Applicability and clinical utility of the German rivermead post-concussion symptoms questionnaire in proxies of children after traumatic brain injury: an instrument validation study.

BACKGROUND: The German Rivermead Post-Concussion Symptoms Questionnaire (RPQ) can be used to assess post-concussion symptoms (PCS) after traumatic brain injury (TBI) in adults, adolescents, and children. METHODS: In this study, we examined the psychometric properties of the German RPQ proxy version (N = 146) for children (8-12 years) after TBI at the item, total and scale score level. Construct validity was analyzed using rank correlations with the proxy-assessed Post-Concussion Symptoms Inventory (PCSI-P), the Patient Health Questionnaire 9 (PHQ-9), and the Generalized Anxiety Disorder Scale 7 (GAD-7). Furthermore, sensitivity testing was performed concerning subjects' sociodemographic and injury-related characteristics. Differential item functioning (DIF) was analyzed to assess the comparability of RPQ proxy ratings for children with those for adolescents. RESULTS: Good internal consistency was demonstrated regarding Cronbach's α (0.81-0.90) and McDonald's ω (0.84-0.92). The factorial validity of a three-factor model was superior to the original one-factor model. Proxy ratings of the RPQ total and scale scores were strongly correlated with the PCSI-P (ϱ = 0.50-0.69), as well as moderately to strongly correlated with the PHQ-9 (ϱ = 0.49-0.65) and the GAD-7 (ϱ = 0.44-0.64). The DIF analysis revealed no relevant differences between the child and adolescent proxy versions. CONCLUSIONS: The German RPQ proxy is a psychometrically reliable and valid instrument for assessing PCS in children after TBI. Therefore, RPQ self- and proxy-ratings can be used to assess PCS in childhood as well as along the lifespan of an individual after TBI.

Psychometric properties of the GAD-7 (General Anxiety Disorder-7): a cross-sectional study of the Peruvian general population.

BACKGROUND: Anxiety disorders are among the main mental health problems worldwide and are considered one of the most disabling conditions. Therefore, it is essential to have measurement tools that can be used to screen for anxiety symptoms in the general population and thus identify potential cases of people with anxiety symptoms and provide them with timely care. Our aim was to evaluate the psychometric properties of the General Anxiety Disorder-7 scale (GAD-7) in the Peruvian population. METHOD: Our study was a cross-sectional study. The sample included people aged 12 to 65 years in Peru. Confirmatory factor analysis, analysis of measurement invariance, convergent validity with the Patient Health Questionnaire-9 (PHQ-9) and internal consistency analysis were performed. RESULTS: In total, 4431 participants were included. The one-factor model showed the best fit (CFI = 0.994; TLI = 0.991; RMSEA = 0.068; WRMR = 1.567). The GAD-7 score showed measurement invariance between men and women and between age groups (adults vs. adolescents) (ΔCFI < 0.01). The internal consistency of the one-factor model was satisfactory (ω = 0.90, α = 0.93). The relationship between depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7) presented a moderate correlation (r = 0.77). CONCLUSIONS: Our study concluded that the GAD-7 score shows evidence of validity and reliability for the one-factor model. Furthermore, because the GAD-7 score is invariant, comparisons can be made between groups (i.e., by sex and age group). Finally, we recommend the use of the GAD-7 for the general population in the Peruvian context.

Psychometric validation of the 15-item Patient Health Questionnaire - Anxiety and Depression Scale (PHQ-ADS) to assess psychological distress in breast cancer survivors.

OBJECTIVE: Psychological distress persists amongst breast cancer survivors, so reliable assessment of symptoms is essential. The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) is a composite measure of depression and anxiety and has been used to measure distress. This study aimed to evaluate the psychometric properties of the PHQ-ADS within breast cancer survivors. METHOD: Breast cancer survivors (N = 280) were recruited online and followed up at 12-months. Depression (PHQ-8) and anxiety (GAD-7) items formed the composite PHQ-ADS score. Additional measures included: distress thermometer (convergent validity), fear of cancer recurrence and COVID distress (discriminant validity), and self-compassion (predictive validity). Confirmatory factor analysis (CFA) using weighted least squares mean and variance adjusted estimation was undertaken. RESULTS: One, two, and bifactor models underlying the PHQ-ADS were evaluated. The bifactor model had the most appropriate model fit overall. Omega hierarchical for the general distress factor was 0.914, accounting for 82% of explained variance. This suggests the PHQ-ADS is sufficiently unidimensional to warrant use of a total composite score. The PHQ-ADS demonstrated strong convergent and moderate discriminant validity. Self-compassion was an independent predictor of distress at 12-months. CONCLUSIONS: The PHQ-ADS is a valid measure for psychological distress in breast cancer survivors prescribed hormone therapy.

Reliability and validity of the Patient Health Questionnaire-4 scale and its subscales of depression and anxiety among US adults based on nativity.

BACKGROUND: The burdens of anxiety and depression symptoms have significantly increased in the general US population, especially during this COVID-19 epidemiological crisis. The first step in an effective treatment for anxiety and depression disorders is screening. The Patient Health Questionnaire-4 (PHQ-4, a 4-item measure of anxiety/depression) and its subscales (PHQ-2 [a 2-item measure of depression] and Generalized Anxiety Disorder [GAD-2, a 2-item measure of anxiety]) are brief but effective mass screening instruments for anxiety and depression symptoms in general populations. However, little to no study examined the psychometric properties (i.e., reliability and validity) of the PHQ-4 and its subscales (PHQ-2 and GAD-2) in the general US adult population or based on US nativity (i.e., foreign-born vs. the US-born). We evaluated the psychometric properties of the PHQ-4 and its subscales in US adults, as well as the psychometric equivalence of the PHQ-4 scale based on nativity. METHODS: We conducted a cross-sectional survey of 5,140 adults aged ≥ 18 years. We examined the factorial validity and dimensionality of the PHQ-4 with confirmatory factor analysis (CFA). A multiple-group confirmatory factor analysis (MCFA) was used to evaluate the comparability of the PHQ-4 across nativity groups. Reliability indices were assessed. Also, the scales' construct validities were assessed by examining the associations of both the PHQ-4 and its subscales' scores with the sociodemographic characteristics and the 3-item UCLA Loneliness scale. RESULTS: The internal consistencies were high for the PHQ-4 scale (α = 0.92) and its subscales of PHQ-2 (α = 0.86) and GAD-2 (α = 0.90). The CFA fit indices showed evidence for the two-factor structure of the PHQ-4. The two factors (i.e., anxiety and depression) were significantly correlated (r = 0.92). The MCFA demonstrated measurement invariance of the PHQ-4 across the nativity groups, but the model fits the data better in the foreign-born group. There were significant associations of the PHQ-4 scale and its subscales' scores with the sociodemographic characteristics and the UCLA Loneliness scale (all p < 0.001). CONCLUSIONS: The PHQ-4 and its subscales are reliable and valid measures to screen anxiety and depression symptoms in the general US adult population, especially in foreign-born individuals during the COVID-19 pandemic.

Impact of depersonalization on the course of depression: longitudinal observations from the gutenberg health study.

BACKGROUND: Symptoms of depersonalization (DP) and derealization (DR) are a risk factor for more severe impairment, non-response to various treatments, and a chronic course. In this study, we investigated the effects of DP/DR symptoms in patients with clinically significant depressive symptoms on clinical characteristics and various outcomes in a representative population-based sample with a 5-year follow-up. METHODS: The middle-aged sample comprised n = 10,422 persons at baseline, of whom n = 9,301 were free from depressive and DP/DR symptoms. N = 522 persons had clinically significant depression (PHQ-9 ≥ 10) and co-occurring DP/DR symptoms, and n = 599 persons had clinically significant depression (PHQ-9 ≥ 10) without DP/DR symptoms. RESULTS: There were substantial health disparities between persons with and without depression. These disparities concerned a wide range of life domains, including lower quality of the recalled early life experiences with the parents, current socioeconomic status, social integration (partnership, loneliness), current social and interpersonal stressors (family, work), functional bodily complaints (e.g., tinnitus, migraine, chest pain), unhealthy lifestyle, and the prevalence of already developed physical diseases. These disparities persisted to the 5-year follow-up and were exceptionally severe for depressed persons with co-occurring DP/DR symptoms. Among the depressed persons, the co-occurrence of DP/DR symptoms more than doubled the risk for recurrence or persistence of depression. Only 6.9% of depressed persons with DP/DR symptoms achieved remission at the 5-year follow-up (PHQ-9 < 5). Depression with and without co-occurring DP/DR worsened self-rated physical health significantly. The impact of depression with co-occurring DP/DR on the worsening of the self-rated physical health status was stronger than those of age and major medical diseases (e.g., heart failure). However, only depression without DP/DR was associated with mortality in a hazard regression analysis adjusted for age, sex, and lifestyle. CONCLUSIONS: The results demonstrated that DP/DR symptoms represent an important and easily assessable prognostic factor for the course of depression and health outcomes. Given the low remission rates for depression in general and depression with DP/DR in particular, efforts should be made to identify and better support this group, which is disadvantaged in many aspects of life.

Association of Oxidative Stress and Proinflammation with Insomnia in Perimenopause.

Background: The levels of oxidative stress and proinflammatory factors in perimenopausal females increased, and they were also deeply troubled by insomnia. The occurrence of insomnia is related to the changes of oxidative stress and inflammation levels in the body. Perimenopausal insomnia may be related to mild systemic inflammation, and oxidative stress can promote chronic inflammation. However, the underlying mechanism behind the phenomenon is still unclear. Objective: The aim was to investigate whether the occurrence of perimenopausal insomnia disorder is related to higher levels of oxidative stress and inflammation in the body, and to explore the role of inducible nitric oxide synthase (iNOS) in perimenopausal insomnia. Methods: A total of 127 perimenopausal participants were recruited in this study. Participants with global scores of the Pittsburgh sleep quality index (PSQI) >7 were diagnosed with insomnia (n = 54). The patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder-7 (GAD-7) were evaluated, and sociodemographic data were obtained. The serum concentrations of iNOS, interleukin 6 (IL6), and tumor necrosis factor α (TNFα) were measured using commercial assays. Results: In the insomnia group, IL6 levels were positively correlated with scores of component 5 and component 7 of PSQI, respectively. PHQ-9 and GAD-7 were positively correlated with the global score of PSQI component 7 and PSQI, respectively; PHQ-9 was positively correlated with the global score of PSQI component 1. Finally, PHQ-9, iNOS, and IL6 were found to be independent predictors of perimenopausal insomnia using logistic regression. Conclusions: Moderate oxidative stress caused by a certain concentration of iNOS plays a protective role in perimenopausal insomnia, while proinflammation and depression are potential risk factors.

Development of an optimal short form of the GAD-7 scale with cross-cultural generalizability based on Riskslim.

Despite the relatively small number of items in the GAD-7, fewer items are increasingly sought to shorten testing time in large-scale mental health screenings. As a result, short forms based on the GAD-7, the GAD-2, and GAD-mini, have become popular. However, the GAD-2 and GAD-mini have reported lower diagnostic accuracy in some cultural contexts, implying that a validated short-form version of the GAD-7 may be lacking in large-scale cross-cultural anxiety screening. Based on this, to develop an optimal short form of the GAD-7 with cross-cultural stability, we utilized seven GAD-7 datasets from six different countries, totaling 47,484 participants. Five 2 to 6 item short forms of the GAD were constructed using the Riskslim machine learning algorithm. We evaluated the diagnostic accuracy of the GAD-7 short forms in the training and test sets based on the coefficient of determination(R2) and area under the curve(AUC) metrics, and the results showed that GAD-R2 performed poorly in some cultures, and all of the 3 to 6 item short forms of the GAD performed good in cross-cultural diagnostic rates, with the GAD-R6 showing the highest diagnostic accuracy in all cultures; GAD-R3 outperformed GAD-R2, GAD-2, and GAD-mini in all cultures; GAD-R3 had higher generalizability across cultures and special populations; Given that the GAD-R3 was shorter and nearly as accurate as the GAD-R6, we recommend the use of the GAD-R3 in clinical studies and epidemiologic investigations. And we recommend the optimal actual cutoff value of 15 for GAD-R3. Overall, we recommend GAD-R3 as the short-form version of GAD-7 in cross-cultural studies. However, the 2-item GAD scale is also optimal for the short-form version in clinical practice.

Development of a short form of the Japanese version of the Caregiver Reaction Assessment (CRA-J-10) among informal caregivers of older adults.

AIM: To support informal caregivers, a simple assessment tool capturing the multidimensional nature of caregiving experiences, including negative and positive aspects, is required. We developed a short form of the Japanese version of the Caregiver Reaction Assessment (CRA-J), a multidimensional assessment scale for caregiver experiences. METHODS: The internet survey involved 934 Japanese informal caregivers aged 20-79 years (mean age = 58.8 years; 50.2% women) who completed questionnaires, including the CRA-J 18 items (CRA-J-18), consisting of five domains, such as impacts on schedule and finances and positive experiences of caregiving. A 10-item short version of the CRA-J (CRA-J-10; 0-50 points), which was prepared by selecting the two items with the highest factor loadings from each domain, was tested for model fit by confirmatory factor analysis (CFA) and was analyzed for correlations with the CRA-J-18, Zarit Burden Interview (ZBI), Positive Aspects of Caregiving Scale (PACS), Patient Health Questionnaire-9 (PHQ-9), and WHO-Five Well-Being Index (WHO-5). The area under the curve (AUC) in the receiver operating characteristic was evaluated as discriminability for depressive symptoms (PHQ-9 ≥ 10 points). RESULTS: The CFA indicated a good model fit in the CRA-J-10. The CRA-J-10 correlated well with the CRA-J-18 and other variables (CRA-J-18, r = 0.970; ZBI, r = 0.747; PACS, r = -0.467; PHQ-9, r = 0.582; WHO-5, r = -0.588) and showed good discriminant performance for the presence of depressive symptoms (AUC = 0.793, 95% confidence interval = 0.762-0.823). CONCLUSIONS: The CRA-J-10 allows a simple assessment of caregiver experiences, helping support informal caregivers. Geriatr Gerontol Int 2024; 24: 290-296.

Novel Quality Control Metric for the Pharmacotherapy of Major Depressive Disorder: Measuring Guideline Concordance and Its Impact on Symptom Severity.

Objective: Studies suggest that people with major depressive disorder (MDD) often receive treatment that is not concordant with practice guidelines. To evaluate this, we (1) developed a guideline concordance algorithm for MDD pharmacotherapy (GCA-8), (2) scored it using clinical data, and (3) compared its explanation of patient-reported symptom severity to a traditional concordance measure.Methods: This study evaluated 1,403 adults (67% female, 85% non-Hispanic/Latino White, mean age 43 years) with non-psychotic MDD (per ICD-10 codes), from the Penn State Psychiatry Clinical Assessment and Rating Evaluation System (PCARES) registry (visits from February 1, 2015, to April 13, 2021). We (1) scored 1-year concordance using the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines and deviation from 8 pharmacotherapy-related criteria and (2) examined associations between concordance and Patient Health Questionnaire depression module (PHQ-9) scores.Results: The mean GCA-8 score was 6.37 (standard deviation [SD] = 1.30; 8.00 = perfect concordance). Among those who switched drugs (n = 671), 81% (n = 542) did not have their dose increased to the recommended maximum before switching. In our adjusted analyses, we found that a 1 SD increase in the GCA-8 was associated with a 0.78 improvement in the mean PHQ-9 score (P < .001). The comparison concordance measure was not associated with the mean PHQ-9 score (ß = -0.20; P = .20; R2 = 0.53), and adding the GCA-8 score significantly improved the model (R2 = 0.54; Vuong test P = .008).Conclusions: By measuring naturalistic MDD pharmacotherapy guideline concordance with the GCA-8, we revealed potential treatment gaps and an inverse association between guideline concordance and MDD symptom severity.

Interpersonal Sensitivity as a Mediator of the Effect of Childhood Parenting Quality on Depressive Symptoms.

ABSTRACT: The aim of this study was to analyze whether interpersonal sensitivity mediates the effect of qualitative parenting characteristics experienced during childhood on the appraisal of life experiences and depression severity during adulthood in adult community volunteers. A total of 404 Japanese adult volunteers answered the following four self-report questionnaires: Parental Bonding Instrument, Interpersonal Sensitivity Measure, Life Experiences Survey, and Patient Health Questionnaire-9. Structural equation modeling was performed to analyze whether childhood parenting quality increases depressive symptom severity through interpersonal sensitivity, which then affects the appraisal of recent life events. In the two structural equation models, inadequate care and excessive overprotection received during childhood were associated with the negative evaluation of life experiences and depression severity in adulthood through high interpersonal sensitivity. Our findings indicate interpersonal sensitivity as a mediator of the effect of inadequate care and excessive overprotection experienced in childhood on the negative evaluation of life experiences and depression severity in adulthood.

Expressive suppression moderates the relationship between PTSD from COVID-19 and somatization and validation of the Arabic version of Patient Health Questionnaire-15 (PHQ-15).

BACKGROUND: Lebanese adults have been crippled for years by several crises, including the lately COVID-19 pandemic. These massive civilian traumas have increased the risk of post-traumatic stress disorder (PTSD) in this population. Extensive literature pointed to the association between PTSD and somatization; however, the nature of this relationship remains unknown. We sought to contribute further to work in this area by testing the moderating role of emotion regulation in the relationship between COVID-19- related PTSD and somatization. As a secondary objective, we aimed to examine the psychometric properties of an Arabic translation of the somatization measure Patient Health Questionnaire-15 (PHQ-15) in terms of factorial validity and internal consistency before its use in the present study. METHODS: This cross-sectional study was conducted between September and October 2021. A total of 403 Lebanese adults residing in Lebanon were recruited. Eligible participants received an online link to the survey. The Patient Health Questionnaire-15 was used to assess somatization, PTSD Checklist-Civilian Version for PTSD and Emotion Regulation Questionnaire for emotion regulation. RESULTS: The results of the exploratory factor analysis (EFA) revealed a three-factor solution explaining 48.79% of the common variance. Confirmatory Factor Analysis results of the three-factor model obtained in the EFA indicated a good fit with a significant CFI of 0.98, TLI 0.98 and a GFI of .97, a RMSEA of .04 [90% CI .01, .06]. Higher PTSD symptoms were associated with somatization. In addition, we found that one specific ER component, i.e. expressive suppression, significantly moderated the relationship between PTSD from the COVID pandemic and somatization. In particular, the interaction PTSD from the COVID-19 pandemic by expressive suppression was significantly associated with somatization; at low, medium and high levels of expressive suppression, higher PTSD from the COVID-19 pandemic was significantly associated with higher somatization scores. As for our secondary objective, findings revealed that the Arabic version of the PHQ-15 exhibited good psychometric properties. In particular, the scale yielded a three-factor structure, and good internal consistency (Cronbach's alpha = 0.87). CONCLUSION: The moderating role of expressive suppression on the link between PTSD and somatization presents a novel finding in the field of trauma. Additionally, making a psychometrically sound Arabic version of the PHQ-15 available is a valuable addition to the literature.

Psychometric properties of the GAD-7 and PROMIS-Anxiety-4a among youth with depression and suicidality: Results from the Texas youth depression and suicide research network.

There is a tremendous need for brief, valid, and free assessments of anxiety in child mental healthcare. The goal of this study was to determine the psychometric properties of two such measures, the GAD-7 and PROMIS-Anxiety-4a, in 1000 children, adolescents, and young adults (8-20 years-old) with depression and/or suicidality. The GAD-7, the PROMIS-Anxiety-4a, and other validated assessments of anxiety, physical functioning, and psychiatric diagnoses were completed. Confirmatory factor analyses showed an acceptable fit for a single factor in both measures via all indices but the RMSEA. They demonstrated measurement invariance across pre-adolescents (8-12 years-old) and adolescents and emerging adults (13-20 years-old), though scalar invariance was not observed for the GAD-7. Both measures showed strong convergent validity, GAD-7: r = 0.68; PROMIS-Anxiety-4a: r = 0.75, divergent validity with a measure of physical function, GAD-7: r = -0.24; PROMIS-Anxiety-4a: r = -0.28, good internal consistency, ω = 0.89 for both, and high test-retest reliability, GAD-7: r = 0.69; PROMIS-Anxiety-4a: r = 0.71. Both measures also showed acceptable sensitivity and specificity in detecting the presence of any anxiety disorder, GAD-7 cut-off score of 10: AUC = 0.75; PROMIS-Anxiety-4a cutoff score of 12: AUC = 0.79. The GAD-7 correlated similarly with the Screen for Child Anxiety Related Disorders total score and generalized anxiety subscale, and also showed similar diagnostic sensitivity and specificity when used to detect the presence of any anxiety disorder vs. generalized anxiety disorder specifically. Results suggest that both of these brief, publicly available instruments are valid and reliable assessments of anxiety among youth in treatment for depression and/or suicidality.

Identifying a stable and generalizable factor structure of major depressive disorder across three large longitudinal cohorts.

The Patient Health Questionnaire 9 (PHQ-9) is the current standard outpatient screening tool for measuring and tracking the nine symptoms of major depressive disorder (MDD). While the PHQ-9 was originally conceptualized as a unidimensional measure, it has become clear that MDD is not a monolithic construct, as evidenced by high comorbidities with other theoretically distinct diagnoses and common symptom overlap between depression and other diagnoses. Therefore, identifying reliable and temporally stable subfactors of depressive symptoms could allow research and care to be tailored to different depression phenotypes. This study improved on previous factor analysis studies of the PHQ-9 by leveraging samples that were clinical (participants with depression only), large (N = 1483 depressed individuals in total), longitudinal (up to 5 years), and from three diverse (matching racial distribution of the United States) datasets. By refraining from assuming the number of factors or item loadings a priori, and thus utilizing a solely data-driven approach, we identified a ranked list of best-fitting models, with the parsimonious one achieving good model fit across studies at most timepoints (average TLI >= 0.90). This model categorizes the PHQ-9 items into four factors: (1) Affective (Anhedonia + Depressed Mood), (2) Somatic (Sleep + Fatigue + Appetite), (3) Internalizing (Worth/Guilt + Suicidality), (4) Sensorimotor (Concentration + Psychomotor), which may be used to further precision psychiatry by testing factor-specific interventions in research and clinical settings.

Use of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires for clinical decision-making and psychological referral in ophthalmic care: a multicentre observational study.

OBJECTIVES: The aim of this study was to evaluate the influence of anxiety and depression on clinician decision-making in patients suffering from chronic eye disease in ophthalmological clinical practice. DESIGN AND SETTING: This multicentre observational study, in collaboration with the WHO, included ophthalmologists and their patients affected by chronic eye disease. States of anxiety and depression were screened with specific questionnaires, the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), self-administered by patients before the visit. In the present analysis, we report data from three major eye care centres in Italy between 2021 and 2022. PRIMARY AND SECONDARY OUTCOMES: To assess self-reported changes in ophthalmologists' clinical approach (communication style and their clinical-therapeutic strategies) and decisions after knowing questionnaire scores (primary aim), and to analyse the PHQ-9 and GAD-7 scores in patients with chronic eye diseases (secondary aim). RESULTS: 41 ophthalmologists and 359 patients were included. The results from PHQ-9 and GAD-7 scores showed critical depression and anxiety status scores (PHQ-9 ≥5 and GAD-7 ≥10) in 258 patients. In 74% of cases, no actions were taken by the ophthalmologists based on these scores; in 26% of cases, they changed their clinical approach; and in 14% of cases, they referred the patients for psychological/psychiatric evaluation. CONCLUSIONS: States of anxiety and depression affect many patients with chronic eye conditions and need to be detected and managed early to improve patients' well-being. Providing ophthalmologists with knowledge of their patients' psychological conditions can change the clinical management and attitude towards referral for a psychological evaluation. Further studies are needed to expand our knowledge of how to raise awareness among ophthalmologists regarding multimorbidity of patients suffering from chronic eye diseases in order to achieve better clinical outcomes.

Analysis of the dimensional structure of the Patient Health Questionnaire-9 (PHQ-9) in undergraduate students at a public university in Brazil.

BACKGROUND: The prevalence of mental health-related problems has increased in recent years, especially among young adults, such as university students. Several measurement instruments have been developed to identify individuals at risk for depression, such as the Patient Health Questionnaire-9 (PHQ-9). However, different dimensional structures of the PHQ-9 can make it difficult to interpret and compare research results. To analyze the dimensional structure and convergent validity of the PHQ-9 in university students. METHODS: This is a cross-sectional study developed with 3163 students enrolled in different courses at a university in southern Brazil. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to identify the most parsimonious and best-fitting model. Convergent validity was verified through the significant relationship (p < 0.05) between theoretically related constructs (sleep quality, alcohol consumption, and physical activity practice). RESULTS: The EFA resulted in two models (unidimensional and two-dimensional), with better indices for the two-dimensional model. In the CFA, both the unidimensional and the two-dimensional models presented satisfactory fit indices that were higher for the unidimensional model. LIMITATIONS: The analysis of convergent validity is limited by the absence of a gold standard for comparison. CONCLUSIONS: This study provided support for the unidimensional structure of the PHQ-9, with adequate convergent validity, among university students.

Comparison of the EPDS and PHQ-9 in the assessment of depression among pregnant women: Similarities and differences.

BACKGROUND: Perinatal depression has attracted increasing attention. However, a detailed investigation of the network structure of depression is still lacking. We aim to examine the similarities and differences between the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) from a network perspective. METHODS: A cross-sectional study was conducted from August 2020 to March 2022. We followed the STROBE checklist to report our research. Pregnant women (n = 2484) were recruited. All participants completed the EPDS and PHQ-9. We mainly used network analyses for statistical analysis and constructed two network models: the EPDS and PHQ-9 models. RESULTS: The detection rates of prenatal depression measured by the EPDS and PHQ-9 were 30.2 % and 28.2 %, respectively. In the EPDS network, the EPDS8 'sad or miserable' node (strength = 1.2161) was the most central node, and the EPDS10 'self-harming' node (strength = 0.4360) was the least central node. In the PHQ-9 network, the PHQ4 'fatigue' node (strength = 0.9815) was the most central node, and PHQ9 'suicide' was the least central symptom (strength = 0.5667). For both models, 'sad' acted as an important central symptom. CONCLUSIONS: Psychological symptoms may be more important in assessing depression using the EPDS, while physical symptoms may be more influential in assessing depression using the PHQ-9. For both the EPDS and PHQ-9, "sad" was an important central symptom, suggesting that it may be the most important target for further maternal depression interventions in the future.

Cultural adaptation to Bolivian Quechua and psychometric analysis of the Patient Health Questionnaire PHQ-9.

OBJECTIVE: Cultural adaptation of the Patient Health Questionnaire-PHQ-9 to Bolivian Quechua and analysis of the internal structure validity, reliability, and measurement invariance by sociodemographic variables. METHODS: The PHQ-9 was translated and back-translated (English-Quechua-English) to optimise translation. For the cultural adaptation, experts, and people from the target population (e.g., in focus groups) verified the suitability of the translated PHQ-9. For the psychometric analysis, we performed a Confirmatory Factor Analysis (CFA) to evaluate internal validity, calculated α and ω indices to assess reliability, and performed a Multiple Indicator, Multiple Cause (MIMIC) model for evaluating measurement invariance by sex, age, marital status, educational level and residence. We used standard goodness-of-fit indices to interpret both CFA results. RESULTS: The experts and focus groups improved the translated PHQ-9, making it clear and culturally equivalent. For the psychometric analysis, we included data from 397 participants, from which 73.3% were female, 33.0% were 18-30 years old, 56.7% reported primary school studies, 63.2% were single, and 62.0% resided in urban areas. In the CFA, the single-factor model showed adequate fit (Comparative Fit Index = 0.983; Tucker-Lewis Index = 0.977; Standardized Root Mean Squared Residual = 0.046; Root Mean Squared Error of Approximation = 0.069), while the reliability was optimal (α = 0.869-0.877; ω = 0.874-0.885). The invariance was confirmed across all sociodemographic variables (Change in Comparative Fit Index (delta) or Root Mean Square Error of Approximation (delta) < 0.01). CONCLUSIONS: The PHQ-9 adapted to Bolivian Quechua offers a valid, reliable and invariant unidimensional measurement across groups by sex, age, marital status, educational level and residence.

Estimating the prognostic value of cross-sectional network connectivity for treatment response in depression.

BACKGROUND: Tightly connected symptom networks have previously been linked to treatment resistance, but most findings come from small-sample studies comparing single responder v. non-responder networks. We aimed to estimate the association between baseline network connectivity and treatment response in a large sample and benchmark its prognostic value against baseline symptom severity and variance. METHODS: N = 40 518 patients receiving treatment for depression in routine care in England from 2015-2020 were analysed. Cross-sectional networks were constructed using the Patient Health Questionnaire-9 (PHQ-9) for responders and non-responders (N = 20 259 each). To conduct parametric tests investigating the contribution of PHQ-9 sum score mean and variance to connectivity differences, networks were constructed for 160 independent subsamples of responders and non-responders (80 each, n = 250 per sample). RESULTS: The baseline non-responder network was more connected than responders (3.15 v. 2.70, S = 0.44, p < 0.001), but effects were small, requiring n = 750 per group to have 85% power. Parametric analyses revealed baseline network connectivity, PHQ-9 sum score mean, and PHQ-9 sum score variance were correlated (r = 0.20-0.58, all p < 0.001). Both PHQ-9 sum score mean (ß = -1.79, s.e. = 0.07, p < 0.001), and PHQ-9 sum score variance (ß = -1.67, s.e. = 0.09, p < 0.001) had larger effect sizes for predicting response than connectivity (ß = -1.35, s.e. = 0.12, p < 0.001). The association between connectivity and response disappeared when PHQ-9 sum score variance was accounted for (ß = -0.28, s.e. = 0.19, p = 0.14). We replicated these results in patients completing longer treatment (8-12 weeks, N = 22 952) and using anxiety symptom networks (N = 70 620). CONCLUSIONS: The association between baseline network connectivity and treatment response may be largely due to differences in baseline score variance.

A psychometric evaluation of the 16-item PHQ-ADS concomitant anxiety and depression scale in the UK biobank using item response theory.

BACKGROUND: The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) provides a reliable and valid measure of concomitant depression and anxiety. However, research on its psychometric efficiency and optimal scale length using item-response theory (IRT) has not been reported. This study aimed to optimize the length of the PHQ-ADS scale without losing information by discarding items that were a poor fit to the IRT model. METHODS: The UK Biobank is a large cohort study designed to investigate risk factors for a broad range of disease. PHQ-ADS data were available from n = 152,826 participants (age = 55.87 years; SD = 7.73; 56.4 % female), 30.4 % of the entire UK Biobank sample. Psychometric properties of the PHQ-ADS were investigated using a 2-parameter IRT and Mokken analysis. Item statistics included discrimination, difficulty and Loevinger H coefficients of monotonicity. RESULTS: In the entire 16-item scale, item discrimination ranged from 1.40 to 4.22, with the item 'worrying' showing the highest level of discrimination and the item 'sleep disturbance' showing the lowest. Mokken analysis showed that the 16-item PHQ-ADS scale could be reduced to a 7-item scale without loss of test information. The reduced scale comprised mainly items measuring cognitive-affective symptoms of anxiety/depression, whereas items measuring somatic symptoms were discarded. The revised scale showed high discrimination and scalability. LIMITATIONS: Findings are limited by the use of cross-sectional data that only included the baseline online questionnaire, but not other waves. CONCLUSIONS: IRT is a useful technique for scale reductions which serve the clinical and epidemiological need to optimize screening questionnaires to reduce redundancy and maximize information. A reduced-item 7-item PHQ-ADS scale reduces the response burden on participants in epidemiological research settings, without loss of information.

Measurement invariance and differential item functioning of the PHQ-9 and GAD-7 between working age and older adults seeking treatment for common mental disorders.

BACKGROUND: The nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalised Anxiety Disorder (GAD-7) scale are widely used clinically and within research, and so it is important to determine how the measures, and individual items within the measures, are answered by adults of differing ages. This study sought to evaluate measurement invariance and differential item functioning (DIF) of the PHQ-9 and GAD-7 between working age and older adults seeking routine psychological treatment. METHODS: Data of working age (18-64 years old) and older (≥65) adults in eight Improving Access to Psychological Therapies (IAPT) services were used. Confirmatory factor analysis (CFA) was used to establish unidimensionality of the PHQ-9 and GAD-7, with multiple-group CFA to test measurement invariance and The Multiple Indicators, Multiple Causes Models approach to assess DIF. The employed methods were applied to a propensity score matched (PSM) sample in sensitivity analyses to control for potential confounding. RESULTS: Data from 166,816 patients (159,325 working age, 7491 older) were used to show measurement invariance for the PHQ-9 and GAD-7, with limited evidence of DIF and similar results found with a PSM sample (n = 5868). LIMITATIONS: The localised sample creates an inability to detect geographical variance, and the potential effect of unmeasured confounders cannot be ruled out. CONCLUSIONS: The findings support the use of the PHQ-9 and GAD-7 measures for working age and older adults, both clinically and in research settings. This study validates using the measures for these age groups to assess clinically significant symptom thresholds, and monitor treatment outcomes between them.