Factorial Validity and Invariance of an Adolescent Depression Symptom Screening Tool
Context: Depression is among the most common mental health disorder in youth, results in significant impairment, and is associated with a higher risk of suicide. Screening is essential but assessment tools may not be appropriate across races or do not account for the complex interrelatedness of various demographics including gender, socio-economic status and race. Objectives: (1) To determine the factor structure of the Patient Health Questionnaire-Adolescent (PHQ-A) for measuring depression in a group of adolescent athletes; and (2) to determine measurement invariance between Blacks and Whites on the PHQ-A. Design: Retrospective cohort design. Setting: Data obtained from a secure database collected at a free, comprehensive, mass pre-participation physical exam (PPE) event hosted by a large health care system. Participants: Participants included 683 high school athletes (Black n=416; White n=267). Independent variables included somatic and affective factors contributing to the construct of depression measured by the PHQ-A and participant race (Black and White). Main Outcome Measures : (1) Factors upon which the construct of depression is measured and (2) measurement invariance between Blacks and Whites. Results: A two-factor model, including affective and somatic components, was specified and exhibited an adequate fit to the data (CFI> .90). All items exhibited moderate to high squared multiple correlation values (R2 = .10–.65), suggesting that these items resonated relatively well with participants. The two-factor model demonstrated noninvariance Black and White participants (RMSEA = .06-.08). Conclusions: Overall, the structure of the PHQ-A is supported by a two-factor model in adolescent athletes, measuring both affective and somatic symptoms of depression. A two factor PHQ-A structure is not fully invariant for the adolescents sampled across participant groups, implying that the model functions differently between Blacks and Whites sampled.