A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population

Background: The 4-item Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report questionnaire that consists of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). Given that PHQ-4, PHQ-2, and GAD-2 have not been validated in the general population, this study aimed to investigate their reliability and validity in a large general population sample and to generate normative data.Methods: A nationally representative face-to-face household survey was conducted in Germany in 2006. The survey questionnaire consisted of the PHQ-4, other self-report instruments, and demographic characteristics.Results: Of the 5030 participants (response rate = 72.9%), 53.6% were female and mean (SD) age was 48.4 (18.0) years. The sociodemographic characteristics of the study sample closely match those of the total populations in Germany as well as those in the United States. Confirmatory factor analyses showed very good fit indices for a two-factor solution (RMSEA .027: 90% CI .023-.032). All models tested were structurally invariant between different age and gender groups. Construct validity of the PHQ-4, PHQ-2, and GAD-2 was supported by intercorrelations with other self-report scales and with demographic risk factors for depression and anxiety. PHQ-2 and GAD-2 scores of 3 corresponded to percentile ranks of 93.4% and 95.2%, respectively, whereas PHQ-2 and GAD-2 scores of 5 corresponded to percentile ranks of 99.0% and 99.2%, respectively.Limitation: A criterion standard diagnostic interview for depression and anxiety was not included.Conclusions: Results from this study support the reliability and validity of the PHQ-4, PHQ-2, and GAD-2 as ultra-brief measures of depression and anxiety in the general population. The normative data provided in this study can be used to compare a subject's scale score with those determined from a general population reference group. (C) 2009 Elsevier B.V. All rights reserved.

背景：含4个条目的患者健康问卷（PHQ - 4）是一种超简短的自评问卷，由一个含2个条目的抑郁量表（PHQ - 2）和一个含2个条目的焦虑量表（GAD - 2）组成。鉴于PHQ - 4、PHQ - 2和GAD - 2尚未在普通人群中得到验证，本研究旨在调查它们在一个大型普通人群样本中的信度和效度，并生成常模数据。 方法：2006年在德国进行了一项具有全国代表性的面对面家庭调查。调查问卷包括PHQ - 4、其他自评工具以及人口统计学特征。 结果：在5030名参与者中（应答率 = 72.9%），53.6%为女性，平均（标准差）年龄为48.4（18.0）岁。研究样本的社会人口统计学特征与德国以及美国的总体人口特征非常匹配。验证性因素分析显示，双因素模型的拟合指数非常好（近似误差均方根RMSEA为0.027，90%置信区间为0.023 - 0.032）。所有测试的模型在不同年龄和性别组之间结构不变。PHQ - 4、PHQ - 2和GAD - 2的结构效度得到了与其他自评量表以及与抑郁和焦虑的人口统计学风险因素的相互关系的支持。PHQ - 2和GAD - 2得分为3时，分别对应第93.4%和95.2%的百分位数，而PHQ - 2和GAD - 2得分为5时，分别对应第99.0%和99.2%的百分位数。 局限：未包括针对抑郁和焦虑的标准诊断性访谈。 结论：本研究结果支持PHQ - 4、PHQ - 2和GAD - 2作为普通人群中抑郁和焦虑的超简短测量工具的信度和效度。本研究提供的常模数据可用于将受试者的量表分数与从普通人群参照组中确定的分数进行比较。（C）2009爱思唯尔有限公司。保留所有权利。