Psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) in 9230 adults across seven European countries

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

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.

Institut für Klinische und Gesundheitspsychologie
Externe Organisation(en)
Vilnius University (VU), University of Zagreb, Uppsala University, Freie Universität Berlin (FU), Norwegisches Forschungszentrum für Gewalt und traumatischen Stress, SWPS University of Social Sciences and Humanities, University of Nicosia, Ilia State University, Leiden University, Universidade de Coimbra, Universitätsklinikum Hamburg-Eppendorf, Utrecht University, The Georgian Centre for Psychosocial and Medical Rehabilitation of Torture Victims Tbilisi, Georgia., Medical School Hamburg, Universidade do Porto, Ivane Javakhishvili Tbilisi State University
Journal of Affective Disorders
Anzahl der Seiten
ÖFOS 2012
501010 Klinische Psychologie
ASJC Scopus Sachgebiete
Psychiatry and Mental health, Clinical Psychology
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