Psychometric Evaluation of Patient Health Questionnaire 9 Hindi for Use with Patients with Cancer in Community Palliative Care Settings.

Abstract

Objectives: Patient Health Questionnaire 9 (PHQ-9) has previously undergone validation with patients with various types of cancer, but psychometric validation of PHQ-9 Hindi among patients with cancer receiving palliative care services in northern regions of India is required. This study aimed at psychometric validation of a culturally adapted version of PHQ-9 Hindi for early screening of depression among cancer patients receiving palliative care services in a community setting.

Materials and methods: A sample of adult patients (n = 228) with cancer receiving palliative care services in a community setting participated in the research. A 50% subset of the sample was contacted for repeat assessment twice, each after a period of 3-4 weeks. For validation, a previously adapted version of PHQ-9 Hindi, along with a demographic sheet, was employed to collect data. In addition, we used the recently validated Integrated Palliative Care Outcome Scale to assess the validity of PHQ-9 within palliative care settings. Exploratory and confirmatory factor analyses were conducted, followed by test-retest reliability, interclass correlation, construct validity and divergent validity examination.

Results: The exploratory factor analysis revealed a two-factor solution consistent with the hypothesised model, yielding two sub-scales namely, physical and emotional concerns. The confirmatory factor indices within our sample were conclusive suggesting a relatively good fit between the hypothesised model and the observed data, thus confirming the cross-cultural validity of PHQ-9 Hindi. The physical sub-scale confirmed moderate internal consistency (α = 0.5) while the emotional sub-scale presented high internal consistency (α = 0.734). The associations between PHQ-9 Hindi with IPOS Hindi individual items were significant (P < 0.001).

Conclusion: A psychometrically validated version of PHQ-9 Hindi has been presented to screen depression among patients with cancer in northern parts of India. Further research is required to adapt and check the validity of PHQ-9 in other regional languages among different populations across the country.