Is depression comparable between asylum seekers and native Germans? An investigation of measurement invariance of the PHQ-9.
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
01 02 2020
01 02 2020
Historique:
received:
18
03
2019
revised:
18
10
2019
accepted:
10
11
2019
pubmed:
21
11
2019
medline:
22
1
2021
entrez:
21
11
2019
Statut:
ppublish
Résumé
Asylum seekers show high prevalence of depressive disorders compared to native populations. For the assessment of depression, the Patient Health Questionnaire-9 (PHQ-9) is a widely used instrument that has shown high validity and reliability. However, it is largely unknown whether PHQ-9 scores are comparable between asylum seekers living in Western countries and native populations, and whether results can be interpreted without reservation. Data from asylum seekers living in Germany (n = 243) and Germans without a migration background (n = 171) were used to analyze measurement invariance of the PHQ-9. Configural, scalar, and metric invariance was investigated, and test functioning was determined. The PHQ-9 was not measurement invariant across Germans without a migration background and asylum seekers living in Germany. Differences were found regarding metric invariance and scalar invariance. The items anhedonia, depressed mood, appetite changes, psychomotor changes, and suicidal ideation had lower loadings and lower thresholds in asylum seekers compared to Germans without a migration background. That led to an overestimation translated into approximately one point on the sum-score. The study limitations include a heterogeneous sample of asylum seekers regarding countries of origin, and the utilization of the different language versions of the PHQ-9. Our results may have implications for studies comparing levels of depression between asylum seekers and native Western samples. Even with the same latent level of depression, asylum seekers may have higher scores on several items and consequently a higher sum score. Therefore, the present results suggest a new determination or differentiation of the cut-off scores that were derived from Western samples.
Sections du résumé
BACKGROUND
Asylum seekers show high prevalence of depressive disorders compared to native populations. For the assessment of depression, the Patient Health Questionnaire-9 (PHQ-9) is a widely used instrument that has shown high validity and reliability. However, it is largely unknown whether PHQ-9 scores are comparable between asylum seekers living in Western countries and native populations, and whether results can be interpreted without reservation.
METHOD
Data from asylum seekers living in Germany (n = 243) and Germans without a migration background (n = 171) were used to analyze measurement invariance of the PHQ-9. Configural, scalar, and metric invariance was investigated, and test functioning was determined.
RESULTS
The PHQ-9 was not measurement invariant across Germans without a migration background and asylum seekers living in Germany. Differences were found regarding metric invariance and scalar invariance. The items anhedonia, depressed mood, appetite changes, psychomotor changes, and suicidal ideation had lower loadings and lower thresholds in asylum seekers compared to Germans without a migration background. That led to an overestimation translated into approximately one point on the sum-score.
LIMITATIONS
The study limitations include a heterogeneous sample of asylum seekers regarding countries of origin, and the utilization of the different language versions of the PHQ-9.
CONCLUSION
Our results may have implications for studies comparing levels of depression between asylum seekers and native Western samples. Even with the same latent level of depression, asylum seekers may have higher scores on several items and consequently a higher sum score. Therefore, the present results suggest a new determination or differentiation of the cut-off scores that were derived from Western samples.
Identifiants
pubmed: 31744740
pii: S0165-0327(19)30692-5
doi: 10.1016/j.jad.2019.11.055
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
451-458Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.