Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz 55131, Germany.
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig 04103, Germany.
J Public Health (Oxf). 2023 Aug 28;45(3):e426-e436. doi: 10.1093/pubmed/fdac169.
The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health.
To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n = 3 802).
Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning-with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude.
We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded.
本研究调查了患者健康问卷-9 的反应行为的区域差异。我们测试了测量不变性和不同项目和测试功能在以前分裂的东德和西德之间：前德意志民主共和国和德意志联邦共和国。在社会主义与资本主义和集体主义与个人主义制度中不同的社会化经验可能会影响对心理健康的文化敏感评估。
为了对此进行实证检验，我们使用了因子分析和项目反应理论框架，根据德国普通人群的几个代表性样本，根据出生地和当前居住地区分东德人和西德人（n=3802）。
在所有调查中，我们发现东德人的抑郁总分略高于西德人。大多数项目没有显示出不同的项目功能-在自我伤害倾向的评估中存在一个关键的例外。量表分数基本不变，仅表现出少量的测试功能差异。尽管如此，它们平均占观察到的组间差异的四分之一左右，这在效应大小方面。
我们探讨了可能的原因，并讨论了项目水平差异的解释。总体而言，在统一后对东德和西德抑郁症状发展的分析是可行的，并且在统计学上是有根据的。
