Chae Duckhee, Lee Jiyeon, Lee Eun-Hyun
College of Nursing, Chonnam National University, Republic of Korea.
College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Republic of Korea.
Asian Nurs Res (Korean Soc Nurs Sci). 2025 Feb;19(1):1-12. doi: 10.1016/j.anr.2024.12.005. Epub 2024 Dec 24.
This review aimed to evaluate the internal structure (structural validity, internal consistency, and measurement invariance) of the Patient Health Questionnaire-9 (PHQ-9), which is one of the most widely used self-administered instruments for assessing and screening depression.
The updated COnsensus-based Standards for the selection of health Measurement Instruments methodology for a systematic review of self-reported instruments was used. PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library databases were searched from their inception up to February 28, 2023.
This study reviewed 98 psychometric studies reported on in 90 reports conducted in 40 countries. Various versions of the PHQ-9 were identified: one-factor structures (8 types), two-factor structures (10 types), bifactor structures (4 types), three-factor structure (1 type), and second-order three-factor structure (1 type). There was sufficient high-quality evidence for structural validity of the one-factor structure with nine items scored using a four-point Likert scale based on confirmatory factor analysis, for internal consistency with a quantitatively pooled Cronbach α of .85, and for measurement invariance across sex, age, education level, marital status, and income groups. There was sufficient high-quality evidence for structural validity, internal consistency (Cronbach's α = .76- .92, ω = 0.83- .92), and measurement invariance across sex for the PHQ-8 (which excluded item 9: "suicidality or self-harm thoughts").
The one-factor PHQ-9 and PHQ-8 (excluding item 9) scored using a four-point Likert scale have the best internal structure based on the current evidence. The one-factor PHQ-9 and PHQ-8 justify the use of aggregated total scores in both practice and research. The total score of the PHQ-9 using a four-point Likert scale can be used to compare depression levels across sex, age, education level, marital status, and income groups due to the availability of sufficient evidence for measurement invariance across these demographic groups.
本综述旨在评估患者健康问卷9（PHQ-9）的内部结构（结构效度、内部一致性和测量不变性），PHQ-9是评估和筛查抑郁症最广泛使用的自填式工具之一。
采用基于共识的健康测量工具选择标准更新版方法，对自报告工具进行系统综述。检索了PubMed、Embase、CINAHL、PsycINFO和Cochrane图书馆数据库，检索时间从各数据库建库至2023年2月28日。
本研究回顾了40个国家90篇报告中报道的98项心理测量学研究。识别出了PHQ-9的各种版本：单因素结构（8种）、双因素结构（10种）、双因素结构（4种）、三因素结构（1种）和二阶三因素结构（1种）。基于验证性因子分析，有充分的高质量证据支持单因素结构的结构效度，该结构有9个项目，采用四点李克特量表评分；内部一致性方面，定量合并的克朗巴哈α系数为0.85；在性别、年龄、教育水平、婚姻状况和收入组间具有测量不变性。对于PHQ-8（排除第9项：“自杀或自伤想法”），有充分的高质量证据支持其结构效度、内部一致性（克朗巴哈α系数=0.76 - 0.92，ω系数=0.83 - 0.92）以及在性别间的测量不变性。
基于现有证据，采用四点李克特量表评分的单因素PHQ-9和PHQ-8（排除第9项）具有最佳的内部结构。单因素PHQ-9和PHQ-8在实践和研究中都证明了使用合计总分的合理性。由于有足够的证据支持在这些人口统计学组间具有测量不变性，采用四点李克特量表的PHQ-9总分可用于比较不同性别、年龄、教育水平、婚姻状况和收入组的抑郁水平。
