中风患者健康问卷-9 的因子结构：与非脑卒中人群的比较

IF 3.5 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research Pub Date : 2024-11-16 DOI:10.1016/j.jpsychores.2024.111983

J.J. Blake , T. Munyombwe , F. Fischer , T.J. Quinn , C.M. Van der Feltz-Cornelis , J.M. De Man-van Ginkel , I.S. Santos , Hong Jin Jeon , S. Köhler , M.T. Schram , J.L. Wang , H.F. Levin-Aspenson , M.A. Whooley , S.E. Hobfoll , S.B. Patten , A. Simning , F. Gracey , N.M. Broomfield

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引用次数: 0

摘要

背景目前还不清楚中风后的某些躯体症状是否会对患者健康问卷-9（PHQ-9）（一种自我报告的抑郁问卷）的项目产生负荷。我们通过因子分析，以非中风对比组为基准，对中风样本中的这些问题进行了调查。方法二次数据集包括 787 名中风参与者和 12016 名非中风参与者。通过倾向得分匹配法选取了 1574 名对比参与者作为子样本。通过比较单因素、双因素和双因素模型的拟合统计量来评估维度。结果由躯体因素和认知情感因素组成的双因素模型比单维模型显示出更好的拟合度（CFI = 0.984 对 CFI = 0.974，p <.001），但因素之间的高相关性表明了单维性（r = 0.866）。中风和非中风之间的配置不变性得到了支持（CFI = 0.983，RMSEA = 0.080），不变阈值（p = 0.092）和负荷（p = 0.103）也得到了支持。由于疲劳和食欲截距的差异，出现了强不变量（p < .001，ΔCFI = -0.003）。这些差异导致在使用总分法时，相对于对比样本，中风患者的抑郁程度被中度高估（Cohen's d = 0.434）。研究结果表明，PHQ-9 测量的是脑卒中的单个因素。由于脑卒中患者可能会在第 4 项报告较多的疲倦感，因此如果患者接近临界值并有明显的脑卒中后疲倦感，在将其归类为抑郁时应谨慎。在比较中风患者和其他人群的总分时也应谨慎。

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The factor structure of the Patient Health Questionnaire-9 in stroke: A comparison with a non-stroke population

Background

It is unclear if certain post-stroke somatic symptoms load onto items of the Patient Health Questionnaire-9 (PHQ-9), a self-report depression questionnaire. We investigated these concerns in a stroke sample using factor analysis, benchmarked against a non-stroke comparison group.

Methods

The secondary dataset constituted 787 stroke and 12,016 non-stroke participants. A subsample of 1574 comparison participants was selected via propensity score matching. Dimensionality was assessed by comparing fit statistics of one-factor, two-factor, and bi-factor models. Between-group differences in factor structure were explored using measurement invariance.

Results

A two-factor model, consisting of somatic and cognitive-affective factors, showed better fit than the unidimensional model (CFI = 0.984 versus CFI = 0.974, p < .001), but the high correlation between the factors indicated unidimensionality (r = 0.866). Configural invariance between stroke and non-stroke was supported (CFI = 0.983, RMSEA = 0.080), as were invariant thresholds (p = .092) and loadings (p = .103). Strong invariance was violated (p < .001, ΔCFI = −0.003), stemming from differences in the tiredness and appetite intercepts. These differences resulted in a moderate overestimation of depression in stroke when using a summed score approach, relative to the comparison sample (Cohen's d = 0.434).

Conclusions

The findings suggest that the PHQ-9 measures a single factor in stroke. Because stroke patients may report higher tiredness on item 4, caution is advisable when classifying patients as depressed if they are near the cut-off and have significant post-stroke fatigue. Caution is also advised when comparing total scores between stroke and other populations.

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来源期刊

Journal of Psychosomatic Research 医学-精神病学

CiteScore

7.40

自引率

6.40%

发文量

314

审稿时长

6.2 weeks

期刊介绍： The Journal of Psychosomatic Research is a multidisciplinary research journal covering all aspects of the relationships between psychology and medicine. The scope is broad and ranges from basic human biological and psychological research to evaluations of treatment and services. Papers will normally be concerned with illness or patients rather than studies of healthy populations. Studies concerning special populations, such as the elderly and children and adolescents, are welcome. In addition to peer-reviewed original papers, the journal publishes editorials, reviews, and other papers related to the journal''s aims.