用于评估抑郁症的患者健康问卷8项版（PHQ - 8）的信度及跨国等效性：来自欧洲27个国家的结果
Reliability and cross-country equivalence of the 8-item version of the Patient Health Questionnaire (PHQ-8) for the assessment of depression: results from 27 countries in Europe.
作者信息
Arias de la Torre Jorge, Vilagut Gemma, Ronaldson Amy, Valderas Jose M, Bakolis Ioannis, Dregan Alex, Molina Antonio J, Navarro-Mateu Fernando, Pérez Katherine, Bartoll-Roca Xavier, Elices Matilde, Pérez-Sola Víctor, Serrano-Blanco Antoni, Martín Vicente, Alonso Jordi
机构信息
Care in Long Term Conditions Research Division, King's College London, London, UK.
CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
出版信息
Lancet Reg Health Eur. 2023 Jun 6;31:100659. doi: 10.1016/j.lanepe.2023.100659. eCollection 2023 Aug.
BACKGROUND
The 8-item version of the Patient Health Questionnaire (PHQ-8) is one of the self-reported questionnaires most frequently used worldwide for the screening and severity assessment of depression. However, in some European countries its reliability is unknown, and it is unclear whether its psychometric properties vary between European countries. Therefore, the aim of this study was to assess the internal structure, reliability and cross-country equivalence of the PHQ-8 in Europe.
METHODS
All participants from the 27 countries included in the second wave of the European Health Interview Survey (EHIS-2) between 2014 and 2015 with complete information on the PHQ-8 were included (n = 258,888). The internal structure of the PHQ-8 was assessed using confirmatory factor analyses (CFA) for categorical items. Additionally, the reliability of the questionnaire was assessed based on the internal consistency, Item Response Theory information functions, and item-discrimination (using Graded Response Models), and the cross-country equivalence based on multi-group CFA.
FINDINGS
The PHQ-8 shows high internal consistency for all countries. The countries in which the PHQ-8 was more reliable were Romania, Bulgaria and Cyprus and less reliable were Iceland, Norway and Austria. The PHQ-8 item with highest discrimination was item 2 (feeling down, depressed, or hopeless) in 24 of the 27 countries. Measurement invariance between countries in Europe was observed from multigroup CFA at the configural, metric and scalar levels.
INTERPRETATION
The results from our study, likely the largest study to the date assessing the internal structure, reliability and cross-country comparability of a self-reported mental health assessment measure, shows that the PHQ-8 has an adequate reliability and cross-country equivalence across the 27 European countries included. These results highlight the suitability of the comparisons of the PHQ-8 scores in Europe. They could be helpful to improve the screening and severity assessment of depressive symptoms at the European level.
FUNDING
This work was partially funded by CIBER Epidemiology and Public Health (CIBERESP) as part of the Intramural call of 2021 (ESP21PI05).
背景
患者健康问卷（PHQ - 8）的8项版本是全球最常用于抑郁症筛查和严重程度评估的自我报告问卷之一。然而，在一些欧洲国家，其可靠性尚不清楚，并且其心理测量特性在欧洲国家之间是否存在差异也不明确。因此，本研究的目的是评估欧洲PHQ - 8的内部结构、可靠性和跨国等效性。
方法
纳入2014年至2015年欧洲健康访谈调查（EHIS - 2）第二轮中来自27个国家且具有完整PHQ - 8信息的所有参与者（n = 258,888）。使用分类项目的验证性因子分析（CFA）评估PHQ - 8的内部结构。此外，基于内部一致性、项目反应理论信息函数和项目区分度（使用等级反应模型）评估问卷的可靠性，并基于多组CFA评估跨国等效性。
结果
PHQ - 8在所有国家都显示出较高的内部一致性。PHQ - 8可靠性较高的国家是罗马尼亚、保加利亚和塞浦路斯，可靠性较低的国家是冰岛、挪威和奥地利。在27个国家中的24个国家，区分度最高的PHQ - 8项目是项目2（情绪低落、沮丧或绝望）。从多组CFA在构型、度量和标量水平上观察到欧洲国家之间的测量不变性。
解读
我们的研究结果，可能是迄今为止评估自我报告心理健康评估指标的内部结构、可靠性和跨国可比性的最大规模研究，表明PHQ - 8在纳入的27个欧洲国家中具有足够的可靠性和跨国等效性。这些结果突出了欧洲PHQ - 8分数比较的适用性。它们可能有助于改善欧洲层面抑郁症状的筛查和严重程度评估。
资金
这项工作部分由CIBER流行病学和公共卫生（CIBERESP）资助，作为2021年内部召集（ESP21PI05）的一部分。
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