Patient Health Questionnaire-9 in Spinal Cord Injury: An Examination of Factor Structure as Related to Gender

J Spinal Cord Med, 2009 · DOI: · Published: April 1, 2009

Spinal Cord Injury Mental Health Research Methodology & Design

Simple Explanation

This study looks at how well a common depression screening tool, the PHQ-9, works for people with spinal cord injuries (SCI). It's important because depression is common after SCI, but it can be hard to measure accurately. The researchers wanted to see if the PHQ-9 measures depression the same way for men and women with SCI. This is important because men and women might experience depression differently. The study found that the PHQ-9 generally works well for both men and women with SCI when looking at the overall depression score. However, when trying to break down depression into different types of symptoms (like emotional vs. physical), there might be some important differences between how men and women respond.

Study Duration

Not specified

Participants

1,168 (584 matched pairs of women and men with SCI)

Evidence Level

Not specified

Key Findings

1
The 1-factor structure of the PHQ-9 was supported within and between sexes, indicating it can be used to compare overall depression scores between men and women with SCI.
2
The 2-factor structure showed low congruence between sexes, suggesting potential differences in how certain symptoms are experienced or interpreted by men and women with SCI.
3
For men, psychomotor slowing or feeling fidgety loaded on the cognitive/affective factor, while for women, it loaded on the somatic factor.

Research Summary

This study examined the factor structure of the PHQ-9 in a large sample of men and women with SCI to determine if the structure replicates across gender. Results supported a 1-factor structure of the PHQ-9 that was congruent across sexes, but a 2-factor structure showed low congruence, particularly for women. The findings suggest potential differences in how men and women with SCI experience depressive symptoms, highlighting the need for further research into sex-specific considerations in depression assessment.

Practical Implications

Clinical Practice

Clinicians should be aware that men and women with SCI might experience and report depressive symptoms differently, potentially impacting the interpretation of PHQ-9 subscores.

Research

Future research should focus on identifying where sexes diverge in cognitive, affective, and somatic dimensions of depressive symptoms and whether sex-specific or sex-neutral measures are warranted.

Measure Usage

The PHQ-9 total score can be used to compare depression levels between men and women with SCI, but caution should be used when comparing subscores due to potential gender differences.

Study Limitations

1
Data collected 1 or more years after SCI may not be generalizable to those recently injured.
2
Absence of repeated measures on the same participants limits the ability to determine the consistency of the factor structure over time.
3
Lack of clinician-collected data to verify the consistency of probable depressive disorders.

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