Psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) in 9230 adults across seven European countries: Findings from the ESTSS ADJUST study

Evaldas Kazlauskas, Odeta Gelezelyte, Monika Kvedaraite, Dean Ajdukovic, Kerstin Bergh Johannesson, Maria Böttche, Kristina Bondjers, Małgorzata Dragan, Margarida Figueiredo-Braga, Piotr Grajewski, Xenia Anastassiou-Hadjicharalambous, Jana Darejan Javakhishvili, Chrysanthi Lioupi, Brigitte Lueger-Schuster, Joanne Mouthaan, Ines Rezo Bagaric, Luisa Sales, Ingo Schäfer, Suzan Soydas, Lela TsiskarishviliIrina Zrnic Novakovic, Annett Lotzin

Publications: Contribution to journalArticlePeer Reviewed

Abstract

BACKGROUND: The four-item Patient Health Questionnaire-4 (PHQ-4) is a widely used screening measure for depression and anxiety.

OBJECTIVES: This study aimed to test factor structure and measurement invariance in an adult sample of the general population across seven European countries.

METHOD: A total sample of 9230 adults, 71.3 % female, M age = 44.35 (SD = 14.11) from seven countries (Austria, Croatia, Georgia, Germany, Lithuania, Portugal, and Sweden) participated in the study. We applied confirmatory factor analysis (CFA) to examine the factor structure and measurement invariance testing to evaluate measurement equivalence across countries, gender, and age groups.

RESULTS: The CFA yielded that a two-factor PHQ-4 model with separate depression and anxiety factors had the best fit. Partial scalar measurement invariance was established across different groups based on gender, age, and country.

CONCLUSIONS: The PHQ-4 is a valid and reliable measure that can be applied to screen for depression and anxiety in the general population.

LIMITATIONS: The limitation of the study includes the sampling, which resulted in the sample structure with the majority of females, predominantly of high education and from urban communities.

Original languageEnglish
Pages (from-to)18-23
Number of pages6
JournalJournal of Affective Disorders
Volume335
Early online date15 Aug 2023
DOIs
Publication statusPublished - 15 Aug 2023

Austrian Fields of Science 2012

  • 501010 Clinical psychology

Keywords

  • Anxiety
  • Confirmatory factor analysis
  • Depression
  • Measurement invariance
  • PHQ-4
  • Screening

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