Psychometric Validation of the Patient Health Questionnaire-9 (PHQ-9) in Chinese Adolescent and Adult Psychiatric Inpatient Populations

Wei Li¹Jia-Yi Yin²Qian Wang^3*Jie Zhong^2*

• ¹Shanxi Bethune Hospital, Taiyuan, China
• ²Peking University, Beijing, China
• ³Tongji University Tongji University Press, Shanghai, China

Depressive disorder represents a major public health burden globally, yet the validity of the Patient Health Questionnaire-9 (PHQ-9)—a widely used depression screening tool—remains underexplored in Chinese psychiatric inpatient populations. This study aimed to (1) validate the Chinese version of the PHQ-9 in Chinese psychiatric inpatients (contrasting with community-based findings) and (2) compare its psychometric properties between adolescent and adult inpatients. This cross-sectional study enrolled 485 psychiatric inpatients (including 105 adolescents) from Shanxi Bethune Hospital. Participants completed the Chinese version of the PHQ-9. Analyses encompassed confirmatory factor analysis (CFA), Gaussian Graphical Model-based network analysis, and receiver operating characteristic (ROC) curve analysis to determine optimal diagnostic cutoff scores. Results showed the PHQ-9 had good internal consistency: Cronbach’s α = 0.876 (adolescents) and 0.883 (adults). CFA revealed no significant difference in fit between the unidimensional and two-factor (cognitive-affective vs. somatic) models in adolescents (Δχ²=0.79, p=0.374), with both models showing marginal fit (likely affected by small sample size). In adults, the two-factor model was preferred (Δχ²=6.49, p=0.011). The Network Comparison Test found no significant differences in network structure (M=0.211, p=0.598) or global strength (S=0.262, p=0.186) between age groups, but the adolescent network had poor stability (correlation stability coefficient = 0), limiting interpretation. ROC analysis identified age-specific optimal cutoffs exceeding the conventional threshold of 10: 15.5 for adolescents (sensitivity=0.84, specificity=0.47) and 14.5 for adults (sensitivity=0.79, specificity=0.66). Notably, 64.7% of the total sample scored ≥15 on the PHQ-9, while only 43.7% had a primary diagnosis of depressive disorder (ICD-11 6A7), indicating comorbid depressive symptoms contributed to higher cutoffs. The findings of this study validate the structural and diagnostic validity of the PHQ-9 among Chinese adult psychiatric inpatients, while emphasizing that the interpretation of its factor structure in the adolescent population requires caution. The age-related symptom topological patterns indicated by network analyses are highly likely to be influenced by the insufficient size of the adolescent sample and need to be confirmed by subsequent studies. The results of the ROC curve highlight the clinical significance of formulating population-specific diagnostic cutoffs; however, the impact of comorbidity on the findings of this study must be taken into consideration.