Psychometric properties of the Patient Health Questionnaire-4 among Hong Kong young adults in 2021: Associations with meaning in life and suicidal ideation

Ted C T Fong; Rainbow T H Ho; Paul S F Yip

doi:10.3389/fpsyt.2023.1138755

Psychometric properties of the Patient Health Questionnaire-4 among Hong Kong young adults in 2021: Associations with meaning in life and suicidal ideation

Front Psychiatry. 2023 Mar 9:14:1138755. doi: 10.3389/fpsyt.2023.1138755. eCollection 2023.

Authors

Ted C T Fong¹, Rainbow T H Ho^{1

2}, Paul S F Yip^{2

3}

Affiliations

¹ Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
² Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
³ Centre for Suicide Research and Prevention, Faculty of Social Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.

Abstract

Background: Young adults in Hong Kong are subject to elevated psychological distress given the societal stressors such as civil unrest and COVID-19 pandemic and suicide is a leading cause of death among them. The present study aimed to evaluate the psychometric properties and measurement invariance of the 4-item Patient Health Questionnaire-4 (PHQ-4) as a brief measure of psychological distress and its associations with meaning in life and suicidal ideation (SI) in young adults.

Materials and methods: A mobile survey recruited a large and random sample of 1,472 young adults (Mean age = 26.3 years, 51.8% males) in Hong Kong in 2021. The participants completed the PHQ-4 and Meaning in Life Questionnaire-short form (MLQ-SF) for presence of meaning in life (MIL), SI, COVID-19 impact, and exposure to suicide. Confirmatory factor analysis was conducted to examine the factorial validity, reliability, and measurement invariance of PHQ-4 and MLQ-SF across gender, age, and distress subgroups. Multigroup structural equation model evaluated and compared the direct and indirect effects of latent MIL factor on SI via latent PHQ-4 factor across distress groups.

Results: Both MIL and PHQ-4 supported a 1-factor model with good composite reliability (Ω = 0.80-0.86) and strong factor loadings (λ = 0.65-0.88). Both factors showed scalar invariance across gender, age, and distress groups. MIL showed significant and negative indirect effects (αβ = -0.196, 95% CI = -0.254 to -0.144) on SI via PHQ-4. PHQ-4 showed a stronger mediating role between MIL and SI in the distress group (Δ = -0.146, 95% CI = -0.252 to -0.049) than the non-distress group. Higher MIL predicted higher likelihoods of help-seeking (Odds ratios = 1.46, 95% CI = 1.14-1.88).

Conclusion: The present results support adequate psychometric properties in terms of factorial validity, reliability, convergent validity, and measurement invariance for the PHQ-4 in young adults in Hong Kong. The PHQ-4 demonstrated a substantial mediating role in the relationship between meaning in life and SI in the distress group. These findings support clinical relevance for using the PHQ-4 as a brief and valid measure of psychological distress in the Chinese context.

Keywords: Patient Health Questionnaire-4 (PHQ-4); meaning in life; measurement invariance; mediation; psychological distress; scale validation; suicidal ideation; young adults.

Grants and funding

This study was supported by the Hong Kong Jockey Club Charities Trust, the General Research Fund grant (GRF/HKU 17606521) and the Collaborative Research Fund (C7151-20GF) of the Research Grants Council. The funding organization had no role in the study design, collection, analysis and interpretation of data, in the writing of the manuscript, and in the decision to submit the manuscript for publication.