Academic Journal

Adaptation to San Martín Quechua and psychometric analysis of the Patient Health Questionnaire (PHQ-9) in Peruvian adults.

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος: Adaptation to San Martín Quechua and psychometric analysis of the Patient Health Questionnaire (PHQ-9) in Peruvian adults.
Συγγραφείς: Cjuno J; Universidad Peruana Unión, Unidad de Posgrado de Psicología, Lima, Perú., Gomez-Hurtado H; Universidad Tecnológica del Perú, Lima, Perú. c24461@utp.edu.pe., Shupingahua-Jimenez C; Universidad Peruana Unión, Escuela Profesional de Psicología, Tarapoto, Perú., Aranda-Turpo J; Universidad Peruana Unión, Escuela Profesional de Psicología, Tarapoto, Perú., Julca Guerrero F; Universidad Nacional Santiago Antúnez de Mayolo, Huaraz, Perú., Velásquez-Castillo N; Universidad Católica Los Ángeles de Chimbote, Chimbote, Perú., Anco EWA; Universidad Peruana Unión, Escuela Profesional de Psicología, Tarapoto, Perú., Bazalar-Palacios J; Universidad Científica del Sur, Lima, Perú., Bazo-Alvarez JC; Escuela de Psicología, Universidad Cesar Vallejo, Trujillo, Peru.; Research Department of Primary Care and Population Health, University College London (UCL), London, UK.
Πηγή: BMC psychology [BMC Psychol] 2026 May 02; Vol. 14 (1). Date of Electronic Publication: 2026 May 02.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: BioMed Central Country of Publication: England NLM ID: 101627676 Publication Model: Electronic Cited Medium: Internet ISSN: 2050-7283 (Electronic) Linking ISSN: 20507283 NLM ISO Abbreviation: BMC Psychol Subsets: MEDLINE
Imprint Name(s): Original Publication: London : BioMed Central, [2013]-
Ιατρικοί όροι (MeSH): Patient Health Questionnaire*/standards , Psychometrics*, Humans ; Adult ; Female ; Peru ; Male ; Middle Aged ; Young Adult ; Adolescent ; Reproducibility of Results ; Factor Analysis, Statistical
Περίληψη: Objective: To culturally adapt the Patient Health Questionnaire-9 (PHQ-9) for San Martín Quechua and to evaluate its structural validity, reliability, and measurement invariance in Peruvian adults.
Methods: A psychometric study was conducted on a non-probabilistic sample of 309 Quechua-speaking adults from the San Martín region of Peru, including both men and women aged 18 to 59 years. The study was carried out in two phases. The first phase involved the translation and cultural adaptation of the original English PHQ-9 into the Quechua variant spoken in San Martín. The second phase tested how well the adapted PHQ-9 worked by using different methods: confirmatory factor analysis (CFA) to examine its internal structure, multi-group CFA to assess measurement invariance across groups, the Average Variance Extracted (AVE) to evaluate construct representation, and reliability estimation. Convergent validity was also examined through correlations with related measures.
Results: A unidimensional model of the PHQ-9 Quechua San Martín showed adequate fit (CFI = 0.996, TLI = 0.994, SRMR = 0.048, RMSEA = 0.051) and high reliability (α = 0.86; Ω = 0.87). Measurement invariance was supported across sociodemographic groups (ΔCFI and/or ΔRMSEA < 0.01). Convergent validity was supported by an adequate AVE (0.53). Additionally, PHQ-9 scores correlated moderately with the Generalized Anxiety Disorder-7 and weakly and negatively with the Well-Being Index, supporting convergent validity based on relations with other variables.
Conclusions: The San Martín Quechua PHQ-9 is a valid, reliable, and at least partially invariant single-factor instrument for assessing depressive symptoms in Quechua-speaking adults. It may be useful as a screening tool in similar populations.
(© 2026. The Author(s).)
Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of César Vallejo University (code 440-CEI-EPM-UCV-2024, dated May 11, 2024). The study adhered to the principles of the Declaration of Helsinki; all participants voluntarily agreed to participate, providing their informed consent and documenting their participation. Competing of interests: The authors declare no competing interests.
References: Adelaar WFH. The languages of the Andes (Cambridge University Press, Ed.). 2004. https://books.google.com.pe/books?hl=es&lr=&id=UiwaUY6KsY8C&oi=fnd&pg=PP1&dq=Adelaar+W,+Muysken+P.+The+languages+of+the+Andes.+Cambridge+University+Press%3B+2004.+&ots=FheGGmtzXv&sig=IzTVKFOG40MBEDWeATsQSRkOXX4&redir&#95;esc=y#v=onepage&q=Adelaar%20W%2C%20Muysken%20P.%20The%20languages%20of%20the%20Andes.%20Cambridge%20University%20Press%3B%202004.&f=false .
Arifín WN. Sample size calculator. 2024. https://wnarifin.shinyapps.io/ss&#95;sem&#95;cfi&#95;equal/ .
Arroll B, Goodyear-Smith F, Kerse N, Hwang M, Crengle S, Gunn J, et al. Prevalence of depression among Maori patients in Auckland general practice. J Prim Health Care. 2009;1(1):26–9. https://doi.org/10.1071/HC09026 . (PMID: 10.1071/HC0902620690483)
Base de Datos de Pueblos Indígenas u Originarios. Kichwa. 2023. https://bdpi.cultura.gob.pe/pueblos/kichwa .
Bazo-Alvarez JC, Aparicio ARO, Robles-Mariños R, Julca-Guerrero F, Gómez H, Bazo-Alvarez O, et al. Cultural adaptation to Bolivian Quechua and psychometric analysis of the Patient Health Questionnaire PHQ-9. BMC Public Health. 2024;24(1):129. https://doi.org/10.1186/s12889-023-17566-8 . (PMID: 10.1186/s12889-023-17566-83819547810775527)
Brauer K, Ranger J, Ziegler M. Confirmatory factor analyses in psychological test adaptation and development. Psychol Test Adapt Dev. 2023;4(1):4–12. https://doi.org/10.1027/2698-1866/a000034 . (PMID: 10.1027/2698-1866/a000034)
Carrillo-Larco RM, Guzman-Vilca WC, Leon-Velarde F, Bernabe-Ortiz A, Jimenez MM, Penny ME, et al. Peru – progress in health and sciences in 200 years of independence. Lancet Reg Health Am. 2022;7:100148. https://doi.org/10.1016/j.lana.2021.100148 . (PMID: 10.1016/j.lana.2021.10014836777656)
Cerrón-Palomino, R. Lingüística quechua (Centro Bartolomé de Las Casas, Ed.; Segunda). 2003. https://cbc.org.pe/producto/linguistica-quechua-2/ .
Chen FF. Sensitivity of goodness of fit indexes to lack of measurement invariance. Struct Equation Model. 2007;14(3):464–504. (PMID: 10.1080/10705510701301834)
Cheung GW, Rensvold RB. Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equ Model Multidiscip J. 2002;9(2):233–55. https://doi.org/10.1207/S15328007SEM0902&#95;5 . (PMID: 10.1207/S15328007SEM0902_5)
Cjuno J, Figueroa-Quiñones J, Marca-Dueñas GG, Carranza-Esteban RF. Producción científica sobre depresión en poblaciones quechua hablantes: Una revisión narrativa. Ter Psicol. 2021;39(2):163–74. https://doi.org/10.4067/s0718-48082021000200163 . (PMID: 10.4067/s0718-48082021000200163)
Cjuno J, Julca-Guerrero F, Oruro-Zuloaga Y, Cruz-Mendoza F, Auccatoma-Quispe A, Gómez Hurtado H, et al. Adaptación cultural al Quechua y análisis psicométrico del Patient Health Questionnaire (PHQ-9) en población peruana. Rev Peru Med Exp Salud Publica. 2023;40(3):267–77. https://doi.org/10.17843/rpmesp.2023.403.12571 . (PMID: 10.17843/rpmesp.2023.403.125713799103010959517)
Cork C, Kaiser BN, White RG. The integration of idioms of distress into mental health assessments and interventions: a systematic review. Glob Ment Health. 2019;6:e7. https://doi.org/10.1017/gmh.2019.5 . (PMID: 10.1017/gmh.2019.5)
Costantini L, Pasquarella C, Odone A, Colucci ME, Costanza A, Serafini G, et al. Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): a systematic review. J Affect Disord. 2021;279:473–83. https://doi.org/10.1016/j.jad.2020.09.131 . (PMID: 10.1016/j.jad.2020.09.13133126078)
Cruchinho P, López-Franco MD, Capelas ML, Almeida S, Bennett PM, da Silva MM, et al. Translation, cross-cultural adaptation, and validation of measurement instruments: a practical guideline for novice researchers. J Multidiscip Healthc. 2024;17:2701–28. https://doi.org/10.2147/JMDH.S419714 . (PMID: 10.2147/JMDH.S4197143884070411151507)
Damiano RF, Hoffmann MS, Gosmann NP, Pan PM, Miguel EC, Salum GA. Translating measurement into practice: Brazilian norms for depressive symptom assessment with the Patient Health Questionnaire (PHQ-9). Braz J Psychiatry. 2023;45(4):310–7. https://doi.org/10.47626/1516-4446-2022-2945 . (PMID: 10.47626/1516-4446-2022-29453693434610668311)
Díaz P, Rosario Quiroz FJ, Alomía ERE, IparraguirreYaurivilca NE, MisareCondori MA. Psychometric evidence of the WHO-5 well-being index in a sample of participants from hospitals and older adults care centers in Peru. Front Public Health. 2025;13:1670429. https://doi.org/10.3389/fpubh.2025.1670429 . (PMID: 10.3389/fpubh.2025.1670429)
Epskamp S. semPlot: unified visualizations of structural equation models. Struct Equ Model Multidiscip J. 2015;22(3):474–83. https://doi.org/10.1080/10705511.2014.937847 . (PMID: 10.1080/10705511.2014.937847)
Galenkamp H, Stronks K, Snijder MB, Derks EM. Measurement invariance testing of the PHQ-9 in a multi-ethnic population in Europe: the HELIUS study. BMC Psychiatry. 2017;17(1):349. https://doi.org/10.1186/s12888-017-1506-9 . (PMID: 10.1186/s12888-017-1506-9290658745655879)
Ghazisaeedi M, Mahmoodi H, Arpaci I, Mehrdar S, Barzegari S. Validity, reliability, and optimal cut-off scores of the WHO-5, PHQ-9, and PHQ-2 to screen depression among university students in Iran. Int J Ment Health Addict. 2021;20(3):1824–33. https://doi.org/10.1007/s11469-021-00483-5 . (PMID: 10.1007/s11469-021-00483-5334956917817067)
Gomez Cardona L, Yang M, Seon Q, Karia M, Velupillai G, Noel V, et al. The methods of improving cultural sensitivity of depression scales for use among global indigenous populations: a systematic scoping review. Camb Prisms Glob Ment Health. 2023;10:e83. https://doi.org/10.1017/gmh.2023.75 . (PMID: 10.1017/gmh.2023.75)
Gunzler D, Sehgal AR, Kauffman K, Davey CH, Dolata J, Figueroa M, et al. Identify depressive phenotypes by applying RDoC domains to the PHQ-9. Psychiatry Res. 2020;286:112872. https://doi.org/10.1016/j.psychres.2020.112872 . (PMID: 10.1016/j.psychres.2020.112872321518487434666)
Harry ML, Waring SC. The measurement invariance of the Patient Health Questionnaire-9 for American Indian adults. J Affect Disord. 2019;254:59. https://doi.org/10.1016/j.jad.2019.05.017 . (PMID: 10.1016/j.jad.2019.05.017311082816690433)
Husnain MI ul, Hajizadeh M, Ahmad H, Khanam R. Comorbidity and health-related quality of life among Australian adults with psychological distress: a detailed longitudinal study. J Public Health. 2025;2025:1–12. https://doi.org/10.1007/s10389-025-02490-5 .
Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi. Estudio Epidemiológico de Salud Mental en Hospitales Regionales 2015 - Informe general. 2023. https://www.gob.pe/institucion/insm/informes-publicaciones/4629417-estudio-epidemiologico-de-salud-mental-en-hospitales-regionales-2015-informe-general .
Jorgensen TD, Pornprasertmanit S, Schoemann AM, Rosseel Y. Useful tools for structural equation modeling [R package semTools version 0.5–6]. CRAN: Contributed Packages. 2022. https://doi.org/10.32614/CRAN.PACKAGE.SEMTOOLS .
Kim YE, Lee B. The psychometric properties of the patient health questionnaire-9 in a sample of Korean university students. Psychiatry Investig. 2019;16(12):904. https://doi.org/10.30773/pi.2019.0226 . (PMID: 10.30773/pi.2019.0226318700896933137)
Maroufizadeh S, Omani-Samani R, Almasi-Hashiani A, Amini P, Sepidarkish M. The reliability and validity of the patient health questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility. Reprod Health. 2019;16(1):137. https://doi.org/10.1186/s12978-019-0802-x . (PMID: 10.1186/s12978-019-0802-x315006446734346)
Mokkink LB, Elsman EBM, Terwee CB. COSMIN guideline for systematic reviews of patient-reported outcome measures version 2.0. In: Quality of life research, vol. 33, number 11. Springer Science and Business Media Deutschland GmbH; 2024. https://doi.org/10.1007/s11136-024-03761-6 .
Muñoz-Navarro R, Cano-Vindel A, Medrano LA, Schmitz F, Ruiz-Rodríguez P, Abellán-Maeso C, et al. Utility of the PHQ-9 to identify major depressive disorder in adult patients in Spanish primary care centres. BMC Psychiatry. 2017;17(1):291. https://doi.org/10.1186/s12888-017-1450-8 . (PMID: 10.1186/s12888-017-1450-8287938925550940)
Mwangala PN, Guni JN, Mwangi P, Makandi M, Kerubo A, Odhiambo R, et al. The psychometric properties of the Swahili version of the primary care post traumatic stress disorder screen for DSM-5 among adults in Kenya. Front Psychiatry. 2024;15:1338311. https://doi.org/10.3389/fpsyt.2024.1338311 . (PMID: 10.3389/fpsyt.2024.13383113929031111405344)
Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: how to decide its appropriateness. World J Methodol. 2021;11(4):116. https://doi.org/10.5662/wjm.v11.i4.116 . (PMID: 10.5662/wjm.v11.i4.116343223648299905)
Organización Mundial de la Salud. Fortalecer la atención primaria de salud para hacer frente a la discriminación racial, promover servicios interculturales y reducir las desigualdades sanitarias: síntesis de la investigación. 2022. https://www.who.int/es/publications/i/item/9789240057104?utm&#95;source=chatgpt.com .
Organización Mundial de la Salud. Trastorno depresivo (depresión). 2025. https://www.who.int/es/news-room/fact-sheets/detail/depression?gad&#95;source=1&gclid=Cj0KCQiAi&#95;G5BhDXARIsAN5SX7pg3fiTiSFCsP1ZK65lpAAybmFvwKPyRjdKpWV4nbf-y85Q51MrssQaApzvEALw&#95;wcB .
Patel JS, Oh Y, Rand KL, Wu W, Cyders MA, Kroenke K, et al. Measurement invariance of the patient health questionnaire-9 (PHQ-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: NHANES 2005–2016. Depress Anxiety. 2019;36(9):813–23. https://doi.org/10.1002/da.22940 . (PMID: 10.1002/da.22940313567106736700)
Rios GC, Floyd S, Guerrero FJ. ¿Cuántas lenguas quechuas hay? Una estimación del número de lenguas quechuas. Lexis. 2024;48(1):34–77. https://doi.org/10.18800/lexis.202401.002 . (PMID: 10.18800/lexis.202401.002)
Rosseel Y. Lavaan: an R package for structural equation modeling and more version 0.5-12 (BETA). J Stat Softw. 2012;48(2):36. (PMID: 10.18637/jss.v048.i02)
Sánchez-Villena AR, Ventura-León J. Depresión según identidad étnica en población peruana: un estudio nacional mediante análisis de redes. Acta Colomb Psicol. 2024;27(1):1. https://doi.org/10.14718/acp.2024.27.1.10 . (PMID: 10.14718/acp.2024.27.1.10)
Spitzer RL, Kroenke K, Williams JBW, Group, and the P. H. Q. P. C. S. Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA. 1999;282(18):1737–44. https://doi.org/10.1001/jama.282.18.1737 . (PMID: 10.1001/jama.282.18.173710568646)
Torero A. Idiomas de Los Andes, Lingüística e Historia. 2005. https://es.scribd.com/document/332907998/Alfredo-Torero-F-de-C-Idiomas-de-Los-Andes-Seccion .
Viladrich C, Angulo-Brunet A, Doval E. Un viaje alrededor de alfa y omega para estimar la fiabilidad de consistencia interna. An Psicol. 2017;33(3):755–82. https://doi.org/10.6018/analesps.33.3.268401 . (PMID: 10.6018/analesps.33.3.268401)
Villarreal-Zegarra D, Al-kassab-Córdova A, Otazú-Alfaro S, Cabieses B. Socioeconomic and spatial distribution of depressive symptoms and access to treatment in Peru: a repeated nationwide cross-sectional study from 2014 to 2021. SSM Popul Health. 2024;29:101724. https://doi.org/10.1016/J.SSMPH.2024.101724 . (PMID: 10.1016/J.SSMPH.2024.1017243972310911667185)
Villarreal-Zegarra D, Copez-Lonzoy A, Bernabé-Ortiz A, Melendez-Torres GJ, Bazo-Alvarez JC. Valid group comparisons can be made with the Patient Health Questionnaire (PHQ-9): a measurement invariance study across groups by demographic characteristics. PLoS ONE. 2019;14(9):e0221717. https://doi.org/10.1371/journal.pone.0221717 . (PMID: 10.1371/journal.pone.0221717314987966733536)
Villarreal-Zegarra D, Paredes-Angeles R, Mayo-Puchoc N, Arenas-Minaya E, Huarcaya-Victoria J, Copez-Lonzoy A. Psychometric properties of the GAD-7 (General Anxiety Disorder-7): a cross-sectional study of the Peruvian general population. BMC Psychology. 2024;12(1):183. https://doi.org/10.1186/s40359-024-01688-8 . (PMID: 10.1186/s40359-024-01688-83856613810985987)
Wang Y, Liang L, Sun Z, Liu R, Wei Y, Qi S, et al. Factor structure of the Patient Health Questionnaire-9 and measurement invariance across gender and age among Chinese university students. Medicine. 2023;102(1):e32590. https://doi.org/10.1097/MD.0000000000032590 . (PMID: 10.1097/MD.0000000000032590366078869829284)
Widaman KF, Reise SP. Exploring the measurement invariance of psychological instruments: applications in the substance use domain. In: The science of prevention: methodological advances from alcohol and substance abuse research. 2004. p. 281–324. https://doi.org/10.1037/10222-009 .
World Health Organization. World mental health report: transforming mental health for all. 2022. https://www.who.int/publications/i/item/9789240049338 .
Zariquiey R, Valenzuela P, Peña J, García G. Enciclopedia de las lenguas indígenas u originarias del Perú en el Bicentenario (Ministerio de Cultura; Pontificia Universidad Católica del Perú [PUCP], Ed.). 2024. https://cendoc.chirapaq.org.pe/items/show/10813 .
Contributed Indexing: Keywords: Depression; Indigenous peoples; Patient Health Questionnaire; Quechua people (Source: Mesh)
Entry Date(s): Date Created: 20260502 Date Completed: 20260619 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13281567
DOI: 10.1186/s40359-026-04653-9
PMID: 42069641
Βάση Δεδομένων: MEDLINE