AUTHOR=Caldichoury Nicole , Morales-Asencio Breiner , Castellanos-Alvarenga Luis Mario , Coronado Juan-Carlos , Quispe-Ayala César , Ripoll-Córdoba Daniela , Saldías Carol , Bada Wendy , Alcos-Flores Karen , Zurita-Cueva Boris , Duhalde-Sanhueza Rodrigo , Romo Cristian , Quincho-Apumayta Raúl , Salazar David , Florez Yuliana , Cárdenas Juan , Ardila-Duarte Carlos , Martínez Juan , Castellanos Cesar , López Norman 

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

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1667612

DOI=10.3389/fpsyt.2025.1667612

ISSN=1664-0640

ABSTRACT=IntroductionDepression 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.ObjectiveTo 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.MethodData 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.ResultsThe 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.ConclusionThe 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.