Distributional patterns of item responses and total scores on the PHQ-9 in the general population: Data from the National Health and Nutrition Examination Survey

Abstract

Background: Recently, item responses and total scores on depression screening scales have been reported to have characteristic distributions in the general population. The distributional pattern of responses to the Patient Health Questionnaire-9 (PHQ-9) in the general population has not been well studied. Thus, we carried out a pattern analysis of the PHQ-9 item responses and total scores in US adults. Methods: Data (5372 individuals) were drawn from the 2013-2014 National Health and Nutrition Examination Survey in the United States. The item responses and total score distributions of the PHQ-9 data were investigated with graphical analysis and exponential regression model. Results: Lines of item responses showed the same pattern among the nine items, characterized by crossing at a single point between "not at all" and "several days" and a parallel pattern from "several days" to "nearly every day" on a log-normal scale. The total score distribution of the PHQ-9 exhibited an exponential pattern, except for at the lower end of the distribution. Conclusions: The present results support that the item responses and total scores on the PHQ-9 in the general population show the same characteristic patterns, consistent with the previous studies using the Center for Epidemiologic Studies Depression Scale (CES-D) and Kessler Screening Scale for Psychological Distress (K6).