The PHQ-9 is a brief, 9-item, self-administered screening tool widely used in primary care medical settings to assess the potential presence of Major Depressive Disorder (MDD). Most published research on the PHQ-9 has focused on sensitivity and specificity with regard to the DSM-IV (American Psychiatric Association, in Diagnostic and statistical manual of mental disorders, 4th edn, American Psychiatric Publishing, Arlington, VA, 2000) categorical diagnosis of MDD, and, indeed, the PHQ-9 exhibits very good psychometric properties in this regard. The current research is an effort to more precisely assess what is being measured by the PHQ-9, given the notably heterogeneous nature of MDD as broad diagnostic category. Here, we provide correlations between the PHQ-9 and substantive scales of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, in Minnesota Multiphasic Personality Inventory-Restructured Form: Manual for administration, scoring, and interpretation, University of Minnesota Press, Minneapolis, 2008/2011), a comprehensive measure of personality and psychopathology. Participants were 231 college student volunteers who completed the PHQ-9 and MMPI-2-RF as components of a broader research program. Results show that the PHQ-9 was strongly correlated with the broad Higher-Order EID-Emotional/Internalizing Dysfunction scale of the MMPI-2-RF, as well as with RCd-Demoralization, RC7-Dysfunctional Negative Emotions, NEGE-r-Negative Emotionality, and several specific facet scales. Surprisingly, the correlation with RC2-Low Positive Emotions, was not among the strongest, despite the fact that the PHQ-9 ostensibly targets this specific feature of depression (anhedonia). Substantial correlations with the somatic/cognitive scales of the MMPI-2-RF were also found. Implications for modified interpretation of the PHQ-9, and the need for more precise dimensional (rather than categorical) screening tools, are discussed.
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American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Arlington, VA: American Psychiatric Publishing.
Ben-Porath, Y. S. (2012). Interpreting the MMPI-2-RF. Minneapolis: University of Minnesota Press.
Ben-Porath, Y., & Tellegen, A. (2008/2011). Minnesota Multiphasic Personality Inventory-Restructured Form: Manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press.
Block, A. R., Marek, R. J., Ben-Porath, Y. S., & Kukal, D. (2017). Associations between preimplant psychosocial factors and spinal cord stimulation outcome: Evaluation using the MMPI-2-RF. Assessment,24, 60–70. https://doi.org/10.1177/1073191115601518.
Bowden, S. C., White, J. R., Simpson, L., & Ben-Porath, Y. S. (2014). Elevation discrepancies between MMPI-2 Clinical and MMPI-2-RF Restructured Clinical (RC) Scales in people with seizure disorders. Epilepsy & Behavior,34, 92–98. https://doi.org/10.1016/j.yebeh.2014.03.016.
Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology,100(3), 316.
Harkness, A. R., Finn, J. A., McNulty, J. L., & Shields, S. M. (2012). The Personality Psychopathology Five (PSY–5): Recent constructive replication and assessment literature review. Psychological Assessment,24, 432–443.
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., et al. (2010). Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry,167, 748–751.
Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., … & Eaton, N. R. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): a dimensional alternative to traditional nosologies. Journal of abnormal psychology, 126(4), 454.
Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression and diagnostic severity measure. Psychiatric Annals,32, 509–521.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine,16(9), 606–613.
Krueger, R. F., Hopwood, C. J., Wright, A. G. C., & Markon, K. (2014). Challenges and strategies in helping the DSM become more dimensional and empirically based. Current Psychiatry Reports,16(12), 515.
Marek, R. J., Tarescavage, A. M., Ben-Porath, Y. S., Ashton, K., Rish, J. M., & Heinberg, L. J. (2015). Using presurgical psychological testing to predict 1-year appointment adherence and weight loss in bariatric surgery candidates: Predictive validity and methodological considerations. Surgery for Obesity and Related Diseases.,11, 1171–1181. https://doi.org/10.1016/j.soard.2015.03.020.
McCord, D. M., & Drerup, L. C. (2011). Relative practical utility of the Minnesota Multiphasic Personality Inventory-2 Restructured Clinical Scales versus the Clinical Scales in a chronic pain patient sample. Journal of Clinical and Experimental Neuropsychology,33, 140–146. https://doi.org/10.1080/13803395.2010.495056.
Sellbom, M., Ben-Porath, Y. S., & Bagby, R. M. (2008). On the hierarchical structure of mood and anxiety disorders: Confirmatory evidence and elaboration of a model of temperament markers. Journal of Abnormal Psychology,117(3), 576.
Spitzer, R., Kroenke, K., & Williams, J. (1999). Validation and utility of a self-report Version of PRIME-MD: the PHQ Primary Care Study. Journal of the American Medical Association,282, 1737–1744.
Spitzer, R., Williams, J. B., Kroenke, K., Linzer, M., de Gruy, F. V., Hahn, S. R., et al. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 study. Journal of the American Medical Association,272, 1749–1756.
Spitzer, R. L., Williams, J. B., Kroenke, K., Hornyak, R., & McMurray, J. (2000). Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: The PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. American Journal of Obstetrics and Gynecology, 183, 759–769.
Steiger, J. H. (1980). Tests for comparing elements of a correlation matrix. Psychological Bulletin,87(2), 245.
Tellegen, A. (1985). Structures of mood and personality and their relevance to assessing anxiety, with an emphasis on self-report. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders (pp. 681–706). Hillsdale, NJ: Erlbaum.
Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology,114(4), 522.
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McCord, D.M., Provost, R.P. Construct Validity of the PHQ-9 Depression Screen: Correlations with Substantive Scales of the MMPI-2-RF. J Clin Psychol Med Settings 27, 150–157 (2020). https://doi.org/10.1007/s10880-019-09629-z
- Construct validity