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Evaluating the Validity of PHQ-9 Scores: A Multi-Method Psychometric Investigation of Sources of Variance Beyond Depression Severity
(University of Iceland, School of Health Sciences, Faculty of Psychology, 2026-10-07) Kristófersdóttir, Kristín Hulda; Fanney Þórsdóttir; Faculty of Psychology (UI); Sálfræðideild (HÍ); School of Health Sciences (UI); Heilbrigðisvísindasvið (HÍ)
The Patient Health Questionnaire-9 (PHQ-9) is one of the most widely used self-report measures of depressive symptoms in clinical practice and research. Its scores are often interpreted as indicators of depression severity, yet this interpretation depends on the extent to which responses reflect depressive symptomatology rather than other influences. The aim of this thesis was to evaluate the validity of PHQ-9 scores by examining sources of variance beyond depression severity that may influence item responses. The thesis comprised four interrelated studies conducted with Icelandic samples. Paper I examined the psychometric properties of an existing Icelandic translation of the PHQ-9 using Mokken scale analysis (MSA) and used cognitive interviews to investigate possible sources of weak item functioning. Paper II introduced a revised Icelandic translation of the PHQ-9 and evaluated its psychometric properties using MSA. Paper III used the method of paired comparisons to examine whether PHQ-9 items differ in their perceived sensitivity, that is, the extent to which respondents experience them as uncomfortable to disclose. Paper IV modeled socially desirable responding as a measured cause of method variance in the PHQ-9 to examine whether it systematically influences item responses and whether that influence varies with item sensitivity. The findings showed that the original Icelandic PHQ-9 had suboptimal scalability and that this was associated with several problems, including translation errors, ambiguous wording, multi-barreled item content, symptom overlap, and other response-process issues. The revised Icelandic translation performed better psychometrically, with stronger scalability and a more coherent ordering of respondents along a depression severity continuum. However, not all problems identified in the original version were resolved. The results further showed that PHQ-9 items differ systematically in perceived sensitivity. Items typically grouped as cognitive/affective were generally judged more uncomfortable to disclose than items grouped as somatic. Finally, socially desirable responding was a source of method variance in PHQ-9 responses, systematically lowering symptom reporting while accounting for considerably less variance than depression severity. This method effect varied across items but did not correspond to their perceived sensitivity. In sum, the findings suggest that PHQ-9 scores may reflect more than depression severity alone. The results support a cautious and context-sensitive interpretation of PHQ-9 sum scores. The PHQ-9 may still be useful as a brief indicator of depressive symptoms, particularly in its revised Icelandic form, but its scores should not be treated as fully transparent or pure measures of depression severity. The thesis underscores the importance of examining how instrument design, item content, translation, and response processes shape the meaning of psychological measurement scores.
Verk
Fabrication and characterization of Si1−xGex nanocrystals in as-grown and annealed structures: a comparative study
(2019-09-17) Sultan, Muhammad Taha; Maraloiu, Adrian Valentin; Stavarache, Ionel; Gudmundsson, Jón Tómas; Manolescu, Andrei; Teodorescu, Valentin Serban; Ciurea, Magdalena Lidia; Svavarsson, Halldór Gudfinnur; Verkfræðideild
Multilayer structures comprising of SiO2/SiGe/SiO2 and containing SiGe nanoparticles were obtained by depositing SiO2 layers using reactive direct current magnetron sputtering (dcMS), whereas, Si and Ge were co-sputtered using dcMS and high-power impulse magnetron sputtering (HiPIMS). The as-grown structures subsequently underwent rapid thermal annealing (550-900 degrees C for 1 min) in N-2 ambient atmosphere. The structures were investigated using X-ray diffraction, high-resolution transmission electron microscopy together with spectral photocurrent measurements, to explore structural changes and corresponding properties. It is observed that the employment of HiPIMS facilitates the formation of SiGe nanoparticles (2.1 +/- 0.8 nm) in the as-grown structure, and that presence of such nanoparticles acts as a seed for heterogeneous nucleation, which upon annealing results in the periodically arranged columnar self-assembly of SiGe core-shell nanocrystals. An increase in photocurrent intensity by more than an order of magnitude was achieved by annealing. Furthermore, a detailed discussion is provided on strain development within the structures, the consequential interface characteristics and its effect on the photocurrent spectra.
Verk
Structural brain alterations following adult non-CNS cancers : a systematic review of the neuroimaging literature
(2019-05-04) Amidi, Ali; Wu, Lisa M.; Department of Psychology
Background: Cancer and cancer treatments may impact the brain through several pathways leading to cognitive impairment. Neuroimaging evidence has begun to elucidate the neurobiological underpinnings of cancer-related cognitive impairment. The aim of this paper was to systematically review available literature on structural brain alterations following adult non-central nervous system (CNS) cancers and associated treatments. Methods: This review followed PRISMA guidelines and was registered in PROSPERO (ID#107387). Comprehensive searches were conducted in June 2018 using PubMed and Web of Science. Inclusion criteria were English peer-reviewed journal articles of formal, controlled studies that examined structural neuroimaging outcomes in adult non-CNS cancer patients and survivors. Selected articles were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Thirty-six publications of prospective and cross-sectional studies met inclusion criteria and were included. Structural brain alterations following cancer and its treatment were reported in a majority of the publications as evidenced by reduced global and local gray matter volumes, impaired white matter microstructural integrity, and brain network alterations. Structural alterations were most often evident when cancer-treated groups were compared with healthy controls, and more subtle when compared with cancer controls. Regarding the existence of pretreatment impairments, the evidence was equivocal. There was significant between-study heterogeneity in imaging analytical approaches and use of statistical adjustments. Over half reported associations with cognitive outcomes, though regions and associated cognitive domains were heterogeneous. Conclusions: Structural brain alterations following cancer and cancer treatments were reported in a majority of the reviewed studies. However, the extent of observed alterations depended on the choice of comparison groups. Methodological issues exist that will need to be addressed systematically to ensure the validity of findings. Large-scale prospective studies with extended assessment points are warranted to replicate and build upon initial findings.
Verk
Long-term cognitive dysfunction after radiation therapy for primary brain tumors
(2019-05-04) Haldbo-Classen, Lene; Amidi, Ali; Wu, Lisa M.; Lukacova, Slavka; Oettingen, Gorm von; Gottrup, Hanne; Zachariae, Robert; Høyer, Morten; Department of Psychology
Background: The extent of radiation therapy (RT)-induced changes in cognitive function is unknown. RT with protons instead of photons spares the healthy brain tissue more and is believed to reduce the risk of cognitive dysfunction. There is modest knowledge on which parts of the brain we need to spare, to prevent cognitive dysfunction. To uncover which cognitive domains is most affected, we compared cognitive functioning in brain tumor patients treated with neurosurgery and RT with brain tumor patients treated with neurosurgery alone. Methods: A cross-sectional study assessing cognitive function in 110 patients with a primary brain tumor grades I–III or medulloblastoma (grade IV) treated at Aarhus University Hospital (AUH), Denmark between 2006 and 2016. Two cohorts were established: a cohort of 81 brain tumor patients who had received neurosurgery followed by RT (RT+), and a cohort of 29 brain tumor patients who had only received neurosurgery (RT–). The patients underwent questionnaires and neuropsychological assessment with standardized tests. Results: Mean age was 53.5 years with an average time since diagnosis of 7.3 years. Compared with normative data, lower average scores were observed for the entire group on domains concerning of verbal learning and memory (p <.001), attention and working memory (p <.001), processing speed (p <.001), and executive functioning (p <.001). Compared to RT– patients, RT + patients scored lower on domains concerning processing speed (p =.04) and executive function (p =.05) and had higher impairment frequency on verbal fluency (p =.02) with 16% of patients exceeding 1.5 SD below normative data. Conclusions: Our results indicate that treatment, including RT, for a primary brain tumor may have negative long-term impact on cognitive function, especially on processing speed and executive function.
Verk
Longitudinal dyadic associations of fear of cancer recurrence and the impact of treatment in prostate cancer patients and their spouses
(2019-05-04) Wu, Lisa M.; McGinty, Heather; Amidi, Ali; Bovbjerg, Katrin; Diefenbach, Michael A.; Department of Psychology
Background: Fear of cancer recurrence (FCR) in patients and their spouses is associated with reduced quality of life, but little is known about longitudinal dyadic associations of FCR between them. This study examined (i) the trajectory of FCR from pre-treatment to 12 months later; (ii) dyadic associations of FCR over time; and (iii) whether cancer treatment type predicted later FCR among prostate cancer patients and their spouses. Methods: Sixty-nine patients and 71 spouses of patients with localized prostate cancer completed a FCR measure at baseline (pre-treatment), 6 months and 12 months later (post-treatment). A repeated measures linear mixed model was used to examine FCR trajectories. Actor-partner interdependence models (APIMs) were conducted on the 52 couples with complete data to examine actor and partner effects and treatment type on subsequent FCR. Results: Patients and spouses reported moderate FCR levels over time, though spouses’ FCR was significantly higher than patients’ FCR (p <.001). FCR declined significantly for both groups over time (p <.001). APIMs demonstrated significant actor effects in baseline to 6 month, and 6–12 month models. Surgery was significantly associated with lower spouse FCR at 6 months, and radiation with lower patient FCR at 12 months. Conclusions: This is the first study to have concurrently examined FCR longitudinally in prostate cancer patients and spouses. Patients’ and spouses’ FCR declined from pre- to post-treatment, with spouses experiencing greater FCR than patients over time. FCR in patients and spouses did not appear to impact one another over time. Treatment type impacted FCR in patients and spouses differently.