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Tibubos, A.N.* ; Otten, D.* ; Zöller, D.* ; Binder, H.* ; Wild, P.S.* ; Fleischer, T.* ; Johar, H. ; Atasoy, S. ; Schulze, L.* ; Ladwig, K.H.* ; Schomerus, G.* ; Linkohr, B. ; Grabe, H.J.* ; Kruse, J.* ; Schmidt, C.O.* ; Münzel, T.* ; König, J.* ; Brähler, E.* ; Beutel, M.E.*

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

BMC Psychiatry 21:238 (2021)

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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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Publication type Article: Journal article

Document type Scientific Article

Corresponding Author

Keywords Cognitive-affective Dimension ; Depression ; Regional Differences ; Sex-differences ; Somatic Dimension; Coronary-heart-disease; Spinal-cord-injury; Measurement Invariance; General-population; Cancer-patients; Rating-scales; Phq-9; Prevalence; Severity; Recommendations

ISSN (print) / ISBN 1471-244X

e-ISSN 1471-244X

Journal BMC Psychiatry

Quellenangaben Volume: 21, Issue: 1, Article Number: 238

Publisher BioMed Central

Publishing Place Campus, 4 Crinan St, London N1 9xw, England

Non-patent literature Publications

Reviewing status Peer reviewed

Institute(s) Institute of Epidemiology (EPI)

Grants government of Rhineland-Palatinate ("Stiftung Rheinland-Pfalz fur Innovation")
research program "Wissen schafft Zukunft" of the Johannes Gutenberg-University of Mainz
research program "Center for Translational Vascular Biology (CTVB)" of the Johannes Gutenberg-University of Mainz
Boehringer Ingelheim
PHILIPS Medical Systems
Federal Ministry of Education and Research
Helmholtz Zentrum Munchen - German Research Center for Environmental Health - German Federal Ministry of Education and Research (BMBF)
State of Bavaria
Ministry of Cultural Affairs
Social Ministry of the Federal State of Mecklenburg-West Pomerania
Projekt DEAL
Federal Ministry of Education and Research (BMBF)