Measuring antenatal depressive symptoms across the world: A validation and cross-country invariance analysis of the Patient Health Questionnaire-9 (PHQ-9) in eight diverse low-resource settings.

Journal: Psychological assessment

Volume: 34

Issue: 11

Year of Publication: 2022

Affiliated Institutions:  Department of Psychology, University of Edinburgh. Social Work Department, University of Edinburgh. Faculty of Health, School of Public Health and Social Work, Queensland University of Technology. Australian Centre for Health Law Research, Queensland University of Technology. Centre for Family Research, University of Cambridge. Department of Psychology, University of Ghana. Department of Primary Care and Mental Health, University of Liverpool. Child Protection Unit, University of the Philippines. Department of Psychology, Babes-Bolyai University. Department of Psychology, University of Cape Town. Department of Paediatrics, Faculty of Medicine, University of Kelaniya. Institute for Community Health Research, Hue University. Institute of Criminology, University of Cambridge. Division of Psychology and Language Sciences, University College London. Institute of Life Course Health Research, Department of Global Health, Stellenbosch University. Faculty of Medicine, University of Kelaniya. Caribbean Institute for Health Research, University of the West Indies.

Abstract summary 

Measures that produce valid and reliable antenatal depressive symptom scores in low-resource country contexts are important for efforts to illuminate risk factors, outcomes, and effective interventions in these contexts. Establishing the psychometric comparability of scores across countries also facilitates analyses of similarities and differences across contexts. To date, however, few studies have evaluated the psychometric properties and comparability of the most widely used antenatal depressive symptom measures across diverse cultural, political, and social contexts. To address this gap, we used data from the Evidence for Better Lives Study-Foundational Research (EBLS-FR) project to examine the internal consistency reliability, nomological network validity, and cross-country measurement invariance of the nine-item version of the Patient Health Questionnaire (PHQ-9) in antenatal samples across eight low-resource contexts. We found that the PHQ-9 scores had good internal consistency across all eight countries. Correlations between PHQ-9 scores and constructs conceptually associated with depression were generally consistent, with a few exceptions. In measurement invariance analyses, only partial metric invariance held and only across four of the countries. Our results suggest that the PHQ-9 yields internally consistent scores when administered in culturally diverse antenatal populations; however, the meaning of the scores may vary. Thus, interpretation of PHQ-9 scores should consider local meanings of symptoms of depression to ensure that context-specific conceptualizations and manifestations of antenatal depressive symptoms are adequately reflected. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Authors & Co-authors:  Murray Aja Louise AL Hemady Chad Lance CL Do Huyen H Dunne Michael M Foley Sarah S Osafo Joseph J Sikander Siham S Madrid Bernadette B Baban Adriana A Taut Diana D Ward Catherine L CL Fernando Asvini A Thang Vo Van VV Eisner Manuel M Hughes Claire C Fearon Pasco P Valdebenito Sara S Tomlinson Mark M Pathmeswaran Arunasalam A Walker Susan S

Study Outcome 

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Citations : 
Authors :  20
Identifiers
Doi : 10.1037/pas0001154
SSN : 1939-134X
Study Population
Male,Female
Mesh Terms
Pregnancy
Other Terms
Study Design
Cross Sectional Study
Study Approach
Country of Study
Publication Country
United States