Measurement invariance testing of the patient health questionnaire-9 (PHQ-9) across people with and without diabetes mellitus from the NHANES, EMHS and UK Biobank datasets.
2021
Background: The prevalence of depression is higher among those with diabetes than in the general population.
The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but
measurement invariance of the PHQ-9 across groups of people with and without diabetes has not yet been
investigated.
Methods: Data from three independent cohorts from the USA (n=1,886 with diabetes, n=4,153 without diabetes),
Quebec, Canada (n= 800 with diabetes, n= 2,411 without diabetes), and the UK (n=4,981 with diabetes,
n=145,570 without diabetes), were used to examine measurement invariance between adults with and without
diabetes. A series of multiple group confirmatory factor analyses were performed, with increasingly stringent
model constraints applied to assess configural, equal thresholds, and equal thresholds and loadings invariance,
respectively. One-factor and two-factor (somatic and cognitive-affective items) models were examined.
Results: Results demonstrated that the most stringent models, testing equal loadings and thresholds, had satisfactory
model fit in the three cohorts for one-factor models (RMSEA = .063 or below and CFI = .978 or above)
and two-factor models (RMSEA = .042 or below and CFI = .989 or above).
Limitations: Data were from Western countries only and we could not distinguish between type of diabetes.
Conclusions: Results provide support for measurement invariance between groups of people with and without
diabetes, using either a one-factor or a two-factor model. While the two-factor solution has a slightly better fit,
the one-factor solution is more parsimonious. Depending on research or clinical needs, both factor structures can
be used.
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