Validation of the Arabic Version of Patient Health Questionnaire‐9 in Omani and Yemeni Patients With Chronic Physical Diseases

BACKGROUND: Secondary depression frequently develops in people with chronic diseases, and it may hinder disease progress and treatment outcomes. This study aimed to examine the construct validity and measurement invariance of the Arabic version of the Patient Health Questionnaire-9 (PHQ-9) among patients with chronic physical conditions. METHODS: This cross-sectional study used confirmatory factor analysis (CFA) and multigroup CFA to evaluate the Arabic PHQ-9 in a convenience sample comprising patients with cancer, heart failure (HF), and renal failure (RF) from Oman and Yemen. RESULTS: Out of eight models, the unidimensional PHQ-9 (depression) displayed satisfactory fit when three pairs of error were correlated whereas a similar fit was exhibited by a three-factor (somatic, cognitive/affective, and concentration/motor) solution, which was modified into (somatic, affective, and cognitive-psychomotor) solution based on partial scalar analysis tests. This structure was invariant across all sociodemographic characteristics, with better values of reliability coefficients, average variance extracted, and heterotrait-monotrait ratios of correlation. CONCLUSION: The Arabic PHQ-9 is a reliable and psychometrically stable tool that may differentiate depressive symptoms in people with chronic disorders into three symptom groups. Meaningful comparisons between countries support higher psychological burden of physical disorders in Yemen than Oman.