Measurement invariance of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) across four European countries during the COVID-19 pandemic

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Abstract

Background

The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) are self-report measures of major depressive disorder and generalised anxiety disorder. The primary aim of this study was to test for differential item functioning (DIF) on the PHQ-9 and GAD-7 items based on age, sex (males and females), and country.

Method

Data from nationally representative surveys in UK, Ireland, Spain, and Italy (combined N = 6,054) were used to fit confirmatory factor analytic and multiple-indictor multiple-causes models.

Results

Spain and Italy had higher latent variable means than the UK and Ireland for both anxiety and depression, but there was no evidence for differential items functioning.

Conclusions

The PHQ-9 and GAD-7 scores were found to be unidimensional, reliable, and largely free of DIF in data from four large nationally representative samples of the general population in the UK, Ireland, Italy and Spain.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12888-022-03787-5.

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Most cited references 42

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A brief measure for assessing generalized anxiety disorder: the GAD-7.

Robert L Spitzer, Kurt Kroenke, Janet B W Williams … (2006)

Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

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The PHQ-9: validity of a brief depression severity measure.

K Kroenke, R L Spitzer, J. Williams (2001)

While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

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The PHQ-9

Kurt Kroenke, Robert L Spitzer, Janet B W Williams (2001)

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Author and article information

Contributors

Sarah Butter: s.butter@sheffield.ac.uk

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 1 March 2022

Publication date PMC-release: 1 March 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 154

Affiliations

[1 ]GRID grid.12641.30, ISNI 0000000105519715, Ulster University, ; Coleraine, Northern Ireland

[2 ]GRID grid.11835.3e, ISNI 0000 0004 1936 9262, Department of Psychology, , University of Sheffield, ; Cathedral Court, 1 Vicar Lane, S1 2LT Sheffield, England

[3 ]GRID grid.5379.8, ISNI 0000000121662407, University of Manchester, ; Manchester, England

[4 ]GRID grid.83440.3b, ISNI 0000000121901201, University College London, ; London, England

[5 ]GRID grid.4464.2, ISNI 0000 0001 2161 2573, Royal Holloway, , University of London, ; Egham, England

[6 ]GRID grid.10025.36, ISNI 0000 0004 1936 8470, University of Liverpool, ; Liverpool, England

[7 ]GRID grid.95004.38, ISNI 0000 0000 9331 9029, Maynooth University, ; Maynooth, Ireland

[8 ]GRID grid.8217.c, ISNI 0000 0004 1936 9705, Trinity College Dublin, ; Dublin, Ireland

[9 ]GRID grid.4795.f, ISNI 0000 0001 2157 7667, Complutense University of Madrid, ; Madrid, Spain

[10 ]GRID grid.5608.b, ISNI 0000 0004 1757 3470, University of Padua, ; Padua, Italy

Article

Publisher ID: 3787

DOI: 10.1186/s12888-022-03787-5

PMC ID: 8886334

PubMed ID: 35232409

SO-VID: 28c284cd-5a10-42c2-857c-530bc657669e

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 24 September 2021

Date accepted : 16 February 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000269, Economic and Social Research Council;

Funded by: FundRef http://dx.doi.org/10.13039/501100001632, Ulster University;

Funded by: FundRef http://dx.doi.org/10.13039/501100000858, University of Sheffield;

Funded by: Health Research Board and the Irish Research Council

Funded by: Ministry of Science and Innovation

Funded by: FundRef http://dx.doi.org/10.13039/501100004587, Instituto de Salud Carlos III;

Funded by: FundRef http://dx.doi.org/10.13039/501100002911, Universidad Complutense de Madrid;

Funded by: University “La Sapienza” of Roma

Funded by: University of Padua

Custom metadata

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: phq-9,gad-7,depression,anxiety,measurement invariance

Data availability:

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: phq-9, gad-7, depression, anxiety, measurement invariance

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Measurement invariance of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) across four European countries during the COVID-19 pandemic

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Abstract

Background

Method

Results

Conclusions

Supplementary Information

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Novel Coronavirus Disease COVID-19

Most cited references 42

A brief measure for assessing generalized anxiety disorder: the GAD-7.

The PHQ-9: validity of a brief depression severity measure.

The PHQ-9

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