ArticleJournal of affective disorders2017
Factor structure and longitudinal measurement invariance of PHQ-9 for specialist mental health care patients with persistent major depressive disorder: Exploratory Structural Equation Modelling.
Article in Journal of affective disorders, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- Recommendations for Research and Clinical Implementation of Ambulatory Assessment, Mood Monitoring, Digital Phenotyping, and Remote Measurement Technology in Mood Disorders: Synthesis of Systematic Review Findings.JMIR mental health · 2026Pooled it
- Longitudinal invariance of the Patient Health Questionnaire-9 among patients receiving pharmacotherapy for major depressive disorder: A secondary analysis of clinical trial data.Psychological assessment · 2024Trial
- The validity of the Strengths and Difficulties Questionnaire (SDQ) for children with ADHD symptoms.PloS one · 2019Trial
- Depressive symptoms and psychometric evaluation of the PHQ-9 among caregivers of breast cancer patients in Pakistan: a cross-sectional study.BMC psychiatry · 2026Article
- A psychometric assessment of the Patient Health Questionnaire-9 for people living with acutely-treated HIV in Thailand.Psychiatry research communications · 2026Article
- Longitudinal measurement invariance of the Personality Inventory for ICD-11 across Black and White American older adults.Psychological assessment · 2026Article
- Internal structure and factorial invariance of the Patient Health Questionnaire -9 (PHQ-9) in a large Argentinean sample.BMC psychiatry · 2026Article
- Performance of active and passive ambulatory assessment measures and mood monitoring in bipolar disorder: a systematic review.International journal of bipolar disorders · 2026Review
- Factor structure and measurement invariance of the 8-item CES-D: a national longitudinal sample of Chinese adolescents.BMC psychiatry · 2023Article
- Depression and suicide attempts in Chinese adolescents with mood disorders: the mediating role of rumination.European archives of psychiatry and clinical neuroscience · 2023Article
- Measurement Invariant but Non-Normal Treatment Responses in Guided Internet Psychotherapies for Depressive and Generalized Anxiety Disorders.Assessment · 2023Article
- Acoustic Analysis of Speech for Screening for Suicide Risk: Machine Learning Classifiers for Between- and Within-Person Evaluation of Suicidality.Journal of medical Internet research · 2023Article
- Prevalence of depressive symptoms and correlates among individuals who self-reported SARS-CoV-2 infection after optimizing the COVID-19 response in China.Frontiers in public health · 2023Article
- Rapid transition from in-person to videoconferencing psychotherapy in a counselor training clinic: A safety and feasibility study during the COVID-19 pandemic.Journal of counseling and development : JCD · 2022Article
- Longitudinal assessment of depression during the first year after stroke: Dimensionality and measurement invariance.Journal of psychosomatic research · 2022Article
- Psychometric Properties and Factor Structure of the Patient Health Questionnaire-9 as a Screening Tool for Depression Among Ecuadorian College Students.Frontiers in psychology · 2022Article
- Greek Validation of the Factor Structure and Longitudinal Measurement Invariance of the Strengths and Difficulties Questionnaire-Self Report (SDQ-SR): Exploratory Structural Equation Modelling.Child psychiatry and human development · 2021Article
- Socio-demographic, behavioural and psycho-social factors associated with depression in two Russian cities.Journal of affective disorders · 2021Article
- The factor structure of depressive symptoms in patients with obesity enrolled in the RAINBOW clinical trial.Journal of affective disorders · 2021Article
- The factor structure of major depressive symptoms in a sample of Chinese earthquake survivors.BMC psychiatry · 2021Article
Corrections and comments
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Authors and funding
10 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundThe Patient Health Questionnaire-9 (PHQ-9) is a widely used instrument for measuring levels of depression in patients in clinical practice and academic research; its factor structure has been investigated in various samples, with limited evidence of measurement equivalence/invariance (ME/I) but not in patients with more severe depression of long duration. This study aims to explore the factor structure of the PHQ-9 and the ME/I between treatment groups over time for these patients.
methods187 secondary care patients with persistent major depressive disorder (PMDD) were recruited to a randomised controlled trial (RCT) with allocation to either a specialist depression team arm or a general mental health arm; their PHQ-9 score was measured at baseline, 3, 6, 9 and 12 months. Exploratory Structural Equational Modelling (ESEM) was performed to examine the factor structure for this specific patient group. ME/I between treatment arm at and across follow-up time were further explored by means of multiple-group ESEM approach using the best-fitted factor structure.
resultsA two-factor structure was evidenced (somatic and affective factor). This two-factor structure had strong factorial invariance between the treatment groups at and across follow up times. LIMITATIONS: Participants were largely white British in a RCT with 40% attrition potentially limiting the study's generalisability. Not all two-factor modelling criteria were met at every time-point.
conclusionPHQ-9 has a two-factor structure for PMDD patients, with strong measurement invariance between treatment groups at and across follow-up time, demonstrating its validity for RCTs and prospective longitudinal studies in chronic moderate to severe depression.
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