Factorial Validity and Invariance of an Adolescent Depression Symptom Screening Tool

Abstract

Context: Depression is among the most common mental health disorders in youth, results in significant impairment, and is associated with a higher risk of suicide. Screening is essential, but assessment tools may not account for the complex interrelatedness of various demographic factors, such as sex, socioeconomic status, and race.

Objectives: To determine the (1) the factor structure of the Patient Health Questionnaire-Adolescent (PHQ-A) for measuring depression in a group of adolescent athletes and (2) measurement invariance between Black and White patients on the PHQ-A.

Design: Retrospective cohort design.

Setting: Data were obtained from a secure database collected at a free, comprehensive, mass preparticipation physical examination event hosted by a large health care system.

Patients or other participants: Participants were 683 high school athletes (Black = 416, White = 267). The independent variables were somatic and affective factors contributing to the construct of depression measured by the PHQ-A and participant race (Black or White).

Main outcome measure(s): (1) Factors upon which the construct of depression is measured and (2) measurement invariance between Black and White participants.

Results: A 2-factor model, involving affective and somatic components, was specified and exhibited adequate fit to the data (comparative fit index >0.90). All items exhibited moderate to high squared multiple correlation values (R2 = 0.10-0.65), suggesting that these items resonated relatively well with participants. The 2-factor model demonstrated noninvariance between Black and White participants (root mean square error of approximation = 0.06-0.08).

Conclusions: Overall, the structure of the PHQ-A was supported by a 2-factor model in adolescent athletes, measuring both affective and somatic symptoms of depression. However, a 2-factor PHQ-A structure was not fully invariant for the adolescents sampled across participant groups, indicating that the model functioned differently between the Black and White participants sampled.

Keywords: adolescent athletes; mental health screening; psychology.