The DOI matches its Crossref record; 71 of the 71 references it cites were found in a registry or an index.
Measurement invariance of the patient health questionnaire‐9 (PHQ‐9) depression screener in U.S. adults across sex, race/ethnicity, and education level: NHANES 2005–2016
Open accessAbstract
BACKGROUND: Despite its popularity, little is known about the measurement invariance of the Patient Health Questionnaire-9 (PHQ-9) across U.S. sociodemographic groups. Use of a screener shown not to possess measurement invariance could result in under/over-detection of depression, potentially exacerbating sociodemographic disparities in depression. Therefore, we assessed the factor structure and measurement invariance of the PHQ-9 across major U.S. sociodemographic groups. METHODS: U.S. population representative data came from the 2005-2016 National Health and Nutrition Examination Survey (NHANES) cohorts. We conducted a measurement invariance analysis of 31,366 respondents across sociodemographic factors of sex, race/ethnicity, and education level. RESULTS: Considering results of single-group confirmatory factor analyses (CFAs), depression theory, and research utility, we justify a two-factor structure for the PHQ-9 consisting of a cognitive/affective factor and a somatic factor (RMSEA = 0.034, TLI = 0.985, CFI = 0.989). On the basis of multiple-group CFAs testing configural, scalar, and strict factorial invariance, we determined that invariance held for sex, race/ethnicity, and education level groups, as all models demonstrated close model fit (RMSEA = 0.025-0.025, TLI = 0.985-0.992, CFI = 0.986-0.991). Finally, for all steps ΔCFI was <-0.004, and ΔRMSEA was <0.01. CONCLUSIONS: We demonstrate that the PHQ-9 is acceptable to use in major U.S. sociodemographic groups and allows for meaningful comparisons in total, cognitive/affective, and somatic depressive symptoms across these groups, extending its use to the community. This knowledge is timely as medicine moves towards alternative payment models emphasizing high-quality and cost-efficient care, which will likely incentivize behavioral and population health efforts. We also provide a consistent, evidence-based approach for calculating PHQ-9 subscale scores.
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“The PHQ-8 has good reliability (α=.86-.89) and has shown validity across different racial and ethnic groups [69].”
From App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (2022) · cites this paper as [69]
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The PHQ-9: Validity of a brief depression severity measure
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Self-citationOverweight, Obesity, and Depression: A Systematic Review and Meta-analysis of Longitudinal Studies
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Depression, pain, and catastrophizing in adults with sickle cell disease and chronic pain
Fanfan, D., Prince, E. J., Molokie, R. E., Schlaeger, J. M., Shah, N., Doorenbos, A. Z., Ezenwa, M. O., Matthie, N., Knisely, M. R., Steffen, A. D., et al. (2026) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2026.09.008
Schäffler, L., Hapfelmeier, A., Sterner, P., Bühner, M., Linde, K., Gensichen, J., Pitschel‐Walz, G., Schneider, A., & Teusen, C. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02383-y
Badía, M. D. C., Alarcón, R., Trillo, J., & Miranda-Paez, J. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1878684
Nkansah, F., & Joshua, U. I. (2026) · International Journal of Modern Science and Research Technology · doi:10.67317/ijmsrt26oct025
Azizi, B. A., Bjärtå, A., Meurling, J., Tabrizi, F., Saadat, S., Talbian, W., & Afsharzada, M. S. (2026) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2026.101189
Metadata
- Authors
- Patel, J. S., Oh, Y., Rand, K. L., Wu, W., Cyders, M. A., Kroenke, K., & Stewart, J. C.
- Affiliations
- Indiana University – Purdue University Indianapolis (US)
- Texas Tech University (US)
- Regenstrief Institute (US)
- Corresponding author
- Stewart, Jesse C.
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2019-07-29
- Volume
- 36
- Issue
- 9
- Pages
- 813-823
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- PMC
- PMC6736700
- OpenAlex
- W2786060782
- Cited by
- 306
- References
- 71
- Citations by year
- 2026: 47 · 2025: 49 · 2024: 83 · 2023: 49 · 2022: 36 · 2021: 25 · 2020: 11 · 2019: 5
- FWCI
- 13.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- PMC
- Funders
- National Heart, Lung, and Blood Institute (R01HL122245)
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- PHQ-9, measurement invariance, depression screening, factor structure, somatic depressive symptoms, sociodemographic disparities, sex differences, race and ethnicity, educational attainment, NHANES
- MeSH terms
- Patient Health Questionnaire, Depression, Depressive Disorder, Educational Status, Ethnicity, Factor Analysis, Statistical, Female, Humans, Male, Mass Screening, Middle Aged, Nutrition Surveys, Psychometrics, Racial Groups
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