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Title: Measurement invariances of the PHQ-9 across gender and age groups in Chinese adolescents
Authors: Leung, DYP 
Mak, YW 
Leung, SF 
Chiang, VCL 
Loke, AY 
Issue Date: 2020
Source: Asia-Pacific psychiatry, 2020, e12381, p. 1-6
Abstract: Introduction The nine-item Patient Health Questionnaire (PHQ-9) is widely used to determine the severity of depression in adult populations, but its psychometric properties with regard to adolescents has been poorly explored. The present study aims to identify the factor structure and examine the measurement invariance of this instrument across genders and age groups in a Chinese adolescent sample.
Methods A large sample of Chinese schoolchildren completed the PHQ-9 in a cross-sectional survey in Hong Kong (N = 10 933). A confirmatory factor analysis (CFA) to test the factor structure and a multiple group CFA to test the gender and age invariances of the PHQ-9 in adolescents were conducted. Cronbach alpha was used to assess the reliability of the questionnaire, and Pearson correlations with anxiety, self-esteem, and perceived control were used to assess its construct validity.
Results The CFA results indicate that a one-factor model with three pairs of item correlations fitted the PHQ-9 data well, and measurement invariances by age and gender were supported. The PHQ-9 also possesses adequate internal consistency (>.84) and is strongly correlated with anxiety (>.77), self-esteem (<-.57), and perceived control (<-.56) in the expected directions in the overall sample and in the gender and age subsamples.
Discussion The results support the claim that the PHQ-9 is a reliable and valid scale and can be used to assess and compare depressive severity across ages and genders during the period of adolescence.
Keywords: Sage
Chinese adolescents
Measurement invariances
Publisher: Wiley-Blackwell
Journal: Asia-Pacific psychiatry 
ISSN: 1758-5864
EISSN: 1758-5872
DOI: 10.1111/appy.12381
Rights: This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License (, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
© 2020 The Authors. Asia‐Pacific Psychiatry published by John Wiley & Sons Australia, Ltd
The following publication Leung, D. Y. P., Mak, Y. W., Leung, S. F., Chiang, V. C. l., & Loke, A. Y. (2020). Measurement invariances of the PHQ‐9 across gender and age groups in Chinese adolescents. Asia‐Pacific Psychiatry, e12381, 1-6 is available at
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