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 Tsiskarishvili; Irina Zrnic Novakovic; Annett Lotzin

doi:10.1016/j.jad.2023.05.007

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

J Affect Disord. 2023 Aug 15:335:18-23. doi: 10.1016/j.jad.2023.05.007. Epub 2023 May 8.

Authors

Evaldas Kazlauskas¹, Odeta Gelezelyte², Monika Kvedaraite², Dean Ajdukovic³, Kerstin Bergh Johannesson⁴, Maria Böttche⁵, Kristina Bondjers⁶, Małgorzata Dragan⁷, Margarida Figueiredo-Braga⁸, Piotr Grajewski⁷, Xenia Anastassiou-Hadjicharalambous⁹, Jana Darejan Javakhishvili¹⁰, Chrysanthi Lioupi⁹, Brigitte Lueger-Schuster¹¹, Joanne Mouthaan¹², Ines Rezo Bagaric¹³, Luisa Sales¹⁴, Ingo Schäfer¹⁵, Suzan Soydas¹⁶, Lela Tsiskarishvili¹⁷, Irina Zrnic Novakovic¹¹, Annett Lotzin¹⁵

Affiliations

¹ Center for Psychotraumatology, Institute of Psychology, Vilnius University, Lithuania. Electronic address: evaldas.kazlauskas@fsf.vu.lt.
² Center for Psychotraumatology, Institute of Psychology, Vilnius University, Lithuania.
³ Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia.
⁴ National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
⁵ Division of Clinical Psychological Intervention, Freie Universität Berlin, Germany.
⁶ National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden; Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway.
⁷ Faculty of Psychology, University of Warsaw, Poland.
⁸ Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal; Trauma Observatory, Centre for Social Studies (CES), University of Coimbra, Portugal.
⁹ Psychology Program, School of Ηumanities, Social Sciences and Law, University of Nicosia, Cyprus.
¹⁰ Faculty of Arts and Science, Institute of Addiction Studies, Ilia State University, Tbilisi, Georgia.
¹¹ Unit of Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Austria.
¹² Department of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, the Netherlands.
¹³ Department of Social Work, Faculty of Law, University of Zagreb, Croatia.
¹⁴ Trauma Observatory, Centre for Social Studies (CES), University of Coimbra, Portugal; Unit of Psychiatry, Hospital Militar, Coimbra, Portugal.
¹⁵ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁶ Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Utrecht University, the Netherlands.
¹⁷ Faculty of Arts and Science, Institute of Addiction Studies, Ilia State University, Tbilisi, Georgia; The Georgian Centre for Psychosocial and Medical Rehabilitation of Torture Victims, Tbilisi, Georgia.

PMID: 37164064
DOI: 10.1016/j.jad.2023.05.007

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.

Keywords: Anxiety; Confirmatory factor analysis; Depression; Measurement invariance; PHQ-4; Screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anxiety / diagnosis
Anxiety / epidemiology
Anxiety Disorders* / diagnosis
Depression / diagnosis
Depression / epidemiology
Europe
Factor Analysis, Statistical
Female
Humans
Male
Patient Health Questionnaire*
Psychometrics
Reproducibility of Results
Surveys and Questionnaires