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School of Behavioral and Brain Sciences, Ponce Health Sciences University, 388 Zona Industrial Reparada 2, Ponce, PR 00716,
USA
ISSN: 0976-3031
Research Article
VALIDATION AND DIMENSIONALITY OF PATIENT HEALTH QUESTIONNAIRE FOR
DEPRESSION (PHQ-8 AND PHQ-9) IN HISPANIC LGBT+ COMMUNITY
Juan AníbalGonzález-Rivera
School of Behavioral and Brain Sciences, Ponce Health Sciences University, 388 Zona Industrial Reparada 2,
Ponce, PR 00716, USA
DOI: http://dx.doi.org/10.24327/ijrsr.2019.1012.4970
ARTICLE INFO ABSTRACT
This study aimed to obtain the psychometric properties of the Patient Health Questionnaire for
Depression (PHQ) in a sample of the Hispanic LGBT+ community. Besides, the factor structure of
the PHQ was analyzed to examine which model (one-factor or two-factor model) presents the best
evidence of validity. The PHQ was administered to 352 participants from the LGBT+ community.
According to our results, 27.5% of the participants show clinically significant symptoms of
depression. Four versions of the PHQ (two unifactorial models and two bifactorial models) were
examined. The results show an adequate psychometric quality of both unidimensional versions in
the sample studied. All items, both PHQ-9 and PHQ-8, obtained suitable discrimination indexes and
presented appropriate factor loads. The reliability of both versions was high, and the correlation with
the Satisfaction with Life Scale was as expected, moderate, and negative. In summary, these results
suggest that both versions of the PHQ have adequate psychometric properties to measure depressive
symptomatology in the Hispanic LGBT+ community.
INTRODUCTION
Among the most frequent mental health problems with the
most significant impact on the psychological well-being of
people in the LGBT+ community (lesbian, gay, bisexual,
transgender, queer, intersex, and related communities) are
symptoms and depressive disorders1,2,3. Research from Europe
and North America provides ample evidence that people in the
LGBT+ community suffer more from mood disorders than
heterosexual individuals3,4,5. Other international research
indicates that approximately 33% of the LGBT+ community
has symptoms associated with the major depressive disorder;
however, 60% of these have never received psychological or
psychiatric treatment6. This high prevalence can be explained
by the minority stress model7, which states that members of
marginalized groups are at risk of suffering psychiatric
problems because of the social difficulties and stressors they
face in society.
Unfortunately, Puerto Rico and Latin America do not have
statistics on the prevalence of depressive disorders in the
LGBT+ community. However, in a recent survey of Hispanic
LGBT+ community in Puerto Rico, it was reported that 23.4%
of the participants presented mild depression, 12.5% moderate
depression, 6.3% moderately severe depression, 6.3% severe
depression, and 24.5% presented suicidal ideations8. This
prevalence percentage exceeds 10.4% reported from a general
population sample in Puerto Rico9,10. This data demonstrates
the need for epidemiological studies focused directly on the
Hispanic LGBT+ community, especially with the growing
academic and clinical interest in the mental health of sexual
minority populations11.
In order to conduct rigorous research on the mental health of
the LGBT+ Hispanic community, brief, valid, and reliable
measuring instruments are needed as the first step in Latin
America, the Caribbean, and Puerto Rico. Therefore, a short
and valid scale to measure depressive symptoms in the
Hispanic LGBT+ community will be beneficial for social
scientists who study the history and outcomes of depressive
symptoms in this community. After reviewing several
instruments, we decided to validate the two versions of the
Patient Health Questionnaire (PHQ-9 and PHQ-8)12,13 as a
measure of depressive symptoms for the Hispanic LGBT+
community.
Available Online at http://www.recentscientific.com
International Journal of
Recent Scientific
Research
International Journal of Recent Scientific Research
Vol. 10, Issue, 12(F), pp. 36670-36676, December, 2019
Copyright © Juan AníbalGonzález-Rivera, 2019, this is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the
original work is properly cited.
DOI: 10.24327/IJRSR
CODEN: IJRSFP (USA)
Article History:
Received 13th September, 2019
Received in revised form 11th
October, 2019
Accepted 8th November, 2019
Published online 28th December, 2019
Key Words:
Depression, Hispanics, LGBT, patient
health questionnaire, psychometric
properties, validation
International Journal of Recent Scientific Research Vol. 10, Issue, 12(F), pp. 36670-36676, December, 2019
36671 | P a g e
Patient Health Questionnaire
The Patient Health Questionnaire (PHQ)12,13 is one of the most
internationally recognized instruments due to its ability to
identify symptoms in people with depressive disorders and
their sensitivity to monitor changes in psychological and
psychopharmacological treatments14. The PHQ was initially
developed as a nine-item screening inventory for depression
(PHQ-9) and a two-week time frame that mimics the criteria
outlined in the Diagnostic and Statistical Manual of Mental
Disorders (DSM–IV-TR)15. Each item addresses one of the
DSM-IV criteria15: depressed mood, anhedonia, changes in
appetite, sleep problems, physical agitation or retardation,
feeling tired or fatigued, feeling guilty or worthless, executive
functioning issue, and suicidality (item 9). Exclusion of the
final item results in the PHQ-8, a popular choice for
epidemiological studies16.
PHQ-9 is commonly used in primary care settings, hospitals,
psychiatric centers, and emergency rooms, and it has been
validated and adapted in different countries, populations, and
languages obtaining excellent psychometric properties17–27. The
PHQ-8 has also been shown to be a valid instrument for
evaluating depression symptoms in specific populations16,28–30.
However, no psychometric studies of PHQ-9 or PHQ-8 have
been conducted in the Hispanic LGBT + community. In fact,
after an extensive literature review, we only identified a study
in the world that analyzes the psychometric properties of PHQ-
9 in LGBT communities (Vietnamese sexual minority
women)28.
On the other hand, a considerable number of studies
demonstrate a one-factor solution for both versions31,32, which
coincides with the conceptualization of depression in the DSM-
5 (one-dimensional theory of depression)33. However, other
studies have shown a two-factor model for PHQ-9, one of them
corresponding to somatic items (sleep disturbances, changes in
appetite and fatigue) and the other to non-somatic or affective
items (depressed mood, feelings of hopelessness and suicidal
thoughts)34,35,36. Internal consistency (Cronbach’s alpha) of the
PHQ-9 ranged from 0.79 to 0.9217,20,22,37–39 and PHQ-8 ranged
from 0.81 to 0.8929,30,40.
Purpose of the Study
This study aimed to obtain the psychometric properties of the
Patient Health Questionnaire for Depression (PHQ) in a sample
of the Hispanic LGBT+ community. Specifically, this research
has four main objectives: examine the dimensionality of the
PHQ through the analysis of confirmatory factors with
structural equations, analyze the discrimination capacity of the
items of the instrument, analyze the reliability of the PHQ
using the internal consistency index Cronbach and Omega
alpha, and analyze the divergent validity using the Pearson
correlation coefficient. Four versions of the PHQ will be
analyzed, and recommendations will be offered on which of
these are the most appropriate for assessing depressive
symptoms in the Hispanic LGBT+ community.
METHODS
Research Design
This study has a non-experimental instrumental design41. The
purpose of this type of methodology is to challenge the
factorial structure of the instrument and check if the PHQ-9 has
adequate psychometric properties to be used in the Hispanic
LGBT + community of Puerto Rico. To collect the data, we use
the PsychData platform, and as a method of promotion, we use
a paid advertisement on most social networks. Once the
participants accessed the platform, they read the informed
consent, which explained the objective of the study, the
inclusion criteria, and the possible risks. The participants
received no compensation for their participation. The
Institutional Review Board (IRB) of Albizu University in San
Juan, Puerto Rico, approved the study (Code: SP16-23).
Participants
A sample of 352 LGBT+ individuals was used, with an average
age of 34.46 (SD = 12.38). The sample descriptions are
presented in Table 1. The inclusion criteria were: to be of 18
years or more, be Hispanic, be a resident of Puerto Rico, and
self-identify with the LGBT+ community.
Table 1 Sample Description.
n %
Sex
Male
Female
Trans
206
142
4
58.5%
40.3%
1.2%
Sexual orientation
Gay
Lesbian
Bisexual
Queer
Pansexual
194
95
51
6
6
55.1%
27.0%
14.5%
1.7%
1.7%
Academic Preparation
High school
Associate degree/technical
Bachelor’s degree
Master’s degree
Doctoral degree
37
41
138
80
56
10.5%
11.6%
39.2%
22.7%
15.9%
Annual Income
$0–25,000
$26,000–50,000
$51,000–100,000
$101,000 or more
203
91
39
19
57.7%
25.9%
11.1%
5.4%
Note: N = 352.
Measurement
Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 (Spanish
version) is a 9-item self-report measure that is used to assess
depression severity and criteria for a major depressive episode.
Each item is rated in frequency on a 4-point (0 = not at all, 3 =
nearly every day) scale and total scores may range from 0 to
27. The authors12,13 suggest five levels of severity: minimal
(total score, 0–4); mild (total score, 5–9); moderate (total score,
10–14); moderately severe (total score, 15–19); and severe
(total score, 20–27). A score of 10 or above is frequently used
as a cut point to identify patients with major depression.
The answers offered by the participants in the first eight items
of the PHQ-9 were used to analyze the psychometric properties
of the PHQ-8 (Spanish version), which does not include item 9.
Studies that have studied the level of concordance of the two
versions of the PHQ justify the use of the same cut-off points
for clinical and research purposes. For this reason, the same
cohort points as PHQ-9 will be used to categorize the severity
of depression symptoms: minimal (total score, 0–4); mild (total
score, 5–9); moderate (total score, 10–14); moderately severe
Juan AníbalGonzález-Rivera., Validation and Dimensionality of Patient Health Questionnaire for Depression (Phq-8 And Phq-9) in Hispanic Lgbt+ Community
36672 | P a g e
(total score, 15–19); and severe (total score, 20–27). Same as
PHQ-9, a score of 10 or above is frequently used as a cut point
to identify patients with major depression.
Satisfaction with Life Scale (SWLS). The SWLS is a 5-item
self-report measure that is used to assess life satisfaction (e.g., I
am very satisfied with my life; In most ways, my life is close to
my ideal). The authors of the SWLS42 believe that life
satisfaction constitutes the cognitive component of subjective
well-being. Participants were asked to indicate their level of
agreement with the statements on a 7-point Likert-type scale (1
= strongly disagree to 7 = strongly agree). The lowest score
that can be obtained is five, and the highest is 35. High scores
suggest high life-satisfaction. In our study, the scale obtained
an internal consistency index of .91 in Cronbach's alpha.
Data Analysis
All analyses were performed in STATA 15. Specifically, we
perform descriptive statistics, data distribution analysis
(Kolmogorov-Smirnov with Lilliefors significance correction,
Doornik-Hansen), item discrimination analysis, reliability
analysis, and correlations among the total scores of the scales.
In addition, a confirmatory factor analysis (CFA) with the
maximum likelihood estimation method and Satorra–Bentler
adjustments were made43. To examine the models, we use the
following statistics: χ2
sb, RMSEAsb, SRMR, TLIsb, CFIsb, and
AIC. A suitable model should have an RMSEAsb less than .08,
SRMR less than .05, and CFIsb and TLIsb values greater than
.9044. Likewise, CFIsband TLIsb values greater than .90
represent an adequate adjustment of the model44. The model
with the lowest AIC shows a better fit45. Meanwhile, the
literature suggests that the regression coefficients of the items
should be greater than .5046.
In addition, item-total correlations (rbis) were made as a
measure of item discrimination. Values (rbis) greater than .30
have an acceptable discrimination capacity47. The reliability of
both versions of the PHQ was examined using Cronbach's
alpha and the omega coefficient. The literature suggests that
both values should be greater than .7048,49. The correlation
between the PHQ-9, PHQ-8, and SWLS was calculated using
Pearson's product-moment coefficient (r). Values less than .35
are considered weak or low correlations; values between .36
and .67 are considered moderate correlations; values between
.68 and .89 are seen considered high correlations, and, finally,
values from .90 onwards are considered very high
correlations50. Finally, following the recommendations of
Fornell and Larcker51, we examined the convergent and
discriminatory validity of two bifactorial models of PHQ
through the Average Variance Extracted (AVE). An AVE
greater than .50 is a convergent validity indicator, given that
50% of the variance of the variable is due to its indicators52.
The discriminatory validity of each factor is determined by
comparing the maximum shared variance (MSV) and the
average shared variance (ASV) with the AVE. The MSV and
ASV must be less than AVE of each factor.
RESULTS
Descriptive Analysis of the PHQ-9 and PHQ-8
The mean PHQ-9 score was 7.13 (SD = 6.06), and the PHQ-8
score was 6.76 (SD = 5.60). When calculating the
Kolmogorov-Smirnov statistic with Lilliefors significance
correction, it was shown that the PHQ-9 and PHQ-8 data do not
follow a normal distribution (KS(352) = .140, p < .001).
Likewise, the multivariate normality of both versions was
analyzed using the Doornik-Hansen statistical test53. Both the
PHQ-9 (χ2(18) = 618.682, p< .001) and the PHQ-8 (χ2(16) =
494.968, p < .001) showed no normality in the data. For this
reason, the Satorra-Bentler adjustments were used in the
CFA43.
Using the five levels of severity depression12,13, we categorize
the total scores of both versions of the PHQ (see Table 2). Only
2.6% (n = 9) of the participants presented discrepancies in
clinically significant scores (≥10); that is, 9 participants
obtained a score of 10 in the PHQ-9 and a score of 9 in the
PHQ-8. This results in a 97.4% concordance in the
identification of clinically significant symptoms between the
PHQ-8 and PHQ-9. The average percentage of participants
with clinically significant symptoms was 27.5%.
Table 2 Distribution of depressive symptom severity
Note: N = 352.
Structure Validity
Several confirmatory factorial analyses were performed to
determine the factorial structure of PHQ and identify the
underlying dimensions behind its items. Specifically, four
competitive models were evaluated: a unifactorial model where
the nine original items were loaded to one factor (PHQ-9),
another unifactorial model where the first eight items were
loaded to one factor (PHQ-8), a two-correlated-factor model of
the PHQ-9, and a two-correlated-factor model of the PHQ-8.
The four models show an adequate adjustment to the data (see
Table 3). The items showed regression coefficients greater than
.50.
Table 3 Goodness-of-fit test for analyzed models.
Note. sb = Satorra–Bentler adjustments; χ2
sb= Corrected Chi-
square test; GL = degrees of freedom; RMSEAsb = corrected
root mean square error of approximation; SRMR =
Standardized Root Mean Square Residual;CFIsb= corrected
Comparative Fit Index; TLIsb= corrected Tucker–Lewis Index;
AIC = Akaike Information Criterion; χ2
sb are significant, p <
0.001.
Since all four models presented good adjustments, comparative
analyzes do not allow us to identify the dimensionality of the
scale in this sample. For this reason, we decided to test the
bifactor models and examine their convergent and
discriminatory validity through the AVE, ASV and MSV. The
results showed that the MSV and ASV values exceeded the
AVE of all factors (see Table 4). This means that the two
dimensions of the two versions share a substantial amount of
variance with each other, which confirms that both factors
measure the same construct: depression symptoms. This is
confirmed by observing high correlations between latent
International Journal of Recent Scientific Research Vol. 10, Issue, 12(F), pp. 36670-36676, December, 2019
36673 | P a g e
variables, as well as correlations of the direct scores (see Table
4).This suggests that the best versions of the PHQ are one-
dimensional models (see Figure 1).
Table 4 Average variance extracted, and correlations of the
bifactors models.
AVE MSV
ASV
1 2
PHQ-9 Factor 1
0.58 0.79 0.79 - 0.89
**
Factor 2
0.45 0.79 0.79 0.74
**
-
PHQ-8 Factor 1
0.62 0.81 0.81 - 0.90
**
Factor 2
0.45 0.81 0.81 0.74
**
-
Note. AVE = average variance extracted; MSV = maximum
shared variance; ASV = average shared variance; Factor 1 =
non-somatic or affective items; Factor 2 = somatic items; ** =
significant correlations p< 0.001.The values on the diagonal
represent the correlations between the latent factors, while the
values below the diagonal represent the correlations of the
direct scores.
Figure 1 One-dimensional models of the Patient Health Questionnaire for
Depression (PHQ-9 and PHQ-8).
Item Analysis
For the PHQ-9, the indexes ranged between .60–.73; and for
the PHQ-8, the indexes ranged between .64–.77. These values
indicate that all items discriminate adequately47. Table 5
presents the discrimination indexes and standardized regression
coefficients.
Table 5 Item discrimination indexes, regression coefficients
(β) on its respective dimensions, and confidence intervals.
Items PHQ-9 PHQ-8
r
bis
β
95% C.I.
r
bis
β
95% C.I.
1. Little interest or pleasure in
doing things? .68
.74
[.66, .82] .67
.74
[.66, .81]
2. Feeling down, depressed, or
hopeless? .71
.77
[.71, .83] .70
.77
[.71, .83]
3. Trouble falling or staying
asleep, or sleeping too much? .61
.64
[.57, .71] .62
.66
[.59, .72]
4. Feeling tired or having little
energy? .64
.67
[.60, .73] .65
.68
[.62, .75]
5. Poor appetite or overeating? .61
.63
[.54, .72] .61
.64
[.56, .73]
6. Feeling bad about yourself —
or that you are a failure or have
let yourself or your family
down?
.73
.79
[.74, .84] .71
.77
[.72, .82]
7. Trouble concentrating on
things, such as reading the
newspaper or watching
.65
.69
[.62, .76] .64
.69
[.62, .76]
Items PHQ-9 PHQ-8
television?
8. Moving or speaking so
slowly that other people could
have noticed? Or so fidgety or
restless that you have been
moving a lot more than usual?
.61
.65
[.56, .73] .60
.64
[.56, .73]
9. Thoughts that you would be
better off dead, or thoughts of
hurting yourself in some way?
.60
.66
[.58, .74] - - -
Note: β = standardized regression coefficients; 95% C.I. = 95% confidence
intervals of regression coefficients.
Reliability and Divergent Validity
The Cronbach alpha index of the PHQ-9 was .89,and the PHQ-
8 was .88. The omega coefficient of the PHQ-9 was .89, and
the PHQ-8 was .88. These indexes comply with the
recommendations of the literature (> .70)48,49. Pearson's r
correlation analysis showed a moderate, negative and
statistically significant association between PHQ-9 and SWLS
(r = –.58, p< .001, r2 = .34), and between PHQ-8 and SWLS (r
= –.57, p< .001, r2 = .32), providing evidence of divergent
validity in both versions of the PHQ. Table 6 presents the
Cronbach's Alpha, omega coefficient, correlation index
between the scales, mean, standard deviation, Skewness, and
Kurtosis.
Table 6 Means, standard deviations, Skewness, Kurtosis,
alphas, omega coefficient, and correlations.
M SD Skewness Kurtosis
α
1 2
1. PHQ-9 7.13 6.06 1.05 .450 .89 .89 -
2. PHQ-8 6.76 5.60 .99 .33 .88 .88 .99
**
-
3. SWLS 23.01 8.02 –.47 –.73 .91 .91 –.58
**
–.57
**
Note. M = Mean; SD = standard deviation; = Cronbach’s
alpha coefficient;
= omega coefficient; ** = significant
correlations p< 0.001. Skewness standard error= .14;Kurtosis
standard error = .28.
DISCUSSION
This study aimed to validate the Patient Health Questionnaire
for Depression as a brief measure of depressive symptom
severity for the Hispanic LGBT+ community. We must begin
by pointing out that, despite its limitations, this is the first study
that analyzes the psychometric properties of PHQ-8 and PHQ-9
in the Hispanic LGBT+ community. The results show an
adequate psychometric quality of both unidimensional versions
in the sample studied. In accordance with that shown by the
majority of studies with Latino samples29,54,55, the unifactorial
model of both versions showed a good fit. All items showed
loads greater than .63, and the discrimination indexes of the
items were greater than .60. The reliability of both versions was
also high, and the correlation with the SWLS was as expected,
moderate and negative. In general, these results suggest that
both versions of the PHQ have adequate psychometric
properties to measure depressive symptomatology in the
Hispanic LGBT+ community.
In theoretical terms, the results support the one-dimensional
composition of the scales, which coincides with the
conceptualization of depression in the DSM-5 (one-
dimensional theory of depression)33. Although the
unidimensional model of depression has been challenged by
Juan AníbalGonzález-Rivera., Validation and Dimensionality of Patient Health Questionnaire for Depression (Phq-8 And Phq-9) in Hispanic Lgbt+ Community
36674 | P a g e
several authors on the factor structure of the DSM symptom
criteria56–58 and by several studies on the PHQ34–36,59, 60, our
results support that a one-factor model meets more evidence of
construct validity. This confirms that the internal structure of
PHQ-9 and PHQ-8 fluctuates depending on the socio-cultural
context where the instrument is administered or by the model
of depression that researchers use as the theoretical framework.
Even the results of other studies with samples of Hispanics
advocating for a two-factor model are questionable and
inconclusive. For example, a study in Colombia analyzed the
dimensionality of the scale in a sample of students using an
exploratory factor analysis59. The factorial distribution showed
two factors, where items 7 and 8 obtained higher loads in factor
1 (not somatic), and the authors decided to keep them in factor
2 (somatic) to maintain the theoretical consistency of the
bifactorial model. However, statistical evidence is not
compatible with its decision. In contrast, our findings argue
that the two-factor model may not be applicable in the Hispanic
LGBT+ community due to its lack of validity of construct
evidenced through the average variance extracted (AVE). The
high correlations between the two factors, both in the
correlation rates between the latent factors and between the
direct scores of somatic and no-somatic dimensions,
empirically support the lack of validity and the low
discriminatory capacity between the dimensions.
In practical terms, our study demonstrated an almost perfect
concordance between PHQ-8 and PHQ-9 to identify clinically
significant depression symptoms using a 10-score cut-off as
recommended by most studies12,13. This result suggests that
both versions are effective for the detection of clinical
symptoms, and we recommend their use in the Hispanic
LGBT+ community. Perhaps the choice of which of these two
instruments to use depends on the purpose of the clinician or
the researcher. For example, PHQ-8 omits the need for
immediate suicide prevention services and makes it an
excellent option for cross-sectional investigations and
epidemiological studies. For its part, the PHQ-9, since it
evaluates the presence of suicidal ideation, is an excellent
assessment tool in clinical settings that require a brief report of
symptoms. We have to consider that these instruments were
developed primarily for use in primary health care, where rapid
diagnoses are required without losing effectiveness. For a
population (LGBT) where the prevalence of depression ranged
between 25% - 33% (27.5% in this study)6,8, both versions of
the PHQ are useful and effective tools to assess the diagnosis
and severity of depression symptoms, as well as the changes of
these over time, which allows a follow-up of the treatment. In
addition, another advantage is that both versions are self-
administered, require little time to respond, and can be applied
simultaneously to several people.
This study has several limitations. The main limitation of this
study was that the psychometric behavior of PHQ-9 was not
evaluated against a reference standard, that is, the structured
psychiatric interview, and that it was only evaluated in a
specific population. Future studies should include a structured
psychiatric interview to use as a reference to be able to
examine the criterion validity of both versions and confirm the
sensitivity of the cut-off points. Second, the sample gathered
was a convenience one, so it was not random. Thirdly, the
reliability of the instrument over time was not examined.
However, the advanced statistics we use empirically strengthen
our findings. Finally, we do not use a standardized procedure to
collect the data; This increases the standard error of the
measure.
Despite its limitations, it is worth mentioning the several
strengths that this research holds. In the first place, it is the first
time that the psychometric properties of PHQ-9 and PHQ-8 are
examined in a sample of the Hispanic LGBT+ community. In
fact, it is the first time that these instruments have been
evaluated in Puerto Rico. In addition, our results confirm the
need to constantly review the psychometric properties of
measuring instruments in mental health, given the important
variations that can be observed in the pattern of response to
questionnaires between different populations and cultures. In
turn, our findings strengthen the need to review psychological
measurement scales over time and cultures continually. For
future studies, we recommend that a cross-validation process
be carried out with another sample to test the factorial
invariance of the instrument, as well as evaluate the concurrent
validity of the instruments using other scales that measure
depression. It would also be a great contribution to this issue to
examine temporal reliability through the test-retest technique.
CONCLUSIONS
In conclusion, due to the adequate psychometric properties
evidenced in this study, its easy administration, its brevity and
minimum operational requirements, the PHQ-9 and PHQ-8 are
an effective tool for the detection of symptoms associated with
depression in Hispanic LGBT+ community. In addition, it was
demonstrated that the two one-dimensional versions of the
PHQ can be used for the development of new clinical research
in this community.
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How to cite this article:
Juan AníbalGonzález-Rivera.2019, Validation and Dimensionality of Patient Health Questionnaire for Depression (Phq-
8 And
Phq-9) in Hispanic Lgbt+ Community. Int J Recent Sci Res. 10(12), pp. 36670-36676.
DOI: http://dx.doi.org/10.24327/ijrsr.2020.1012.4970
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