# Factor Structures in the Depressive Symptoms Domains in the 9Q for Northern Thai Adults and Their Association with Chronic Diseases

## TL;DR

This study examines how depressive symptoms are structured in Thai adults using a new tool and finds that chronic diseases are linked to specific types of symptoms.

## Contribution

The study introduces a two-factor model for depressive symptoms in Thai adults and links chronic diseases to specific symptom domains.

## Key findings

- A two-factor model (cognitive-affective and somatic) fits depressive symptoms better in Thai adults.
- Dyslipidemia is linked to both cognitive-affective and somatic depressive symptoms.
- Migraine and peptic ulcer disease are associated with somatic depressive symptoms.

## Abstract

Most of the common models to examine depression are one-factor models; however, previous studies provided several-factor structure models on each depressive symptom using the Patient Health Questionnaire-9 (PHQ-9). The Nine-Questions Depression-Rating Scale (9Q) is an alternative assessment tool that was developed for assessing the severity of depressive symptoms in Thai adults. This study aimed to examine the factor structure of this tool based on the factor structure models for the PHQ-9 provided in previous studies using confirmatory factor analysis (CFA). We also examined the association of chronic diseases and depressive symptoms using the Multiple Indicators Multiple Causes model among 1346 participants aged 19 years old or more without psychiatric disorders. The results show that the two-factor CFA model with six items in the cognitive-affective domain and three items in the somatic domain provided the best fit for depressive symptoms in the study population (RMSEA = 0.077, CFI = 0.953, TLI = 0.936). Dyslipidemia was positively associated with both cognitive-affective symptoms (β = 0.120) and somatic depressive symptoms (β = 0.080). Allergies were associated with a higher level of cognitive-affective depressive symptoms (β = 0.087), while migraine (β = 0.114) and peptic ulcer disease (β = 0.062) were associated with a higher level of somatic symptoms. Increased age was associated with a lower level of somatic symptoms (β = −0.088). Our findings suggested that considering depressive symptoms as two dimensions yields a better fit for depressive symptoms. The co-occurrence of chronic diseases associated with depressive symptoms should be monitored.