De La Rosa Jennifer S, Chism Greg T, Herder Katherine E, Mun Chung Jung, Aaron Rachel V
Comprehensive Center for Pain and Addiction, University of Arizona.
Department of Family and Community Medicine, University of Arizona College of Medicine-Tucson.
medRxiv. 2025 Aug 28:2025.08.08.25333327. doi: 10.1101/2025.08.08.25333327.
The 8-item Patient Health Questionnaire (PHQ-8) is the most widely implemented clinical depression screener in the world and is increasingly influential in population surveillance of unmet mental health needs. However, in the context of chronic pain (CP), depression screening could be complicated by overlapping symptoms. Inaccurate attribution of CP symptoms to depression could lead to overestimation of depressive symptom severity or even artifactual inflation of depression prevalence estimates. Results of small, non-representative studies are heterogenous; suitability of the PHQ-8 to screen for depression in those with CP remains unclear. We aimed to determine the reliability and equivalence of PHQ-8 in adults with and without CP.
This cross-sectional observational population study used representative data from the 2019 National Health Interview Survey. Descriptive statistics and visualizations were generated; reliability, cross-group equivalence and measurement invariance were assessed.
The final sample contained 30,983 U.S. adults. Prevalence of clinically significant depressive symptoms was 3.5% in those without CP, 20.1% in those with CP, and 34.8% in those with high-impact chronic pain (HICP). Reliability, measurement invariance and cross-group equivalence were observed at the configural, metric, and scalar levels. No evidence consistent with overestimation of depression prevalence or severity in the contexts of CP or HICP was observed.
The PHQ-8 is reliable and measures depressive symptoms equivalently in the context of CP, supporting the continued use of PHQ-8 to screen for depression in clinical and research settings and in population surveillance of adults with and without CP. CP was associated with five times higher prevalence of clinically significant depressive symptoms; findings suggest this reflects true cross-group differences in prevalence and severity of depressive symptoms and is unlikely to result from measurement issues.
This work was funded in part by the Comprehensive Center for Pain & Addiction, University of Arizona, and by NIH K23HD104934.
8项患者健康问卷（PHQ - 8）是世界上应用最广泛的临床抑郁症筛查工具，在未满足的心理健康需求的人群监测中越来越有影响力。然而，在慢性疼痛（CP）的背景下，抑郁症筛查可能会因症状重叠而变得复杂。将CP症状错误归因于抑郁症可能导致对抑郁症状严重程度的高估，甚至导致抑郁症患病率估计值的人为夸大。小型、非代表性研究的结果参差不齐；PHQ - 8在CP患者中筛查抑郁症的适用性仍不明确。我们旨在确定PHQ - 8在有和没有CP的成年人中的可靠性和等效性。
这项横断面观察性人群研究使用了2019年国家健康访谈调查的代表性数据。生成了描述性统计数据和可视化结果；评估了可靠性、跨组等效性和测量不变性。
最终样本包括30983名美国成年人。无CP者中具有临床意义的抑郁症状患病率为3.5%，CP患者中为20.1%，高影响慢性疼痛（HICP）患者中为34.8%。在构型、度量和标量水平上观察到了可靠性、测量不变性和跨组等效性。未观察到与在CP或HICP背景下高估抑郁症患病率或严重程度一致的证据。
PHQ - 8是可靠的，并且在CP背景下能够等效地测量抑郁症状，支持在临床和研究环境以及有和没有CP的成年人的人群监测中继续使用PHQ - 8筛查抑郁症。CP与具有临床意义的抑郁症状患病率高出五倍相关；研究结果表明，这反映了抑郁症状患病率和严重程度在跨组之间的真实差异，不太可能是由测量问题导致的。
这项工作部分由亚利桑那大学疼痛与成瘾综合中心以及美国国立卫生研究院K23HD104934资助。
