Rasch Analysis of the Indonesian PHQ-9 in ICU Patients with CHD
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Abstract
Background: Screening and management of depression in patients with CHD is essential. PHQ-9 is a measurement that can be used, yet its reliability in investigating depression among CHD patients at the ICU has not been widely performed. Purpose: This study aimed to examine the construct validity of the Indonesian version of the PHQ-9 in CHD patients undergoing ICU treatment. Methods: Construct validity and differential item functioning (DIF) were analyzed using the Rasch model. A total of 102 CHD patients completed the Indonesian PHQ-9. Analyses included reliability and separation indices, infit-outfit MNSQ, ZSTD, point-measure correlations, unidimensionality, item-person maps, and DIF assessment. Results: Item and person reliabilities were 0.97 and 0.67, respectively, with a person separation strata of 2.25. Most items fit the Rasch model, with minor misfits (items 7 and 9 for MNSQ; items 1, 4, and 8 for ZSTD). All items had positive point-measure correlations and met at least one fit criterion. The measure explained 52.8% of the variance, with 5.6%–10.2% unexplained variance across the first five contrasts. Thresholds ranged from 1.35 to 2.38. Local dependence was low (r = 0.29), and no significant DIF was identified. Item 3 was the easiest; item 9 the most difficult. Conclusion: The Indonesian version of the PHQ-9 is a valid and reliable tool for detecting depression in ICU patients with CHD. However, its sensitivity to both mild and major depressive disorders remains limited. Instrument refinement, the use of complementary assessments, and a larger sample size are recommended for further analysis.
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