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Blake, J. J. 
ORCID: https://orcid.org/0000-0002-4105-3825, Munyombwe, T., Fischer, F., Quinn, T. J., Van der Feltz-Cornelis, C. M., De Man-van Ginkel, J. M., Santos, I. S., Jeon, Hong Jin, Köhler, S., Schram, M. T., Wang, J. L., Levin-Aspenson, H. F., Whooley, M. A., Hobfoll, S. E., Patten, S. B., Simning, A., Gracey, F. ORCID: https://orcid.org/0000-0002-1416-7894 and Broomfield, N. M. ORCID: https://orcid.org/0000-0003-2599-3435
(2025)
The factor structure of the Patient Health Questionnaire-9 in stroke: A comparison with a non-stroke population.
Journal of Psychosomatic Research, 188.
ISSN 0022-3999
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Abstract
Background: It is unclear if certain post-stroke somatic symptoms load onto items of the Patient Health Questionnaire-9 (PHQ-9), a self-report depression questionnaire. We investigated these concerns in a stroke sample using factor analysis, benchmarked against a non-stroke comparison group. Methods: The secondary dataset constituted 787 stroke and 12,016 non-stroke participants. A subsample of 1574 comparison participants was selected via propensity score matching. Dimensionality was assessed by comparing fit statistics of one-factor, two-factor, and bi-factor models. Between-group differences in factor structure were explored using measurement invariance. Results: A two-factor model, consisting of somatic and cognitive-affective factors, showed better fit than the unidimensional model (CFI = 0.984 versus CFI = 0.974, p <.001), but the high correlation between the factors indicated unidimensionality (r = 0.866). Configural invariance between stroke and non-stroke was supported (CFI = 0.983, RMSEA = 0.080), as were invariant thresholds (p =.092) and loadings (p =.103). Strong invariance was violated (p <.001, ΔCFI = −0.003), stemming from differences in the tiredness and appetite intercepts. These differences resulted in a moderate overestimation of depression in stroke when using a summed score approach, relative to the comparison sample (Cohen's d = 0.434). Conclusions: The findings suggest that the PHQ-9 measures a single factor in stroke. Because stroke patients may report higher tiredness on item 4, caution is advisable when classifying patients as depressed if they are near the cut-off and have significant post-stroke fatigue. Caution is also advised when comparing total scores between stroke and other populations.
| Item Type: | Article |
|---|---|
| Additional Information: | Data access statement: We are unable to share the data publicly. Funding statement: None received. |
| Uncontrolled Keywords: | confirmatory factor analysis,depression,dimensionality,phq-9,self-report,stroke,clinical psychology,psychiatry and mental health ,/dk/atira/pure/subjectarea/asjc/3200/3203 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 21 Nov 2024 11:30 |
| Last Modified: | 20 Dec 2024 01:13 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/97743 |
| DOI: | 10.1016/j.jpsychores.2024.111983 |
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