Can a global score for anxiety and depression be obtained from the Patient Health Questionnaire (PHQ-4) in the Peruvian population that has experienced the death of a loved one? Empirical support for a unidimensional or two-dimensional model.
DOI:
https://doi.org/10.52379/mcs.v8i3.425Keywords:
Ansiedad, depresión, PHQ-4, psicometríaAbstract
Introduction: Worldwide, anxiety and depression are the most common mental disorders, both in clinical settings and in the general population. The Patient Health Questionnaire-4 is the most widely used open access instrument to assess anxiety and depression in both clinical and community settings. Objective: The study aims to evaluate the psychometric evidence of the Patient Health Questionnaire (PHQ-4). Method: 1015 Peruvian individuals between 18 and 69 years old (M=26.4, SD=9.93, 58.6% women) who experienced the death of a loved one participated. Techniques derived from Classical Test Theory and Item Response Theory (IRT) were used. Results: Three models were tested: one-dimensional (CFI = 0.989; TLI = 0.966; RMSEA = 0.075), the two-factor model (CFI = 1.000; TLI = 1.000; RMSEA = 0.000) and the bifactor model which did not converge. The two-factor model was the one that came closest to a perfect model. Reliability, evaluated using the omega coefficient, was adequate for both the unidimensional model (? = 0.88) and the two-factor model (? anxiety = 0.83; ? depression = 0.78). The IRT analysis indicated that the PHQ-4 items are adequate indicators that can discriminate between those who do or do not present the traits of anxiety and depression. Regarding the relationship between the PHQ-4 and pandemic grief, both the unidimensional model and the two-factor model demonstrated appropriate fit indices. It was shown that the one-dimensional and two-factor models are invariant according to gender and age. Conclusion: Although the one-factor model and two correlated factors show adequate fit indices, the second had a better fit. Furthermore, this model presented adequate reliability, discrimination and a significant relationship with dysfunctional grief.
Downloads
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. https://doi.org/10.1016/j.jpsychores.2022.110970
Kroenke K, Spitzer RL, Williams JBW, Löwe B. An Ultra-Brief Screening Scale for Anxiety and Depression: The PHQ–4. Psychosomatics 2009;50(6):613–21. https://doi.org/10.1016/s0033-3182(09)70864-3
Löwe B, Wahl I, Rose M, Spitzer C, Glaesmer H, Wingenfeld K, Schneider A, Brähler E. A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2010;122(1–2): 86-95. https://doi.org/10.1016/j.jad.2009.06.019
Nochaiwong S, Ruengorn C, Thavorn K, Hutton B, Awiphan R, Phosuya C, Ruanta Y, Wongpakaran N, Wongpakaran T. Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis. Sci Rep. 2021;11(1):1–18. https://doi.org/10.1038/s41598-021-89700-8
Organización Mundial de la Salud. Salud mental y COVID-19: datos iniciales sobre las repercusiones de la pandemia. In Organización Mundial de la Salud. 2022. URL
Ross AM, Ramlawi S, Fakhraei R, Murphy MSQ, Ducharme R, Dingwall-Harvey ALJ, White RR, Ritchie K, Muldoon K, El-Chaâr D. The psychological impact of the COVID-19 pandemic and a SARS-CoV-2 testing programme on obstetric patients and healthcare workers. Womens Health. 2022;18:1-14. https://doi.org/10.1177/17455057221103101
Organización Mundial de la Salud. Trastornos mentales; 2022. URL
Elflein J. Percentage of respondents worldwide who have felt anxiety or depression for more than two weeks as of 2020, by region. Statista; 2022. URL
Zhang SX, Batra K, Xu W, Liu T, Dong RK, Yin A, Delios AY, Chen BZ, Chen RZ, Miller S, Wan X, Ye W, Chen J. Mental disorder symptoms during the COVID-19 pandemic in Latin America – a systematic review and meta-analysis. Epidemiol Psychiatr Sci. 2022;31:1-13. https://doi.org/10.1017/S2045796021000767
Villarreal-Zegarra D, Copez-Lonzoy A, Vilela-Estrada A, Huarcaya-Victoria J. Depression, post-traumatic stress, anxiety, and fear of COVID-19 in the general population and health-care workers. BMC Psychiatry. 2021;21(455):1–14. URL
Shear MK, Skritskaya NA. Bereavement and anxiety. Curr Psychiatry Rep. 2012;14(3):169–175. https://doi.org/10.1007/s11920-012-0270-2
Sarigiannis KA, Tringali JJ, Vu J, England AE, Lietzau S, Hebert C, Banayan D, Basapur S, Glover CM, Shah RC, Gerhart J, Greenberg JA. Symptoms of Anxiety, Depression, and Stress among Families of Critically Ill Patients with COVID-19 A Longitudinal Clinical Trial. Ann Am Thorac Soc. 2023;20(5):705–12. https://doi.org/10.1513/AnnalsATS.202209-797OC
Komischke-Konnerup KB, Zachariae R, Johannsen M, Nielsen LD, O’Connor M. Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis. J Affect Disord Rep. 2021;4:100140. https://doi.org/10.1016/j.jadr.2021.100140
Garabiles MR, Lao CK, Yip P, Chan EWW, Mordeno I, Hall BJ. Psychometric Validation of PHQ–9 and GAD–7 in Filipino Migrant Domestic Workers in Macao (SAR), China. J Pers Assess. 2020;102(6):833-44. https://doi.org/10.1080/00223891.2019.1644343
Stochl J, Fried EI, Fritz J, Croudace TJ, Russo DA, Knight C, Jones PB, Perez J. On Dimensionality, Measurement Invariance, and Suitability of Sum Scores for the PHQ-9 and the GAD-7. Assessment. 2022;29(3):355–66. https://doi.org/10.1177/1073191120976863
Kocalevent RD, Finck C, Jimenez-Leal W, Sautier L, Hinz A. Standardization of the Colombian version of the PHQ-4 in the general population. BMC Psychiatry. 2014;14(1):1-8. https://doi.org/10.1186/1471-244X-14-205
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An Inventory for Measuring Depression. Arch Gen Psychiatr. 1961;4(6):561–71. https://doi.org/10.1001/ARCHPSYC.1961.01710120031004
Kroenke K, Spitzer R, Williams JB. The PHQ-9. J Gen Intern Med. 2001;16:606-13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361-70. https://doi.org/10.1111/J.1600-0447.1983.TB09716.X
Kim HW, Shin C, Lee SH, Han C. Standardization of the Korean version of the patient health Questionnaire-4 (PHQ-4). Clin Psychopharmacol Neurosci. 2021;19(1):104-11. https://doi.org/10.9758/CPN.2021.19.1.104
Khubchandani J, Brey R, Kotecki J, Kleinfelder JA, Anderson J. The Psychometric Properties of PHQ-4 Depression and Anxiety Screening Scale Among College Students. Arch Psychiatr Nurs. 2016;30(4):457-462. https://doi.org/10.1016/j.apnu.2016.01.014
Materu J, Kuringe E, Nyato D, Galishi A, Mwanamsangu A, Katebalila M, Shao A, Changalucha J, Nnko S, Wambura 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):1-8. https://doi.org/10.1186/s12888-020-02735-5
Ahmadi SM, Arani AM, Bakhtiari M, Davazdah Emamy MH. Psychometric properties of Persian version of patient health questionnaires-4 (PHQ-4) in coronary heart disease patients. Iran J Psychiatry Behav Sci. 2019;13(4):1-7. https://doi.org/10.5812/ijpbs.85820
López Guerra VM, Aguirre Mejía AJ, Guerrero Alcedo JM. Propiedades psicométricas y estructura factorial del cuestionario de salud del paciente PHQ-4 en estudiantes universitarios ecuatorianos. Rev. cuba. enferm. 2022;38(3):1–15. URL
Esteban RFC, Mamani-Benito O, Cjuno J, Tito-Betancur M, Caycho-Rodríguez T, Vilca LW, Barrios I. Adaptación y validación de la Patient Health Questionnaire for Depression and Anxiety (PHQ-4) en una muestra de quechua hablantes peruanos. Med. clín. soc. 2024;8(1):63-74. https://doi.org/10.52379/mcs.v8i1.361
Ventura-León JL. ¿Componentes principales o factores comunes?: Comentarios al artículo de Hederich-Martínez y Caballero-Domínguez (2016). CES Psicol. 2017;10(1):146–7. https://doi.org/10.21615/cesp.10.1.9
Ahmadi SM, Arani AM, Bakhtiari M, Davazdah Emamy MH. Psychometric properties of Persian version of patient health questionnaires-4 (PHQ-4) in coronary heart disease patients. Iran J Psychiatry Behav Sci. 2019;13(4):1-7. https://doi.org/10.5812/ijpbs.85820
Sanabria-Mazo JP, Gómez-Acosta A, Castro-Muñoz JA, et al. Dimensionality and reliability of the online version of the Patient Health Questionnaire-4 (PHQ-4) in a large Colombian sample: Results from the PSY-COVID study. Curr Psychol. 2024;43:11182–92. https://doi.org/10.1007/s12144-023-05180-1
Alvarez EAC, Virú-Flores H, Alburqueque-Melgarejo J, Roque-Quezada JC, Valencia JG, Matta GAG, Quiroz DAL. Validación Del Cuestionario Sobre La Salud Del Paciente–9 (Phq-9) En internos de medicina humana de una universidad de referencia del Perú durante la pandemia Covid-19. Rev. Fac. Med. Hum. 2022;22(3):540-6. https://doi.org/10.25176/RFMH.v22i3.3179
Huarcaya-Victoria J, De-Lama-Morán R, Quiros M, Bazán J, López K, Lora D. Propiedades psicométricas del Patient Health Questionnaire (PHQ-9) en estudiantes de medicina en Lima, Perú. Rev Neuropsiquiatr. 2020;83(2):72-8. https://doi.org/10.20453/rnp.v83i2.3749
Anicama GJ, Ignacio CF, Talla BK, Bruno CB. PROPIEDADES PSICOMÉTRICAS DE LA ESCALA DEL TRASTORNO DE ANSIEDAD GENERALIZADA: GAD-7 EN UNIVERSITARIOS DE LIMA, PERÚ. ACPP. 2023;6(2):260-73. https://doi.org/10.56891/acpp.v6i2.361
Franco-Jimenez RA, Nuñez-Magallanes A. Propiedades psicométricas del GAD-7 , GAD-2 y GAD-Mini en universitarios peruanos in Peruvian College Students. Propósitos y Representaciones. 2022;10(1):1-12. http://dx.doi.org/10.20511/pyr2022.v10n1.1437
Furr RM. Psychometrics: An introduction (3rd ed.). Sage publications; 2018.
Hambleton RK, Swaminathan H. Item response theory: Principles and applications. Kluwer Academic Publishers; 1985.
Ato M, López-García JJ, Benavente A. Un sistema de clasificación de los diseños de investigación en psicología. Anal Psicol. 2013;29(3):1038-59. https://doi.org/10.6018/analesps.29.3.178511
Hernández-Ávila CE, Escobar NAC. Introducción a los tipos de muestreo. Alerta. 2019;2(1):75-79. https://doi.org/10.5377/alerta.v2i1.7535
Baltar F, Brunet I. Social research 2.0: virtual snowball sampling method using Facebook. Internet Res. 2012;22(1):57-74. https://doi.org/10.1108/10662241211199960
Lee SA, Neimeyer RA. Pandemic Grief Scale: A screening tool for dysfunctional grief due to a COVID-19 loss. Death Stud 2022;46(1):14-24. https://doi.org/10.1080/07481187.2020.1853885
Caycho-Rodríguez T, Vilca LW, Vivanco-Vidal A, Saroli-Araníbar D, Carbajal-León C, Gallegos WLA, Lee SA. Assessment of dysfunctional grief due to death from COVID-19 in Peru: adaptation and validation of a Spanish version of the pandemic grief scale. Trends Psychol. 2021; 29: 595-616. https://doi.org/10.1007/s43076-021-00091-1
Lee SA, Neimeyer RA, Breen LJ. The Utility of the Pandemic Grief Scale in Identifying Functional Impairment from COVID-19 Bereavement. J Palliat Med. 2021;24(12):1783–8. https://doi.org/10.1089/jpm.2021.0103
McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res. 1995;4(4):293-307. https://doi.org/10.1007/BF01593882
Browne MW, Cudeck R. Alternative Ways of Assessing Model Fit. Sociol Methods Res. 1992;21(2):230-58. https://doi.org/10.1177/0049124192021002005
Xia Y, Yang Y. RMSEA, CFI, and TLI in structural equation modeling with ordered categorical data: The story they tell depends on the estimation methods. Behav Res Methods. 2019;51(1):409-28. https://doi.org/10.3758/s13428-018-1055-2
Dominguez-Lara SA. Propuesta de puntos de corte para cargas factoriales: una perspectiva de fiabilidad de constructo. Enferm Clin. 2018;28(6):401-2. https://doi.org/10.1016/j.enfcli.2018.06.002
Viladrich C, Angulo-Brunet A, Doval E. A journey around alpha and omega to estimate internal consistency reliability. Anal Psicol. 2017;33(3):755-82. https://doi.org/10.6018/analesps.33.3.268401
Byrne BM. Testing for multigroup equivalence of a measuring instrument: a walk through the process. Psicothema. 2008; 20(4): 872–82. URL
Rutkowski L, Svetina D. Measurement Invariance in International Surveys: Categorical Indicators and Fit Measure Performance. Appl Meas Educ. 2017;30(1):39-51. https://doi.org/10.1080/08957347.2016.1243540
Samejima F. Graded response model. In Van Der Linden, W. J. & Hambleton (Eds.). Handbook of modern item response theory. New York: Springer Verlag. pp. 85-100). Springer New York. 1997. https://doi.org/10.1007/978-1-4757-2691-6_5
Maydeu-Olivares A. Goodness-of-Fit Assessment of Item Response Theory Models. Meas. 2013;11(3):71–101. https://doi.org/10.1080/15366367.2013.831680
Revelle W. Package ‘psych’. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://cran.rstudio.org/web/packages/psych/psych.pdf; 2022.
Rosseel Y. Lavaan: An R package for structural equation modeling. J Stat Softw 2012; 48(2): 1-36. https://doi.org/10.18637/jss.v048.i02
Chalmers RP. mirt?: A Multidimensional Item Response Theory Package for the R Environment. J Stat Softw. 2012;48(6):1-29. https://doi.org/10.18637/jss.v048.i06
Ventura-León JL. PsyMetricTools (Software). Github. 2024.
Rizopoulos D. ltm?: An R Package for Latent Variable Modeling and Item Response Theory Analyses. J Stat Softw. 2006;17(5):1-25. https://doi.org/10.18637/jss.v017.i05
Tibubos AN, Otten D, Zöller D, Binder H, Wild PS, Fleischer T, Johar H, Atasoy S, Schulze L, Ladwig KH, Schomerus G, Linkohr B, Grabe HJ, Kruse J, Schmidt CO, Münzel T, König J, Brähler E, Beutel ME. Bidimensional structure and measurement equivalence of the Patient Health Questionnaire-9: sex-sensitive assessment of depressive symptoms in three representative German cohort studies. BMC Psychiatry. 2021; 21(1):1–13. https://doi.org/10.1186/s12888-021-03234-x
Lobos-Rivera ME, Flores?Monterrosa AN, Tejada?Rodríguez JC, Chacón?Andrade ER, Caycho?Rodríguez T, Lee SA, Valencia PD, Carbajal?León C, Vilca LW, Reyes?Bossio M, Gallegos M. Pandemic grief in El Salvador: factors that predict dysfunctional grief due to a COVID?19 death among Salvadoran adults. Psicol Reflex Crit. 2023;36(9):1-11. https://doi.org/10.1186/s41155?023?00250?6
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Carlos Carbajal-León, Tomás Caycho-Rodríguez, Daniel E. Yupanqui-Lorenzo, Christopher Lino-Cruz, Isabel Cabrera Orosco, José Ventura-León, Lindsey W. Vilca, Mario Reyes-Bossio, Christian Córdova-Robles
This work is licensed under a Creative Commons Attribution 4.0 International License.