{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:36:42Z","timestamp":1785775002360,"version":"3.56.0"},"reference-count":64,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T00:00:00Z","timestamp":1584921600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Seventh Framework Programme","award":["EC grant 602150"],"award-info":[{"award-number":["EC grant 602150"]}]},{"DOI":"10.13039\/501100007731","name":"ZNS - Hannelore Kohl Stiftung","doi-asserted-by":"publisher","award":["Germany"],"award-info":[{"award-number":["Germany"]}],"id":[{"id":"10.13039\/501100007731","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The dimensionality of depression and anxiety instruments have recently been a source of controversy. Objectives and Design: In a European-wide sample of patients after Traumatic Brain Injury (TBI), we aim to examine the factorial structure, validity, and association of the Patient Health Questionnaire for depression (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) instruments. This study is based on longitudinal observational data. We conducted analyses of factorial structure and discriminant validity of outcomes six-months after TBI. We also examined the prevalence, co-occurrence, and changes of scores on the PHQ-9 and GAD-7 at 3-, 6-, and 12-month post-TBI assessments. Participants: At six-months post-TBI assessment, 2137 (738 (34.5%) women) participants completed the PHQ-9 and GAD-7 questionnaires. For the longitudinal analysis, we had 1922 participants (672 (35.0%) women). Results: The results of exploratory factor analysis suggested a general latent construct underlying both PHQ-9 and GAD-7 measures. Confirmatory factor analyses showed a slight improvement in the fit indices for the bifactorial model. The Omega hierarchical test clearly differentiated two subfactors of PHQ-9 and GAD-7 items over and above the underlying general factor; however, most of the variance (85.0%) was explained by the general factor and the explained variance of the subfactors was small. The PHQ-9 and GAD-7 performed similarly in detecting post-traumatic stress disorder (PTSD). As defined by conventional cut-offs, depression and anxiety have different prevalence rates in the sample. The scales also differed in their relationships with the short form of health survey (SF-36v2) subscales. The longitudinal analysis showed high stability of depression and anxiety symptoms: 49\u201367% of the post-TBI patients with comorbid depression and anxiety reported the persistence of the symptoms over time. Discussion: The factorial structure analysis favors a general latent construct underlying both depression and anxiety scales among patients after TBI. We discuss the implications our findings and future research directions.<\/jats:p>","DOI":"10.3390\/jcm9030873","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T13:04:04Z","timestamp":1585055044000},"page":"873","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Factorial Structure and Validity of Depression (PHQ-9) and Anxiety (GAD-7) Scales after Traumatic Brain Injury"],"prefix":"10.3390","volume":"9","author":[{"given":"Ali","family":"Teymoori","sequence":"first","affiliation":[{"name":"The Department of Social Psychology, Helmut Schmidt University, 22043 Hamburg, Germany"},{"name":"The Institute of Medical Psychology and Medical Sociology, Georg August University, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Gorbunova","sequence":"additional","affiliation":[{"name":"The Institute of Medical Psychology and Medical Sociology, Georg August University, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fardzadeh","family":"Haghish","sequence":"additional","affiliation":[{"name":"The Institute of Medical Psychology and Medical Sociology, Georg August University, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Real","sequence":"additional","affiliation":[{"name":"The Institute of Medical Psychology and Medical Sociology, Georg August University, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0172-9904","authenticated-orcid":false,"given":"Marina","family":"Zeldovich","sequence":"additional","affiliation":[{"name":"The Institute of Medical Psychology and Medical Sociology, Georg August University, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Jhen","family":"Wu","sequence":"additional","affiliation":[{"name":"The Institute of Medical Psychology and Medical Sociology, Georg August University, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Polinder","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus University Medical Center, 3000 Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1317-2138","authenticated-orcid":false,"given":"Thomas","family":"Asendorf","sequence":"additional","affiliation":[{"name":"The Institute of Medical Psychology and Medical Sociology, Georg August University, 37073 G\u00f6ttingen, Germany"},{"name":"Institute of Medical Statistics, Medical Center, Georg August University, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3228-9692","authenticated-orcid":false,"given":"David","family":"Menon","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, University of Cambridge\/Addenbrooke\u2019s Hospital, Box 157, Cambridge CB2 0QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"CENTER-TBI Investigators and Participants","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"v. Steinb\u00fcchel","sequence":"additional","affiliation":[{"name":"The Institute of Medical Psychology and Medical Sociology, Georg August University, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1001\/archpsyc.62.6.593","article-title":"Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication","volume":"62","author":"Kessler","year":"2005","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/j.jaac.2010.05.017","article-title":"Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication\u2013Adolescent Supplement (NCS-A)","volume":"49","author":"Merikangas","year":"2010","journal-title":"J. Am. Acad. Child Adolesc. 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