Systematic Reviews of the Factor Structure and Measurement Invariance of the Patient Health Questionnaire-9 (PHQ-9) and Validation of the European Portuguese Version in Community Settings
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2020
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Background: This research sought to review studies that examined the factor structure of the PHQ-9 using a
confirmatory factor analysis approach (Study 1); to review studies that tested the measurement invariance of the
PHQ-9 (Study 2); to examine the psychometric properties of the European Portuguese version in the general
population (Study 3). Methods: Using PRISMA guidelines, a search was performed on Web of Science, PsycINFO,
and Scopus from 2001 to August 2019. Assessment of eligibility criteria and data extraction were conducted by two
independent researchers (Studies 1 and 2). In Study 3, data were collected from 1479 Portuguese adults, using a
cross-sectional design. The BDI-II and the GDS-15 were administered to examine convergent validity. Results: The
systematic review identified four-factor models of the PHQ-9 (Study 1). Nineteen studies supported a one-factor
model, whereas 12 found evidence for a two-factor model. Both models were supported in general, clinical,
psychiatric, and international samples. Study 2 identified ten studies that examined PHQ-9 measurement invariance
across 18 groups. The PHQ-9 measurement invariance was fully supported across studies. Study 3 revealed that a
two-factor model showed a close fit to data in the European Portuguese version of the PHQ-9. Measurement
invariance, reliability, and convergent and divergent validity were also established. Limitations: Study 3 did not include
a gold standard measure of depression to evaluate PHQ-9 diagnostic properties. Conclusions: Conceptual implications
of the findings are discussed, and recommendations for using the Portuguese version of the PHQ-9 as a screening
measure in community settings are also highlighted
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PSICOLOGIA, PSYCHOLOGY