Reliability and validity of the Kurdish version of the patient health questionnaire-15 in a trauma-affected population.

BACKGROUND

Somatic symptoms are common among trauma-exposed populations and are often associated with persistent distress and functional impairment, highlighting the need for culturally appropriate assessment tools.

OBJECTIVE

This study aimed to translate and culturally adapt the Patient Health Questionnaire-15 (PHQ-15), a screening measure of somatic symptom burden, into Central Kurdish and assess its psychometric properties among survivors of chemical gas exposure.

METHODS

A total of 534 survivors were recruited through community and registry sources. After translation and cultural adaptation, item 4 and item 11 were removed due to cultural and gender-specific considerations and limited psychometric performance, resulting in a 13-item version. Factor structure was examined using confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM). Measurement invariance across gender and age groups was evaluated using multi-group CFA. Internal consistency was assessed using McDonald’s omega. An exploratory network analysis (EBICglasso) examined conditional associations among symptoms.

RESULTS

Both a unidimensional CFA model (CFI = 0.988, RMSEA = 0.054) and a three-factor ESEM model (CFI = 0.992, RMSEA = 0.046) showed good model fit, with the ESEM structure providing a more differentiated representation of pain/fatigue, gastrointestinal, and cardiopulmonary domains. Measurement invariance testing supported full scalar invariance across gender, while partial metric invariance was observed across age groups. Internal consistency was acceptable (ω = 0.70–0.83). Network estimates demonstrated acceptable stability, with correlation stability coefficients of 0.59 for edge strength and 0.52 for bridge strength, and should be interpreted as exploratory.

CONCLUSION

The culturally adapted 13-item Kurdish PHQ demonstrates acceptable reliability and initial evidence of construct validity in trauma-exposed survivors of chemical attacks. The instrument may be used as a screening tool for somatic symptom burden in this context, while further validation in broader Kurdish populations is recommended.