Factor structure and measurement invariance of the Patient Health Questionnaire-9 (PHQ-9): a systematic review and random-effects meta-analysis

January 1, 2026Open Access

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Key Points

This systematic review aims to assess the factor structure and measurement invariance of the Patient Health Questionnaire-9 (PHQ-9) across various populations.
Conducted systematic review and random-effects meta-analysis of PHQ-9 studies published from 2010 onwards.
Selected studies based on fit and reliability indices, including CFI, TLI, RMSEA, SRMR, and Cronbach's α.
Applied a COSMIN-inspired methodological quality screen and pooled data from selected structural validation studies.
Pooled estimates for CFI were 0.966 (95% CI 0.949 to 0.983) with high heterogeneity (I²=87.0%).
Pooled TLI was 0.957 (95% CI 0.925 to 0.989), indicating strong model fit among the studies.
Cronbach's α showed an internal consistency of 0.834 (95% CI 0.742 to 0.895), with very high heterogeneity (I²=99.4%).

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Assesses factor structure and measurement invariance in adult populations, highlighting score interpretation issues.

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Koo et al. (2026) studied this question.

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