Research Directory
Cross-Cultural Diagnostics & Measurement Invariance
Patient Health Questionnaire-9: Measurement Invariance Across Indonesia, Germany, and USA
When assessing mental health conditions across diverse global populations, a fundamental scientific question arises: Do psychological instruments measure the same underlying emotional experiences in different countries, or do cultural variations distort symptom reporting? Addressing this challenge, IndoPsyCare clinician-scientist Eric Sucitra, M.Psi., Psikolog, alongside Riangga Novrianto, M.Psi., Psikolog, Yolanda T. Pasaribu, M.Psi., Psikolog, Prof. Tania M. Lincoln, and Dr. phil. Edo S. Jaya, M.Psi., Psikolog, conducted an extensive multinational investigation into the measurement invariance of the Patient Health Questionnaire-9 (PHQ-9).
Cross-National Equivalence of Depressive Symptom Assessment
Published in Assessment, the study rigorously compared large cohorts across Indonesia, Germany, and the United States. Evaluating whether construct, metric, and scalar invariance held true across distinct linguistic and socio-cultural environments, the findings establish that the core constructs of depressive symptomatology tapped by the PHQ-9 operate consistently across Western and Southeast Asian contexts, validating direct epidemiological comparisons and evidence-based clinical screening in Indonesian clinical practice.
Peer-Reviewed Abstract
"The Patient Health Questionnaire-9 (PHQ-9) is a screening tool for assessing depressive symptomatology that has received widespread use. However, there is a scarcity of research on whether the instrument measures the same construct between high-income (HIC) and low- and middle-income countries (LMICs). Online surveys were utilized to assess samples across Indonesia, Germany, and the USA (N = 2350). Measurement Invariance (MI) was computed using multi-group confirmatory factor analyses. We found the general factor model to have a good fit and configural, metric, scalar, and residual MI across three countries. There were no significant differences in mean scores (Indonesia, M = 1.87, SD = 0.56; Germany, M = 1.90, SD = 0.65; USA, M = 1.90, SD = 0.75). These results highlight that depressive symptomatology is universal across distinct geographical regions, regardless of the population's income levels. Hence, this study further emphasizes the urgency of developing universal, accessible assessment and treatment for depression."
Citation: Sucitra, E., Novrianto, R., Pasaribu, Y. T., Lincoln, T. M., & Jaya, E. S. (2025). An analysis of measurement invariance of the Patient Health Questionnaire-9 between Indonesia, Germany, and the USA. Assessment, 10731911251361230.
Universality of Anxiety Experiences: Cross-National GAD-7 Evaluation
Anxiety is frequently considered an elemental human reaction, yet whether self-reported anxiety scales reflect universal psychological distress or culture-specific worry patterns has remained an ongoing debate. In a foundational study published in the Journal of Affective Disorders, Dr. phil. Edo S. Jaya, M.Psi., Psikolog, together with Riangga Novrianto, M.Psi., Psikolog, Nimaz I. Dewantary, M.Psi., Psikolog, Christiana L. Ticoalu, M.Psi., Psikolog, and Dr. Meike Riehle, examined the universality of anxiety experiences across Germany, Indonesia, and the United States.
Cross-Cultural Invariance of the GAD-7
Utilizing multi-group confirmatory factor analysis on large-scale international samples, the research empirically evaluated the measurement equivalence of the Generalized Anxiety Disorder-7 (GAD-7). The findings provide robust empirical backing for the structural invariance of anxiety symptoms across highly divergent cultural landscapes, confirming that excessive worry, autonomic arousal, and restlessness are experienced and articulated with uniform psychometric validity across Western and Southeast Asian populations.
Peer-Reviewed Abstract
"BACKGROUND: Generalized Anxiety Disorder-7 (GAD-7) is a widely used self-report that assesses generalized anxiety disorder symptomatology. Whilst previous studies have reported good-to-excellent psychometric properties across different languages, it remains unclear whether GAD-7 measures the same construct across Western and non-Western countries. Here, we tested the hypothesis that the GAD-7 is measurement invariant across Western and non-Western countries and the hypothesis that a less severe GAD symptomatology can be found in non-Western countries. METHODS: The present study employed an online survey to examine the GAD-7's measurement invariance (MI) across community samples from Indonesia, Germany, and the USA (N = 2350). MI was computed using multiple-group confirmatory factor analyses with a general factor model of the GAD-7. RESULTS: The general factor of the GAD-7 had good model fit and configural, metric, scalar, and residual MI across the three countries. No significant differences were found in mean scores (Indonesia, M = 1.78, SD = 0.64, Germany, M = 1.84, SD = 0.69, USA, M = 1.87, SD = 0.79; F (2, 1514) = 3.079, p = 0.046; Games-Howell post-hoc analysis, tGermany-Indonesia = 1.720, p = 0.199; tGermany-USA = 0.750, p = 0.734; tIndonesia-USA = 2.330, p = 0.053). LIMITATIONS: This study's online nature may have inflated cross-country similarities and reduced data generalizability. CONCLUSION: The full MI demonstrates the GAD-7 captures the same GAD construct across Western and non-Western countries. Inconsistent with the previous findings GAD severity levels were similar across countries. Despite some possible reservations, the GAD-7 appears to be a culturally fair GAD measure."
Citation: Jaya, E. S., Novrianto, R., Dewantary, N. I., Ticoalu, C. L., & Riehle, M. (2024). The universality of anxiety experiences between Germany, Indonesia, and the US: A measurement invariance analysis. Journal of Affective Disorders, 361, 334-340.
Clinical Utility of the Indonesian PHQ in Psychiatric Outpatient Settings
In frontline psychiatric and psychological clinical practice, reliable, rapid screening tools are indispensable for ruling out common mental disorders and triaging patients effectively per global diagnostic standards. In research published in the Asian Journal of Psychiatry, Dr. phil. Edo S. Jaya, M.Psi., Psikolog, Riangga Novrianto, M.Psi., Psikolog, Dr. Martin Pillny, and Prof. Tjhin Wiguna evaluated the real-world diagnostic performance and clinical utility of the Indonesian Patient Health Questionnaire (PHQ).
Diagnostic Precision per ICD-11 Outpatient Criteria
Administering the adapted PHQ to a representative cohort of psychiatric outpatients, the clinician-scientists evaluated sensitivity, specificity, and negative predictive values in alignment with the World Health Organization's ICD-11 classification. The results demonstrate the exceptional clinical utility of the Indonesian PHQ as an evidence-based triage instrument, particularly for confidently ruling out depressive and anxiety conditions in busy clinical environments.
Peer-Reviewed Abstract
"This study aimed to assess the diagnostic accuracy of the Patient Health Questionnaire (PHQ) for identifying common mental disorders in an outpatient clinical psychologist office setting in Indonesia. A total of 661 outpatients from a clinical psychology office in Jakarta, Indonesia, participated in the study. The complete PHQ was administered, and its results were compared with diagnoses made by clinical psychologists based on ICD-11 criteria, including somatoform disorder (n = 6), depression (n = 117), Generalized Anxiety Disorder (GAD, n = 50), panic disorder (n = 42), bulimia nervosa (n = 2), binge eating disorder (n = 2), and other diagnoses such as OCD and BPD (n = 442). Receiver operating characteristics were computed to examine cut-off points, and optimal cut-off points based on the Youden Index were identified for somatoform disorder (PHQ-15 ≥ 13), depression (PHQ-9 ≥ 13), GAD (GAD- 7 ≥ 10), and panic disorder (PHQ-PD ≥ 7). Cut-off points for the alcohol abuse and eating disorder modules of the PHQ could not be determined due to a lack of sample, and AUC was suboptimal for PHQ-9, GAD-7, and PHQ-ED. The Indonesian PHQ demonstrated good sensitivity but low specificity in identifying somatoform disorder, depression, GAD, and panic disorders based on ICD-11 criteria among Indonesian clinical psychologist office outpatients. In the Indonesian outpatient psychiatric context, the utility of the Indonesian PHQ appeared to be most effective in ruling out diagnoses."
Citation: Jaya, E. S., Novrianto, R., Pillny, M., & Wiguna, T. (2024). Indonesian patient health questionnaire's clinical utility in psychiatric outpatients: Ruling out conditions per ICD-11 criteria. Asian Journal of Psychiatry, 100, 104184.
Cross-Cultural Invariance of the UCLA Loneliness Scale
Loneliness is recognized globally as a critical public health and mental health concern, often exacerbated by rapid social transformation. However, does loneliness mean the same subjective experience in collectivist societies as in individualist cultures? Investigating this question in a seminal paper published in Assessment, Steffi Hartanto, M.Psi., Psikolog and Dr. phil. Edo S. Jaya, M.Psi., Psikolog collaborated with Joli Hudiyana, Prof. Tania M. Lincoln, Muhammad A. Shadiqi, Mirra N. Milla, and Prof. Hamdi Muluk.
Measurement Invariance Across Indonesia, Germany, and the United States
The study tested the measurement invariance of both the full 20-item UCLA Loneliness Scale (ULS-20) and its 8-item brief version (ULS-8) across Indonesian, German, and American populations. The psychometric analyses revealed nuanced cross-cultural insights: while the conceptual construct of social isolation and emotional longing possesses universal core dimensions, specific scale items require careful psychometric calibration when translating across cultural matrices, setting vital guidelines for global mental health assessment.
Peer-Reviewed Abstract
"The UCLA Loneliness Scale (ULS-20) and its short version (ULS-8) are widely used to measure loneliness. However, the question remains whether or not previous studies using the scale to measure loneliness are measuring the construct equally across countries. The present study examined the measurement invariance (MI) of both scales in Germany, Indonesia, and the United States (N = 2350). The one-, two-, and three-factor structure of the ULS-20 did not meet the model fit cut-off criteria in the total sample. The ULS-8 met the model fit cut-off criteria and has configural, but not metric invariance because two items unrelated to social isolation were not MI. The final six items (ULS-6) exclusively related to social isolation had complete MI. Participants from the United States scored highest in the ULS-6, followed by participants from Germany and then Indonesia. We conclude that the ULS-6 is an appropriate measure for cross-cultural studies on loneliness."
Citation: Hudiyana, J., Lincoln, T. M., Hartanto, S., Shadiqi, M. A., Milla, M. N., Muluk, H., & Jaya, E. S. (2022). How Universal Is a Construct of Loneliness? Measurement Invariance of the UCLA Loneliness Scale in Indonesia, Germany, and the United States. Assessment, 29(8), 1795-1805.
