Reliability and dimensionality of PHQ-9 in screening depression symptoms among health science students in Cartagena, 2014
Abstract
Introduction: Depression among university students must be screened with valid instruments. The Patient Health Questionnaire (PHQ-9) is reliable and valid for screening depression in a university context; however, its psychometric performance in Colombia is unknown.
Objective: To estimate the reliability and dimensionality of PHQ-9 as a screening instrument for depressive symptoms among health sciences students of a university in Cartagena, Colombia.
Materials y methods: We analyzed the factorial structure and reliability of the PHQ-9 in a sample of 550 students for expected prevalence of clinically-meaningful depressive symptoms (CMDS) of 25% with a confidence level of 95% and an error level of 3%. We used the free Spanish version of PHQ-9 for Colombia, authorized by its creators. A confirmatory factorial analysis, and an estimate of internal consistency using Cronbach´s alfa and McDonald´s omega were obtained.
Results: We analyzed 541 surveys. The average age of the group was 20.18 (SD=2.59) years old, 354 (63.77%) participants were women and 196 (36.23%) men. CMDS prevalence was 27.3%. The confirmatory factorial analysis exhibited a two-factor model, which explained the total variance of 42.80%. The proportion of variance explained by the factors was 0.243 (item 5) and 0.587 (item 2). Cronbach´s alfa was 0.830 and McDonald´s omega, 0.89.
Conclusions: PHQ-9 was a valid and reliable tool for screening depressive symptoms among health sciences students in a university in Cartagena, Colombia.
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References
Thota AB, Sipe TA, Byard GJ, Zometa CS, HahnRA, McKnight-Eily LR, et al. Collaborative care to improve the management of depressive disorders: A community guide systematic review and meta-analysis. Am J Prev Med. 2012;42:525-38. http://dx.doi.org/10.1016/j.amepre.2012.01.019
Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, De Girolamo G, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011;29:90.
http://dx.doi.org/10.1186/1741-7015-9-90
Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et al. The global prevalence of common mental disorders: A systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014;43:476-93. http://dx.doi.org/10.1093/ije/dyu038
Ibrahim AK, Kelly SJ, Adams CE. A systematic review of studies of depression prevalence in university students. J Psychiatr Res. 2013;47:391-400. http://dx.doi.org/10.1016/j.jpsychires.2012.11.015
Amézquita-Medina ME, González-Pérez RE, Zuluaga-Mejía D. Prevalencia de la depresión, ansiedad y comportamiento suicida en la población estudiantil de pregrado de la Universidad de Caldas, año 2000. Rev Colomb Psiquiatr.2003;32:341-56.
Falla G, Marcela P, Sanabria-Ferrand PA. Prevalencia de la sintomatología depresiva en una población estudiantil de la Facultad de Medicina de la Universidad Militar Nueva Granada, Bogotá - Colombia. Rev Fac Med. 2006;54:76-87.
Fergusson DM, Woodward LJ. Mental health, educational, and social role outcomes of adolescents with depression. Arch Gen Psychiatry. 2002;59:225-31. http://dx.doi.org/10.1001/archpsyc.59.3.225
Lepine J, Gastpar M, Mendlewicz J, Tylee A. Depression in the community: The first pan-European study DEPRES (Depression Research in European Society). Int Clin Psychopharmacol. 1997;12:19-29.
Vinas-Poch F, Villar E, Caparros B, Juan J, Cornella M, Pérez I. Feelings of hopelessness in a Spanish university population - Descriptive analysis and its relationship to adapting to university, depressive symptomatology and suicidal ideation. Soc Psychiatry Psychiatr Epidemiol. 2004;39:326-34. http://dx.doi.org/10.1007/s00127-004-0756-2
Kessler RC, Berglund P, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSMIV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62:593-602. http://dx.doi.org/10.1001/archpsyc.62.6.593
Thombs BD, Ziegelstein RC. Depression screening in primary care: Why the Canadian task force on preventive health care did the right thing. Can J Psychiatry. 2013;58:692-6.
Lowe B, Spitzer RL, Grafe K, Kroenke K, Quenter A, Zipfel S, et al. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord. 2004;78:131-40. http://dx.doi.org/10.1016/S0165-0327(02)00237-9
Williams JW, Pignone M, Ramírez G, Pérez-Stellato C. Identifying depression in primary care: A literature synthesis of case-finding instruments. Gen Hosp Psychiatry. 2002;24:225-37. http://dx.doi.org/10.1016/S0163-8343(02)00195-0
Maurer DM. Screening for depression. Am Fam Physician. 2012;85:139-44.
Campo-Arias A, Oviedo HC. Propiedades psicométricas de una escala: la consistencia interna. Rev Salud Pública (Bogotá). 2008;10:831-9. http://dx.doi.org/10.1590/S0124-00642008000500015
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. Gen Intern Med. 2001;16:606-13. http://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x
Williams N. PHQ-9. Occup Med (Lond). 2014;64:139-40. http://dx.doi.org/10.1093/occmed/kqt154
Kocalevent RD, Hinz A, Brähler E. Standardization of the depression screener Patient Health Questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry. 2013;35:551-5.http://dx.doi.org/10.1016/j.genhosppsych.2013.04.006
Sung SC, Low CC, Fung DS. Screening for major and minor depression in a multiethnic sample of Asian primary care patients: A comparison of the nine-item Patient Health Questionnaire (PHQ-9) and the 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16).Asia Pac Psychiatry. 2013;5:249-58. http://dx.doi.org/10.1111/appy.12101
Baader T, Molina J, Venezian S, Rojas C, Farías R, Fierro-Freixenet C, et al. Validación y utilidad de la encuesta PHQ-9 (Patient Health Questionnaire) en el diagnóstico de depresión en pacientes usuarios de atención primaria en Chile. Rev Chil Neuro-Psiquiat. 2012;9:10-22. http://dx.doi.org/10.4067/S0717-92272012000100002
Londoño A, Romero P, Casas G. The association between armed conflict, violence and mental health: A cross sectional study comparing two populations in Cundinamarca department, Colombia. Confl Health. 2012;6:2-6. http://dx.doi.org/10.1186/1752-1505-6-12
Castro-Camacho L, Escobar JM, Sáenz-Moncaleano C, Delgado-Barrera L, Aparicio-Turbay S, Molano JC, et al. Salud mental en el hospital general: resultados del Cuestionario de Salud del Paciente (PHQ) en cuatro servicios de atención. Rev Colomb Psiquiatr. 2012;41:61-85. http://dx.doi.org/10.1016/S0034-7450(14)60069-X
Arango-Lasprilla JC, Plaza SL, Drew A, Romero JL, Pizarro JA, Francis A, et al. Family needs and psychosocial functioning of caregivers of individuals with spinal cord injury from Colombia, South America. Neuro Rehabilitation. 2010;27:83-93. http://dx.doi.org/10.3233/NRE-2010-0583
Wittkampf KA, Naeije L, Schene AH, Huyser J, van Weert HC. Diagnostic accuracy of the mood module of the Patient Health Questionnaire: A systematic review. Gen Hosp Psychiatry. 2007;29:388-95. http://dx.doi.org/10.1016/j.genhosppsych.2007.06.004
Devon HA, Block ME, Moyle-Wright P, Ernst DM, Hayden SJ, Lazzara DJ, et al. A psychometric toolbox for testing validity and reliability. J Nurs Sch. 2007;39:155-64. http://dx.doi.org/10.1111/j.1547-5069.2007.00161.x
Sánchez R, Echeverry J. Validación de escalas de medición en salud. Rev Salud Pública. 2004;6:302-18. http://dx.doi.org/10.1590/S0124-00642004000300006
Campo-Arias A, Herazo E, Oviedo H. Análisis de factores: fundamentos para la evaluación de instrumentos de medición en salud mental. Rev Colomb Psiquiatr. 2012;41:657-71. http://dx.doi.org/10.1016/S0034-7450(14)60036-6
Batista-Foguet JM, Coenders G, Alonso J. Confirmatory factor analysis. Its role on the validation of health related questionnaires. Med Clin (Barc). 2004;122(Suppl.1):21-7.
Dum M, Pickren J, Carter-Sobell L, Sobell MB. Comparing the BDI-II and the PHQ-9 with outpatient substance abusers. Addict Behav. 2008;33:381-7. http://dx.doi.org/10.1016/j.addbeh.2007.09.017
Baas K, Cramer A, Koeter M, van De Lisdonk E, van Weert H, et al. Measurement invariance with respect to ethnicity of the Patient Health Questionnaire-9 (PHQ-9). J Affect Disord. 2011;129:229-35. http://dx.doi.org/10.1016/j.jad.2010.08.026
Krause J, Reed K, McArdlee JJ. Factor structure and predictive validity of somatic and nonsomatic symptoms from the Patient Health Questionnaire-9: A longitudinal study after spinal cord injury. Arch Phys Med Rehabil. 2010;91:1218-24. http://dx.doi.org/10.1016/j.apmr.2010.04.015
Richardson EJ, Richards JS. Factor structure of the PHQ-9 screen for depression across time since injury among persons with spinal cord injury. Rehabil Psychol. 2008;53:243-9.
Krause JS, Bombardier C, Carter R. Assessment of depressive symptoms during inpatient rehabilitation for spinal cord injury: Is there an underlying somatic factor when using the PHQ? Rehabil Psychol. 2008;53:513-20.http://dx.doi.org/10.1037/a0013354
Elhai JD, Contractor AA, Tamburrino M, Fine TH, Prescott MR, Shirley E, et al. The factor structure of major depression symptoms: A test of four competing models using the Patient Health Questionnaire-9. Psychiatry Res. 2012;199:169-73. http://dx.doi.org/10.1016/j.psychres.2012.05.018
Yoon S, Lee Y, Han C, Pae CU, Yoon HK, Patkar A, et al. Usefulness of the patient health questionnaire-9 for Korean medical students. Acad Psychiatry. 2014;38:661-7. http://dx.doi.org/10.1007/s40596-014-0140-9
Adewuya AO, Ola BA, Afolabi O. Validity of the Patient Health Questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. J Affect Disord. 2006;93:89-93. http://dx.doi.org/10.1016/j.jad.2006.05.021
Zinbarg RE. Coefficients alpha, beta, omega, and the glb: Comments on Sijtsma. Psychometrika. 2009;74:145-54. http://dx.doi.org/10.1007/s11336-008-9102-z
Posada-Villa JA, Trevisi-Fuentes C. Prevalencia, severidad y necesidades no satisfechas del tratamiento de los trastornos de ansiedad, relacionados con sustancias, del estado de ánimo y del control de impulsos en adultos según el Estudio Nacional de Salud Mental, Colombia, 2003. Medunab. 2004;7:65-72.
Sánchez-Pedraza R, Gómez-Restrepo C. Conceptos básicos sobre validación de escalas. Rev Col Psiquiatr. 1998;27:121-30.
Aguilar-Barojas S. Fórmulas para el cálculo de la muestra en investigaciones de salud. Salud en Tabasco. 2005;11:333-8.
Calderón M, Gálvez-Buccollini JA, Cueva G, Ordóñez C, Bromley C, Fiestas F. Validación de la versión peruana del PHQ-9 para el diagnóstico de depresión. Rev Peru Med Exp Salud Pública. 2012;29:578-9. http://dx.doi.org/10.1590/S1726-46342012000400027
Cassiani-Miranda CA, Pérez-Aníbal E, Vargas-Hernández MC, Herazo-Bustos MI, Villarreal-Villanueva MP, Tuirán-Tuirán J, et al. Desempeño psicométrico de la escala PHQ-9 para el tamizaje de sintomatología depresiva en estudiantes universitarios de Cartagena, año 2014. Tesis. Cartagena: Universidad de Cartagena; 2015.
Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297-334. http://dx.doi.org/10.1007/BF02310555
McDonald RP. Theoretical foundations of principal factor analysis, canonical factor analysis, and alpha factor analysis. Br J Math Stat Psychol. 1970;23:1-21. http://dx.doi.org/10.1111/j.2044-8317.1970.tb00432.x
Zinbarg R, Revelle W, Yovel I, Li W. Cronbach’s alpha, Revelle’s beta, and McDonald’s omega hierarchical: Their relations with each other and two alternative conceptualizations of reliability. Psychometrika. 2005;70:123-33. http://dx.doi.org/10.1007/s11336-003-0974-7
Kang H. A guide on the use of factor analysis in the assessment of construct validity. J Korean Acad Nurs. 2013;43:587-94. http://dx.doi.org/10.4040/jkan.2013.43.5.587
Bartlett MS. Test of significance in factor analysis. Br J Math Stat Psychol. 1950;3:77. http://dx.doi.org/10.1111/j.2044-8317.1950.tb00285.x
Kaiser HF. An index of factorial simplicity. Psychometrika. 1974;34:31-6. http://dx.doi.org/10.1007/BF02291575
Kahn JH. Factor analysis in counseling psychology research, training, and practice: Principles, advances, and applications. Couns Psychol. 2006;34:684-718. http://dx.doi.org/10.1177/0011000006286347
Yu X, Tam WW, Wong PT, Lam T, Stewart SM. The Patient Health Questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong. Compr Psychiatry. 2012;53:95-102. http://dx.doi.org/10.1016/j.comppsych.2010.11.002
Chen S, Fang Y, Chiu H, Fan H, Jin T, Conwell Y. Validation of the nine-item Patient Health Questionnaire to screen for major depression in a Chinese primary care population. Asia Pac Psychiatry. 2013;5:61-8. http://dx.doi.org/10.1111/appy.12063
Wang W, Bian Q, Zhao Y, Li X, Wang W, Du J, et al. Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry. 2014;36:539-44. http://dx.doi.org/10.1016/j.genhosppsych.2014.05.021
Keszei AP, Novak M, Streiner DL. Introduction to health measurement scales. J Psychosom Res. 2010;68:319-23. http://dx.doi.org/10.1016/j.jpsychores.2010.01.006
Terwee CB, Bot S, De Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34-42. http://dx.doi.org/10.1016/j.jclinepi.2006.03.012
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