Psychometric Properties and Factor Structure of the Patient Health Questionnaire-9 as a Screening Tool for Depression Among Ecuadorian College Students

Background The Patient Health Questionnaire-9 (PHQ-9) is the most well-known self-report measure to screen for depressive symptomatology, although discerning which is the factor structure that represents the best fit remains a challenge. Objective The aim of this study was to analyze the psychometric properties and factorial structure of the Spanish version of the PHQ-9 in a large sample of Ecuadorian college students. Methods A total of 5,394 students ( M = 22.03 years; SD = 3.05; 54.8% female) from three Ecuadorian universities were surveyed using a computerized questionnaire within a 4-week assessment period. The PHQ-9 was tested for factorial structure, reliability, and correlations with other mental health-related measures. Results The hierarchical model that included a general factor and three nested factors had a better fit, and such a hierarchical structure remained invariant across sex and age. Total omega value (ω) was 0.90 for the total scale and hierarchical omega values (ω h ) were 0.68 for the general factor, as well as 0.34, 0.38, and 0.44 for the respective nested factors (somatic, cognitive/affective, concentration/motor). Moreover, PHQ-9 scores were significantly higher among women, although effect sizes of comparison of those sex differences were very small. Finally, the PHQ-9 scores correlated with multiple mental health indicators (psychological inflexibility, loneliness, stress, and satisfaction with life). Discussion The Spanish version of the PHQ-9 showed good psychometric properties among Ecuadorian college students. The hierarchical structure showed the best fit for the data, including not only a dominant general factor, but also the somatic, cognitive/affective and concentration/motor subcomponents. In conclusion, the PHQ-9 tool seems to represent an easy-to-implement screening questionnaire to design preventive programs for those Ecuadorian college students at risk of developing depressive disorders.

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