Psychometric properties of the ultra-brief self-report Patient Health Questionnaire-4 (PHQ-4) to assess anxiety and depression in Arabic-speaking adults

Abstract

Background Anxiety and depression are psychiatric disorders that often coexist and share some features. Developing a simple and cost-efective tool to assess anxiety and depression in the Arabic-speaking population, predominantly residing in low- and middle-income nations where research can be arduous, would be immensely benefcial. The study aimed to translate the four-item composite Patient Health Questionnaire – 4 (PHQ-4) into Arabic and evaluate its psychometric properties, including internal reliability, sex invariance, composite reliability, and correlation with measures of psychological distress. Methods 587 Arabic-speaking adults were recruited between February and March 2023. An anonymous self-administered Google Forms link was distributed via social media networks. We utilized the FACTOR software to explore the factor structure of the Arabic PHQ-4. Results Confrmatory factor analysis (CFA) indicated that ft of the two-factor model of the PHQ-4 scores was modest (χ 2 / df=.13/1=.13, RMSEA=.001, SRMR=.002, CFI=1.005, TLI=1.000). Internal reliability was excellent (McDonald’s omega=.86; Cronbach’s alpha=.86). Indices suggested that confgural, metric, and scalar invariance were supported acrosssex. No significant diference wasfound between males and females in terms of the PHQ-4 total scores, PHQ-4 anxiety scores, and PHQ-4 depression scores. The total score of the PHQ-4 and its depression and anxiety scores were signifcantly and moderately-tostrongly associated with lower wellbeing and higher Depression Anxiety and Stress Scale (DASS) total and subscales scores. Conclusion The PHQ-4 proves to be a reliable, valid, and cost-efective tool for assessing symptoms related to depression and anxiety. To evaluate the practical efectiveness of the Arabic PHQ-4 and to further enhance the data on its construct validity, future studies should assess the measure in diverse contexts and among specifc populations