko M Ono Yutaka Y Furukawa Toshiaki A TA

Frontiers in psychiatry 20200722

<h4>Background</h4>Epidemiological studies have shown that total scores in depression screening scales change with age, but the mechanism underlying these age-related changes remains unclear. Previous research has indicated that item responses in depression screening scales exhibit characteristic distributions in the general population. We analyzed Patient Health Questionnaire-9 (PHQ-9) data from a representative survey conducted in the USA, to determine how the response pattern for each item ch ...[more]

PMID: 32793010

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Project description:ObjectivesAccurately measuring disability is critical toward policy development, economic analyses, and determining individual-level effects of health interventions. Nationally representative population surveys such as the National Health and Nutrition Examination Survey provide key opportunities to measure disability constructs such as activity limitations. However, only very limited work has previously evaluated the item response properties of questions pertaining to limitations in National Health and Nutrition Examination Survey.MethodsThis was a cross-sectional study. We included participants ⩾20 years old for the 2013-2018 National Health and Nutrition Examination Survey cycles. Activity limitations, and a smaller number of body function impairments or participation restrictions, were determined from interview questions. We performed item response theory models (a two-parameter logistic and a graded response model) to characterize discriminating information along the latent continuum of activity limitation.ResultsWe included 17,057 participants. Although each particular limitation was somewhat rare (maximally 13%), 7214 (38%) responded having at least one limitation. We found a high amount of discriminating information at 1-2 standard deviations above average limitation, though essentially zero discrimination below that range. Items had substantial overlap in the range at which they provided information distinguishing individuals. The ordinal graded response model including 20 limitations provided greater information than the dichotomous two-parameter logistic model, though further omitting items from the graded response model led to loss of information.ConclusionNational Health and Nutrition Examination Survey disability-related questions, mostly specifically activity limitations, provided a high degree of information distinguishing individuals with higher than average limitations on the latent continuum, but essentially zero resolution to distinguish individuals with low or average limitations. Future work may focus on developing items which better distinguish individuals at the "lower" end of the limitation spectrum.

Project description:BackgroundTo investigate the distribution of intraocular pressure (IOP) and refractive errors according to age group in a representative sample of non-glaucomatous Korean adults.MethodsA total of 7,277 adults (≥ 19 years) who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011 underwent ophthalmic examination were divided into three groups according to age: the young- (19-39 years), middle- (40-59 years), and old- (≥ 60 years) age groups. Simple and multiple regression analyses between IOP and various parameters (including the refractive error) were conducted.ResultsThe mean IOP of the total population was 14.0 ± 0.1 mmHg [young: 13.9 ± 0.1 mmHg; middle: 14.1 ± 0.1 mmHg; old: 13.8 ± 0.2 mmHg (P for trend = 0.085)]. Myopia and high myopia were more prevalent in the young- (70.8% and 16.1%, respectively), compared to the middle- (44.6% and 10.9%) and old- (8.9% and 2.2%) age groups. Univariate analysis in the total population showed that higher IOP was associated with myopic refractive error, the female gender, higher body mass index (BMI), diabetes, hypertension, and hypercholesterolemia (all P<0.05). In the young- and middle-age groups, higher IOP was associated with myopic refractive error, the female gender, higher BMI, hypercholesterolemia and diabetes (all P<0.05). In the old-age group, the association between IOP and refractive error was not significant (P = 0.828). In multiple linear regression analysis, similar significant relationships between the refractive error and IOP were found in the young- and middle-age groups (beta = -0.08 and -0.12; P = 0.002 and <0.001 for young- and middle-age group, respectively), but not in the old-age group (beta = 0.03; P = 0.728), after adjusting for age, gender, BMI, region of habitation, diabetes, hypertension, and hypercholesterolemia.ConclusionsMyopic refractive error was an independent predictor of higher IOP in non- glaucomatous eyes, and the association between refractive error and IOP differed according to age.

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Age-Related Changes in Item Responses to the Patient Health Questionnaire-9: Evidence From the National Health and Nutrition Examination Survey.

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Age-Related Changes in Item Responses to the Patient Health Questionnaire-9: Evidence From the National Health and Nutrition Examination Survey.

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