Comparing five depression measures in depressed Chinese patients using item response theory: an examination of item properties, measurement precision and score comparability.

Yue ZHAO, Wai CHAN, Barbara Chuen Yee LO

Research output: Journal PublicationsJournal Article (refereed)peer-review

8 Citations (Scopus)


BACKGROUND:Item response theory (IRT) has been increasingly applied to patient-reported outcome (PRO) measures. The purpose of this study is to apply IRT to examine item properties (discrimination and severity of depressive symptoms), measurement precision and score comparability across five depression measures, which is the first study of its kind in the Chinese context.
METHODS:A clinical sample of 207 Hong Kong Chinese outpatients was recruited. Data analyses were performed including classical item analysis, IRT concurrent calibration and IRT true score equating. The IRT assumptions of unidimensionality and local independence were tested respectively using confirmatory factor analysis and chi-square statistics. The IRT linking assumptions of construct similarity, equity and subgroup invariance were also tested. The graded response model was applied to concurrently calibrate all five depression measures in a single IRT run, resulting in the item parameter estimates of these measures being placed onto a single common metric. IRT true score equating was implemented to perform the outcome score linking and construct score concordances so as to link scores from one measure to corresponding scores on another measure for direct comparability.
RESULTS:Findings suggested that (a) symptoms on depressed mood, suicidality and feeling of worthlessness served as the strongest discriminating indicators, and symptoms concerning suicidality, changes in appetite, depressed mood, feeling of worthlessness and psychomotor agitation or retardation reflected high levels of severity in the clinical sample. (b) The five depression measures contributed to various degrees of measurement precision at varied levels of depression. (c) After outcome score linking was performed across the five measures, the cut-off scores led to either consistent or discrepant diagnoses for depression.
CONCLUSIONS:The study provides additional evidence regarding the psychometric properties and clinical utility of the five depression measures, offers methodological contributions to the appropriate use of IRT in PRO measures, and helps elucidate cultural variation in depressive symptomatology. The approach of concurrently calibrating and linking multiple PRO measures can be applied to the assessment of PROs other than the depression context.
Original languageEnglish
Number of pages14
JournalHealth and Quality of Life Outcomes
Publication statusPublished - 4 Apr 2017
Externally publishedYes


  • HONG Kong (China)
  • DIAGNOSIS of mental depression
  • ITEM response theory
  • STATISTICAL accuracy
  • MENTAL depression
  • COMPARATIVE studies
  • EMOTIONS (Psychology)
  • FACTOR analysis
  • RESEARCH methodology
  • MEDICAL cooperation
  • QUALITY of life
  • EVALUATION research
  • SUICIDAL ideation
  • Depressive symptomatology
  • Item response theory
  • Measurement precision
  • Outcome score linking
  • Patient-reported outcome measures
  • Score concordances


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