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Measurement properties of the Patient Health Questionnaire 15 (PHQ-15) and Somatic Symptom Disorder B-criteria scale (SSD-12), including revised 1-week versions.

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Title: Measurement properties of the Patient Health Questionnaire 15 (PHQ-15) and Somatic Symptom Disorder B-criteria scale (SSD-12), including revised 1-week versions.
Authors: Hybelius J; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden., Af Winklerfelt Hammarberg S; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden., Ahnlund Hoffmann A; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden., Spansk E; Uppsala University Hospital, Uppsala, Sweden., Olsson A; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden., Strand E; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden., Söderström Winter L; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden., Åkerlund T; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden., Björkander D; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden., Kosic A; School of Law, Psychology and Social work, Örebro University, Örebro, Sweden., Chahin G; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden., Epstein M; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden.; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden., Axelsson E; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden. erland.axelsson@ki.se.; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden. erland.axelsson@ki.se.
Source: Scientific reports [Sci Rep] 2026 Apr 26; Vol. 16 (1). Date of Electronic Publication: 2026 Apr 26.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE
Imprint Name(s): Original Publication: London : Nature Publishing Group, copyright 2011-
MeSH Terms: Somatoform Disorders*/diagnosis , Somatoform Disorders*/psychology , Patient Health Questionnaire* , Medically Unexplained Symptoms*, Psychometrics/methods ; Humans ; Female ; Male ; Adult ; Reproducibility of Results ; Middle Aged ; Aged ; Surveys and Questionnaires ; Symptom Burden ; Young Adult ; Sweden
Abstract: The Patient Health Questionnaire 15 (PHQ-15), which measures somatic symptom burden, and the Somatic Symptom Disorder B-criteria scale 12 (SSD-12), which measures symptom preoccupation, are widely used questionnaires in behavioral medicine. This study built on the existing literature by evaluating the PHQ-15 and SSD-12 in Swedish, and in revised 1-week versions that could facilitate repeated measurements. The questionnaires were completed online by clinical trial participants with persistent physical symptoms (n = 194), and healthy volunteers (n = 160). For both conventional and revised 1-week versions, we evaluated item distributions, factor structure, internal consistency, construct validity based on correlations with other constructs, and test-retest reliability. Regardless of timeframe, the PHQ-15 factor structure combined general and domain-specific factors. The SSD-12 showed a three-factor structure reflecting Expectation of a chronic course, Health anxiety, and Symptom focus and impairment. For both questionnaires, internal consistency and construct validity were mostly supported, but adequate test-retest reliability was only observed in the clinical data and for averages of timepoints. Test-retest reliability in the healthy volunteer data was poor. This study is cautiously supportive of wider use of revised PHQ-15 and SSS-12 versions with a 1-week focus to facilitate repeated measurements of somatic symptom burden and symptom preoccupation in clinical populations.
Competing Interests: Declarations. Competing interests: All authors (JH, SWH, AAH, ES, AO, ES, LSW, TÅ, DB, AK, GC, ME, EA) are involved in the conduct and analysis clinical trials where week-by-week measurements are used.
References: Löwe, B. et al. Persistent physical symptoms: definition, genesis, and management. Lancet 403, 2649–2662. https://doi.org/10.1016/S0140-6736(24)00623-8 (2024). (PMID: 10.1016/S0140-6736(24)00623-838879263)
Kitselaar, W. M., van der Vaart, R., Perschl, J., Numans, M. E. & Evers, A. W. M. Predictors of Persistent Somatic Symptoms in the General Population: A Systematic Review of Cohort Studies. Psychosom. Med. 85, 71–78. https://doi.org/10.1097/PSY.0000000000001145 (2023). (PMID: 10.1097/PSY.000000000000114536315905)
Kleinstäuber, M. et al. Aetiological understanding of fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome and classificatory analogues: A systematic umbrella review. Clin. Psychol. Europe. 5 https://doi.org/10.32872/cpe.11179 (2023).
Ajjan, R. A., Doble, E., Holt, R. I. G. & Marrero, D. Patient related outcome measures (PROMs) in long term conditions-is it time to bring them into routine clinical practice? BMJ 386, q (1921). (2024) https://doi.org/10.1136/bmj.q1921.
Kroenke, K., Spitzer, R. L. & Williams, J. B. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom. Med. 64, 258–266. https://doi.org/10.1097/00006842-200203000-00008 (2002). (PMID: 10.1097/00006842-200203000-0000811914441)
Hybelius, J. et al. Measurement Properties of the Patient Health Questionnaire-15 and Somatic Symptom Scale-8: A Systematic Review and Meta-Analysis. JAMA Netw. Open. 7, e2446603. https://doi.org/10.1001/jamanetworkopen.2024.46603 (2024). (PMID: 10.1001/jamanetworkopen.2024.466033956562011579800)
Dimsdale, J. E. et al. Somatic symptom disorder: an important change in DSM. J. Psychosom. Res. 75, 223–228. https://doi.org/10.1016/j.jpsychores.2013.06.033 (2013). (PMID: 10.1016/j.jpsychores.2013.06.03323972410)
Toussaint, A. et al. Development and Validation of the Somatic Symptom Disorder-B Criteria Scale (SSD-12). Psychosom. Med. 78, 5–12. https://doi.org/10.1097/psy.0000000000000240 (2016). (PMID: 10.1097/psy.000000000000024026461855)
Toussaint, A., Löwe, B., Brähler, E. & Jordan, P. The Somatic Symptom Disorder - B Criteria Scale (SSD-12): Factorial structure, validity and population-based norms. J. Psychosom. Res. 97, 9–17. https://doi.org/10.1016/j.jpsychores.2017.03.017 (2017). (PMID: 10.1016/j.jpsychores.2017.03.01728606504)
Toussaint, A. et al. Validity of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in primary care. Fam Pract. 35, 342–347. https://doi.org/10.1093/fampra/cmx116 (2018). (PMID: 10.1093/fampra/cmx11629145575)
Hüsing, P., Bassler, M., Löwe, B., Koch, S. & Toussaint, A. Validity and sensitivity to change of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in a clinical population. Gen. Hosp. Psychiatry. 55, 20–26. https://doi.org/10.1016/j.genhosppsych.2018.08.006 (2018). (PMID: 10.1016/j.genhosppsych.2018.08.00630232051)
Li, T. et al. Validation of the Chinese Version of the Somatic Symptom Disorder-B Criteria Scale for Detecting DSM-5 Somatic Symptom Disorders: A Multicenter Study. Psychosom. Med. 82, 337–344. https://doi.org/10.1097/PSY.0000000000000786 (2020). (PMID: 10.1097/PSY.000000000000078632058460)
Abasi, I. et al. Psychometric properties of the Persian version of the somatic symptom disorder-B Criteria Scale (SSD-12) in community and clinical samples. Gen. Hosp. Psychiatry. 78, 1–8. https://doi.org/10.1016/j.genhosppsych.2022.04.010 (2022). (PMID: 10.1016/j.genhosppsych.2022.04.01035728363)
Lim, Y. J. Validation of the Somatic Symptom Disorder-B Criteria Scale for Adults in South Korea. Alpha Psychiatry. 23, 230–234. https://doi.org/10.5152/alphapsychiatry.2022.21823 (2022). (PMID: 10.5152/alphapsychiatry.2022.21823364262739627769)
Salma, S., Kahija, L. & Rahmandani, A. Y. F. in Proceedings of International Conference on Psychological Studies (ICPsyche). 165–174.
McNabney, S. M., Hilgendorf, W., Stefanidis, D. & Gletsu-Miller, N. Factor Structure and Psychometric Properties of the Somatic Symptom Disorder – B Criteria Scale (SSD-12) Among Candidates for Bariatric Surgery. Curr. Developments Nutr. 8 https://doi.org/10.1016/j.cdnut.2024.103246 (2024).
Pignon, B. et al. Somatic Symptom Disorder-B criteria scale (SSD-12): Psychometric properties of the French version and associations with health outcomes in a population-based cross-sectional study. J. Psychosom. Res. 176, 111556. https://doi.org/10.1016/j.jpsychores.2023.111556 (2024). (PMID: 10.1016/j.jpsychores.2023.11155638056109)
Aiyegbusi, O. L. et al. Key considerations to reduce or address respondent burden in patient-reported outcome (PRO) data collection. Nat. Commun. 13, 6026. https://doi.org/10.1038/s41467-022-33826-4 (2022). (PMID: 10.1038/s41467-022-33826-4362241879556436)
Arndt, S., Jorge, R., Turvey, C. & Robinson, R. G. Adding subjects or adding measurements: Which increases the precision of longitudinal research? J. Psychiatr Res. 34, 449–455. https://doi.org/10.1016/s0022-3956(00)00042-x (2000). (PMID: 10.1016/s0022-3956(00)00042-x11165313)
Joustra, M. L., Janssens, K. A. M., Schenk, H. M. & Rosmalen, J. G. M. The four week time frame for somatic symptom questionnaires reflects subjective symptom burden best. J. Psychosom. Res. 104, 16–21. https://doi.org/10.1016/j.jpsychores.2017.11.006 (2018). (PMID: 10.1016/j.jpsychores.2017.11.00629275780)
Witthöft, M., Hiller, W., Loch, N. & Jasper, F. The latent structure of medically unexplained symptoms and its relation to functional somatic syndromes. Int. J. Behav. Med. 20, 172–183. https://doi.org/10.1007/s12529-012-9237-2 (2013). (PMID: 10.1007/s12529-012-9237-222618306)
Hybelius, J. et al. A unified Internet-delivered exposure treatment for undifferentiated somatic symptom disorder: single-group prospective feasibility trial. Pilot Feasibility Stud. 8, 149. https://doi.org/10.1186/s40814-022-01105-0 (2022). (PMID: 10.1186/s40814-022-01105-0358543929294766)
Hybelius, J. et al. Effect of internet-delivered exposure therapy versus healthy lifestyle promotion for patients with persistent physical symptoms (SOMEX1): a randomized controlled trial with planned moderator analysis. Psychol. Med. 55, e226. https://doi.org/10.1017/S0033291725101244 (2025). (PMID: 10.1017/S00332917251012444077641212360694)
Beauducel, A. & Herzberg, P. Y. On the performance of maximum likelihood versus means and variance adjusted weighted least squares estimation in CFA. Struct. Equation Modeling-a Multidisciplinary J. 13, 186–203. https://doi.org/10.1207/s15328007sem1302_2 (2006). (PMID: 10.1207/s15328007sem1302_2)
Guadagnoli, E. & Velicer, W. F. Relation of sample size to the stability of component patterns. Psychol. Bull. 103, 265–275. https://doi.org/10.1037/0033-2909.103.2.265 (1988). (PMID: 10.1037/0033-2909.103.2.2653363047)
MacCallum, R. C., Widaman, K. F., Zhang, S. & Hong, S. Sample size in factor analysis. Psychol. Methods. 4, 84–99. https://doi.org/10.1037/1082-989x.4.1.84 (1999). (PMID: 10.1037/1082-989x.4.1.84)
Gagnier, J. J., Lai, J., Mokkink, L. B. & Terwee, C. B. COSMIN reporting guideline for studies on measurement properties of patient-reported outcome measures. Qual. Life Res. 30, 2197–2218. https://doi.org/10.1007/s11136-021-02822-4 (2021). (PMID: 10.1007/s11136-021-02822-433818733)
Claassen-van Dessel, N., van der Wouden, J. C., Twisk, J. W. R., Dekker, J. & van der Horst, H. E. Predicting the course of persistent physical symptoms: Development and internal validation of prediction models for symptom severity and functional status during 2years of follow-up. J. Psychosom. Res. 108, 1–13 (2018). https://doi.org/10.1016/j.jpsychores.2018.02.009.
Häuser, W., Bialas, P., Welsch, K. & Wolfe, F. Construct validity and clinical utility of current research criteria of DSM-5 somatic symptom disorder diagnosis in patients with fibromyalgia syndrome. J. Psychosom. Res. 78, 546–552. https://doi.org/10.1016/j.jpsychores.2015.03.151 (2015). (PMID: 10.1016/j.jpsychores.2015.03.15125864805)
Bailer, J. et al. Health anxiety and hypochondriasis in the light of DSM-5. Anxiety Stress Coping. 29, 219–239. https://doi.org/10.1080/10615806.2015.1036243 (2016). (PMID: 10.1080/10615806.2015.103624325846805)
Körber, S., Frieser, D., Steinbrecher, N. & Hiller, W. Classification characteristics of the Patient Health Questionnaire-15 for screening somatoform disorders in a primary care setting. J. Psychosom. Res. 71, 142–147. https://doi.org/10.1016/j.jpsychores.2011.01.006 (2011). (PMID: 10.1016/j.jpsychores.2011.01.00621843748)
Axelsson, E. & Hedman-Lagerlöf, E. Validity and clinical utility of distinguishing between DSM-5 somatic symptom disorder and illness anxiety disorder in pathological health anxiety: Should we close the chapter? J. Psychosom. Res. 165, 111133. https://doi.org/10.1016/j.jpsychores.2022.111133 (2023). (PMID: 10.1016/j.jpsychores.2022.11113336624001)
Sheehan, D. V. et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J. Clin. Psychiatry. 59 (Suppl 20), 22–33 (1998). (PMID: 9881538)
Axelsson, E., Andersson, E., Ljótsson, B., Wallhed Finn, D. & Hedman, E. The Health Preoccupation Diagnostic Interview: Inter-rater reliability of a structured interview for diagnostic assessment of DSM-5 somatic symptom disorder and illness anxiety disorder. Cogn. Behav. Ther. 45, 259–269. https://doi.org/10.1080/16506073.2016.1161663 (2016). (PMID: 10.1080/16506073.2016.116166327096407)
Kroenke, K., Spitzer, R. L. & Williams, J. B. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med. Care. 41, 1284–1292. https://doi.org/10.1097/01.MLR.0000093487.78664.3C (2003). (PMID: 10.1097/01.MLR.0000093487.78664.3C14583691)
Spitzer, R. L., Kroenke, K., Williams, J. B. & Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch. Intern. Med. 166, 1092–1097. https://doi.org/10.1001/archinte.166.10.1092 (2006). (PMID: 10.1001/archinte.166.10.109216717171)
Salkovskis, P. M., Rimes, K., Warwick, H. & Clark, D. The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol. Med. 32, 843–853. https://doi.org/10.1017/S0033291702005822 (2002). (PMID: 10.1017/S003329170200582212171378)
Axelsson, E., Lindsäter, E., Ljótsson, B., Andersson, E. & Hedman-Lagerlöf, E. The 12-item Self-Report World Health Organization Disability Assessment Schedule (WHODAS) 2.0 Administered Via the Internet to Individuals With Anxiety and Stress Disorders: A Psychometric Investigation Based on Data From Two Clinical Trials. JMIR Ment Health. 4, e58. https://doi.org/10.2196/mental.7497 (2017). (PMID: 10.2196/mental.7497292220805741825)
Navarro, D. & Foxcroft, D. in Learning statistics with jamovi: a tutorial for psychology students and other beginners 77–79 (2019).
Sellbom, M. & Tellegen, A. Factor analysis in psychological assessment research: Common pitfalls and recommendations. Psychol. Assess. 31, 1428–1441. https://doi.org/10.1037/pas0000623 (2019). (PMID: 10.1037/pas000062331120298)
Hu, L. & Bentler, P. M. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct. Equation Modeling: Multidisciplinary J. 6, 1–55. https://doi.org/10.1080/10705519909540118 (1999). (PMID: 10.1080/10705519909540118)
Cohen, J. in Statistical power analysis for the behavioral sciences 78–81 (Lawrence Erlbaum Associates, 1988).
Sennerstam, V. et al. Exhaustion Disorder in Primary Care: A Comparison With Major Depressive Disorder and Adjustment Disorder. Scand. J. Psychol. 66, 315–326. https://doi.org/10.1111/sjop.13087 (2025). (PMID: 10.1111/sjop.1308739648299)
Bland, J. M. & Altman, D. G. Correlation in restricted ranges of data. BMJ 342, d556 (2011). https://doi.org/10.1136/bmj.d556.
Franco-Martinez, A., Alvarado, J. M. & Sorrel, M. A. Range Restriction Affects Factor Analysis: Normality, Estimation, Fit, Loadings, and Reliability. Educ. Psychol. Meas. 83, 262–293. https://doi.org/10.1177/00131644221081867 (2023). (PMID: 10.1177/0013164422108186736866065)
Kroenke, K., Spitzer, R. L., deGruy, F. V. & Swindle, R. A Symptom Checklist to Screen for Somatoform Disorders in Primary Care. Psychosomatics 39, 263–272. https://doi.org/10.1016/s0033-3182(98)71343-x (1998). (PMID: 10.1016/s0033-3182(98)71343-x9664773)
Lee, S., Ma, Y. L. & Tsang, A. Psychometric properties of the Chinese 15-item patient health questionnaire in the general population of Hong Kong. J. Psychosom. Res. 71, 69–73. https://doi.org/10.1016/j.jpsychores.2011.01.016 (2011). (PMID: 10.1016/j.jpsychores.2011.01.01621767685)
Zhang, L. et al. Validation of the Chinese version of the PHQ-15 in a tertiary hospital. BMC Psychiatry. 16, 89. https://doi.org/10.1186/s12888-016-0798-5 (2016). (PMID: 10.1186/s12888-016-0798-5270443094820992)
Axelsson, E., Österman, S. & Hedman-Lagerlöf, E. Joint factor analysis and approximate equipercentile linking of common trait health anxiety measures: A cross-sectional study of the 14-, 18- and 64-item Health Anxiety Inventory, the Illness Attitude Scale, and the 14-item Whiteley Index. BMC Psychiatry. 23, 658. https://doi.org/10.1186/s12888-023-05151-7 (2023). (PMID: 10.1186/s12888-023-05151-73767413510483785)
Picariello, F., Chilcot, J., Chalder, T., Herdman, D. & Moss-Morris, R. The Cognitive and Behavioural Responses to Symptoms Questionnaire (CBRQ): Development, reliability and validity across several long-term conditions. Br. J. Health Psychol. 28, 619–638. https://doi.org/10.1111/bjhp.12644 (2023). (PMID: 10.1111/bjhp.1264436690909)
van der Feltz-Cornelis, C. M. et al. Diagnostic accuracy of the Dutch version of the Somatic Symptom Disorder - B Criteria Scale (SSD-12) compared to the Whiteley Index (WI) and PHQ-15 in a clinical population. J. Psychosom. Res. 173, 111460. https://doi.org/10.1016/j.jpsychores.2023.111460 (2023). (PMID: 10.1016/j.jpsychores.2023.11146037607421)
Hybelius, J. et al. Basic emotions reported by individuals with persistent physical symptoms receiving exposure therapy versus healthy lifestyle promotion in primary care. Sci. Rep. 16, 7170. https://doi.org/10.1038/s41598-026-39962-x (2026). (PMID: 10.1038/s41598-026-39962-x4170299812920773)
Contributed Indexing: Keywords: Patient health questionnaire; Psychometrics; Reliability; Surveys and questionnaires; Symptom preoccupation
Entry Date(s): Date Created: 20260426 Date Completed: 20260627 Latest Revision: 20260627
Update Code: 20260628
PubMed Central ID: PMC13111608
DOI: 10.1038/s41598-026-50290-y
PMID: 42036527
Database: MEDLINE
Description
ISSN:2045-2322
DOI:10.1038/s41598-026-50290-y