Using the patient health questionnaire-9 to measure depression among racially and ethnically diverse primary care patients
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OBJECTIVE: The Patient Health Questionnaire depression scale (PHQ-9) is a well-validated, Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV) criterion-based measure for diagnosing depression, assessing severity and monitoring treatment response. The performance of most depression scales including the PHQ-9, however, has not been rigorously evaluated in different racial/ethnic populations. Therefore, we compared the factor structure of the PHQ-9 between different racial/ethnic groups as well as the rates of endorsement and differential item functioning (DIF) of the 9 items of the PHQ-9. The presence of DIF would indicate that responses to an individual item differ significantly between groups, controlling for the level of depression.
MEASUREMENTS: A combined dataset from 2 separate studies of 5,053 primary care patients including non-Hispanic white (n=2,520), African American (n=598), Chinese American (n=941), and Latino (n=974) patients was used for our analysis. Exploratory principal components factor analysis was used to derive the factor structure of the PHQ-9 in each of the 4 racial/ethnic groups. A generalized Mantel-Haenszel statistic was used to test for DIF.
RESULTS: One main factor that included all PHQ-9 items was found in each racial/ethnic group with α coefficients ranging from 0.79 to 0.89. Although endorsement rates of individual items were generally similar among the 4 groups, evidence of DIF was found for some items.
CONCLUSIONS: Our analyses indicate that in African American, Chinese American, Latino, and non-Hispanic white patient groups the PHQ-9 measures a common concept of depression and can be effective for the detection and monitoring of depression in these diverse populations.
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- Using the patient health questionnaire-9 to measure depression among racially and ethnically diverse primary care patients
Journal of General Internal Medicine
Volume 21, Issue 6 , pp 547-552
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- 1. Department of Psychiatry, UCSF, 1001 Potrero Ave., Suite 7M, 94110, San Francisco, CA
- 2. Charles B. Wang Community Health Center, New York, NY, USA
- 3. New York University, New York, NY, USA
- 4. Indiana University School of Medicine, Indianapolis, IN, USA
- 5. Regenstrief Institute, Inc., Indianapolis, IN, USA
- 6. Biometrics Research Department, New York Psychiatric Institute, New York, NY, USA
- 7. Department of Psychiatry, Columbia University, New York, NY, USA