Factorial validity and gender invariance of the Patient Health Questionnaire (PHQ-9) in student-athletes

Depressive symptoms are prevalent in student-athletes. Evidence for the factorial validity of measures assessing depressive symptoms in student-athletes is presently absent from the literature. This study examined the best fitting factorial structure and invariance across sexes of the PHQ-9. Data were collected from 1,524 student-athletes from institutions in the North-Eastern United States. Confirmatory factor analyses of 4 factorial structures of the Patient Health Questionnaire-9 (PHQ-9) were conducted, followed by invariance analyses across sexes. All tested models showed an excellent fit for all tested models and a unidimensional model of the PHQ-9 was chosen for further analyses. Metric and scalar invariance for the identified model across sexes was supported. The participants in this study reported an unusually low (3.13%) prevalence of elevated depressive symptoms, which may indicate underreporting of symptoms. Using a unidimensional, composite score via the PHQ-9 is a valid assessment of depressive symptoms in male and female student-athletes.