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August 4, 2025

Departing from four points: Psychometric implications of modifying response scale width for the PHQ-9 in repeated measurements

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Authors

MMMilana Damjenić MihaldžićSSSiniša SubotićGSGregor Sočan

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Overview

This within-participant study demonstrates that wider response scales improve psychometric properties in PHQ-9 assessments, suggesting current 4-point scales remain valid.

Key Points

  • Reducing the response scale width to 2-3 points produced floor effects and decreased variability, impacting results.
  • Internal consistency and test-retest reliability improved from 2 to 5 response scale points, with minimal gains beyond this.
  • Confirmatory factor analysis showed a one-factor model fit well across all response scale widths, indicating no systematic trends.
  • The findings affirm the 4-point response scale's effectiveness for depression screening, advising against narrower scales.

Cite This Study

Mihaldžić et al. (2025) studied this question.

synapsesocial.com/papers/689a0f86e6551bb0af8d09f0https://doi.org/10.21203/rs.3.rs-7107242/v1
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Measuring Depression and Anxiety With 4 Items? Adaptation of the PHQ-4 to Increase Its Sensitivity to Subclinical Variability2025
  2. 2Predictive accuracy of the 2- and 8-item versions of the PHQ in measuring symptoms of depression: Brazilian National Health Survey (PNS) 2013-20192025
  3. 3Why are we still using the PHQ-9? A Historical Review and Psychometric Evaluation of Measurement Invariance2025
  4. 4Experienced, bothered by, or both: People differ in how they understand the Patient Health Questionnaire (PHQ) items2025
  5. 5Measurement Invariance by Gender, Ethnicity, and International Student Status with the PHQ-9 in a University Setting2025