Are comparisons of mental disorders between Chinese and German students possible? An examination of measurement invarian
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RESEARCH ARTICLE
Open Access
Are comparisons of mental disorders between Chinese and German students possible? An examination of measurement invariance for the PHQ-15, PHQ-9 and GAD-7 Yan Zhou1* , Jing Xu2 and Winfried Rief1
Abstract Background: The Patient Health Questionnaire (PHQ) is one of the most commonly used instruments to assess mental disorders. However, research on its cross-cultural measurement invariance is not yet sufficient. This study examined the measurement invariance of the Chinese and German versions of the PHQ’s somatic symptom severity scale (PHQ-15), depressive symptom severity scale (PHQ-9) and seven-item Generalized Anxiety Disorder (GAD-7) scale as a prerequisite for their use in cross-cultural comparisons. Methods: We used online data collected from groups of Chinese students in China (n = 413) and German students in Germany (n = 416). Separate measurement models for each group were examined using confirmatory factor analysis and measurement invariance testing was conducted to test the cross-cultural equivalence. Results: Findings demonstrated that the PHQ-9 and GAD-7 had partial scalar measurement invariance, but the cross-cultural measurement invariance of the PHQ-15 could not be confirmed. Comparisons of latent means did not indicate differences in the levels of depression and anxiety symptoms between Chinese and German samples. Conclusion: The PHQ-9 and GAD-7 can be used in cross-cultural comparison of prevalence, but the intercultural use of PHQ-15 is more problematic. Findings are discussed from intercultural and methodological perspectives. Keywords: Cross-cultural comparison, Measurement invariance, Patient Health Questionnaire-15 (PHQ-15), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7)
Background Depression, anxiety disorders and somatoform disorders are the most common mental disorders worldwide and differences in epidemiology exist across countries and cultures [1, 2]. Previous studies showed that base rates of depression and anxiety disorders are lower in China than in American and European countries [1, 3–5], and prevalence rates of somatoform disorders are inconsistent [6, 7]. For * Correspondence: [email protected] 1 Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, D-35032 Marburg, Germany Full list of author information is available at the end of the article
example, the 12-month prevalence of anxiety disorders in China was 5.0% compared to 15.3% in Germany [8, 9] and for major depressive episodes was 3.6% in China and 6% in Germany [8, 10]. Cultural, linguistic and methodological aspects could contribute to explaining the differences in prevalence rates of disorders. According to a literature review [4], the lower prevalence of major depressive disorders that persisted in East/Southeast Asia compared to other regions of the world still remained, even after adjusting for methodological differences. The study showed evidence that cross-national differences may re
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