Journal of Occupational Health Psychology Copyright 2005 by the Educational Publishing Foundation

2005, Vol. 10, No. 4, 363–381 1076-8998/05/$12.00 DOI: 10.1037/1076-8998.10.4.363

The Physical Health Questionnaire (PHQ): Construct Validation of a

Self-Report Scale of Somatic Symptoms
Aaron C. H. Schat E. Kevin Kelloway
McMaster University St. Mary’s University

Serge Desmarais
University of Guelph

The authors report the results of 3 studies that were conducted to evaluate the psychometric
properties of the Physical Health Questionnaire (PHQ), a brief self-report scale of somatic
symptoms. In Study 1, exploratory factor analysis results revealed 4 empirically distinct dimen-
sions of somatic symptoms: gastrointestinal problems, headaches, sleep disturbances, and respi-
ratory illness. In Study 2, this structure was replicated using confirmatory factor analysis, and
correlations of the PHQ dimensions with measures of negative affect, psychological health, and
job performance provided further validity evidence. In Study 3, a minor revision to the wording
of several items helped to address the limitations of one of the PHQ subscales. Together, these
results provide evidence of the construct validity of the PHQ.

Keywords: physical health, somatic symptoms, validity, measurement, work stress

More than 20 years ago, Schwab (1980) lamented the
lack of attention investigators paid to the construct
validity of measures that they used in organizational
research. In his article, Schwab suggested that research-
ers often proceed to examine substantive relationships
between variables before adequate evidence of the con-
struct validity of the variables’ measures has been gath-
ered. Although the situation may have improved some-
what since Schwab’s article, several recent articles (e.g.,
Hinkin, 1995; Judd & McClelland, 1998) have ac-
knowledged that researchers in social and organiza-
tional psychology, organizational behavior, and man-
Aaron C. H. Schat, DeGroote School of Business, Mc-
Master University, Hamilton, Ontario, Canada; E. Kevin
Kelloway, Department of Management, St. Mary’s Univer-
sity, Halifax, Nova Scotia, Canada; Serge Desmarais, De-
partment of Psychology, University of Guelph, Guelph,
Ontario, Canada.
An earlier version of this article was presented at the 17th
Annual Convention of the Society of Industrial and Orga-
nizational Psychology, Toronto, Ontario, Canada, April
2002. Portions of this research were supported by an On-
tario Graduate Scholarship and a Social Sciences and Hu-
manities Research Council of Canada (SSHRC) doctoral
fellowship to Aaron C. H. Schat and SSHRC research grants
to E. Kevin Kelloway and Serge Desmarais. We thank Greg
Chung-Yan for his comments on an earlier version of this
article.
Correspondence concerning this article should be ad-
dressed to Aaron C. H. Schat, DeGroote School of Business,
McMaster University, 1280 Main Street West, Hamilton,
Ontario, L8S 4M4, Canada. E-mail: schata@mcmaster.ca
agement pay too little attention to issues of
measurement, and in particular, to evaluating the con-
struct validity of measurement scales. This lack of at-
tention to construct validity can lead to erroneous con-
clusions about how the variables being investigated are
related and, more generally, can impede scientific
progress. Thus, it behooves researchers to give more
consideration to psychometric issues in their research.
Accordingly, in this article, we present the results of
a psychometric examination of the Physical Health
Questionnaire (PHQ), a scale measuring somatic symp-
toms. An earlier version of this scale was originally
developed by Spence, Helmreich, and Pred (1987) and
has since been revised and used by a number of other
researchers (e.g., Rogers & Kelloway, 1997; Schat &
Kelloway, 2000, 2003). None of the studies using the
early or revised versions of the scale, however, have
reported extensive consideration of its psychometric
properties. The aim of the present research is to rigor-
ously examine the construct validity of the PHQ to
determine whether it constitutes a meaningful and valid
measure of self-reported somatic health for use in or-
ganizational research. This validation study is particu-
larly important given the existence of several published
studies that have used earlier versions of the scale.
Conceptualizing Physical Health
Before we discuss issues related to the measure-
ment of physical health, we briefly review its con-

363
364 SCHAT, KELLOWAY, AND DESMARAIS
struct domain and discuss the biological mechanisms
by which psychological functioning (e.g., stress,
emotions) is posited to influence physical health. We
note, however, that a comprehensive review of these
issues is beyond the scope of the present research and
refer interested readers to more thorough treatments
thereof (e.g., Cohen & Herbert, 1996; Herbert &
Cohen, 1993; Kiecolt-Glaser & Glaser, 1988).
Over the past number of years, there has been a
growing recognition of the relationship between hu-
man psychological and physical health and a growing
base of literature empirically demonstrating this con-
nection (for reviews, see Cohen & Herbert, 1996;
Herbert & Cohen, 1993). Psychological function-
ing—and in particular exposure to stressful life ex-
periences and emotional reactions to same— has been
implicated as a potential contributor to a wide range
of physical diseases and symptoms, including upper
respiratory infections, gastrointestinal problems, and
cardiovascular illness. A substantial body of research
has accumulated that examines the potential linkages
between psychological stress and physical disease.
One linkage for which substantial evidence exists is
the role of immunosuppression—the suppression of
immune function in response to exposure to stres-
sors—in increasing people’s susceptibility to infec-
tious disease (Cohen, 1996). As Cohen noted, how-
ever, the complexity of the immune system, coupled
with the methodological limitations of measuring this
complexity in human studies, makes it difficult to
gather clear evidence of the mechanisms by which
stress influences immune functioning. The available
evidence suggests that experiencing stressors and
negative affective reactions to them influence sym-
pathetic nervous system activation and hormonal re-
sponses, which in turn affect the immune system
(e.g., Cohen, 1996).
One domain in which the association between
stress and health has received considerable attention
is the occupational health literature. Research in this
area has found that exposure to work-related stress is
associated with suppressed immune functioning
(O’Leary, 1990) and increased risk of infectious dis-
ease (e.g., Cohen & Williamson, 1991; Schaubroeck,
Jones, & Xie, 2001) as well as musculoskeletal com-
plaints (e.g., myalgia; Lundberg et al., 1999; see also
Carayon, Smith, & Haims, 1999), increased fibrino-
gen levels in women (Davis, Matthews, Meilahn, &
Kiss, 1985), asthma, ulcers, and the risk of stroke
(Quick, Quick, Nelson, & Hurrell, 2001). Given these
findings, it is not surprising that the empirical evi-
dence supports an association between job stress and
health care utilization and costs (e.g., Ganster, Fox, &
Dwyer, 2001; Manning, Jackson, & Fusilier, 1996).
Measuring Physical Health
Physical strain measures have ranged from mea-
suring relatively minor somatic symptoms such as
sleep disturbances, upper respiratory infections, and
digestive problems (e.g., Spence et al., 1987) to life-
threatening conditions such as elevated blood pres-
sure (Barling & Kelloway, 1996), hypertension
(Schwartz, Pickering, & Landsbergis, 1996), and cor-
onary heart disease (Karasek & Theorell, 1990;
Krantz, Contrada, Hill, & Friedler, 1988). Although
behavioral and physiological indicators of somatic
health have been used in a number of studies of work
stress (e.g., Evans & Johnson, 2000), self-reports
constitute the most widely used method of measure-
ment in this area and, in addition to the PHQ, include
the Occupational Stress Indicator (Cooper, Sloan, &
Williams, 1988), the Symptoms Checklist (Bartone,
Ursano, Wright, & Ingraham, 1989), and the Physical
Symptoms Inventory (Spector & Jex, 1998). Despite
the wide use of physical health measures in occupa-
tional health research, their validity has rarely been
the subject of focused investigation and is often not
assessed beyond internal consistency reliability. In
fact, as Spector and Jex (1998) noted, “considering
the widespread use of self-report measures of job-
related stressors and strains, it is surprising that rel-
atively little attention has been paid to demonstrating
construct validity of specific scales” (p. 359).
Why has so little attention been paid to validating
measures of physical health in the literature? We
offer two reasons for this. First, there appears to be a
lack of attention to construct validity in the study of
organizational behavior in general (Schwab, 1980),
of which the study of work-related stress and strain is
a part. Second, in occupational health and work stress
research, physical health is rarely the focus of inves-
tigation; rather, it tends to be used as a stress outcome
variable (i.e., strain). Thus, its measurement typically
receives only cursory consideration, often limited to
a brief overview of the scale and its internal consis-
tency reliability. This is also true of the PHQ, which
has been used as an outcome measure in studies of
Type A behavior (Spence et al., 1987) and workplace
aggression (Rogers & Kelloway, 1997; Schat &
Kelloway, 2000, 2003).
The widespread use of self-report measures, how-
ever, makes the availability of a psychometrically
sound, yet efficiently administered, self-report mea-
sure of somatic health critical to research in this area.
 PHYSICAL HEALTH QUESTIONNAIRE
In this article, we report the results of three studies
that were conducted to examine the psychometric
properties of the PHQ. In the first study, we provide
an initial assessment of validity by conducting ex-
ploratory factor analysis and reliability analysis on
the PHQ items. In the second study, we extend these
results by replicating the factor structure obtained in
Study 1, assessing measurement invariance across
two different samples and providing further tests of
construct validity by examining the associations be-
tween the PHQ dimensions and measures of negative
affect, psychological health, and job performance.
Study 2 also included additional reliability (i.e., in-
ternal consistency) analyses of the items composing
the PHQ dimensions. In the third study, we evaluate
whether a minor wording change to several PHQ
items helps to overcome a limitation observed in
Studies 1 and 2 and whether the factor structure
remains consistent following this change.
Physical Health Questionnaire
The PHQ is a shortened and modified version of
the health scale developed by Spence et al. (1987) in
their study of the Type A behavior pattern. Because
the health scale was not the primary focus of their
study, their discussion of its development was rather
brief. The information available in their article sug-
gests that 32 items were developed to tap four di-
mensions of somatic health: quality of sleep, diges-
tion problems, headaches, and respiratory problems.
On the basis of item–total correlations, the 32-item
scale was reduced to a 22-item scale. Spence et al.
reported that the four subscales were significantly
intercorrelated (ranging from .17 to .43) and exhib-
ited internal consistency reliabilities above ␣ ⫽ .75.
A revised and abbreviated (14-item) version of
Spence et al.’s (1987) scale was used by Rogers and
Kelloway (1997) and Schat and Kelloway (2000,
2003) in their studies of workplace aggression and
violence. In their study, Rogers and Kelloway (1997)
used three of the four original subscales (omitting the
items pertaining to respiratory difficulties from their
analyses) as indicators of a single latent variable of
somatic health, although they grouped the items into
subscales based on conceptual rather than empirical
grounds. Schat and Kelloway (2000, 2003) used the
same 14-item scale as Rogers and Kelloway (1997),
but rather than using the four subscales separately,
they created an overall index of somatic health based
on all the items. In both of these studies, the subscale
and overall scale reliabilities were above ␣ ⫽ .80.
Although previous research using this scale sug-
365
gests that the original and revised versions of the
scale have reasonable levels of internal consistency, a
more comprehensive evaluation of its psychometric
properties—particularly the construct validity of the
revised version—is needed. In the following two
studies, we sought to provide a more rigorous psy-
chometric evaluation of the PHQ than has been done
previously.
Study 1
The primary purpose of this study was to provide
a preliminary empirical assessment of the dimension-
ality of the PHQ via exploratory factor analysis
(EFA). Its secondary purpose was to examine the
internal consistency reliability (i.e., Cronbach’s al-
pha) of the items comprising the obtained factors.
Spence et al. (1987) wrote items to tap four dimen-
sions of somatic health (i.e., quality of sleep, diges-
tion problems, headaches, and respiratory problems).
Accordingly, to provide evidence of discriminant va-
lidity, the four dimensions of somatic health the items
assess should be empirically distinguishable from
one another (although, because they all reflect man-
ifestations of somatic symptoms, we expected them
to correlate to some degree). Therefore, the results of
the factor analysis should demonstrate a four-factor
solution in which the PHQ items have high loadings
on the somatic health dimensions to which they cor-
respond and low cross-loadings (⬍.3) with the other
PHQ factors.
Method
Participants1
In this study, surveys were sent to 496 staff members
from a hospital in Ontario, Canada. Of the surveys, 197
were returned, representing a response rate of 39.7%. Of the
respondents, 92% were female and 8% were male. Partici-
pants’ mean age was 43.4 years (SD ⫽ 8.5), and mean
organizational tenure was 14.9 years (SD ⫽ 7.7). Nurses
and health care aides composed approximately 55% of the
sample, with various other occupations (e.g., clerical, di-
etary, housekeeping, technicians) composing the remaining
45%.
1
The sample from which data for this study come cor-
responds to Sample 1 of Schat and Kelloway’s (2000)
study; however, in this study we focus on item-level data for
the PHQ, whereas the focus of their earlier study was
scale-level data.
366 SCHAT, KELLOWAY, AND DESMARAIS
Measure
To assess somatic health, we used the PHQ, a modified
version of Spence et al.’s (1987) measure of health. The
scale consisted of 14 items (see the Appendix) pertaining to
the frequency with which respondents experience sleep dis-
turbances, headaches, respiratory infections, and gastroin-
testinal problems. Items 1–11 were rated on a 7-point fre-
quency scale, ranging from 1 (not at all) to 7 (all of the
time). Items 12–14 had different frequency-related response
options (see the Appendix for details). Prior to analyzing the
data, we reverse coded all items but Item 4 (endorsement of
this item indicated the absence of symptoms, whereas en-
dorsement of all other items indicated the presence of symp-
toms) so that higher mean scores reflect better somatic
health. The results suggest that the different wording of Item
4 did not adversely affect the factor loadings that were
observed for this item.
Data Analysis
To obtain an initial assessment of the factor structure of
the PHQ, we used principal-components extraction and
rotated the extracted factors to a varimax criterion. The
obtained solution is then cross-validated with data from
independent samples using confirmatory factor analysis
(CFA) in Study 2. This approach, in which EFA precedes
CFA, is generally considered the most appropriate approach
when a scale’s factor structure is first being examined
(Tabachnick & Fidell, 1996) and has been suggested as a
viable strategy for theory development and analysis (Gerb-
ing & Hamilton, 1996).
Results
Prior to conducting the EFA on Sample 1, we
examined the distributions of the PHQ items. Al-
though several items demonstrated slight skewness
(e.g., Items 10 and 13), there were no serious viola-
tions of univariate (e.g., the skewness coefficients for
these items were ⬍2) or multivariate normality, and
all other assumptions were met. One concern that did
emerge, however, was the amount of missing data
produced by Item 14. Sixteen cases were missing
data on this item, whereas no other item had more
than 3 cases missing data. The likely explanation for
this pattern of missing data is that any respondent
who responded with “0 times” to Item 13 (reflecting
no serious respiratory illnesses) would not be able to
respond to Item 14 (which reflects the duration of the
respiratory illness and has, as its lowest response
option, “1 day”). Inspection of the original data re-
veals that 11 of the 16 respondents with missing data
on Item 14 answered “0 times” to Item 13 and a
number of them actually wrote “0 times” or “N/A”
(not applicable) beside that item. Excluding these
cases results in a reduction in sample size (N ⫽ 173
following list-wise deletion) but more importantly
results in the systematic exclusion of healthier re-
spondents (i.e., those who reported experiencing no
serious respiratory infections), compromising the
representativeness of the sample. One means by
which this systematic exclusion could be avoided
would be to impute the lowest response option (i.e.,
a value of 1) on Item 14 for these respondents (re-
sulting in N ⫽ 184). Although this strategy is not
ideal, it is preferable to excluding such individuals
from the sample, which runs the risk of the results
being idiosyncratic to more symptomatic members of
the population and, therefore, less representative. To
determine the appropriateness of this strategy, we
conducted the EFA on both the original (nonimputed)
data (N ⫽ 173) and the adjusted (in which values of
1 were imputed on Item 14 for respondents who
responded “0 times” to Item 13) data (N ⫽ 184). In
both analyses, the sample sizes and the number of
items on the PHQ (14 items) represent case-to-vari-
able ratios that exceed the general guidelines that
have been suggested for EFA (5:1; Gorsuch, 1983).
Because the results were nearly identical,2 we de-
cided to adopt the adjustment strategy described ear-
lier, believing its limitations are less problematic than
excluding a group of less symptomatic respondents.
We also note that in Study 3, we report on the results
of an investigation in which the wording and re-
sponse options of this item are revised to overcome
this limitation.
Principal-components extraction with varimax ro-
tation was performed on the 14 PHQ items using
SPSS for Windows. In both analyses, four factors
were extracted that cumulatively explained 68.9% of
the item variance. The item factor loadings, commu-
nalities, and proportions of variance for individual
factors are found in Table 1, along with item means
and standard deviations. The four factors represented
the following four aspects of physical symptoms:
Gastrointestinal Problems, Headaches, Sleep Distur-
bance, and Respiratory Infections. Following vari-
max rotation, the four factors explained 20.04%,
17.74%, 17.42%, and 13.66% of the item variance,
respectively. Although we hypothesized that the fac-
tors are likely intercorrelated, we used orthogonal
(varimax) rotation because data from Monte Carlo
simulations have shown that varimax rotation accu-
rately represents known parameter estimates (Gerb-
ing & Hamilton, 1996). We note, however, that the
2
Owing to space limitations, we do not report the de-
tailed EFA results for the nonadjusted sample here. How-
ever, they are available on request.
 PHYSICAL HEALTH QUESTIONNAIRE 367

Table 1
Means, Standard Deviations, Factor Loadings, Communalities, and Proportions of Variance for
Principle-Components Extraction With Varimax Rotation for Physical Health Questionnaire Items (Study 1)
Factor loading
Gastrointestinal Sleep Respiratory
Item M SD Problems Headaches Disturbance Infections Communalities
1. How often have you had
difficulty getting to sleep
at night? 4.82 1.42 .24 .21 .65 .11 .54
2. How often have you
woken up during the
night? 4.14 1.53 .06 .05 .85 .11 .74
3. How often have you had
nightmares or disturbing
dreams? 5.54 1.34 .36 .28 .56 .13 .53
4. How often has your
sleep been peaceful and
undisturbed? 4.61 1.54 .07 .17 .85 .03 .76
5. How often have you
experienced headaches? 4.59 1.62 .11 .82 .14 .01 .71
6. How often did you get a
headache when there
was a lot of pressure on
you to get things done? 4.98 1.63 .21 .89 .17 .09 .88
7. How often did you get a
headache when you were
frustrated because things
were not going the way
they should have or
when you were annoyed
at someone? 5.25 1.57 .24 .84 .23 .07 .83
8. How often have you
suffered from an upset
stomach (indigestion)? 5.42 1.39 .79 .16 .23 .14 .72
9. How often did you have
to watch that you ate
carefully to avoid
stomach upsets? 5.40 1.77 .90 .07 .08 .14 .83
10. How often did you feel
nauseated (“sick to your
stomach”)? 5.84 1.20 .75 .16 .26 .17 .68
11. How often were you
constipated or did you
suffer from diarrhea? 5.32 1.53 .63 .24 .03 .19 .50
12. How many times have
you had minor colds
(that made you feel
uncomfortable but didn’t
keep you sick in bed or
make you miss work)? 5.19 1.34 .14 .14 .06 .77 .64
13. How many times have
you had respiratory
infections more severe
than minor colds that
“laid you low” (such as
bronchitis, sinusitis, etc.)? 6.19 1.18 .28 .06 .14 .72 .63
14. When you had a bad
cold or flu, how long did
it typically last? 4.37 1.95 .09 ⫺.05 .09 .79 .65
Percentage of variance
(following rotation) 20.04 17.74 17.42 13.65
Note. Factor loadings exceeding .40 are presented in boldface.
368 SCHAT, KELLOWAY, AND DESMARAIS
results of an EFA involving principal-axis extraction
and oblique (i.e., promax) rotation were consistent
with the reported results and that the hypothesized
factor correlations were incorporated into our CFA
model in Study 2.
Using Cronbach’s (1951) coefficient alpha formula
(as implemented in SPSS for Windows), we calcu-
lated the internal consistency reliabilities of the four
PHQ subscales. These analyses revealed Cronbach’s
alpha of .83, .88, .80, and .66, for Gastrointestinal
Problems, Headaches, Sleep Disturbance, and Respi-
ratory Infections, respectively.
Discussion
This study was carried out as an initial step in the
validation of the PHQ and involved assessing its
factor structure and internal consistency reliability.
The results of the EFA supported the hypothesized
four-dimensional conceptualization corresponding to
the dimensions of physical health that constituted the
original scale (Spence et al., 1987). Specifically, the
results showed that the PHQ is composed for four
factors representing the following four types of phys-
ical symptoms: Gastrointestinal Problems, Head-
aches, Sleep Disturbances, and Respiratory Infec-
tions. The EFA solution showed that the factors were
empirically distinguishable and accounted for sub-
stantial amounts of item variance. In addition, the
PHQ dimensions demonstrated acceptable levels of
internal consistency reliability, although Cronbach’s
alpha was somewhat low for the Respiratory Infec-
tions subscale (i.e., ␣ ⫽ .66).
One of the limitations that emerged in this study
was that Item 14 was characterized by a greater
proportion of missing data than other PHQ items,
likely because of an idiosyncrasy in the response
options used for that item. In particular, a number of
respondents who endorsed the lowest response option
for Item 13 (which measures frequency of experienc-
ing serious respiratory symptoms) did not select a
response on Item 14 (which measures duration of
serious respiratory symptoms). To prevent the sys-
tematic exclusion of these respondents from the anal-
yses, we provisionally adopted an approach whereby
the lowest response option was imputed on Item 14
for these respondents. Comparison of the EFA results
with and without this adjustment showed that they
were nearly identical. Therefore, we elected to adopt
the same strategy in Study 2.
Together, the results of Study 1 provide prelimi-
nary construct validity evidence for the PHQ. How-
ever, these results are only preliminary, and addi-
tional assessment of the PHQ’s construct validity is
needed. This should include replicating the obtained
factor solution on independent data, investigating
whether a hierarchical factor solution provides a
good representation of the structure of the PHQ, and
examining the relationships between the PHQ dimen-
sions and measures of other relevant variables (e.g.,
affect, psychological health) to provide additional
evidence of convergent and discriminant validity.
These issues were examined in Study 2.
Study 2
The purpose of Study 2 was to extend our inves-
tigation of the validity of the PHQ. To this end, we
examined the following issues. First, to evaluate the
robustness of the exploratory factor structure, we
conducted a CFA of the items using a sample of
social service employees. This involved comparing
three models: a one-factor model, a four-factor or-
thogonal model, and a four-factor oblique model. If
the one-factor model demonstrated superior fit, it
would demonstrate that the PHQ factors are not em-
pirically distinguishable. Superior fit of either of the
four-factor models would demonstrate the empirical
distinctiveness of the PHQ dimensions. However,
because we expect the four somatic health dimen-
sions to be related with one another, we hypothesize
that the four-factor oblique model will demonstrate
significantly better fit than the four-factor orthogonal
model. Accordingly, we present the following
hypotheses:
Hypothesis 1: Each PHQ item will be signifi-
cantly associated with one of the four dimen-
sions of somatic health (to reflect the pattern of
results that emerged from the EFA).
Hypothesis 2: The four PHQ factors will be
empirically distinguishable from one another yet
still exhibit significant intercorrelation.
The CFA model that represents this hypothesis is a
four-factor oblique model (in which the four factors
are allowed to correlate freely with one another). A
more sophisticated variation of this model is a hier-
archical model comprising four first-order factors
representing the four types of somatic symptoms and
one second-order factor representing general physical
health. Various commentators have suggested that
hierarchical factor analysis has been underutilized
(e.g., Floyd & Widaman, 1995) and can be useful for
explaining complex factor solutions (Nunnally &
 PHYSICAL HEALTH QUESTIONNAIRE
Bernstein, 1994). The fact that previous research
using the PHQ (e.g., Schat & Kelloway, 2003;
Spence et al., 1987) has used the scale to compute a
single overall index of somatic health provides addi-
tional impetus for such a model. Therefore, in addi-
tion to the models described above, we also specified
a model to test whether a hierarchical factor solution
adequately represents the structure of somatic symp-
toms as measured by the PHQ.
Second, these CFA results were cross-validated
using data from an independent sample of health care
workers. Specifically, we tested the invariance of the
parameters in the final CFA model (i.e., the factor
loadings and intercorrelations) across the two sam-
ples in the study.
Third, the validity of the PHQ was further assessed
by using CFA to test whether the PHQ dimensions
are correlated with yet empirically distinct from a
measure of negative affect. Negative affect comprises
one element of the nomological network (see Cron-
bach & Meehl, 1955) of somatic health. For example,
there is evidence to suggest that negative affect may
become manifest in physical symptoms (Watson &
Clark, 1984; see also Spector, Zapf, Chen, & Frese,
2000). Moreover, on the basis of the physical health
literature reviewed earlier (e.g., Cohen, 1996), one of
the pathways by which exposure to stressors has been
proposed to adversely influence immune functioning
is via negative affect (and its potential influence on
nervous system and hormonal functioning). As a
result, a significant correlation between a measure of
negative affect and the PHQ dimensions could be
considered as evidence of the PHQ’s construct
validity.
Although we believe that negative affect is an
important element of the nomological network of
somatic health, we are mindful that other researchers
have expressed the concern that negative affect may
confound measures of strain, such as somatic symp-
toms (Brief, Burke, George, Robinson, & Webster,
1988). As a result, in addition to testing the hypoth-
esis that there is an association between negative
affect and the PHQ dimensions, our analyses also
include an assessment of the extent to which they are
empirically distinct from one another.
Hypothesis 3: The PHQ factors will be signifi-
cantly associated with, but empirically distinct
from, negative affect.
Fourth, psychological health is also part of the
nomological network of somatic health, and both
psychological and physical symptoms represent po-
369
tential stress outcomes (i.e., strains; Pratt & Barling,
1988). Because previous research has found psycho-
logical health to be correlated with somatic symp-
toms (Herbert & Cohen, 1993) such as headaches
(Rasmussen, 1993) and colds and flus (Stone, Reed,
& Neale, 1987), moderate correlations between the
PHQ factors and psychological health would provide
further construct validity evidence for the PHQ.
Hypothesis 4: The PHQ factors will be posi-
tively correlated with a measure of psychologi-
cal health.
Fifth, we examined the correlation between the
PHQ dimensions and a self-report measure of job
performance to further assess the PHQ’s discriminant
validity. Research has shown that exposure to work-
related stressors can adversely affect job performance
(e.g., Motowidlo, Packard, & Manning, 1986; Stew-
art & Barling, 1996). As a result, reductions in job
performance can be considered a type of behavioral
strain, just as somatic symptoms are a type of phys-
ical strain. However, physical symptoms and job
performance represent very different types of strain
that would not be expected to correlate to a high
degree. Therefore, we examined this correlation to
assess the discriminant validity of the PHQ.3
Finally, we examine the internal consistency of the
subscales to replicate and extend the results of Study
1 and those obtained by previous researchers (Rogers
& Kelloway, 1997; Schat & Kelloway, 2000, 2003;
Spence et al., 1987).
Method
Participants4
Participants in this study came from two sources. Sample
1 comprised employees of a social service agency respon-
sible for the administration of group homes for develop-
mentally disabled adults in Ontario, Canada. Of the 670
surveys that were sent, 205 were returned, for a response
3
Because predicting a nonsignificant correlation amounts
to setting out to prove the null hypothesis, we do not include
a formal hypothesis regarding the relationship between the
PHQ and job performance.
4
The two samples in this study correspond to samples
whose data were used in previous research by Schat and
Kelloway (2000, 2003). Specifically, Sample 1 corresponds
to Sample 2 of their 2000 study, and Sample 2 corresponds
to the sample used in their 2003 study. However, the anal-
yses reported here are distinct from those reported in their
earlier studies as they reported only scale-level data for the
PHQ, whereas in this study we report on item-level data.
370 SCHAT, KELLOWAY, AND DESMARAIS
rate of 30.6%. Seventy-seven percent of the respondents
were female, and the mean age and organizational tenure of
participants were 35.4 years (SD ⫽ 10.5) and 4.7 years
(SD ⫽ 3.7), respectively. Approximately 90% of the sample
consisted of residential counselors and support workers, 5%
were program managers, and the remainder included voca-
tional counselors and relief staff. Sample 2 comprised em-
ployees from three small health care settings in Ontario,
Canada. A total of 863 surveys were distributed, of which
229 were returned, resulting in a response rate of 26.5%.
Eighty-seven percent of the respondents were female. Mean
age and organizational tenure of participants were 40.9
(SD ⫽ 9.8) and 10 years (SD ⫽ 7.3), respectively. A
number of different occupations were represented in the
sample, including nurses and health care aides (approxi-
mately 45%), laboratory and technical staff (13%), and
social workers and counselors (7%).
Measures
PHQ. To assess somatic health, we used the same ver-
sion of the PHQ described in Study 1.
Psychological health. Psychological health was mea-
sured with the 12-item version of the General Health Ques-
tionnaire (GHQ; Banks et al., 1980). The GHQ is often used
to detect minor levels of psychiatric disturbance in the
general population and consists of items relating to depres-
sion, self-confidence, and problem-solving. A 7-point re-
sponse scale was used, with responses ranging from 1
(never) to 7 (always); higher mean scores indicate greater
psychological health. Previous research using the 12-item
version of the GHQ has found its internal consistency to
range from ␣ ⫽ .82 to .90 (Banks et al., 1980; Schat &
Kelloway, 2000). In this study, ␣s ⫽ .86 and .90 for
Samples 1 and 2, respectively.
Negative affect. Negative affect was measured with
Warr’s (1990) six-item scale. Participants were asked how
often their jobs made them uneasy, contented, depressed,
relaxed, enthusiastic, and tense. A 7-point response scale
ranging from 1 (never) to 7 (all of the time) was used.
Positive items (e.g., contented) were reverse coded so that
higher scores represented more negative affect. Internal
consistency of the scale was ␣ ⫽ .84 and .86 for Samples 1
and 2, respectively.
Job performance. Participants provided self-ratings of
their job performance using Stewart and Barling’s (1996)
20-item scale of interpersonal job performance. This scale
was designed to measure performance in direct care roles,
and therefore a number of participants not in these roles did
not provide ratings (resulting in a slightly smaller sample
size for analyses in which this scale is used). A 7-point
response scale was used, ranging from 1 (strongly disagree)
to 7 (strongly agree). Internal consistency of the scale was
␣ ⫽ .92 and .90 for Samples 1 and 2, respectively.
Data Analysis
In this study, data analyses were carried out in the fol-
lowing steps. First, the replicability of the final model
determined via EFA in Study 1 was assessed using CFA,
based on data from Sample 1. Specifically, the fit of the
hypothesized four-factor oblique model was compared with
the fit of a one-factor model and a four-factor orthogonal
model. Convergence of the factor structure across the EFA
and CFA and superior fit of the four-factor oblique model
compared with the one-factor and four-factor orthogonal
models would provide evidence of the scale’s construct
validity.
Second, after comparing these first-order models, we
assessed the fit of a hierarchical CFA model, consisting of
four first-order factors (Gastrointestinal Problems, Head-
aches, Sleep Disturbance, and Respiratory Illness) and one
second-order factor (General Physical Health) using Sample
1 data. The invariance of the parameters of this model
across Samples 1 and 2 was then assessed via multisample
analyses conducted using LISREL 8 (Joreskog & Sorbom,
1996). To test for the invariance of the PHQ factor loadings
and correlations across the two samples, we compared mod-
els in which these parameters are constrained to be equal
with a model in which the parameters are freely estimated
(i.e., not constrained to be equivalent). The constrained
models are nested within the freely estimated model, allow-
ing for the chi-square difference test to test for differences
in the fit of the models. A significant difference in the
chi-square between the two models would suggest a lack of
invariance between the two samples.
Third, to further assess the validity of the PHQ, we
compared the fit of a series of CFA models comprising the
four PHQ factors and a measure of negative affect. The
three models tested were (a) a five-factor oblique model, in
which the four PHQ factors and negative affect represent
separate factors; (b) a one-factor model, in which all PHQ
and negative affect items load onto a single latent variable;
and (c) a four-factor oblique model, in which the negative
affect items load onto all four PHQ factors. Of the three
models to be examined, the one-factor model is the most
constrained model and the four-factor model the least con-
strained. On balance, the superiority of the five-factor model
would provide the strongest support for Hypothesis 3, be-
cause in this model, the PHQ dimensions and negative
affect are correlated with one another but represent inde-
pendent factors. The one-factor model stands in nested
sequence to the five-factor model, but the four-factor model
does not. Therefore, the chi-square difference test was used
to compare the five- and one-factor models, and other fit
indices (e.g., root-mean-square error of approximation
[RMSEA] and goodness-of-fit index [GFI]) were used to
compare the five- and four-factor models. To limit the
complexity of reporting the results, we report the results
using Sample 1 data only. However, we note that the results
were consistent in Sample 2 and are available on request.
Fourth, the PHQ dimensions were correlated with mea-
sures of psychological health and job performance, to assess
convergent and discriminant validity, respectively. Finally,
internal consistency analyses were conducted.
Results
Confirmatory Factor Analysis of PHQ Items
(Sample 1)
Before conducting CFA on Samples 1 and 2, we
tested all assumptions and found them to be within
acceptable limits. As occurred in Study 1, the amount
 PHYSICAL HEALTH QUESTIONNAIRE
of missing data on Item 14 was higher than for the
other PHQ items. In Sample 1, 8 respondents were
missing data on Item 14, whereas no other item had
more than 2 respondents with missing data. In Sam-
ple 2, 18 respondents were missing data on Item 14,
whereas no other item had more than 2 respondents
with missing data. In each sample, all but one of the
Item 14 nonrespondents had endorsed the lowest
option on Item 13. Therefore, using the procedure
outlined in Study 1, values of 1 were imputed for
these respondents, resulting in final samples of N ⫽
194 and N ⫽ 222 for Samples 1 and 2, respectively.
The case-to-variable ratios in these analyses exceed
9:1, which meet the general guidelines that have been
suggested for CFA (between 5:1 and 10:1; Bentler &
Chou, 1987).
We conducted CFA on the covariance matrix of
the PHQ items using maximum likelihood estima-
tion as implemented in LISREL 8 (Joreskog &
Sorbom, 1996). Fit indices for the four-factor
oblique and orthogonal models and a one-factor
model are presented in Table 2. As shown, the
one-factor model provides poor fit to the data,
␹2(77, N ⫽ 194) ⫽ 541.78, p ⬍ .001; RMSEA ⫽
.20, p ⬍ .001; GFI ⫽ .68, as does the four-factor
orthogonal model. ␹2(77, N ⫽ 194) ⫽ 272.08, p ⬍
.001; RMSEA ⫽ .12, p ⬍ .001; GFI ⫽ .82,
whereas the four-factor oblique model provided
adequate but not excellent fit, ␹2(71, N ⫽ 194) ⫽
148.43, p ⬍ .001; RMSEA ⫽ .075, p ⬍ .01; GFI ⫽
.90. CFA models rarely provide good fit to the
data, because of the large number of parameter
constraints inherent in such models (i.e., relatively
few of the total number of possible paths are
estimated). Therefore, assessment of model fit
should involve considerations of comparative as
well as absolute fit (Kelloway, 1998). Accordingly,
because both alternative models we examined are
nested within the four-factor oblique model, a chi-
square difference test was conducted to determine
Table 2
Fit Indices for the Confirmatory Factor Analysis Models of the Physical Health Questionnaire (Study 2,
Sample 1)
Model ␹2
1-factor 541.78**
4-factor orthogonal 272.08**
4-factor oblique (hypothesized) 148.43**
Note. RMSEA ⫽ root-mean-square error of approximation; GFI ⫽ goodness-of-fit index; CFI ⫽ comparative fit index;
PGFI ⫽ parsimonious goodness-of-fit fit index.
* p ⬍ .01. ** p ⬍ .001.
371
which of the three models provided the best fit.
These results showed that the hypothesized four-
factor oblique model provided significantly better
fit than the one-factor, ␹2diff(6) ⫽ 393.35, p ⬍
.001, and four-factor orthogonal models,
␹2diff(6) ⫽ 123.65, p ⬍ .001.
Standardized parameter estimates and associated
R2 values for the four-factor oblique model are
presented in Table 3. As shown, all model param-
eters were significant (p ⬍ .001) and explained
substantial item variance (R2 ranged from .24 to
.73). Parameter estimates representing the associ-
ation between the four factors ranged from ␤ ⫽ .33
to ␤ ⫽ .55.
The fit of the hierarchical model was acceptable,
␹2(73, N ⫽ 194) ⫽ 155.54, p ⬍ .001; RMSEA ⫽
.077, p ⬍ .01; GFI ⫽ .90; comparative fit index [CFI]
⫽ .93; and similar to that of the four-factor oblique
model, providing support for the hierarchical struc-
ture of physical health. A graphical representation of
this structure, including the standardized parameter
estimates representing the relationships among vari-
ables within the model, is presented in Figure 1. As
shown, all parameters are significant in the expected
direction.
Multisample CFA of PHQ Items to Assess
Measurement Invariance
To more rigorously assess the factor structure and
validity of the PHQ, we examined the invariance of the
hierarchical model’s parameters (i.e., first- and second-
order factor loadings and factor covariances) between
Samples 1 and 2. The model was first simultaneously
estimated in both samples, ␹2(146, n ⫽ 194 [Sample 1],
n ⫽ 222 [Sample 2]) ⫽ 306.03, p ⬍ .001. Next, the
parameters in Sample 1 were fixed to be equivalent to
the parameters of Sample 2, ␹2(164, n ⫽ 194 [Sample
1], n ⫽ 222 [Sample 2]) ⫽ 319.28, p ⬍ .001. The
df RMSEA GFI CFI PGFI
77 .20** .68 .59 .50
77 .12** .82 .83 .60
71 .075* .90 .93 .61
372 SCHAT, KELLOWAY, AND DESMARAIS

Table 3
Standardized Parameter Estimates and R2 Values for Confirmatory Factor Analysis of Physical Health
Questionnaire Items (Study 2, Sample 1)
Gastrointestinal Sleep Respiratory
Item M SD Problems Headaches Disturbance Infections R2
1. How often have you had
difficulty getting to sleep at
night? 4.79 1.55 .75 .57
2. How often have you woken up
during the night? 4.05 1.73 .85 .71
3. How often have you had
nightmares or disturbing
dreams? 5.59 1.42 .58 .34
4. How often has your sleep been
peaceful and undisturbed? 4.53 1.53 .67 .45
5. How often have you
experienced headaches? 4.53 1.63 .73 .53
6. How often did you get a
headache when there was a lot
of pressure on you to get things
done? 4.72 1.72 .85 .73
7. How often did you get a
headache when you were
frustrated because things were
not going the way they should
have or when you were
annoyed at someone? 5.36 1.54 .85 .72
8. How often have you suffered
from an upset stomach
(indigestion)? 5.10 1.64 .85 .73
9. How often did you have to
watch that you ate carefully to
avoid stomach upsets? 5.38 1.75 .83 .69
10. How often did you feel nauseated
(“sick to your stomach”)? 5.53 1.40 .79 .63
11. How often were you constipated
or did you suffer from diarrhea? 5.28 1.60 .59 .34
12. How many times have you had
minor colds (that made you feel
uncomfortable but didn’t keep
you sick in bed or make you
miss work)? 4.52 1.69 .74 .54
13. How many times have you had
respiratory infections more
severe than minor colds that
“laid you low” (such as
bronchitis, sinusitis, etc.)? 5.97 1.34 .70 .49
14. When you had a bad cold or
flu, how long did it typically
last? 4.07 1.89 .49 .24
Note. All parameters were significant at p ⬍ .001.

difference of fit between these two models, ␹diff2(18) ⫽
13.25, ns, was nonsignificant, suggesting that the mag-
nitudes of these parameters are invariant across the two
samples.
An additional model, in which the item error vari-
ances were declared invariant (along with the parame-
ters reflecting factor loadings and covariances), was
also specified and its fit compared with the freely esti-
mated model. Its overall fit was ␹2(178, n ⫽ 194 [Sam-
ple 1], n ⫽ 222 [Sample 2]) ⫽ 347.89, p ⬍ .001. The
results of the chi-square difference test, ␹2diff(32) ⫽
41.86, ns, showed a nonsignificant difference in the fit
 PHYSICAL HEALTH QUESTIONNAIRE 373

Item 1
.7 5

.85 Item 2
Sleep . 58
Disturbance Item 3
.66
Item 4

.55
.73 Item 5
. 86
Headaches Item 6
. 85
.74 Item 7
Physical Health
.71 .85 Item 8

Gastro- .83
Item 9
intest inal
.79
Problems
Item 10
.66 .59

Item 11

.76
Respiratory Item 12
Infections .67
Item 13
.48

Item 14

Figure 1. Graphical representation of the hierarchical structure of the Physical Health

Questionnaire (based on the confirmatory factor analysis of Study 2, Sample 1 data). All
parameters are significant at p ⬍ .001. The item numbers indicated in the figure are consistent
with the item numbers indicated in the Appendix.

between these models, suggesting that the parameters
reflecting the factor loadings, factor covariances, and
error variances are invariant across the two samples.
This is particularly strong evidence of measurement
invariance (Vandenberg, 2002) and provides additional
validity evidence for the PHQ.
CFA of PHQ and Negative Affect Items
(Sample 1)
To further assess the discriminant validity of the
PHQ, we compared the fit of a series of CFA models
comprising the four PHQ factors and a measure of
negative affect. Fit indices for the tested models are
presented in Table 4. As expected, the five-factor
oblique model demonstrated significantly better fit to
the data than the one-factor model, ␹2diff(10) ⫽
584.28, p ⬍ .001. Also, as shown in Table 4, the fit
of the less constrained four-factor model (in which
the negative affect items load on all four PHQ fac-
tors) was generally similar to the five-factor model on
a number of the fit indices (e.g., chi-square, GFI).
However, the latter had a lower ␹2/df ratio (2.20) and
better parsimonious fit indices (parsimonious good-
ness-of-fit index [PGFI] ⫽ .64; parsimonious normed
fit index [PNFI] ⫽ .68) than the former (␹2/df ratio ⫽
2.41; PGFI ⫽ .58; PNFI ⫽ .62) suggesting that
although negative affect and the PHQ are correlated,
allowing negative affect items to directly load on
the PHQ factors does not improve—and actually
374 SCHAT, KELLOWAY, AND DESMARAIS

Table 4
Fit Indices for the Confirmatory Factor Analysis Models Including the Physical Health Questionnaire
(PHQ) and Negative Affect Items
Model ␹2 df RMSEA GFI CFI PGFI
a
1-factor 937.07** 170 .170** .62 .52 .50
4-factorb 352.54** 146 .089** .84 .87 .58
5-factorc 352.79** 160 .084** .83 .88 .64
Note. RMSEA ⫽ root-mean-square error of approximation; GFI ⫽ goodness-of-fit index; CFI ⫽ comparative fit index;
PGFI ⫽ parsimonious goodness-of-fit index.
a
This model comprises all PHQ and negative affect items fixed to load on a single factor. b This model comprises the four
PHQ factors, with negative affect items fixed to load on all four factors. c This model comprises the four PHQ factors and
the negative affect items fixed to load on separate factors.
** p ⬍ .001.

reduces—model fit. These results demonstrate that Internal Consistency Analyses

negative affect and physical health (as measured by
the PHQ) are associated but distinct constructs.
Standardized parameter estimates representing the
association between negative affect and the PHQ
dimensions were ␤ ⫽ .47 (Sleep Disturbance), ␤ ⫽
.33 (Headaches), ␤ ⫽ .38 (Gastrointestinal Prob-
lems), and ␤ ⫽ .39 (with Respiratory Illness).5 These
associations support our hypotheses and provide con-
vergent validity evidence for the PHQ.
Internal consistency analyses of the four PHQ sub-
scales revealed the following Cronbach’s alpha val-
ues for Samples 1 and 2, respectively: .84 and .86 for
the Gastrointestinal Problems subscale, .84 and .86
for the Headaches subscale, .79 and .84 for the Sleep
Disturbance subscale, and .66 and .61 for the Respi-
ratory Infections subscale.

Correlations Between the PHQ and GHQ Discussion

Zero-order correlations between psychological
health and the PHQ dimensions were examined and,
as hypothesized, revealed significant associations be-
tween these variables in both samples. Specifically,
the correlations between psychological health and the
four PHQ dimensions for Samples 1 and 2 were,
respectively, .36 and .45 (Gastrointestinal Problems),
.43 and .42 (Headaches), .50 and .62 (Sleep Distur-
bance), and .27 and .23 (Respiratory Infections).
Correlations Between the PHQ and Job
Performance
Zero-order correlations between the PHQ dimen-
sions and self-reported job performance were also
examined.6 As expected, no significant correlations
emerged. Specifically, the correlations between these
variables were, for Samples 1 and 2, respectively, .10
and .002 (Gastrointestinal Problems), .06 and ⫺.04
(Headaches), .05 and .001 (Sleep Disturbance), and
.09 and ⫺.12 (Respiratory Infections). The lack of
correlation provides discriminant validity evidence
for the PHQ.
The results of this study extend the results of Study
1 in several ways. First, the CFAs replicated the
factor structure of the PHQ that was observed using
EFA in Study 1. The hierarchical CFA results ex-
tended these findings by demonstrating that a hierar-
chical solution—in which the four types of somatic
symptoms represent first-order factors and general
physical health represents the second-order factor—
provides a good representation of the structure of the
PHQ. Furthermore, this solution was cross-validated
by demonstrating the invariance of the parameters in
samples of social service employees and health care
workers. Second, the CFAs including negative affect
and PHQ items demonstrated the superior fit of the
5
The zero-order correlations between these variables are
.43, .29, .35, and .31 (all significant at p ⬍ .001).
6
Many items on the job performance scale would not
apply to employees who have no contact with patients or
clients, resulting in somewhat higher levels of missing data
on this scale than others in the study. Therefore, these
analyses are based on sample sizes of N ⫽ 182 for Sample
1 and N ⫽ 193 for Sample 2.
 PHYSICAL HEALTH QUESTIONNAIRE
model in which the four PHQ dimensions and nega-
tive affect represented correlated yet empirically dis-
tinct factors, providing construct validity evidence.
Third, the significant correlations between the GHQ
and PHQ dimensions and the nonsignificant correla-
tions between the measure of job performance and
the PHQ dimensions provide additional evidence of
construct validity. Finally, the reliability analyses
showed that three of the four subscales exhibited
internal consistency coefficients of ␣ ⫽ .79 or
greater.
The most significant limitation in these results with
respect to the validity of the PHQ is the relatively low
levels of internal consistency exhibited by the items
on the Respiratory Illness factor (␣ ⫽ .66 in the
Study 1 sample and .66 and .61 in Samples 1 and 2 of
Study 2, respectively). We believe that one explana-
tion for the low reliability lies with the nature of the
response format used for these three items. As shown
in the Appendix, the response options for these items
differ from one another and those of the other 11
items on the scale. This may create some difficulty
for respondents, resulting in increased levels of
measurement error in their responses and, in turn,
attenuating internal consistency of these items. In
addition, we also discussed the concern with
higher levels of missing data occurring for Item 14
as compared with the other scale items and sug-
gested that this was also due to the nature of the
response options. In Study 3 we sought to address
these concerns by investigating the impact of mod-
ifications to the wording of these items and their
response options.
Study 3
The purpose of this study was to address a limita-
tion of the PHQ that emerged from the results of
Studies 1 and 2. In both of these studies, the 3 items
reflecting respiratory illness exhibited unacceptable
psychometric properties. One of these items (Item
14) was particularly problematic, as its rate of miss-
ing data was higher than other scale items. In this
study, we revised the wording of the 3 items on this
scale to allow for the use of the same response format
as used for the other scale items and conducted a
series of analyses to assess the impact of this revision
on the psychometric properties of the PHQ and, in
particular, on the 3 items composing the Respiratory
Illness subscale.
375
Method
Participants
This study used data from two samples. Both samples
comprised students enrolled in introductory psychology
classes at the University of Guelph (in Ontario, Canada)
who were invited to participate in research (or complete a
small assignment if they preferred to not participate in
research) in exchange for course credit. The survey included
measures of a number of variables related to students’
employment experiences, attitudes, behavior, and well-be-
ing. Data were collected from two different samples of
students, 1 year apart. Sample 1 consisted of 136 partici-
pants, 82.9% of which were women. The average age was
20.41 years (SD ⫽ 3.68). Participants came from various
programs, the most prevalent of which were psychology
(44.7%), biological sciences (9.8%), family and social re-
lations (6.5%), and commerce (5.7%). Seven respondents
did not provide complete data on the PHQ, resulting in a
final sample of N ⫽ 129.
Sample 2 consisted of 198 participants, 81.8% of which
were women. The average age was 19.38 years (SD ⫽
3.05). As with Sample 1, students were enrolled in a variety
of programs, including biological sciences (17.3%), psy-
chology (16.3%), family and social relations (8.7%), and
English (6.1%). Following the deletion of 11 respondents
with missing data on the PHQ, the final sample was N ⫽
187.
Measure
The PHQ, with revisions made to the wording and re-
sponse format of Items 12–14, was used to assess somatic
health. The wording of these items was changed so that the
response options used for the other scale items—a 7-point
scale ranging from 1 (not at all) to 7 (all of the time)—
would also apply to Items 12–14. Below we provide the
revised items:
12. How often have you had minor colds (that made you
feel uncomfortable but didn’t keep you sick in bed or
make you miss work/school)?
13. How often have you had respiratory infections more
severe than minor colds (such as bronchitis sinusitis,
etc.) that “laid you low”?
14. When you have a bad cold or flu, how often does it
last longer than it should?
Data Analysis
To assess the impact of these revisions, we investigated
three issues. First, to determine if the revisions alleviate the
concerns with missing data on Item 14, we examined the
pattern of response and nonresponse to this item. Second,
we conducted multisample CFA to cross-validate the factor
structure of the PHQ that was demonstrated in Studies 1 and
2. Finally, we assessed the internal consistency reliability of
the PHQ subscales, focusing on the Respiratory Illness
376 SCHAT, KELLOWAY, AND DESMARAIS
subscale to determine whether the wording changes im-
proved its internal consistency.
Results
Examination of Pattern of Missing Data
In Sample 1 there was only one case with missing
data on Item 14, and in Sample 2 there were no cases
with missing data. Across all PHQ items, in Sample
1, there were 8 items with no missing data (Items 1,
2, 4, 7, 8, 9, 11, and 12), 4 items with one case
missing data (Items 3, 10, 13, and 14), and 2 items
with two cases missing data (Items 5 and 6). In
Sample 2, there were 5 items with no missing data
(Items 8 –11 and 14), 7 items with one case missing
data (Items 1, 3, 4, 5, 7, 12, and 13), 1 item with two
cases missing data (Item 6), and 1 item with three
cases of missing data (Item 2). Therefore, the data
suggest that the revision to Item 14 reduced the rate
of nonresponse to this item. Moreover, the pattern of
missing data across all PHQ items appears to be
nonsystematic.
Multisample Hierarchical CFA of PHQ Items
Before conducting the CFA on Samples 1 and 2,
we examined the data and found no violations of the
assumptions underlying the analyses. In addition, the
case-to-variable ratios of the analyses conducted are
within the acceptable range (e.g., between 5:1 and
10:1; Bentler & Chou, 1987). The CFAs were based
on the covariance matrix of the PHQ items and were
conducted using maximum likelihood estimation as
implemented in LISREL 8 (Jöreskog & Sörbom,
1996). The model was first freely estimated in both
samples exhibiting acceptable fit, ␹2(146, n ⫽ 129
[Sample 1], n ⫽ 187 [Sample 2]) ⫽ 280.53, p ⬍
.001; RMSEA ⫽ .072, ns; GFI ⫽ .92; CFI ⫽ .94,
with all hypothesized parameters significant in the
expected directions. A second model was then esti-
mated with the Sample 2 parameters (factor loadings,
covariances, and error variances) fixed to be invariant
to those of Sample 1 and also exhibited acceptable fit,
␹2(178, n ⫽ 129 [Sample 1], n ⫽ 187 [Sample 2]) ⫽
322.55, p ⬍ .001; RMSEA ⫽ .065, ns; GFI ⫽ .91;
CFI ⫽ .93. Model comparison showed a nonsignifi-
cant difference between the fit of these two models,
␹2diff(32) ⫽ 42.02, ns, demonstrating the invariance
of the parameters between the two samples.
Internal Consistency Analyses
Internal consistency analyses of the four PHQ sub-
scales revealed the following Cronbach’s alpha val-
ues for Samples 1 and 2, respectively: .84 and .86 for
the Gastrointestinal Problems subscale, .90 in both
samples for the Headaches subscale, .81 in both
samples for the Sleep Disturbance subscale, and .70
and .77 for the Respiratory Illness subscale. The
values for the Respiratory Illness subscale are partic-
ularly notable as they represent a substantial im-
provement in reliability compared with the values
observed in Studies 1 and 2, prior to the revision of
these subscale items (␣ ⬍ .70 in all three samples).
Discussion
This study was undertaken to evaluate the effects
of revisions made to the wording and response format
of the Respiratory Illness items on the PHQ, the
purpose of which was to address problems with miss-
ing data and reliability that emerged in Studies 1 and
2. Results of this study represent three important
contributions of the revisions made to the PHQ Items
12–14 and, more generally, to the validity of the
PHQ. First, the revisions contributed to a reduction in
missing data on Item 14. Nonresponse to this item
was problematic not only because it reduced sample
size (and, therefore, statistical power) but, more sig-
nificantly, because the pattern of nonresponse sys-
tematically excluded the data of healthier respon-
dents (because the item was more likely to result in
the nonresponse of someone experiencing none of the
symptoms indicated by the item). Therefore, that the
wording change led to a substantial reduction in
missing data suggests that it should serve to enhance
both sample size and representativeness in research
using the revised PHQ.
Second, the results suggest that the wording revi-
sion improved the internal consistency of the Respi-
ratory Illness subscale items. Prior to the revision, its
internal consistency was less than ␣ ⫽ .70, whereas
following the revision it exceeded ␣ ⫽ .70. This level
of reliability suggests that the amount of error with
which the PHQ measures the four dimensions of
somatic health falls within conventionally acceptable
levels.
Finally, the CFA results show that the hierarchical
factor structure consisting of four first-order factors
and one second-order general physical health factor
extends to the revised PHQ. Furthermore, because
the data in this study came from a sample of under-
graduate students, the results also demonstrate the
 PHYSICAL HEALTH QUESTIONNAIRE
generalizability of the structure of the PHQ to a
population of undergraduate students (albeit a select
population thereof).
General Discussion
This research was undertaken to evaluate the struc-
ture and psychometric properties of the PHQ. The
factor analysis results across the three studies con-
verged in suggesting that a model consisting of four
first-order factors composed of Gastrointestinal Prob-
lems, Headaches, Sleep Disturbances, and Respira-
tory Illness, and a second-order factor composed of
general physical health, most closely reflected the
data. The EFA solution in Study 1 showed that the
factors were empirically distinguishable and ac-
counted for substantial amounts of item variance. The
CFA results in Study 2 replicated the EFA results and
further established the superiority of the model hy-
pothesizing four oblique first-order factors and a
higher-order general factor over orthogonal and com-
mon factor models.
The demonstration of the factor structure of the
PHQ using EFA on a sample of health care staff
(Study 1) and its cross-validation using CFA on
samples of social services employees, health care
staff (Study 2), and undergraduate students (Study 3)
supports the robustness and generalizability of the
scale’s factor structure and provides strong evidence
of its construct validity. However, it remains for
future research to examine whether the dimensional-
ity of the PHQ generalizes to other populations and is
equivalent for both men and women.
The analyses examining the relationships between
negative affect and the PHQ dimensions demon-
strated that they are significantly associated and em-
pirically distinct. The significant associations be-
tween negative affect and physical health support our
hypotheses and are consistent with previous research
(e.g., Cohen, 1996; Watson & Clark, 1984). The CFA
results also demonstrate that the PHQ factors are
empirically distinguishable from negative affect,
which is important given concerns that have appeared
in the literature regarding the potential confounding
influence of negative affect on self-reports of stress
and strain (e.g., Brief et al., 1988).
The significant correlations between the PHQ di-
mensions and the GHQ and the lack of correlation
between the PHQ and a measure of self-reported job
performance provide additional evidence of the
scale’s construct validity. The correlations between
the PHQ dimensions and the GHQ ranged from .23 to
.62, which are high enough to demonstrate meaning-
377
ful association between the constructs, yet low
enough to suggest that the PHQ is not redundant with
the GHQ. On a more substantive level, these corre-
lations suggest that it is meaningful and important to
separately measure somatic and psychological health
as two different manifestations of strain when a com-
prehensive understanding of participants’ reported
health is required. The absolute values of the corre-
lations between the PHQ dimensions and self-re-
ported job performance ranged from .001 to .12,
providing evidence of the PHQ’s discriminant
validity.
Overall, the internal consistency analyses of the
PHQ subscale items suggest that all four subscales
can be reliably measured with the PHQ. In Studies 1
and 2, the Respiratory Illness subscale exhibited
lower internal consistency than the other three sub-
scales (i.e., ␣ ⬍ .70). Following these studies, we
posited that the different response format used for the
items on this subscale was responsible for this low
internal consistency. The results of Study 3—in
which the effects of modifications to the items’ word-
ing and response format were assessed—substanti-
ated our position, as the internal consistency coeffi-
cients exceeded ␣ ⫽ .70 in both samples.
Limitations and Directions for Future
Research
The data in this study are based entirely on self-
reports, which makes it impossible to objectively
verify the presence of physical symptoms reported by
participants using the PHQ. Despite this and related
concerns with self-reports of physical symptoms, the
available data suggest that alternatives to self-reports,
such as physiological measures, are themselves
fraught with limitations and may be less accurate
than self-reports (Fried, Rowland, & Ferris, 1984).
Furthermore, most stress process models (see Kahn
& Byosiere, 1990, for a review) emphasize the im-
portance of people’s perceptions and subjective ex-
periences, which self-reports are often deemed to
measure. Nonetheless, future research that correlates
more objective measures of somatic health (e.g.,
medical records) with the PHQ dimensions would
provide additional evidence of its construct validity.
Given the growing literature on the effects of sur-
vey characteristics including response format on sur-
vey responses (see Schwarz, 1999, for a review),
research examining the effects and appropriateness of
different response alternatives would also be useful.
The present version of the PHQ uses general frequen-
378 SCHAT, KELLOWAY, AND DESMARAIS
cy-based response options, ranging from not at all to
all of the time. Other response formats that merit
investigation would include options based on specific
frequencies (e.g., ranging from never to daily) or
symptom intensity (e.g., ranging from mild to
severe).
A number of investigators (e.g., Bollen & Lennox,
1991; Fayers, Hand, Bjordal, & Groenvold, 1997;
Spector & Jex, 1998) have suggested the importance
of distinguishing between causal and effect indicators
in measurement. Traditional psychometric theory is
based on the premise that the latent variable deter-
mines the indicators, and therefore, assumes that all
items are effect indicators. With the causal approach,
however, this is reversed, whereby the items deter-
mine the construct. Bollen and Lennox suggested that
the type of indicator on which a measure is based can
influence the type of measurement model that is used
for validation purposes. For example, they argued
that factor and reliability analyses are appropriate for
effect but not causal indicator measures.
To date, the distinction between causal and effect
indicators has not been widely adopted in the orga-
nizational research literature (Spector & Jex, 1998),
and the traditional psychometric approach continues
to be the norm for scale validation. Accordingly, we
elected to apply the traditional psychometric ap-
proach in our assessment of the validity of the PHQ.
We acknowledge, however, that a number of the
PHQ items may be appropriately classified as causal
indicators, and we suggest that researchers should
investigate the potential implications of this classifi-
cation for the PHQ and other organizational
measures.
Despite the validity evidence that we present for
the PHQ, we note that this series of studies does not
fully establish its construct validity, and additional
evidence of convergent and discriminant validity is
needed. Establishing construct validity is a continu-
ous process that unfolds over time with numerous
studies (e.g., Nunnally & Bernstein, 1994; Schwab,
1980), and therefore, a single study— or even several
studies such as we report here— can contribute lim-
ited validity evidence. The validity evidence we
present is based on data collected using a single
method (i.e., self-reports). According to the classic
guidelines suggested by Campbell and Fiske (1959),
further evidence of convergent and discriminant va-
lidity could be provided through the use of different
methods. Indeed, we encourage additional validation
research on the PHQ and other occupational health
measures whose construct validity and psychometric
properties have received too little research attention.
As Spector and Jex (1998) noted, there are hundreds
of measures used in the occupational health literature,
yet very few articles in this literature on scale devel-
opment and validation. Therefore, there are many
measures being used for which limited validity evi-
dence is available. Although comprehensive scale
development and validation is desirable prior to
widespread use of the scale, post hoc validation of
existing measures is superior to the absence thereof,
and we encourage this type of research on measures
for which validity evidence is lacking. The accumu-
lation of the evidence derived from such research is
important on several levels: (a) It ensures that the
measures used are valid; (b) it renders the knowledge
derived from this research more accurate; and, in
turn, (c) it increases the likelihood that interventions
based on such knowledge will be effective.
Conclusion
Taken together, our results suggest that the PHQ is
a psychometrically sound instrument that can be used
to measure four dimensions of somatic health: gas-
trointestinal problems, headaches, sleep disturbances,
and respiratory illness. In addition, composed of only
14 items, the PHQ is a rather brief measure of so-
matic health. With most organizational research stud-
ies involving complex, multivariate designs, instru-
ments that are both efficient to administer and
psychometrically sound are becoming increasingly
important (Stanton, Sinar, Balzer, & Smith, 2002).
Although future research that further examines the
psychometric properties of the scale is required, the
PHQ makes an important contribution to research in
organizational behavior, occupational health psy-
chology, social psychology, and other disciplines in
which a valid self-report measure of physical health
is required.
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 PHYSICAL HEALTH QUESTIONNAIRE 381

Appendix

Physical Health Questionnaire

The following items focus on how you have been feeling physically during the past [period of time]. Please respond by
circling the appropriate number.
Once Some
Not at in a of the Fairly All of
Over the past [period of time] . . . all Rarely while time often Often the time
1. How often have you had
difficulty getting to sleep at
night? 1 2 3 4 5 6 7
2. How often have you woken
up during the night? 1 2 3 4 5 6 7
3. How often have you had
nightmares or disturbing
dreams? 1 2 3 4 5 6 7
4. How often has your sleep
been peaceful and
undisturbed? 1 2 3 4 5 6 7
5. How often have you
experienced headaches? 1 2 3 4 5 6 7
6. How often did you get a
headache when there was a
lot of pressure on you to get
things done? 1 2 3 4 5 6 7
7. How often did you get a
headache when you were
frustrated because things
were not going the way they
should have or when you
were annoyed at someone? 1 2 3 4 5 6 7
8. How often have you suffered
from an upset stomach
(indigestion)? 1 2 3 4 5 6 7
9. How often did you have to
watch that you ate carefully
to avoid stomach upsets? 1 2 3 4 5 6 7
10. How often did you feel
nauseated (“sick to your
stomach”)? 1 2 3 4 5 6 7
11. How often were you
constipated or did you suffer
from diarrhea? 1 2 3 4 5 6 7
12. How many times have you
had minor colds (that made
you feel uncomfortable but
didn’t keep you sick in bed
or make you miss work)? 0 times 1–2 time 3 times 4 times 5 times 6 times 7⫹ times
13. How many times have you
had respiratory infections
more severe than minor
colds that “laid you low”
(such as bronchitis, sinusitis,
etc.)? 0 times 1–2 times 3 times 4 times 5 times 6 times 7⫹ times
14. When you had a bad cold or
flu, how long did it typically
last? 1 day 2 days 3 days 4 days 5 days 6 days 7⫹ days
Note. Item 4 should be reverse scored. This version of the Physical Health Questionnaire was used in Studies 1 and 2. The
wording of and response alternatives for Items 12–14 were revised for Study 3 (see text for details).

Received April 10, 2003

Revision received July 11, 2004
Accepted April 18, 2005 y