MEASUREMENT INVARIANCE OF DEPRESSION AND ANXIETY SCALES IN OLDER ADULTS IN GHANA

Abstract

Objective: This study examined the measurement invariance of depression and anxiety scales across age, gender, and cultural groups of older adults and explored demographic and health-related differences in mental health outcomes. Methods: A cross-sectional quantitative design was employed using data from community-dwelling adults aged 60 years and above. Psychometric analyses included descriptive statistics, reliability testing, and multi-group confirmatory factor analysis (CFA) to assess configural, metric, scalar, and strict invariance across age, gender, and cultural groups. Group differences in depression and anxiety were examined using ANOVA and independent samples t-tests. Results: The depression and anxiety scales demonstrated full measurement invariance across all groups. For age groups, configural invariance showed acceptable fit (CFI = 0.920, TLI = 0.910, RMSEA = 0.050, SRMR = 0.060), with metric (ΔCFI = 0.004), scalar (ΔCFI = 0.007), and strict invariance (ΔCFI = 0.004) supported. Similar results were observed across gender (configural CFI = 0.925, RMSEA = 0.048; ΔCFI ≤ 0.004) and cultural groups (configural CFI = 0.918, RMSEA = 0.051; ΔCFI = 0.004). Depression and anxiety scores increased significantly with age (F = 6.12, p = 0.003, η² = 0.04). Females reported higher anxiety than males (t = 2.87, p = 0.004, d = 0.20), and significant differences were observed across cultural groups (F = 5.21, p = 0.006, η² = 0.03). Depression and anxiety were positively correlated with the number of chronic conditions (r = 0.34 and r = 0.29) and negatively correlated with functional status (r = −0.28 and r = −0.31) and self-reported health (r =-0.30 and r = -0.27). Conclusion: The findings confirm that depression and anxiety scales function equivalently across age, gender, and cultural groups, enabling unbiased comparisons. Observed differences reflect genuine mental health disparities, underscoring the importance of psychometrically sound measures for advancing aging and health equity.