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

Journal of Affective Disorders

Volumn 122, Issue 1-2, 2010, Pages 86-95

  Löwe, Bernd ^a   Wahl, Inka ^a   Rose, Matthias ^a   Spitzer, Carsten ^a   Glaesmer, Heide ^b   Wingenfeld, Katja ^a   Schneider, Antonius ^c   Brähler, Elmar ^b  

^a UNIVERSITY MEDICAL CENTER HAMBURG EPPENDORF   (Germany)

^b UNIVERSITY OF LEIPZIG   (Germany)

^c UNIVERSITY HOSPITAL HEIDELBERG   (Germany)

Author keywords

Anxiety; Depression; Patient Health Questionnaire (PHQ); Psychometrics; Screening; Validation studies

Indexed keywords

ADULT; AGED; ANXIETY; ARTICLE; DEPRESSION; FEMALE; HEALTH SURVEY; HUMAN; MAJOR CLINICAL STUDY; MALE; NEUROPSYCHOLOGICAL TEST; PATIENT HEALTH QUESTIONNAIRE; PRIORITY JOURNAL; RISK FACTOR; SELF REPORT; STRUCTURED INTERVIEW;

ADULT; AGED; ANXIETY DISORDERS; DEPRESSIVE DISORDER; FEMALE; GERMANY; HEALTH SURVEYS; HUMANS; MALE; MASS SCREENING; MIDDLE AGED; PSYCHOMETRICS; QUESTIONNAIRES; REPRODUCIBILITY OF RESULTS;

EID: 77649190622     PISSN: 01650327     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.jad.2009.06.019     Document Type: Article

References (58)

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV. 4th ed (1994), American Psychiatric Association, Washington DC
2. Ansseau M., Dierick M., Buntinkx F., Cnockaert P., De Smedt J., Van Den H.M., and Vander M.D. High prevalence of mental disorders in primary care. J. Affect. Disord. 78 (2004) 49-55
3. Arbuckle J.L. Amos 16.0 User's Guide (2007), Amos Development Cooperation, Spring House, PA
4. Bennett I.M., Coco A., Coyne J.C., Mitchell A.J., Nicholson J., Johnson E., Horst M., and Ratcliffe S. Efficiency of a two-item pre-screen to reduce the burden of depression screening in pregnancy and postpartum: an IMPLICIT network study. J. Am. Board Fam. Med. 21 (2008) 317-325
5. Bentler P.M., and Bonett D.G. Significance tests and goodness of fit in the analysis of covariance structures. Psychol. Bull. 88 (1980) 588-606
6. Bjelland I., Dahl A.A., Haug T.T., and Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J. Psychosom. Res. 52 (2002) 69-77
7. Bland J.M., and Altman D.G. Cronbach's alpha. BMJ 314 (1997) 572
8. Bracken B., and Barona A. State of the art procedures for translating, validating and using psychoeducational tests in cross-cultural assessment. Sch. Psychol. Int. 12 (1991) 119-132
9. Carter R.M., Wittchen H.U., Pfister H., and Kessler R.C. One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depress. Anxiety 13 (2001) 78-88
10. Clark D.A., Steer R.A., and Beck A.T. Common and specific dimensions of self-reported anxiety and depression: implications for the cognitive and tripartite models. J. Abnorm. Psychology 103 (1994) 645-654
11. Cohen J. Statistical power analysis for the behavioral sciences (1988), Lawrence Earlbaum Associates, Hillsdale, NJ
12. Corson K., Gerrity M.S., and Dobscha S.K. Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item. Am. J. Manag. Care 10 (2004) 839-845
13. Demyttenaere K., Bruffaerts R., Posada-Villa J., Gasquet I., Kovess V., Lepine J.P., Angermeyer M.C., Bernert S., de Girolamo G., Morosini P., Polidori G., Kikkawa T., Kawakami N., Ono Y., Takeshima T., Uda H., Karam E.G., Fayyad J.A., Karam A.N., Mneimneh Z.N., Medina-Mora M.E., Borges G., Lara C., de Graaf R., Ormel J., Gureje O., Shen Y., Huang Y., Zhang M., Alonso J., Haro J.M., Vilagut G., Bromet E.J., Gluzman S., Webb C., Kessler R.C., Merikangas K.R., Anthony J.C., Von Korff M.R., Wang P.S., Brugha T.S., Aguilar-Gaxiola S., Lee S., Heeringa S., Pennell B.E., Zaslavsky A.M., Ustun T.B., and Chatterji S. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291 (2004) 2581-2590
14. Ferring D., and Filipp S. Measurement of self-esteem: findings regarding reliability, validity, and stability of the Rosenberg Scale. Diagnostica 42 (1996) 284-292
15. Gilbody S., Richards D., Brealey S., and Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J. Gen. Intern. Med. 22 (2007) 1596-1602
16. Gräfe K., Zipfel S., Herzog W., and Löwe B. Screening for psychiatric disorders with the Patient Health Questionnaire (PHQ). Results from the German validation study. Diagnostica 50 (2004) 171-181
17. Henrich G., and Herschbach P. Questions on life satisfaction - a short measure for assessing quality of life. Eur. J. Psychol. Assess. 16 (2000) 159
18. Holzapfel N., Müller-Tasch T., Wild B., Jünger J., Zugck C., Remppis A., Herzog W., and Löwe B. Depression profile in patients with and without chronic heart failure. J. Affect. Disord. 105 (2008) 53-62
19. Hu L., and Bentler P.M. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct. Equ. Modeling 6 (1999) 1-55
20. Kaplan R.M., and Saccuzzo D.P. Psychological testing. Principles, Applications, and Issues (1993), Brooks/Cole, Pacific Grove
21. Katon W., and Roy-Byrne P. Anxiety disorders: efficient screening is the first step in improving outcomes. Ann. Intern. Med. 146 (2007) 390-392
22. Kessler R.C., McGonagle K.A., Zhao S., Nelson C.B., Hughes M., Eshleman S., Wittchen H.U., and Kendler K.S. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch. Gen. Psychiatry 51 (1994) 8-19
23. Kessler R.C., Keller M.B., and Wittchen H.U. The epidemiology of generalized anxiety disorder. Psychiatr. Clin. North Am. 24 (2001) 19-39
24. Kessler R.C., Berglund P., Demler O., Jin R., Koretz D., Merikangas K.R., Rush A.J., Walters E.E., and Wang P.S. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289 (2003) 3095-3105
25. Kessler R.C., Berglund P., Demler O., Jin R., Merikangas K.R., and Walters E.E. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry 62 (2005) 593-602
26. Kessler R.C., Chiu W.T., Demler O., Merikangas K.R., and Walters E.E. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry 62 (2005) 617-627
27. Kessler R.C., Demler O., Frank R.G., Olfson M., Pincus H.A., Walters E.E., Wang P., Wells K.B., and Zaslavsky A.M. Prevalence and treatment of mental disorders, 1990 to 2003. N. Engl. J. Med. 352 (2005) 2515-2523
28. Kroenke K., Spitzer R.L., and Williams J.B. The PHQ-9. Validity of a brief depression severity measure. J. Gen. Intern. Med. 16 (2001) 606-613
29. Kroenke K., Spitzer R.L., and Williams J.B. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med. Care 41 (2003) 1284-1292
30. Kroenke K., Spitzer R.L., Williams J.B., Monahan P.O., and Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann. Intern. Med. 146 (2007) 317-325
31. Kroenke K., Spitzer R., Williams J.W., and Löwe B. An Ultra-Brief Screening Scale for Anxiety and Depression: the PHQ-4. Psychosomatics 50 (2009) 613-621
32. Lee S.Y., Poon W.Y., and Bentler P.M. A two-stage estimation of structural equation models with continuous and polytomous variables. Br. J. Math. Stat. Psychol. 48 Pt 2 (1995) 339-358
33. Leon A.C., Olfson M., Broadhead W.E., Barrett J.E., Blacklow R.S., Keller M.B., Higgins E.S., and Weissman M.M. Prevalence of mental disorders in primary care. Implications for screening. Arch. Fam. Med. 4 (1995) 857-861
34. Li C., Friedman B., Conwell Y., and Fiscella K. Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. J. Am. Geriatr. Soc. 55 (2007) 596-602
35. Löwe B., Gräfe K., Zipfel S., Spitzer R.L., Herrmann-Lingen C., Witte S., and Herzog W. Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians' diagnosis. J. Psychosom. Res. 55 (2003) 515-519
36. Löwe B., Spitzer R.L., Gräfe K., Kroenke K., Quenter A., Zipfel S., Bucholz C., Witte S., and Herzog W. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses. J. Affect. Disord. 78 (2004) 131-140
37. Löwe B., Gräfe K., Zipfel S., Witte S., Loerch B., and Herzog W. Diagnosing ICD-10 depressive episodes: superior criterion validity of the Patient Health Questionnaire. Psychother. Psychosom. 73 (2004) 386-390
38. Löwe B., Kroenke K., and Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J. Psychosom. Res. 58 (2005) 163-171
39. Löwe B., Decker O., Müller S., Brähler E., Schellberg D., Herzog W., and Herzberg P.Y. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med. Care 46 (2008) 266-274
40. Löwe B., Spitzer R.L., Williams J.B., Mussell M., Schellberg D., and Kroenke K. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen. Hosp. Psych. 30 (2008) 191-199
41. Mitchell A.J., and Coyne J.C. Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. Br. J. Gen. Pract. 57 (2007) 144-151
42. Monahan P.O., Shacham E., Reece M., Kroenke K., Ong'or W.O., Omollo O., Yebei V.N., and Ojwang C. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J. Gen. Intern. Med. 24 (2009) 189-197
43. National Institute for Health and Clinical Excellence. Depression: management of depression in primary and secondary care. Clinical Guideline vol. 23 (2004), NICE, London
44. Pastore D.R., Fisher M., and Friedman S.B. Abnormalities in weight status, eating attitudes, and eating behaviors among urban high school students: correlations with self-esteem and anxiety. J Adolesc. Health 18 (1996) 312-319
45. Quintana S.M., and Maxwell S.E. Implications of recent developments in structural equation modeling for counseling psychology. Couns. Psychol. 27 (1999) 485-527
46. Rief W., Nanke A., Klaiberg A., and Braehler E. Base rates for panic and depression according to the Brief Patient Health Questionnaire: a population-based study. J. Affect. Disord. 82 (2004) 271-276
47. Rosenberg M. Society and the Adolescent Self-Image (1965), Princeton University Press, Princeton, NJ
48. Sackett D.L., and Haynes R.B. The architecture of diagnostic research. BMJ 324 (2002) 539-541
49. Schumacher J., Leppert K., Gunzelmann T., Strauß B., and Brähler E. Resilienzskala - Ein Fragebogen zur Erfassung der psychischen Widerstandsfähigkeit als Personenmerkmal. [Resilience Scale - a questionnaire to assess psychological resilience as personality trait]. Z. Klin. Psychol. Psychiatr. 53 (2005) 16-39
50. Spitzer R.L., Kroenke K., Williams J.B., and Patient Health Questionnaire Primary Care Study Group. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA 282 (1999) 1737-1744
51. Spitzer R.L., Kroenke K., Williams J.B., and Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch. Intern. Med. 166 (2006) 1092-1097
52. Statistisches Bundesamt. Mikrozensus 2005 (2006), Statistisches Bundesamt, Wiesbaden
53. Steiger J.H. Structural model evaluation and modification: an interval estimation approach. Multivariate Behav. Res. 25 (1990) 173-180
54. Thombs B.D., Ziegelstein R.C., and Whooley M.A. Optimizing detection of major depression among patients with coronary artery disease using the patient health questionnaire: data from the heart and soul study. J. Gen. Intern. Med. 23 (2008) 2014-2017
55. Tucker L.R., and Lewis C. The reliability coefficient for maximum likelihood factor analysis. Psychometrika 38 (1973) 1-10
56. U.S. Preventive Services Task Force. Screening for depression: recommendations and rationale. Ann. Intern. Med. 136 (2002) 760-764
57. Wittchen H.U., Zhao S., Kessler R.C., and Eaton W.W. DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch. Gen. Psychiatry 51 (1994) 355-364
58. Wittchen H.U., Carter R.M., Pfister H., Montgomery S.A., and Kessler R.C. Disabilities and quality of life in pure and comorbid generalized anxiety disorder and major depression in a national survey. Int. Clin. Psychopharmacol. 15 (2000) 319-328