A psychometric analysis of the Arabic version of the PHQ-9 for depression screening in cardiovascular disease patients

BACKGROUND: Depression is a prevalent but often underdiagnosed comorbidity among patients with heart failure (HF). This situation increases the risk of mortality and new cardiovascular events. In Oman, 25 % of HF patients succumb to the disease within one year, highlighting the need for effective tools for screening. The Patient Health Questionnaire (PHQ-9) is widely used for depression screening. However, its psychometric properties have not been thoroughly explored in Omani cardiovascular samples. AIMS: This study aimed to assess the psychometric properties of the Arabic PHQ-9 in a sample of cardiovascular disease patients in Oman. METHODS: A cross-sectional study was conducted with 180 Omani HF patients. Confirmatory factor analysis (CFA) compared four structural models of the PHQ-9, examining one-factor and two-factor structures. Measurement invariance across gender, marital status, education, and employment was assessed using multigroup CFA. Convergent validity was evaluated through item-total correlations, and Cronbach's alpha was used to measure internal consistency. Statistical significance was set at P < 0.05. RESULTS: Model 2 demonstrated the best fit without error correlations, outperforming Models 3 and 4. The PHQ - 9 demonstrated strong internal consistency (α = 0.84). Additionally, the Cognitive - Affective subscale (α = 0.76) and the Somatic subscale (α = 0.79) both showed acceptable reliability. Convergent validity was supported by moderate to high item-total correlations. CONCLUSION: The Arabic PHQ-9 is a reliable and effective tool for depression screening in Omani patients with HF. Its ease of administration make it a valuable resource for mental health assessments and preventative interventions in cardiovascular care settings.