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. 2024 Jul 22;24(1):517.
doi: 10.1186/s12888-024-05873-2.

Longitudinal measurement invariance and psychometric properties of the Patient Health Questionnaire-Four in China

Runtang Meng  1   2 , Chen Jiang  3 , Joseph M Dzierzewski  4 , Yihong Zhu  5 , Meng Wang  6 , Nongnong Yang  3 , Xiaoxue Liu  7 , Lina Guo  8 , Yufan Ping  5 , Caojie Zhou  3 , Jiale Xu  3 , Wenjing Zou  3 , Xiaowen Wang  3 , Liping Lu  3 , Haiyan Ma  3   9 , Yi Luo  10 , Karen Spruyt  11
Affiliations

Longitudinal measurement invariance and psychometric properties of the Patient Health Questionnaire-Four in China

Runtang Meng et al. BMC Psychiatry. .

Abstract

Background: Depression and anxiety symptoms among medical students are often a concern. The Patient Health Questionnaire-Four (PHQ-4), an important tool for depression and anxiety screening, is commonly used and easy to administer. This study aimed to assess and update the longitudinal measurement invariance and psychometric properties of the simplified Chinese version.

Methods: A three-wave longitudinal survey was conducted among healthcare students using the PHQ-4. Structural validity was based on one-factor, two-factor, and second-order factor models, construct validity was based on the Self-Rated Health Questionnaire (SRHQ), Sleep Quality Questionnaire (SQQ), and Rosenberg Self-Esteem Scale (RSES), and longitudinal measurement invariance (LMI), internal consistency, and test-retest reliability were based on structural consistency across three time points.

Results: The results of the confirmatory factor analysis indicated that two-factor model was the best fit, and LMI was supported at three time points. Inter-factor, factor-total, and construct validity correlations of the PHQ-4 were acceptable. Additionally, Cronbach's alpha, McDonald's omega, and the intraclass correlation coefficient demonstrated acceptable/moderate to excellent reliability of the PHQ-4.

Conclusions: This study adds new longitudinal evidence that the Chinese version of the PHQ-4 has promising LMI and psychometric properties. Such data lends confidence to the routine and the expanded use of the PHQ-4 for routine screening of depression and anxiety in Chinese healthcare students.

Keywords: Confirmatory factor analysis; Healthcare students; Longitudinal measurement invariance; Patient Health Questionnaire-4; Psychometric properties.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Confirmatory factor analysis results of the PHQ-4 for a two-factor model The one-sided arrows represent factor loadings while the double-sided one represents the covariance between the two factors. The orange, blue, and green color represent values of time 1, 2, and 3 respectively
Fig. 2
Fig. 2
Inter-factor, factor-total, concurrent, and construct correlations between the PHQ, SQQ, and RSES across three time points Color gradient represents correlation level. Red represents a positive correlation. Purple represents a negative correlation Abbreviations: Anx anxiety, Dep depression, PHQ Patient Health Questionnaire, Selfphy self-rated physical condition, Selfpsy self-rated psychological condition, Self self-rated health condition, SDS sleep difficulty subscale, DSS daytime sleepiness subscale, SQQ Sleep Quality Questionnaire, Neg negative subscale, Pos positive subscale, RSES Rosenberg Self‑Esteem Scale, T1 Time 1, T2 Time 2, T3 Time 3
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