Modeling the PHQ-15: The factor structure of somatic symptoms in a large community sample

James Cunningham; Mark Shevlin; Eoin McElroy

doi:10.1177/13591053261442550

Modeling the PHQ-15: The factor structure of somatic symptoms in a large community sample

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Abstract

The Patient Health Questionnaire-15 (PHQ-15) is widely used to assess somatic symptom burden, but its latent structure remains uncertain. This study tested competing PHQ-15 factor models and their associations with demographic and psychological variables in a large, nationally representative UK sample ( N = 1405). Confirmatory factor analyzes using WLSMV evaluated alternative structures reported in the literature. Several multifactor models showed acceptable fit, but a four-factor model comprising pain, cardiopulmonary, gastrointestinal, and fatigue domains provided the best overall fit and outperformed a one-factor solution. Inter-factor correlations were high, indicating substantial overlap between domains and supporting the utility of the total PHQ-15 score. Males reported slightly lower symptom burdens, and younger adults reported more somatic complaints. Findings support multidimensionality alongside a strong general somatic distress tendency, though the PHQ-15 does not fully align with ICD-11 bodily distress disorder criteria.

Original language	English
Article number	13591053261442550
Pages (from-to)	1-14
Number of pages	14
Journal	Journal of Health Psychology
Early online date	26 Apr 2026
DOIs	https://doi.org/10.1177/13591053261442550
Publication status	Published online - 26 Apr 2026

Bibliographical note

Publisher Copyright:
© The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Rights Retention Statement

This Author Accepted Manuscript has been made open access under a Creative Commons Attribution 4.0 International licence (CC BY 4.0) under the terms of Ulster University Rights Retention Policy for Scholarly Works. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

Data Availability Statement

All materials are available from the corresponding author upon reasonable request.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

PHQ-15
somatization
factor analysis
somatic
bodily distress disorder

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10.1177/13591053261442550Licence: CC BY

Main_Manuscript_PHQ_15.Author Accepted Manuscript, 298 KBLicence: CC BY

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title = "Modeling the PHQ-15: The factor structure of somatic symptoms in a large community sample",

abstract = "The Patient Health Questionnaire-15 (PHQ-15) is widely used to assess somatic symptom burden, but its latent structure remains uncertain. This study tested competing PHQ-15 factor models and their associations with demographic and psychological variables in a large, nationally representative UK sample ( N = 1405). Confirmatory factor analyzes using WLSMV evaluated alternative structures reported in the literature. Several multifactor models showed acceptable fit, but a four-factor model comprising pain, cardiopulmonary, gastrointestinal, and fatigue domains provided the best overall fit and outperformed a one-factor solution. Inter-factor correlations were high, indicating substantial overlap between domains and supporting the utility of the total PHQ-15 score. Males reported slightly lower symptom burdens, and younger adults reported more somatic complaints. Findings support multidimensionality alongside a strong general somatic distress tendency, though the PHQ-15 does not fully align with ICD-11 bodily distress disorder criteria.",

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Modeling the PHQ-15: The factor structure of somatic symptoms in a large community sample

Abstract

Bibliographical note

Rights Retention Statement

Data Availability Statement

Funding

UN SDGs

Keywords

Access to Document

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