Measurement invariance of the patient health questionnaire-9 (PHQ-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: NHANES 2005–2016

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dc.contributor.authorPatel, Jay S.
dc.contributor.authorOh, Youngha
dc.contributor.authorRand, Kevin L.
dc.contributor.authorWu, Wei
dc.contributor.authorCyders, Melissa A.
dc.contributor.authorKroenke, Kurt
dc.contributor.authorStewart, Jesse C.
dc.contributor.departmentPsychology, School of Scienceen_US
dc.date.accessioned2021-05-03T16:02:57Z
dc.date.available2021-05-03T16:02:57Z
dc.date.issued2019-07-29
dc.description.sponsorshipBackground: Despite its popularity, little is known about the measurement invariance of the Patient Health Questionnaire-9 (PHQ-9) across U.S. sociodemographic groups. Use of a screener shown not to possess measurement invariance could result in under-detection/treatment of depression, potentially exacerbating sociodemographic disparities in depression. Therefore, we assessed the factor structure and measurement invariance of the PHQ-9 across major U.S. sociodemographic groups. Methods: U.S. population representative data came from the 2005–2016 National Health and Nutrition Examination Survey (NHANES) cohorts We conducted a measurement invariance analysis of 31,366 respondents across sociodemographic factors of sex, race/ethnicity, and education level. Results: Considering results of single-group confirmatory factor analyses (CFAs), depression theory, and research utility, we justify a two-factor structure for the PHQ-9 consisting of a cognitive/affective factor and a somatic factor (RMSEA=0.034, TLI=0.985, CFI=0.989). Based on multiple-group CFAs testing configural, scalar, and strict factorial invariance, we determined that invariance held for sex, race/ethnicity, and education level groups, as all models demonstrated close model fit (RMSEA=0.025–0.025, TLI=0.985–0.992, CFI=0.986–0.991). Finally, for all steps ΔCFI was < −0.004, and ΔRMSEA was < 0.01. Conclusions: We demonstrate that the PHQ-9 is acceptable to use in major U.S. sociodemographic groups and allows for meaningful comparisons in total, cognitive/affective, and somatic depressive symptoms across these groups, extending its use to the community. This knowledge is timely as medicine moves towards alternative payment models emphasizing high-quality and cost-efficient care, which will likely incentivize behavioral and population health efforts. We also provide a consistent, evidence-based approach for calculating PHQ-9 subscale scores.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationPatel, J. S., Oh, Y., Rand, K. L., Wu, W., Cyders, M. A., Kroenke, K., & Stewart, J. C. (2019). Measurement invariance of the patient health questionnaire-9 (PHQ-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: NHANES 2005–2016. Depression and Anxiety, 36(9), 813–823. https://doi.org/10.1002/da.22940en_US
dc.identifier.issn1520-6394en_US
dc.identifier.urihttps://hdl.handle.net/1805/25849
dc.language.isoen_USen_US
dc.publisherWileyen_US
dc.relation.isversionofhttps://doi.org/10.1002/da.22940en_US
dc.relation.journalDepression and Anxietyen_US
dc.sourcePMCen_US
dc.subjectContinental Population Groupsen_US
dc.subjectDepressionen_US
dc.subjectDepressive Disorderen_US
dc.subjectFactor Analysisen_US
dc.titleMeasurement invariance of the patient health questionnaire-9 (PHQ-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: NHANES 2005–2016en_US
dc.typeArticleen_US
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