Psychometric Network Analysis of the Patient Health Questionnaire-4 (PHQ-4) in Paraguayan General Population

Overview

Journal Psicol Reflex Crit

Specialty Psychology

Date 2024 Apr 15

PMID 38619689

Authors

Tomas Caycho-Rodriguez

Aaron Travezano-Cabrera

Julio Torales

Ivan Barrios

Lindsey W Vilca

Antonio Samaniego-Pinho

Rodrigo Moreta-Herrera

Mario Reyes-Bossio

Nicol A Barria-Asenjo

Jesus Ayala-Colqui

Cirilo H Garcia-Cadena

Affiliations

Soon will be listed here.

Abstract

Background: Depression and anxiety are two of the most prevalent and disabling mental disorders worldwide, both in the general population and in outpatient clinical settings.

Objective: This study aimed to analyze the psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) based on network analysis metrics.

Methods: A total of 911 Paraguayans (23.71% women and 76.29% men; mean age 31.25 years, SD = 10.63), selected by non-probabilistic convenience sampling, participated in the study. Network analysis was used to evaluate the internal structure, reliability, and measurement invariance between men and women.

Results: The results revealed that the PHQ-4 is a unidimensional measure through Exploratory Graph Analysis (EGA). Reliability, through structural consistency, identified that 100% of the time, only a single dimension was obtained, and all items remained stable, as they were always replicated within the empirical dimension. The unidimensional structure has shown evidence of configural invariance; therefore, the network structure functioned equally among the different sex groups.

Conclusion: The PHQ-4 presented optimal preliminary evidence of validity based on its internal structure, reliability, and invariance between sexes. Therefore, it may be useful as an accurate and brief measure of anxiety and depressive symptoms in the Paraguayan context.

References

Christodoulaki A, Baralou V, Konstantakopoulos G, Touloumi G . Validation of the Patient Health Questionnaire-4 (PHQ-4) to screen for depression and anxiety in the Greek general population. J Psychosom Res. 2022; 160:110970. DOI: 10.1016/j.jpsychores.2022.110970. View

Renovanz M, Soebianto S, Tsakmaklis H, Keric N, Nadji-Ohl M, Beutel M . Evaluation of the psychological burden during the early disease trajectory in patients with intracranial tumors by the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4). Support Care Cancer. 2019; 27(12):4469-4477. DOI: 10.1007/s00520-019-04718-z. View

Hartung T, Friedrich M, Johansen C, Wittchen H, Faller H, Koch U . The Hospital Anxiety and Depression Scale (HADS) and the 9-item Patient Health Questionnaire (PHQ-9) as screening instruments for depression in patients with cancer. Cancer. 2017; 123(21):4236-4243. DOI: 10.1002/cncr.30846. View

Golino H, Shi D, Christensen A, Garrido L, Nieto M, Sadana R . Investigating the performance of exploratory graph analysis and traditional techniques to identify the number of latent factors: A simulation and tutorial. Psychol Methods. 2020; 25(3):292-320. PMC: 7244378. DOI: 10.1037/met0000255. View

Ohayon M, Hong S . Prevalence of major depressive disorder in the general population of South Korea. J Psychiatr Res. 2005; 40(1):30-6. DOI: 10.1016/j.jpsychires.2005.02.003. View

Hallquist M, Wright A, Molenaar P . Problems with Centrality Measures in Psychopathology Symptom Networks: Why Network Psychometrics Cannot Escape Psychometric Theory. Multivariate Behav Res. 2019; 56(2):199-223. PMC: 7012663. DOI: 10.1080/00273171.2019.1640103. View

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

Schmank C, Goring S, Kovacs K, Conway A . Psychometric Network Analysis of the Hungarian WAIS. J Intell. 2019; 7(3). PMC: 6789747. DOI: 10.3390/jintelligence7030021. View

Gilbody S, Sheldon T, House A . Screening and case-finding instruments for depression: a meta-analysis. CMAJ. 2008; 178(8):997-1003. PMC: 2276549. DOI: 10.1503/cmaj.070281. View

10.

Hevey D . Network analysis: a brief overview and tutorial. Health Psychol Behav Med. 2021; 6(1):301-328. PMC: 8114409. DOI: 10.1080/21642850.2018.1521283. View

11.

ZUNG W . A SELF-RATING DEPRESSION SCALE. Arch Gen Psychiatry. 1965; 12:63-70. DOI: 10.1001/archpsyc.1965.01720310065008. View

12.

Mendoza N, Frondozo C, Dizon J, Buenconsejo J . 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. Curr Psychol. 2022; :1-10. PMC: 8887801. DOI: 10.1007/s12144-022-02833-5. View

13.

Epskamp S, Rhemtulla M, Borsboom D . Generalized Network Psychometrics: Combining Network and Latent Variable Models. Psychometrika. 2017; 82(4):904-927. DOI: 10.1007/s11336-017-9557-x. View

14.

Epskamp S, Fried E . A tutorial on regularized partial correlation networks. Psychol Methods. 2018; 23(4):617-634. DOI: 10.1037/met0000167. View

15.

Soares G, Santiago P, Werneck R, Michel-Crosato E, Jamieson L . A Psychometric Network Analysis of OHIP-14 across Australian and Brazilian Populations. JDR Clin Trans Res. 2020; 6(3):333-342. DOI: 10.1177/2380084420939931. View

16.

Khubchandani J, Brey R, Kotecki J, Kleinfelder J, Anderson J . The Psychometric Properties of PHQ-4 Depression and Anxiety Screening Scale Among College Students. Arch Psychiatr Nurs. 2016; 30(4):457-62. DOI: 10.1016/j.apnu.2016.01.014. View

17.

Giuntoli L, Vidotto G . Exploring Diener's Multidimensional Conceptualization of Well-Being Through Network Psychometrics. Psychol Rep. 2020; 124(2):896-919. DOI: 10.1177/0033294120916864. View

18.

Van Borkulo C, Boschloo L, Borsboom D, Penninx B, Waldorp L, Schoevers R . Association of Symptom Network Structure With the Course of [corrected] Depression. JAMA Psychiatry. 2015; 72(12):1219-26. DOI: 10.1001/jamapsychiatry.2015.2079. View

19.

Kazlauskas E, Gelezelyte O, Kvedaraite M, Ajdukovic D, Johannesson K, Bottche M . 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; 335:18-23. DOI: 10.1016/j.jad.2023.05.007. View

20.

Materu J, Kuringe E, Nyato D, Galishi A, Mwanamsangu A, Katebalila M . The psychometric properties of PHQ-4 anxiety and depression screening scale among out of school adolescent girls and young women in Tanzania: a cross-sectional study. BMC Psychiatry. 2020; 20(1):321. PMC: 7304148. DOI: 10.1186/s12888-020-02735-5. View