Abstract
The theoretical distribution of responses to depressive symptom items in a general population remains unknown. Recent studies have shown that responses to depressive symptom items follow the same pattern in the US and Japanese populations, but the degree to which these findings can be generalized to other countries is unknown. The purpose of this study was to conduct a pattern analysis on the EU population’s responses to depressive symptom items using data from the Eurobarometer. The Eurobarometer questionnaires include six depressive symptom items from the 12-item General Health Questionnaire. The pattern analysis revealed that, across the entire EU population, the ratios between “score = 2” and “score = 1” and between “score = 3” to “score = 2” were similar among the six items and resulted in a common pattern. This common pattern was characterized by an intersection at a single point between “score = 0” and “score = 1” and a parallel pattern between “score = 1” and “score = 3” on a logarithmic scale. Country-by-country analyses revealed that the item responses followed a common characteristic pattern across all 15 countries. Our results suggest that responses to depressive symptom items in a general population follow the same characteristic pattern regardless of the specific country.
Highlights
According to the World Health Organization, depression is the leading cause of disability worldwide, with over 300 million people affected[1]
The characteristic pattern of the item response lines has been replicated for the Patient Health Questionnaire (PHQ) data from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance Survey in the United States[12,13], the Kessler Psychological Distress Scale data from the National Survey of Midlife Development in the United States[14], and the Center for Epidemiologic Studies Depression Scale (CES-D) data from the Irish Longitudinal Study on Ageing (TILDA)[15]
It should be noted that, the GHQ-12 is often labeled as a psychological distress scale, its six negative items are similar to the depressive symptom items on the CES-D and the PHQ-94,17,20. These items that overlap with the CES-D (e.g., “insomnia,” “depressed,” and “my life had been a failure”) and the PHQ-9 (e.g., “sleep disturbance,” “depressed,” “fidgety,” and “feeling bad about yourself ”) exhibited the same characteristic item response pattern as the one identified in previous studies (Fig. 1)[10,13]. These findings indicate the possibility that responses to the negative GHQ-12 items exhibit the same characteristic pattern as those in the CES-D and the PHQ-9
Summary
According to the World Health Organization, depression is the leading cause of disability worldwide, with over 300 million people affected[1]. Based on data from the Japanese Active Survey of Health and Welfare (32,000 individuals), we reported that item responses to the Center for Epidemiologic Studies Depression Scale (CES-D) followed a common pattern across the 16 depressive symptom items[10,11]. The characteristic pattern of the item response lines has been replicated for the Patient Health Questionnaire (PHQ) data from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance Survey in the United States[12,13], the Kessler Psychological Distress Scale data from the National Survey of Midlife Development in the United States[14], and the CES-D data from the Irish Longitudinal Study on Ageing (TILDA)[15]. The degree to which these findings can be generalized to populations of other countries is unknown and, warrants an investigation
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