Validity and reliability of the Patient Health Questionnaire scale (PHQ-9) among university students of Bangladesh

Abstract

This study investigated the reliability and factorial validity of Patient Health Questionnaire-9 (PHQ-9) in the context of university students in Bangladesh. The research aimed to assess whether the original one-dimensional model or a model containing both somatic and cognitive-emotional factors is appropriate in the case of a sample of university students. A repeated cross-sectional survey design based on convenience sampling was used to collect data from 677 university students from both public and private universities. The factor structure of the PHQ-9 was assessed using confirmatory factor analysis (CFA). Measurement invariances were assessed across gender, type of university, level of education and victim of domestic violence. Its convergent validity was determined by investigating its correlations with Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS). Results showed excellent reliability of PHQ-9 as measured by both Cronbach’s α and McDonald’s ω. CFA suggested that a modified one-factor model where the error variances between item-3 (‘sleeping difficulties’) and item-6 (‘feeling as a failure’), item-6 and item-9 (‘suicidal thoughts’), item-4 (‘feeling tired’) and item-9, item-3 and item-9 were allowed to covary is appropriate for the sample. This model provided high values of comparative fit index (CFI), goodness of fit index (GFI), and Tucker Lewis Index (TLI), low value of standardized root mean square residual (SRMR) and a non-significant root mean square error of approximation (RMSEA) as well as a high Factor Determinacy Score Coefficient. Correlation between PHQ-9 and GAD-7 was 0.751 and 0.934 between PHQ-9 and PHQ-ADS. Finally, the model is strictly invariant across gender and university type. Overall, the study provided support for modified unidimensional structure for PHQ-9 and showed high internal consistency along with good convergent validity.