Factorial invariance of the Spanish version of the PHQ-9 by gender and country in Latin America and the Caribbean

Nicole Caldichoury¹Breiner Morales-Asencio²Luis Mario Castellanos-Alvarenga³Juan-Carlos Coronado⁴César Quispe-Ayala⁵Daniela Ripoll-Córdoba⁶Carol Saldías⁷Wendy Bada⁸Karen Alcos-Flores⁵Boris Zurita-Cueva⁹Rodrigo Duhalde-Sanhueza¹⁰Cristian Romo¹¹Raúl Quincho-Apumayta⁵David Salazar¹²Yuliana Florez¹³Juan Cárdenas¹⁴Carlos Ardila-Duarte¹⁵Juan Martínez¹⁶Cesar Castellanos¹⁷Norman López^13,18*

• ¹Universidad de Los Lagos, Osorno, Chile
• ²Consorcio Latinoamericano de Investigación (CLATI). Temuco, Chile., Temuco, Chile
• ³Escuela de Psicología, Facultad de Ciencias Sociales y Comunicaciones, Universidad Santo Tomás, Temuco, Chile
• ⁴Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco., Temuco, Chile
• ⁵Universidad Nacional de Huancavelica, Huancavelica, Peru
• ⁶Consorcio Latinoamericano de Investigación (CLATI)., Temuco, Chile
• ⁷Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomas., Temuco, Chile
• ⁸Universidad Nacional Intercultural de la Amazonia, Pucallpa, Peru
• ⁹Departamento de Neurocirugía, Omni Hospital., Guayaquil, Ecuador
• ¹⁰Coordinador de campos Clínicos, Universidad Santo Tomás, Temuco, Chile
• ¹¹Departamento de Ciencias Exactas, Universidad de Los Lagos, Osorno, Chile
• ¹²Universidad Nacional Daniel Alcides Carrion, Cerro de Pasco, Peru
• ¹³Departamento de Ciencias Sociales, Universidad de la Costa, Barranquilla, Colombia
• ¹⁴Universidad Nacional Autonoma Altoandina de Tarma, Tarma, Peru
• ¹⁵Departamento de Ciencias Básicas, Universidad Metropolitana, Barranquilla, Colombia
• ¹⁶Graduate School of Education, Ana G. Mendez University,, San Juan, Puerto Rico
• ¹⁷Instituto Dominicano para el Estudio de la Salud Integral y la Psicología Aplicada (IDESIP), Santo Domingo, Dominican Republic
• ¹⁸Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomas, Temuco, Chile

Introduction: Depression is one of the leading causes of global disease burden, particularly in regions with high inequality such as Latin America and the Caribbean (LAC). The Patient Health Questionnaire-9 (PHQ-9) is one of the most widely used instruments internationally for screening depressive symptoms, although its structural validity and diagnostic comparability in LAC still require further evidence. Objective: To examine the factorial structure, invariance by sex and country, internal consistency, and concurrent validity of the PHQ-9 in a multinational sample of Latin American adults. Method: Data from 12,124 participants across 15 LAC countries were analyzed, collected through an online form using snowball sampling. Confirmatory factor analysis (CFA) and multigroup invariance analysis were applied, along with Omega coefficient and correlations with GAD-7 and Mini-Z. Results: The PHQ-9 showed a unidimensional structure with excellent fit (CFI = .989; RMSEA = .075), adequate internal consistency (Ω = .89), and evidence of configural, metric, scalar, and strict invariance by sex and country. High correlation with GAD-7 (r = .79) and moderate correlation with Mini-Z (r = .64) supported its concurrent validity. Conclusion: The PHQ-9 demonstrated robust psychometric properties and diagnostic comparability across countries and sexes in LAC. These findings reinforce its utility as a standardized and culturally adaptable tool for screening depressive symptoms in clinical and community settings in the region.