Psychometric Validation of the PHQ-9 in Ostomy Patients and Their Informal Caregivers: Evidence From A European Multicenter Study
Abstract
INTRODUCTION: Depressive symptoms are highly prevalent among individuals with an ostomy and their informal caregivers, negatively affecting quality of life and healthcare outcomes. Although the Patient Health Questionnaire-9 (PHQ-9) is widely used for depression screening, its psychometric properties have not previously been examined simultaneously in ostomy patients and their informal caregivers, limiting its applicability in this clinical context.
AIM: To evaluate the validity, reliability and measurement invariance of the PHQ-9 in a European sample of ostomy patients and their informal caregivers.
METHOD: This secondary analysis used data from a multicenter observational study including 523 ostomy patients (63.9% males, mean age 68.65 years) and 252 informal caregivers (80.6% females, mean age 58.7 years) recruited from outpatient clinics across Italy. Structural validity was examined using confirmatory factor analysis, comparing unidimensional and bidimensional models. Measurement invariance across patients and caregivers was assessed using multigroup confirmatory factor analysis. Internal consistency was assessed using omega coefficients and construct validity was tested through correlations with ostomy-specific and generic quality of life measures.
RESULTS: Confirmatory factor analysis supported a bidimensional structure of the PHQ-9, reflecting somatic and cognitive symptoms for both patients and caregivers, with excellent model fit. Internal consistency was adequate,…
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