The factor structure and measurement invariance of the PHQ-4 and the prevalence of depression and anxiety in a Southeast Asian context amid the COVID-19 pandemic

Norman Biliwang MENDOZA, Cherry Eron FRONDOZO, John Ian Wilzon T. DIZON, Jet Uy BUENCONSEJO

Research output: Contribution to journalArticlespeer-review

1 Citation (Scopus)

Abstract

This study examined the psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) as an ultra-brief screener of depression and anxiety in the Philippines during the COVID-19 outbreak. Data from 4,524 non-clinical community respondents aged 18-73 years old was collected online between March and July 2020. We evaluated the screener’s factor structure, measurement invariance, and criterion-related validity using confirmatory factor analysis (CFA), multigroup CFA, and structural equation modeling (SEM), respectively. We also evaluated the accuracy of the PHQ-4 cut-off scores by comparing the them with the screeners’ full scales (i.e., PHQ-9 and GAD-7). Using the cutoff scores of the screeners, we also estimated the prevalence rates of depression and anxiety. The PHQ-4 has good internal reliability (Cronbach’s α = 0.82). The CFA results show that the two-factor model has an excellent model fit that is superior to the one-factor model. The two-factor model held through increasingly constrained multigroup CFA models across gender, age, and geographical location groups, demonstrating measurement invariance. The SEM model supported the PHQ-4’s theoretical association to stress, negative affect, and positive affect, supporting the screener’s criterion-related validity. In estimating prevalence rates, among those screened by the PHQ-4 cut-off scores for depression (n = 1,905, 42.11%) and anxiety (n = 1,853, 40.96%), 81.78% and 94.06% were consequently screened by the PHQ-9 and GAD-7, respectively. This study supports the reliability, validity, and measurement invariance of the PHQ-4 as an ultra-brief screener of depression and anxiety in a large community sample in Southeast Asia. The inclusion of ultra-brief screeners in COVID-19-related studies and other human disasters, especially among non-clinical samples in low- and middle-income countries, is relevant for the sustainable evaluation and monitoring of the severity mental health symptoms leading to timely and effective mental health service provision. Copyright © 2022 The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Original languageEnglish
JournalCurrent Psychology
Early online dateMar 2022
DOIs
Publication statusE-pub ahead of print - Mar 2022

Citation

Mendoza, N. B., Frondozo, C. E., Dizon, J. I. W. T., & Buenconsejo, J. U. (2022). The factor structure and measurement invariance of the PHQ-4 and the prevalence of depression and anxiety in a Southeast Asian context amid the COVID-19 pandemic. Current Psychology. Advance online publication. doi: 10.1007/s12144-022-02833-5

Keywords

  • Depression
  • Anxiety
  • PHQ-4
  • COVID-19
  • Measurement invariance
  • Philippines
  • PG student publication

Fingerprint

Dive into the research topics of 'The factor structure and measurement invariance of the PHQ-4 and the prevalence of depression and anxiety in a Southeast Asian context amid the COVID-19 pandemic'. Together they form a unique fingerprint.