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 modeling (SEM) study

Leonhart, Rainer, de Vroege, Lars, Zhang, Lan, Liu, Yang, Dong, Zaiquan, Schaefert, Rainer, Nolte, Sandra, Fischer, Felix, Fritzsche, Kurt and van der Feltz-Cornelis, Christina M. 2018, 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 modeling (SEM) study, Frontiers in psychiatry, vol. 9, pp. 1-13, doi: 10.3389/fpsyt.2018.00240.

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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 modeling (SEM) study
Author(s) Leonhart, Rainer
de Vroege, Lars
Zhang, Lan
Liu, Yang
Dong, Zaiquan
Schaefert, Rainer
Nolte, SandraORCID iD for Nolte, Sandra orcid.org/0000-0001-6185-9423
Fischer, Felix
Fritzsche, Kurt
van der Feltz-Cornelis, Christina M.
Journal name Frontiers in psychiatry
Volume number 9
Article ID 240
Start page 1
End page 13
Total pages 13
Publisher Frontiers Media
Place of publication Lausanne, Switzerland
Publication date 2018-06-26
ISSN 1664-0640
Keyword(s) factor structure
patient health questionnaire-15
somatic symptoms
structural equation modeling (SEM)
transcultural
Science & Technology
Life Sciences & Biomedicine
Psychiatry
RANDOMIZED CONTROLLED-TRIAL
PRIMARY-CARE PATIENTS
GENERAL-POPULATION
PSYCHOMETRIC PROPERTIES
SOMATOFORM DISORDERS
ANXIETY DISORDERS
PHYSICAL SYMPTOMS
HONG-KONG
DEPRESSION
VALIDATION
Summary 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 to a 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.
Language eng
DOI 10.3389/fpsyt.2018.00240
Field of Research 111799 Public Health and Health Services not elsewhere classified
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2018, Leonhart, de Vroege, Zhang, Liu, Dong, Schaefert, Nolte, Fischer, Fritzsche and van der Feltz-Cornelis
Persistent URL http://hdl.handle.net/10536/DRO/DU:30117284

Document type: Journal Article
Collections: School of Health and Social Development
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