Valid group comparisons can be made with the Patient Health Questionnaire (PHQ-9): A measurement invariance study across groups by demographic characteristics

Autoři: David Villarreal-Zegarra aff001;  Anthony Copez-Lonzoy aff001;  Antonio Bernabé-Ortiz aff002;  G. J. Melendez-Torres aff006;  Juan Carlos Bazo-Alvarez aff007
Působiště autorů: Instituto Peruano de Orientación Psicológica, Lima, Peru aff001;  CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru aff002;  Universidad San Ignacio de Loyola, Lima, Peru aff003;  Asociación Peruana de Profesionales de las Adicciones, Lima, Peru aff004;  Universidad Científica del Sur, Lima, Peru aff005;  Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, United Kingdom aff006;  Instituto de Investigación, Universidad Católica Los Ángeles de Chimbote, Chimbote, Peru aff007;  Methodology Research Group, Department of Primary Care and Population Health, University College London (UCL), London, United Kingdom aff008;  PSYCOPERU Peruvian Research Institute of Educational and Social Psychology, Lima, Peru aff009
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0221717



Analyze the measurement invariance and the factor structure of the Patient Health Questionnaire-9 (PHQ-9) in the Peruvian population.


Secondary data analysis performed using cross-sectional data from the Health Questionnaire of the Demographic and Health Survey in Peru. Variables of interest were the PHQ-9 and demographic characteristics (sex, age group, level of education, socioeconomic status, marital status, and area of residence). Factor structure was evaluated by standard confirmatory factor analysis (CFA), and measurement invariance by multi-group CFA, using standard goodness-of-fit indices criteria for interpreting results from both CFAs. Analysis of the internal consistency (α and ω) was also pursued.


Data from 30,449 study participants were analyzed, 56.7% were women, average age was 40.5 years (standard deviation (SD) = 16.3), 65.9% lived in urban areas, 74.6% were married, and had 9 years of education on average (SD = 4.6). From standard CFA, a one-dimensional model presented the best fit (CFI = 0.936; RMSEA = 0.089; SRMR = 0.039). From multi-group CFA, all progressively restricted models had ΔCFI<0.01 across almost all groups by demographic characteristics. PHQ-9 reliability was optimal (α = ω = 0.87).


The evidence presents support for the one-dimensional model and measurement invariance of the PHQ-9 measure, allowing for reliable comparisons between sex, age groups, education level, socioeconomic status, marital status, and residence area, and recommends its use within the Peruvian population.

Klíčová slova:

Medicine and health sciences – Mental health and psychiatry – Mood disorders – Depression – Health care – Primary care – Public and occupational health – Socioeconomic aspects of health – Social sciences – Sociology – Education – Educational attainment – People and places – Population groupings – Age groups – Earth sciences – Geography – Geographic areas – Urban areas – Research and analysis methods – Mathematical and statistical techniques – Statistical methods – Factor analysis – Research assessment – Research validity – Physical sciences – Mathematics – Statistics


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