Comparison of the factor structure of the Patient Health Questionnaire for somatic symptoms (PHQ-15) in Germany, the Netherlands, and China

A transcultural Structural Equation Modelling (SEM) study

R. Leonhart, L. de Vroege, L. Zhang, Y. Liu, Z. Dong, R. Schaefert, S. Nolte, F. Fischer, K. Fritzsche, C.M. van der Feltz-Cornelis

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Background
Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China.

Method
Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed.

Results
The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples.

Conclusion
The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted toa bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.
Original languageEnglish
Article number240
Number of pages13
JournalFrontiers in Psychology
Volume9
DOIs
Publication statusPublished - 2018

Fingerprint

Netherlands
Germany
China
Depression
Medically Unexplained Symptoms
Surveys and Questionnaires
Statistical Factor Analysis
Delivery of Health Care

Keywords

  • ANXIETY DISORDERS
  • DEPRESSION
  • GENERAL-POPULATION
  • HONG-KONG
  • PHYSICAL SYMPTOMS
  • PRIMARY-CARE PATIENTS
  • PSYCHOMETRIC PROPERTIES
  • RANDOMIZED CONTROLLED-TRIAL
  • SOMATOFORM DISORDERS
  • VALIDATION
  • factor structure
  • patient health questionnaire-15
  • somatic symptoms
  • structural equation modeling (SEM)
  • transcultural

Cite this

@article{aa036e3b51954b1199f0888bf87ab852,
title = "Comparison of the factor structure of the Patient Health Questionnaire for somatic symptoms (PHQ-15) in Germany, the Netherlands, and China: A transcultural Structural Equation Modelling (SEM) study",
abstract = "BackgroundPersistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China.MethodCross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed.ResultsThe general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples.ConclusionThe PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted toa bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.",
keywords = "ANXIETY DISORDERS, DEPRESSION, GENERAL-POPULATION, HONG-KONG, PHYSICAL SYMPTOMS, PRIMARY-CARE PATIENTS, PSYCHOMETRIC PROPERTIES, RANDOMIZED CONTROLLED-TRIAL, SOMATOFORM DISORDERS, VALIDATION, factor structure, patient health questionnaire-15, somatic symptoms, structural equation modeling (SEM), transcultural",
author = "R. Leonhart and {de Vroege}, L. and L. Zhang and Y. Liu and Z. Dong and R. Schaefert and S. Nolte and F. Fischer and K. Fritzsche and {van der Feltz-Cornelis}, C.M.",
year = "2018",
doi = "10.3389/fpsyt.2018.00240",
language = "English",
volume = "9",
journal = "Frontiers in Psychology",
issn = "1664-1078",
publisher = "Frontiers Media S.A.",

}

Comparison of the factor structure of the Patient Health Questionnaire for somatic symptoms (PHQ-15) in Germany, the Netherlands, and China : A transcultural Structural Equation Modelling (SEM) study. / Leonhart, R.; de Vroege, L.; Zhang, L.; Liu, Y. ; Dong, Z.; Schaefert, R.; Nolte, S.; Fischer, F.; Fritzsche, K.; van der Feltz-Cornelis, C.M.

In: Frontiers in Psychology, Vol. 9, 240, 2018.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Comparison of the factor structure of the Patient Health Questionnaire for somatic symptoms (PHQ-15) in Germany, the Netherlands, and China

T2 - A transcultural Structural Equation Modelling (SEM) study

AU - Leonhart, R.

AU - de Vroege, L.

AU - Zhang, L.

AU - Liu, Y.

AU - Dong, Z.

AU - Schaefert, R.

AU - Nolte, S.

AU - Fischer, F.

AU - Fritzsche, K.

AU - van der Feltz-Cornelis, C.M.

PY - 2018

Y1 - 2018

N2 - BackgroundPersistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China.MethodCross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed.ResultsThe general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples.ConclusionThe PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted toa bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.

AB - BackgroundPersistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China.MethodCross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed.ResultsThe general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples.ConclusionThe PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted toa bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.

KW - ANXIETY DISORDERS

KW - DEPRESSION

KW - GENERAL-POPULATION

KW - HONG-KONG

KW - PHYSICAL SYMPTOMS

KW - PRIMARY-CARE PATIENTS

KW - PSYCHOMETRIC PROPERTIES

KW - RANDOMIZED CONTROLLED-TRIAL

KW - SOMATOFORM DISORDERS

KW - VALIDATION

KW - factor structure

KW - patient health questionnaire-15

KW - somatic symptoms

KW - structural equation modeling (SEM)

KW - transcultural

U2 - 10.3389/fpsyt.2018.00240

DO - 10.3389/fpsyt.2018.00240

M3 - Article

VL - 9

JO - Frontiers in Psychology

JF - Frontiers in Psychology

SN - 1664-1078

M1 - 240

ER -