View in EDS HTML Full Text PDF Full Text

The Latent Structure of Depression and Anxiety Symptoms: A Bifactor Exploratory Structural Equation Model of the PHQ‐9 and GAD‐7 in Primary Care.

Saved in:
Bibliographic Details
Title: The Latent Structure of Depression and Anxiety Symptoms: A Bifactor Exploratory Structural Equation Model of the PHQ‐9 and GAD‐7 in Primary Care.
Authors: Esteller‐Collado, Gabriel (AUTHOR), Prieto‐Vila, Maider (AUTHOR), Antuña‐Camblor, Celia (AUTHOR), Carpallo‐González, María (AUTHOR), González‐Blanch, César (AUTHOR), Ruíz‐Rodríguez, Paloma (AUTHOR), Moriana, Juan Antonio (AUTHOR), Medrano, Leonardo Adrián (AUTHOR), Cano‐Vindel, Antonio (AUTHOR), Muñoz‐Navarro, Roger (AUTHOR)
Source: International Journal of Methods in Psychiatric Research. Jun2026, Vol. 35 Issue 2, p1-11. 11p.
Subjects: Mental depression, Anxiety, Structural equation modeling, Primary care, Generalized anxiety disorder, Comorbidity, Psychological tests
Abstract: Introduction: The high comorbidity between depression and anxiety challenges traditional nosological models. In order to better reflect this overlap, dimensional approaches seek to clarify whether these symptoms reflect a single underlying construct of general distress or a more complex multidimensionality. The aim was to examine the underlying structure of depression and anxiety symptoms, measured by the PHQ‐9 and GAD‐7, by estimating and comparing three factor models: one‐factor, two‐factor correlated, and bifactor. Methods: Data from 1704 primary care (PC) patients from the PsicAP clinical trial were analysed. Dimensionality was assessed using hierarchical Exploratory Graph Analysis (EGA), and models were estimated using Exploratory Structural Equation Modelling (ESEM). Model fit was compared using the χ2, CFI, TLI, RMSEA, and SRMR indices. Results: The bifactor model offered the most acceptable comparative fit to the data (CFI = 0.956; TLI = 0.928; RMSEA = 0.076; SRMR = 0.028). Bifactor indices revealed a relevant but not dominant general factor (ECV = 0.40), indicating it does not account for sufficient variance to justify an essentially unidimensional interpretation. Furthermore, the specific factors of depression and anxiety emerged as well‐defined constructs (H > 0.75) with modest reliable specific variance (ωHS: 0.22 and 0.27, respectively). Discussion: The findings suggest a hierarchical structure where a general factor of distress coexists with specific factors. This suggests the potential utility of considering a multi‐level perspective in clinical assessment, accounting for both shared distress and specific symptom profiles. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Methods in Psychiatric Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
Text:
  Availability: 1
Header DbId: pbh
DbLabel: Psychology and Behavioral Sciences Collection
An: 194812913
AccessLevel: 6
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Latent Structure of Depression and Anxiety Symptoms: A Bifactor Exploratory Structural Equation Model of the PHQ‐9 and GAD‐7 in Primary Care.
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Esteller‐Collado%2C+Gabriel%22">Esteller‐Collado, Gabriel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Prieto‐Vila%2C+Maider%22">Prieto‐Vila, Maider</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Antuña‐Camblor%2C+Celia%22">Antuña‐Camblor, Celia</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Carpallo‐González%2C+María%22">Carpallo‐González, María</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22González‐Blanch%2C+César%22">González‐Blanch, César</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ruíz‐Rodríguez%2C+Paloma%22">Ruíz‐Rodríguez, Paloma</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Moriana%2C+Juan+Antonio%22">Moriana, Juan Antonio</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Medrano%2C+Leonardo+Adrián%22">Medrano, Leonardo Adrián</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cano‐Vindel%2C+Antonio%22">Cano‐Vindel, Antonio</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Muñoz‐Navarro%2C+Roger%22">Muñoz‐Navarro, Roger</searchLink> (AUTHOR)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="JN" term="%22International+Journal+of+Methods+in+Psychiatric+Research%22">International Journal of Methods in Psychiatric Research</searchLink>. Jun2026, Vol. 35 Issue 2, p1-11. 11p.
– Name: Subject
  Label: Subjects
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Mental+depression%22">Mental depression</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Structural+equation+modeling%22">Structural equation modeling</searchLink><br /><searchLink fieldCode="DE" term="%22Primary+care%22">Primary care</searchLink><br /><searchLink fieldCode="DE" term="%22Generalized+anxiety+disorder%22">Generalized anxiety disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Comorbidity%22">Comorbidity</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+tests%22">Psychological tests</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: The high comorbidity between depression and anxiety challenges traditional nosological models. In order to better reflect this overlap, dimensional approaches seek to clarify whether these symptoms reflect a single underlying construct of general distress or a more complex multidimensionality. The aim was to examine the underlying structure of depression and anxiety symptoms, measured by the PHQ‐9 and GAD‐7, by estimating and comparing three factor models: one‐factor, two‐factor correlated, and bifactor. Methods: Data from 1704 primary care (PC) patients from the PsicAP clinical trial were analysed. Dimensionality was assessed using hierarchical Exploratory Graph Analysis (EGA), and models were estimated using Exploratory Structural Equation Modelling (ESEM). Model fit was compared using the χ2, CFI, TLI, RMSEA, and SRMR indices. Results: The bifactor model offered the most acceptable comparative fit to the data (CFI = 0.956; TLI = 0.928; RMSEA = 0.076; SRMR = 0.028). Bifactor indices revealed a relevant but not dominant general factor (ECV = 0.40), indicating it does not account for sufficient variance to justify an essentially unidimensional interpretation. Furthermore, the specific factors of depression and anxiety emerged as well‐defined constructs (H > 0.75) with modest reliable specific variance (ωHS: 0.22 and 0.27, respectively). Discussion: The findings suggest a hierarchical structure where a general factor of distress coexists with specific factors. This suggests the potential utility of considering a multi‐level perspective in clinical assessment, accounting for both shared distress and specific symptom profiles. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of International Journal of Methods in Psychiatric Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=194812913
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1002/mpr.70089
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 1
    Subjects:
      – SubjectFull: Mental depression
        Type: general
      – SubjectFull: Anxiety
        Type: general
      – SubjectFull: Structural equation modeling
        Type: general
      – SubjectFull: Primary care
        Type: general
      – SubjectFull: Generalized anxiety disorder
        Type: general
      – SubjectFull: Comorbidity
        Type: general
      – SubjectFull: Psychological tests
        Type: general
    Titles:
      – TitleFull: The Latent Structure of Depression and Anxiety Symptoms: A Bifactor Exploratory Structural Equation Model of the PHQ‐9 and GAD‐7 in Primary Care.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Esteller‐Collado, Gabriel
      – PersonEntity:
          Name:
            NameFull: Prieto‐Vila, Maider
      – PersonEntity:
          Name:
            NameFull: Antuña‐Camblor, Celia
      – PersonEntity:
          Name:
            NameFull: Carpallo‐González, María
      – PersonEntity:
          Name:
            NameFull: González‐Blanch, César
      – PersonEntity:
          Name:
            NameFull: Ruíz‐Rodríguez, Paloma
      – PersonEntity:
          Name:
            NameFull: Moriana, Juan Antonio
      – PersonEntity:
          Name:
            NameFull: Medrano, Leonardo Adrián
      – PersonEntity:
          Name:
            NameFull: Cano‐Vindel, Antonio
      – PersonEntity:
          Name:
            NameFull: Muñoz‐Navarro, Roger
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 06
              Text: Jun2026
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 10498931
          Numbering:
            – Type: volume
              Value: 35
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: International Journal of Methods in Psychiatric Research
              Type: main
ResultId 1