Differential Item Functioning on the Patient Health Questionnaire 8 by Disease Subtype, Language, Sex, and Age Among People With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study

Sophie Hu^{1

2}, Marie-Eve Carrier¹, Marie-Claude Geoffroy^{2

3}, Meira Golberg¹, Linda Kwakkenbos^{4

5}, Susan J Bartlett^{2

6}, Catherine Fortuné⁷, Amy Gietzen⁸, Karen Gottesman⁹, Geneviève Guillot¹⁰, Laura K Hummers¹¹, Amanda Lawrie-Jones^{12

13}, Vanessa L Malcarne¹⁴, Michelle Richard¹⁵, Maureen Sauvé^{16

17}, Luc Mouthon¹⁸, Andrea Benedetti^{2

6}, Brett D Thombs^{1

2}; SPIN Investigators

Collaborators, Affiliations

Collaborators

SPIN Investigators:
Claire E Adams, Marie Hudson, Maureen D Mayes, James Stempel, Robyn K Wojeck, Christian Agard, Laurent Alric, Marc André, Floryan Beaslay, Elana J Bernstein, Sabine Berthier, Lyne Bissonnette, Sophie Blaise, Eva Bories, Alessandra Bruns, Carlotta Cacciatore, Patricia Carreira, Marion Casadevall, Benjamin Chaigne, Lorinda Chung, Benjamin Crichi, Thylbert Deltombe, Christopher P Denton, Tannvir Desroche, Robyn Domsic, James V Dunne, Bertrand Dunogue, Regina Fare, Dominique Farge-Bancel, Paul R Fortin, Tracy Frech, Loraine Gauzère, Anne Gerber, Jessica K Gordon, Brigitte Granel-Rey, Aurélien Guffroy, Geneviève Gyger, Eric Hachulla, Daphna Harel, Monique Hinchcliff, Sabrina Hoa, Michael Hugues, Alena Ikic, Sindhu R Johnson, Nader Khalidi, Kimberly S Lakin, Marc Lambert, Maggie Larche, David Launay, Yvonne C Lee, Paul Legendre, Catarina Leite, Hélène Maillard, Nancy Maltez, Joanne Manning, Isabelle Marie, Maria Martin Lopez, Thierry Martin, Ariel Masetto, Arsène Mekinian, Sheila Melchor Díaz, Morgane Mourguet, Christelle Nguyen, Karen Nielsen, Mandana Nikpour, Louis Olagne, Vincent Poindron, Janet Pope, Susanna Proudman, Grégory Pugnet, Loïc Raffray, François Rannou, Alexis Régent, Frederic Renou, Sébastien Rivière, David Robinson, Esther Rodríguez Almazar, Tatiana Sofia Rodríguez-Reyna, Sophie Roux, Perrine Smets, Vincent Sobanski, Robert F Spiera, Virginia Steen, Evelyn Sutton, Carter Thorne, Damien Vagner, John Varga, Pearce Wilcox, Vanessa Cook, Cassidy Dal Santo, Monica D'Onofrio, Elsa-Lynn Nassar

Affiliations

¹ Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada.
² McGill University, Montreal, Quebec, Canada.
³ Douglas Mental Health University Institute, Montreal, Quebec, Canada.
⁴ Radboud University Behavioural Science Institute, Nijmegen, the Netherlands.
⁵ Radboud University Medical Center, Nijmegen, the Netherlands.
⁶ Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
⁷ Ottawa Scleroderma Support Group, Ottawa, Ontario, Canada.
⁸ Steffens Scleroderma Foundation, Albany, New York.
⁹ National Scleroderma Foundation, Los Angeles, California.
¹⁰ Sclérodermie Québec, Longueuil, Quebec, Canada.
¹¹ Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹² Scleroderma Australia, Melbourne, Victoria, Australia.
¹³ Scleroderma Victoria, Melbourne, Victoria, Australia.
¹⁴ San Diego State University, San Diego, California.
¹⁵ Scleroderma Atlantic, Halifax, Nova Scotia, Canada.
¹⁶ Scleroderma Society of Ontario, Hamilton, Ontario, Canada.
¹⁷ Scleroderma Canada, Hamilton, Ontario, Canada.
¹⁸ Hôpital Cochin, Paris, France.

PMID: 41556631
DOI: 10.1002/acr.70041

Differential Item Functioning on the Patient Health Questionnaire 8 by Disease Subtype, Language, Sex, and Age Among People With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study

Sophie Hu et al. Arthritis Care Res (Hoboken). 2026.

. 2026 Jan 20.

doi: 10.1002/acr.70041. Online ahead of print.

Authors

Collaborators

SPIN Investigators:
Claire E Adams, Marie Hudson, Maureen D Mayes, James Stempel, Robyn K Wojeck, Christian Agard, Laurent Alric, Marc André, Floryan Beaslay, Elana J Bernstein, Sabine Berthier, Lyne Bissonnette, Sophie Blaise, Eva Bories, Alessandra Bruns, Carlotta Cacciatore, Patricia Carreira, Marion Casadevall, Benjamin Chaigne, Lorinda Chung, Benjamin Crichi, Thylbert Deltombe, Christopher P Denton, Tannvir Desroche, Robyn Domsic, James V Dunne, Bertrand Dunogue, Regina Fare, Dominique Farge-Bancel, Paul R Fortin, Tracy Frech, Loraine Gauzère, Anne Gerber, Jessica K Gordon, Brigitte Granel-Rey, Aurélien Guffroy, Geneviève Gyger, Eric Hachulla, Daphna Harel, Monique Hinchcliff, Sabrina Hoa, Michael Hugues, Alena Ikic, Sindhu R Johnson, Nader Khalidi, Kimberly S Lakin, Marc Lambert, Maggie Larche, David Launay, Yvonne C Lee, Paul Legendre, Catarina Leite, Hélène Maillard, Nancy Maltez, Joanne Manning, Isabelle Marie, Maria Martin Lopez, Thierry Martin, Ariel Masetto, Arsène Mekinian, Sheila Melchor Díaz, Morgane Mourguet, Christelle Nguyen, Karen Nielsen, Mandana Nikpour, Louis Olagne, Vincent Poindron, Janet Pope, Susanna Proudman, Grégory Pugnet, Loïc Raffray, François Rannou, Alexis Régent, Frederic Renou, Sébastien Rivière, David Robinson, Esther Rodríguez Almazar, Tatiana Sofia Rodríguez-Reyna, Sophie Roux, Perrine Smets, Vincent Sobanski, Robert F Spiera, Virginia Steen, Evelyn Sutton, Carter Thorne, Damien Vagner, John Varga, Pearce Wilcox, Vanessa Cook, Cassidy Dal Santo, Monica D'Onofrio, Elsa-Lynn Nassar

Affiliations

¹ Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada.
² McGill University, Montreal, Quebec, Canada.
³ Douglas Mental Health University Institute, Montreal, Quebec, Canada.
⁴ Radboud University Behavioural Science Institute, Nijmegen, the Netherlands.
⁵ Radboud University Medical Center, Nijmegen, the Netherlands.
⁶ Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
⁷ Ottawa Scleroderma Support Group, Ottawa, Ontario, Canada.
⁸ Steffens Scleroderma Foundation, Albany, New York.
⁹ National Scleroderma Foundation, Los Angeles, California.
¹⁰ Sclérodermie Québec, Longueuil, Quebec, Canada.
¹¹ Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹² Scleroderma Australia, Melbourne, Victoria, Australia.
¹³ Scleroderma Victoria, Melbourne, Victoria, Australia.
¹⁴ San Diego State University, San Diego, California.
¹⁵ Scleroderma Atlantic, Halifax, Nova Scotia, Canada.
¹⁶ Scleroderma Society of Ontario, Hamilton, Ontario, Canada.
¹⁷ Scleroderma Canada, Hamilton, Ontario, Canada.
¹⁸ Hôpital Cochin, Paris, France.

PMID: 41556631
DOI: 10.1002/acr.70041

Abstract

Objective: Somatic items used in depression assessments can potentially overlap with symptoms related to physical illness, including systemic sclerosis (SSc). No studies have looked at whether somatic depression items may be influenced by diffuse versus limited SSc disease subtypes, which are associated with varying degrees of symptom presentation. The objective of this study was to evaluate differential item functioning (DIF) in items of the 8-item Patient Health Questionnaire (PHQ-8) across SSc subtypes. We also assessed the PHQ-8 for DIF across language (English and French), sex, and age.

Methods: Participants enrolled in the Scleroderma Patient-Centered Intervention Network Cohort who completed the PHQ-8 at enrollment between April 2014 and October 2020 were included. Confirmatory factor analysis (CFA) was used to evaluate the unidimensional structure of the PHQ-8, and DIF analyses based on SSc subtype, language, sex, and age were conducted using Multiple Indicators Multiple Causes models.

Results: In total, 2,191 participants were included. CFA with several covarying error terms supported a one-factor structure for the PHQ-8 (Tucker-Lewis Index = 0.99, Comparative Fit Index = 0.98, Root Mean Square Error of Approximation = 0.08). We did not identify statistically significant DIF based on SSc subtype. Statistically significant DIF was found in one item for language, one item for sex, and two items for age. However, the effect of DIF on overall PHQ-8 scores was negligeable in all cases.

Conclusion: We did not find evidence that the PHQ-8 performs differently across SSc subtypes, language of administration, sex, and age groups.

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References

1. Kroenke K, Spitzer RL, Williams JBW. The PHQ‐9: validity of a brief depression severity measure. J Gen Intern Med 2001;16(9):606–613. doi:10.1046/j.1525-1497.2001.016009606.x
1. Moriarty AS, Gilbody S, McMillan D, et al. Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ‐9): a meta‐analysis. Gen Hosp Psychiatry 2015;37(6):567–576. doi:10.1016/j.genhosppsych.2015.06.012
1. Levis B, Benedetti A, Thombs BD; DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire‐9 (PHQ‐9) for screening to detect major depression: individual participant data meta‐analysis. BMJ 2019;365:l1476. doi:10.1136/bmj.l1476
1. Levis B, Bhandari PM, Neupane D, et al; Depression Screening Data (DEPRESSD) PHQ Group. Data‐driven cutoff selection for the Patient Health Questionnaire‐9 depression screening tool. JAMA Netw Open 2024;7(11):e2429630. doi:10.1001/jamanetworkopen.2024.29630
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing; 2013.

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Differential Item Functioning on the Patient Health Questionnaire 8 by Disease Subtype, Language, Sex, and Age Among People With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study

Collaborators

Affiliations

Differential Item Functioning on the Patient Health Questionnaire 8 by Disease Subtype, Language, Sex, and Age Among People With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study

Authors

Collaborators

Affiliations

Abstract

References

LinkOut - more resources

Full Text Sources

Miscellaneous