PSYCHOMETRIC PROPERTIES OF THE UKRAINIAN VERSION OF THE PATIENT HEALTH QUESTIONNAIRE–15 (PHQ-15)
DOI:
https://doi.org/10.32782/cusu-psy-2026-2-24Keywords:
somatization, somatic symptoms, psychometric properties, PHQ-15, reliability, validity, factor structureAbstract
The article presents the psychometric evaluation of the Ukrainian version of the Patient Health Questionnaire–15 (PHQ-15), a brief self-report measure designed to assess the severity of common somatic symptoms. The study aimed to examine the internal consistency, construct validity, factor structure, and known-groups validity of the Ukrainian PHQ-15 in clinical and community samples. A cross-sectional sample included 206 Ukrainian-speaking adults aged 18 to 71 years: 62 participants formed the clinical group and 144 formed the community group. Construct validity was assessed using the Four-Dimensional Symptom Questionnaire (4DSQ), the Generalized Anxiety Disorder scale (GAD-7), and the Patient Health Questionnaire–9 (PHQ-9). Statistical procedures included Cronbach’s alpha and McDonald’s omega, Spearman correlations, exploratory and confirmatory factor analyses, and independentgroup comparisons. Internal consistency was acceptable in both the clinical group (α = .726; ω = .732) and the community group (α = .763; ω = .767). PHQ-15 scores showed statistically significant positive associations with somatization, distress, depression, and anxiety, with the strongest association observed for the 4DSQ somatization subscale, supporting convergent validity. Confirmatory factor analysis indicated that the complete 15-item onefactor model provided the most appropriate balance between model fit and theoretical interpretability (CFI = .900; TLI = .883; RMSEA = .061; SRMR = .095). Participants in the clinical group reported significantly more severe somatic symptoms than those in the community group. The instrument also differentiated participants according to recent significant stress, the presence of physical illness, and deterioration in physical health. The findings support the reliability and validity of the Ukrainian PHQ-15 as a brief screening measure of somatic symptom burden. Its use may facilitate standardized assessment in psychological, psychiatric, psychotherapeutic, primary-care, and epidemiological research settings in Ukraine, including studies of mental health under prolonged war-related stress.
References
Алексіна Н., Герасименко О., Лавриненко Д., Савченко О. Українська адаптація шкали для оцінки генералізованого тривожного розладу GAD-7: досвід діагностики в умовах воєнного стану. Insight: the psychological dimensions of society. 2024. № 11. С. 77–103. DOI: 10.32999/2663-970X/2024-11-5.
Чабан О. С., Хаустова О. О., Асанова А. Е., Трачук Л. Є., Ассонов Д. О. Практична психосоматика: діагностичні шкали : навч. посіб. / за заг. ред. О. С. Чабана, О. О. Хаустової. 2-ге вид., випр. і допов. Київ : Видавничий дім «Медкнига», 2019.
Allen L. A., Woolfolk R. L., Escobar J. I., Gara M. A., Hamer R. M. Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial. Archives of Internal Medicine. 2006. Vol. 166, No. 14. P. 1512–1518. DOI: 10.1001/archinte.166.14.1512.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5-TR. 5th ed., text rev. Washington, DC : American Psychiatric Association Publishing, 2022.
Barbati A., Geraci A., Niro F., Pezzi L., Sarchiapone M. Do migration and acculturation impact somatization? A scoping review. International Journal of Environmental Research and Public Health. 2022. Vol. 19, No. 23. Art. 16011. DOI: 10.3390/ijerph192316011.
Brown R. J., Schrag A., Trimble M. R. Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. American Journal of Psychiatry. 2005. Vol. 162, No. 5. P. 899–905. DOI: 10.1176/appi.ajp.162.5.899.
Chaban O., Oleksiienko A. Psychosomatic consequences of violence in war conditions: analysis of the relationship with the type of trauma and the level of stress. Psychosomatic Medicine and General Practice. 2025. Vol. 10, No. 2. DOI: 10.26766/pmgp.v10i2.620.
De Gucht V., Fischler B. Somatization: a critical review of conceptual and methodological issues. Psychosomatics. 2002. Vol. 43, No. 1. P. 1–9. DOI: 10.1176/appi.psy.43.1.1.
Fink P., Toft T., Hansen M. S., Ørnbøl E., Olesen F. Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients. Psychosomatic Medicine. 2007. Vol. 69, No. 1. P. 30–39. DOI: 10.1097/PSY.0b013e31802e46eb.
Fonagy P., Gergely G., Jurist E. L., Target M. Affect regulation, mentalization, and the development of the self. London : Routledge, 2018. DOI: 10.4324/9780429471643.
Hagnell O., Rorsman B. Suicide and endogenous depression with somatic symptoms in the Lundby Study. Neuropsychobiology. 1978. Vol. 4. P. 180–187. DOI: 10.1159/000117631.
Haller H., Cramer H., Lauche R., Dobos G. Somatoform disorders and medically unexplained symptoms in primary care. Deutsches Ärzteblatt International. 2015. Vol. 112. P. 279–287. DOI: 10.3238/arztebl.2015.0279.
Han C., Pae C.-U., Patkar A. A., Masand P. S., Kim K. W., Joe S.-H., Jung I.-K. Psychometric properties of the Patient Health Questionnaire-15 for measuring the somatic symptoms of psychiatric outpatients. Psychosomatics. 2009. Vol. 50, No. 6. P. 580–585. DOI: 10.1016/S0033-3182(09)70859-X.
Hogeveen J., Grafman J. Alexithymia. Handbook of Clinical Neurology. 2021. Vol. 183. P. 47–62.
Katon W., Kleinman A., Rosen G. Depression and somatization: a review. American Journal of Medicine. 1982. Vol. 72, No. 1. P. 127–135. DOI: 10.1016/0002-9343(82)90599-X.
Kocalevent R.-D., Hinz A., Brähler E. Standardization of a screening instrument (PHQ-15) for somatization syndromes in the general population. BMC Psychiatry. 2013. Vol. 13. Art. 91. DOI: 10.1186/1471-244X-13-91.
Kohut A., Chaban O. The evaluation of psychometric properties of the Ukrainian versions of PCL-5, PHQ-9 and GAD-7 scales. Psychosomatic Medicine and General Practice. 2025. Vol. 10, No. 1. DOI: 10.26766/pmgp.v10i1.597.
Kroenke K., Spitzer R. L., Williams J. B. W. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001. Vol. 16, No. 9. P. 606–613. DOI: 10.1046/j.1525-1497.2001.016009606.x.
Kroenke K., Spitzer R. L., Williams J. B. W. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine. 2002. Vol. 64, No. 2. P. 258–266. DOI: 10.1097/00006842-200203000-00008.
Leonhart R., De Vroege L., Zhang L. et al. Comparison of the factor structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China: a transcultural structural equation modeling study. Frontiers in Psychiatry. 2018. Vol. 9. Art. 240. DOI: 10.3389/fpsyt.2018.00240.
Lipowski Z. J. Somatization: a borderland between medicine and psychiatry. CMAJ. 1986. Vol. 135, No. 6. P. 609–614.
Löwe B., Spitzer R. L., Williams J. B. W., Mussell M., Schellberg D., Kroenke K. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. General Hospital Psychiatry. 2008. Vol. 30, No. 3. P. 191–199. DOI: 10.1016/j.genhosppsych.2008.01.001.
Lushchak O., Velykodna M., Bolman S., Strilbytska O., Berezovskyi V., Storey K. B. Prevalence of stress, anxiety, and symptoms of post-traumatic stress disorder among Ukrainians after the first year of Russian invasion: a nationwide cross-sectional study. The Lancet Regional Health – Europe. 2024. Vol. 36. Art. 100773. DOI: 10.1016/j.lanepe.2023.100773.
Marty P. A major process of somatization: the progressive disorganization. International Journal of Psycho-Analysis. 1968. Vol. 49, No. 2. P. 246–249.
McDougall J. Theaters of the body: a psychoanalytic approach to psychosomatic illness. New York : Norton, 1989.
Morina N., Akhtar A., Barth J., Schnyder U. Psychiatric disorders in refugees and internally displaced persons after forced displacement: a systematic review. Frontiers in Psychiatry. 2018. Vol. 9. Art. 433. DOI: 10.3389/fpsyt.2018.00433.
Pilowsky I. Aspects of abnormal illness behavior. Indian Journal of Psychiatry. 1993. Vol. 35, No. 3. P. 145–150.
Proroković A., Čavka M., Ćubela Adorić V. Psychosomatic and depressive symptoms in civilians, refugees, and soldiers: 1993–2004 longitudinal study in Croatia. Croatian Medical Journal. 2005. Vol. 46, No. 2. P. 275–281.
Schaefert R., Hausteiner-Wiehle C., Häuser W., Ronel J., Herrmann M., Henningsen P. Non-specific, functional, and somatoform bodily complaints. Deutsches Ärzteblatt International. 2012. Vol. 109. P. 803–813. DOI: 10.3238/arztebl.2012.0803.
Schur M. Comments on the metapsychology of somatization. Psychoanalytic Study of the Child. 1955. Vol. 10, No. 1. P. 119–164. DOI: 10.1080/00797308.1955.11822553.
Sikharulidze G., Van Geloven N., Lelashvili E. et al. Posttraumatic stress disorder and somatic complaints in a deployed cohort of Georgian military personnel: mediating effect of depression and anxiety. Journal of Traumatic Stress. 2017. Vol. 30, No. 6. P. 626–634. DOI: 10.1002/jts.22235.
Smakowski A., Hüsing P., Völcker S. et al. Psychological risk factors of somatic symptom disorder: a systematic review and meta-analysis of cross-sectional and longitudinal studies. Journal of Psychosomatic Research. 2024. Vol. 181. Art. 111608. DOI: 10.1016/j.jpsychores.2024.111608.
Spitzer R. L., Kroenke K., Williams J. B. W., Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. 2006. Vol. 166, No. 10. P. 1092–1097. DOI: 10.1001/archinte.166.10.1092.
Terluin B., Van Rhenen W., Schaufeli W. B., De Haan M. The Four-Dimensional Symptom Questionnaire (4DSQ): measuring distress and other mental health problems in a working population. Work & Stress. 2004. Vol. 18, No. 3. P. 187–207. DOI: 10.1080/0267837042000297535.
Van Ravesteijn H., Wittkampf K., Lucassen P. et al. Detecting somatoform disorders in primary care with the PHQ-15. Annals of Family Medicine. 2009. Vol. 7, No. 3. P. 232–238. DOI: 10.1370/afm.985.
Waller E., Scheidt C. E., Hartmann A. Attachment representation and illness behavior in somatoform disorders. Journal of Nervous and Mental Disease. 2004. Vol. 192, No. 3. P. 200–209. DOI: 10.1097/01.nmd.0000116463.17588.07.
Wang S., Barrett E., Hicks M. H.-R. et al. Associations between mental health symptoms, trauma, quality of life and coping in adults living in Ukraine: a cross-sectional study a year after the 2022 Russian invasion. Psychiatry Research. 2024. Vol. 339. Art. 116056. DOI: 10.1016/j.psychres.2024.116056.
Wise T. N., Mann L. S. The attribution of somatic symptoms in psychiatric outpatients. Comprehensive Psychiatry. 1995. Vol. 36, No. 6. P. 407–410. DOI: 10.1016/S0010-440X(95)90247-3.
Witthöft M., Hiller W., Loch N., Jasper F. The latent structure of medically unexplained symptoms and its relation to functional somatic syndromes. International Journal of Behavioral Medicine. 2013. Vol. 20, No. 2. P. 172–183. DOI: 10.1007/s12529-012-9237-2.
World Health Organization. International classification of diseases for mortality and morbidity statistics. 11th rev. Geneva : WHO, 2019.
Yasenok V., Neumann E., Raineri A. et al. Mental Health Assessment of the Population: study protocol of the MAP research program in Ukraine (MAP-U) and in Zurich (MAP-Z). International Journal of Public Health. 2025. Vol. 69. Art. 1607271. DOI: 10.3389/ijph.2024.1607271.
Zhang L., Fritzsche K., Liu Y. et al. Validation of the Chinese version of the PHQ-15 in a tertiary hospital. BMC Psychiatry. 2016. Vol. 16. Art. 89. DOI: 10.1186/s12888-016-0798-5.
