Psychometric properties of the PHQ-9 in Peruvian users with alcohol use problems based on Samejima’s graded response model

Authors

  • Aaron Caycho-Caja Investigador de la FCCTYP de la Universidad de San Martí­n de Porres
  • Zoraida Barrios- Sallo Universidad César Vallejo
  • Eder Orihuela-Manrique Universidad Privada del Norte

DOI:

https://doi.org/10.21134/986

Keywords:

PHQ-9, Item Response Theory, Alcohol users, Samejima's Model, GRM

Abstract

Introduction. The PHQ-9 is a scarcely explored instrument from the perspective of item response theory (IRT), particularly in clinical samples with alcohol use problems. Therefore, the aim of the present study is to provide validity evidence for the PHQ-9 based on IRT. Method. A total of 484 individuals with alcohol use problems were selected from the Peruvian national survey (ENDES); 82% were male, and the remaining 17% were female. The study employed a cross-sectional, instrumental design within the framework of IRT, specifically using Samejima’s graded response model. Unidimensionality of the construct was assessed through confirmatory factor analysis, followed by evaluation of model fit indices for a single factor. Additionally, item discrimination and difficulty parameters were examined, along with item and test characteristic curves, among other analyses. Results. The initial factor analysis supported the unidimensionality of the model, which was further confirmed by adequate IRT model fit indices (RMSEA = .062, SRMSR = .068, TLI = .972, CFI = .979). Item 4 (fatigue) showed the highest discrimination, while item 9 (suicidal ideation) exhibited the greatest difficulty. Moreover, the response option “more than half the days” showed a low probability of being selected. Additionally, the depression construct significantly predicted alcohol use (? = 0.24, p < .001). Conclusion. The PHQ-9 is a psychometric instrument suitable for use in clinical populations with alcohol use problems.

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Author Biography

  • Aaron Caycho-Caja, Investigador de la FCCTYP de la Universidad de San Martí­n de Porres

    Investigador Renacyt, Magí­ster en Psicologí­a con Mención en Psicologí­a
    Clí­nica y de la Salud – UNMSM, egresado del Doctorado de Psicologí­a -
    UNMSM, licenciado en psicologí­a - UNFV. Poseo experiencia en intervención
    psicológica de Adolescentes en Conflicto con la Ley Penal, así­ como también
    he trabajado en la intervención de pacientes dependientes de sustancias
    psicoactivas adultos y adolescentes en instituciones privadas y públicas.
    Asimismo, me desempeño en la docencia universitaria, soy expositor e
    investigador interesado en las temáticas de adicciones, psicologí­a social y
    psicometrí­a con publicaciones en revistas de diversas bases de datos.

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. American Psychiatric Association

American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision. American Psychiatric Association

Abad, F. J., Olea, J., Ponsoda, J., & García, C. (2011). Medición en ciencias sociales y de la salud. Síntesis.

Arias de la Torre, J., Vilagut, G., Ronaldson, A., Valderas, J. M., Bakolis, I., Dregan, A., Molina, A. J., Navarro-Mateu, F., Pérez, K., Bartoll-Roca, X., Elices, M., Pérez-Sola, V., Serrano-Blanco, A., Martín, V., & Alonso, J. (2023). Reliability and cross-country equivalence of the 8-item version of the Patient Health Questionnaire (PHQ-8) for the assessment of depression: results from 27 countries in Europe. The Lancet regional health. Europe, 31, 100659. https://doi.org/10.1016/j.lanepe.2023.100659

Ato, M., Lo?pez, J., & Benavente, A. (2013). Un sistema de clasificacio?n de los disen?os de investigacio?n en psicologi?a. Anales de Psicologi?a, 29(3), 1038-1059. https://doi.org/10.6018/analesps.29.3.178511

Attorresi, H., Lozzia, G.S., Abal, F.J.P, Galibert M.S., & Aguerri, M.E. (2009). Teoría de Respuesta al ítem. Conceptos Básicos y aplicaciones para La medición de constructos psicológicos. Revista Argentina de Clínica Psicológica 18, 179-188. https://www.cienciared.com.ar/ra/usr/35/825/racp_xviii_2_pp179_188.pdf

Baker, F.B. (1992). Item Response Theory: Parameter Estimation Techniques. Marcel Dekker.

Barroso, S. M., Melo, A. P. S., da Silva, M. A., & Guimarães, M. D. C. (2019). Evaluation of the Brazilian version of Patient Health Questionnaire (PHQ-9) in Quilombola population using the Item Response Theory. Salud Mental, 42(1), 43–50. https://doi.org/10.17711/SM.0185-3325.2019.006

Carranza-Esteban, R. F., Mamani-Benito, O., Cjuno, J., Tito-Betancur, M., Caycho-Rodríguez, T., Vilca, L. W., Torales, J., & Barrios, I. (2024). Adaptation and Validation of the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) in a sample of Quechua-speaking Peruvians. Medicina Clinica y Social, 8(1), 63–74.

Cumbe, V. F. J., Muanido, A., Manaca, M. N., Fumo, H., Chiruca, P., Hicks, L., De Jesus Mari, J., & Wagenaar, B. H. (2020). Validity and item response theory properties of the Patient Health Questionnaire-9 for primary care depression screening in Mozambique (PHQ-9-MZ). BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02772-0

Damiano, R. F., Hoffmann, M. S., Gosmann, N. P., Pan, P. M., Miguel, E. C., & Salum, G. A. (2023). Translating measurement into practice: Brazilian norms for depressive symptom assessment with the Patient Health Questionnaire (PHQ-9). Brazilian Journal of Psychiatry, 45(4), 310–317. https://doi.org/10.47626/1516-4446-2022-2945

Desalu, J. M., Kim, J., Zaso, M. J., Corriders, S. R., Loury, J. A., Minter, M. L., & Park, A. (2019). Racial discrimination, binge drinking, and negative drinking consequences among black college students: serial mediation by depressive symptoms and coping motives. Ethnicity and Health, 24(8), 874–888. https://doi.org/10.1080/13557858.2017.1380170

Dominguez-Lara, S. (2018). Magnitud del efecto, una guía rápida. Educación Médica, 19(4), 251-254. https://doi.org/10.1016/j.edumed.2017.07.002

Gao, X., & Liu, Z. (2024). Analyzing the psychometric properties of the PHQ-9 using item response theory in a Chinese adolescent population. Annals of General Psychiatry, 23(1). https://doi.org/10.1186/s12991-024-00492-3

Grewal, G., Polisetty, T., Cannon, D., Ardeljan, A., Vakharia, R. M., Rodriguez, H. C., & Levy, J. C. (2022). Alcohol Abuse, Morbid Obesity, Depression, Congestive Heart Failure, and Chronic Pulmonary Disease are Risk Factors for 90-Day Readmission After Arthroscopic Rotator Cuff Repair. Arthroscopy, Sports Medicine, and Rehabilitation, 4(5), e1683–e1691. https://doi.org/10.1016/j.asmr.2022.06.015

Hair, J., Black, W., Babin, B., & Anderson, R. (2014). Multivariate data analysis. (7th Edition). Pearson.

Hernández-Vásquez, M., Azañedo, D., Rubilar-González, J., Huarez, B., & Grendas, L. (2016). Evolución y diferencias regionales de la mortalidad por suicidios en el Perú, 2004-2013. Revista Peruana de Medicina Experimental y Salud Publica, 33(4), 751-757. https://dx.doi.org/10.17843/rpmesp.2016.334.2562

Instituto Nacional de Salud Mental (2024). La depresión y el suicidio: mitos y creencias. INSM. https://www.insm.gob.pe/oficinas/comunicaciones/notasdeprensa/2012/006.html

Instituto Nacional de Estadística e Informática (2022). Microdatos: Base de datos de la Encuesta Demográfica y de Salud Familiar—ENDES Perú. Instituto Nacional de Estadística e Informática. http://iinei.inei.gob.pe/microdatos/.

Kessler, R. C., & Ustün, T. B. (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International journal of methods in psychiatric research, 13(2), 93–121. https://doi.org/10.1002/mpr.168

Keum, B. T. H., & Cano, M. A. (2023). Online racism, depressive and anxiety symptoms, coping-related drinking motives, and alcohol use severity among Black, Latina/o/x, and Asian emerging adults. Addictive Behaviors, 136. https://doi.org/10.1016/j.addbeh.2022.107468

Kitamura, T., Usui, Y., Wakamatsu, M., Minatani, M., & Hada, A. (2023). What Are The Core Symptoms of Antenatal Depression? A Study Using Patient Health Questionnaire-9 among Japanese Pregnant Women in the First Trimester. Healthcare (Switzerland), 11(10). https://doi.org/10.3390/healthcare11101494

Lingán-Huamán, S. K., Dominguez-Lara, S., Alarcón-Almeyda, M. S., de Moura, G. B., & Paiva, T. T. (2023). Psychometric Properties of the Patient Health Questionnaire-9 in Peruvian University Students. Psihologijske Teme, 32(3), 451–470. https://doi.org/10.31820/pt.32.3.3

Ma, S., Yang, J., Yang, B., Kang, L., Wang, P., Zhang, N., Wang, W., Zong, X., Wang, Y., Bai, H., Guo, Q., Yao, L., Fang, L., & Liu, Z. (2021). The Patient Health Questionnaire-9 vs. the Hamilton Rating Scale for Depression in Assessing Major Depressive Disorder. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.747139

MacCallum, R. C., Browne, M. W., & Sugawara, H. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2), 130–149. https://doi.org/10.1037/1082-989X.1.2.130

McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol research: current reviews, 40(1), arcr.v40.1.01. https://doi.org/10.35946/arcr.v40.1.01

Ministerio de Educación (2023). Noticias. MINEDU. https://juventud.gob.pe/2023/06/el-32-3-de-jovenes-de-15-a-29-anos-presentaron-algun-problema-de-salud-mental/

Organización Mundial de la Salud (2023). Depresión. WHO. https://www.who.int/es/news-room/fact-sheets/detail/depression

Organización Mundial de la Salud (2017). Depression and Other Common Mental Disorders. WHO. https://www.who.int/publications/i/item/depression-global-health-estimates

Organización Panamericana de la Salud (2021). Serie – alcohol y suicidio. OPS. https://www.paho.org/es/documentos/serie-alcohol-alcohol-suicidio

Palmer, E. O. C., Ker, S., Rentería, M. E., Carmody, T., & Rush, A. J. (2024). Psychometric evaluation and linking of the PHQ-9, QIDS-C, and VQIDS-C in a real-world population with major depressive disorder. Neuropsychiatric Disease and Treatment, 20, 671–687. https://doi.org/10.2147/NDT.S444223

Reich, H., Rief, W., Brähler, E., & Mewes, R. (2018). Cross-cultural validation of the German and Turkish versions of the PHQ-9: An IRT approach. BMC Psychology, 6(1). https://doi.org/10.1186/s40359-018-0238-z

Samejima, F. (1969). Estimation of latent ability using a response pattern of graded scores. Psychometrika Monograph Supplement, 34(4, Pt. 2), 100.

Santomauro, D.F.; Herrera, A.M.M.; Shadid, J.; Zheng, P.; Ashbaugh, C.; Pigott, D.M.; Abbafati, C.; Adolph, C.; Amlag, J.O.; Aravkin, A.Y.; et al. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet, 398, 1700–1712. https://doi.org/10.3390/jcm13185423

Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA, 282(18), 1737–1744. https://doi.org/10.1001/jama.282.18.1737

Villanueva-Blasco, V. J., Mateu-Mollá, J., Villanueva-Silvestre, V., & Vázquez-Martínez, A. (2022). Relationship Between Depression and Risky Alcohol Consumption in Women: the Mediating Role of Coping Styles and Age. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-022-00931-w

Villarreal-Zegarra, D., Copez-Lonzoy, A., Bernabé-Ortiz, A., Melendez-Torres, G. J., & Bazo-Alvarez, J. C. (2019). Valid group comparisons can be made with the Patient Health Questionnaire (PHQ-9): A measurement invariance study across groups by demographic characteristics. PloS one, 14(9), e0221717. https://doi.org/10.1371/journal.pone.0221717

Wang, H., Zhu, Y., Shi, J., Huang, X., & Zhu, X. (2022). Time perspective and family history of alcohol dependence moderate the effect of depression on alcohol dependence: A study in Chinese psychiatric clinics. Frontiers in psychology, 13, 903535. https://doi.org/10.3389/fpsyg.2022.903535

Yeo, Y., Jeong, S. M., Shin, D. W., Han, K., Yoo, J., Yoo, J. E., & Lee, S. P. (2022). Changes in Alcohol Consumption and Risk of Heart Failure: A Nationwide Population-Based Study in Korea. International Journal of Environmental Research and Public Health, 19(23). https://doi.org/10.3390/ijerph192316265

Yoshimura, A., Matsushita, S., Kimura, M., Yoneda, J. ichi, Maesato, H., Yokoyama, A., & Higuchi, S. (2022). Influence of ADHD, especially attention-deficit characteristics, on the course of alcohol-dependent individuals. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-022-04455-4

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Published

2025-07-29

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How to Cite

Psychometric properties of the PHQ-9 in Peruvian users with alcohol use problems based on Samejima’s graded response model. (2025). Health and Addictions Journal Revista Salud Y Drogas, 25(2), 48-64. https://doi.org/10.21134/986

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