Leonhart Rainer, de Vroege Lars, Zhang Lan, Liu Yang, Dong Zaiquan, Schaefert Rainer, Nolte Sandra, Fischer Felix, Fritzsche Kurt, van der Feltz-Cornelis Christina M
Department Social Psychology and Methodology, Institute of Psychology, University of Freiburg, Freiburg, Germany.
Clinical Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, Netherlands.
Front Psychiatry. 2018 Jun 26;9:240. doi: 10.3389/fpsyt.2018.00240. eCollection 2018.
Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China. Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany = 2,517, the Netherlands = 456) and from China ( = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed. The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples. The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted to a bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.
持续性躯体症状与心理困扰、功能受损及寻求医疗帮助行为相关。患者健康问卷（PHQ）-15用作躯体化筛查工具及躯体症状严重程度监测工具。已描述了一个双因素模型，包含一个一般因素和四个正交的特定症状因素。本研究的目的是评估并阐明PHQ-15在西欧不同国家内部以及与中国之间的因素结构。对来自两个西欧国家（德国 = 2517例，荷兰 = 456例）和中国（ = 1329例）的三个患者数据样本进行了横断面二次数据分析。进行了验证性因素分析（CFA）和结构方程模型（SEM）分析。在每个样本中均发现了一般因素。然而，尽管PHQ-15的结果估计了躯体症状在不同方面的严重程度，但这些分量表在欧洲和中国背景下可能具有不同含义。在德国和荷兰的数据集中可以复制因素结构，但在中国的数据集中则不行。对于中国数据集，建议采用一种心肺因素结构不同的双因素模型。PHQ-15能够在三个样本中区分躯体化与焦虑和抑郁。PHQ-15是一份有效的问卷，能够在欧洲或中国等不同文化中区分躯体化与焦虑和抑郁。它可以拟合用于分类数据的双因素模型，不过，该模型仅推荐用于一般因素。结果未证实正交分量表在非欧洲样本中的应用。这些差异不能归因于医疗保健环境的差异或伴随的抑郁或焦虑的差异，相反，涉及疾病概念的文化因素可能在此发挥作用，因为它们可能在问卷翻译中起作用。需要进一步研究来探讨这一点，并且需要针对中国的PHQ-15因素结构进行重复研究。
