Reliability and validity of the PHQ-8 in first-time mothers who used assisted reproductive technology

Abstract

Abstract STUDY QUESTION Is the Patient Health Questionnaire-8 (PHQ-8) a valid and reliable measure of depression in first-time mothers who conceived via ART? SUMMARY ANSWER The results from this study provide initial support for the reliability and validity of the PHQ-8 as a measure of depression in mothers who have conceived using ART. WHAT IS KNOWN ALREADY Women who achieved a clinical pregnancy using ART experience many stressors and may be at an increased risk of depression. The PHQ-8 is a brief measure designed to detect the presence and severity of depressive symptoms. It has been validated in many populations; however, it has not been validated for use in this population. STUDY DESIGN, SIZE, DURATION This is a cross-sectional study of 171 first-time mothers in the USA, recruited through Amazon’s Mechanical Turk (MTurk). PARTICIPANTS/MATERIALS, SETTING, METHODS The reliability of the PHQ-8 was measured through a Cronbach’s alpha, the convergent validity was measured through the correlation between the PHQ-8 and the Generalized Anxiety Disorder-7 (GAD-7) measure of anxiety symptoms, and the structural validity was measured through a Confirmatory Factor Analysis. MAIN RESULTS AND THE ROLE OF CHANCE The Cronbach’s alpha for the total PHQ-8 was acceptable (α = 0.922). The correlation between the PHQ-8 and the GAD-7 was large (r = 0.88) indicating good convergent validity. Ultimately, a bifactor model provided the best model fit (χ2(13) = 23.8, P = 0.033; Comparative Fit Index = 0.987; Root Mean Square Error of Approximation = 0.07, Tucker–Lewis Index = 0.972). LIMITATIONS, REASONS FOR CAUTION The results are limited by: the predominantly white and well-educated sample, a lack of causation between the use of artificial reproductive technology and depressive symptoms, including mothers with children up to 5 years old, convergent validity being based on associations with a related construct instead of the same construct, lack of test-retest reliability, divergent validity and criterion-related validity, data collected through MTurk, and the fact that the measures used were all self-report and therefore may be prone to bias. WIDER IMPLICATIONS OF THE FINDINGS Consistent with previous literature, a bifactor model for the PHQ-8 was supported. As such, when assessing depression in first-time mothers who conceived via ART, using both the PHQ-8 total score and subdomain scores may yield the most valuable information. The results from this study provide preliminary support for the reliability and validity of the PHQ-8 as a measure of depression in first-time mothers who conceived using ART. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was used for the completion of this study. Throughout the study period and manuscript preparation, the authors were supported by the department funds at Baylor University. The authors declare that they have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.