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Article: Psychometric properties of the Patient Health Questionnaire-4 among Hong Kong young adults in 2021: Associations with meaning in life and suicidal ideation

TitlePsychometric properties of the Patient Health Questionnaire-4 among Hong Kong young adults in 2021: Associations with meaning in life and suicidal ideation
Authors
Keywordsmeaning in life
measurement invariance
mediation
Patient Health Questionnaire-4 (PHQ-4)
psychological distress
scale validation
suicidal ideation
young adults
Issue Date9-Mar-2023
PublisherFrontiers Media
Citation
Frontiers in Psychiatry, 2023, v. 14 How to Cite?
Abstract

Background: Young adults in Hong Kong are subject to elevated psychological distress given the societal stressors such as civil unrest and COVID-19 pandemic and suicide is a leading cause of death among them. The present study aimed to evaluate the psychometric properties and measurement invariance of the 4-item Patient Health Questionnaire-4 (PHQ-4) as a brief measure of psychological distress and its associations with meaning in life and suicidal ideation (SI) in young adults.

Materials and methods: A mobile survey recruited a large and random sample of 1,472 young adults (Mean age = 26.3 years, 51.8% males) in Hong Kong in 2021. The participants completed the PHQ-4 and Meaning in Life Questionnaire–short form (MLQ-SF) for presence of meaning in life (MIL), SI, COVID-19 impact, and exposure to suicide. Confirmatory factor analysis was conducted to examine the factorial validity, reliability, and measurement invariance of PHQ-4 and MLQ-SF across gender, age, and distress subgroups. Multigroup structural equation model evaluated and compared the direct and indirect effects of latent MIL factor on SI via latent PHQ-4 factor across distress groups.

Results: Both MIL and PHQ-4 supported a 1-factor model with good composite reliability (Ω = 0.80–0.86) and strong factor loadings (λ = 0.65–0.88). Both factors showed scalar invariance across gender, age, and distress groups. MIL showed significant and negative indirect effects (αβ = −0.196, 95% CI = −0.254 to −0.144) on SI via PHQ-4. PHQ-4 showed a stronger mediating role between MIL and SI in the distress group (Δ = −0.146, 95% CI = −0.252 to −0.049) than the non-distress group. Higher MIL predicted higher likelihoods of help-seeking (Odds ratios = 1.46, 95% CI = 1.14–1.88).

Conclusion: The present results support adequate psychometric properties in terms of factorial validity, reliability, convergent validity, and measurement invariance for the PHQ-4 in young adults in Hong Kong. The PHQ-4 demonstrated a substantial mediating role in the relationship between meaning in life and SI in the distress group. These findings support clinical relevance for using the PHQ-4 as a brief and valid measure of psychological distress in the Chinese context.


Persistent Identifierhttp://hdl.handle.net/10722/331913
ISSN
2023 Impact Factor: 3.2
2023 SCImago Journal Rankings: 1.155
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorFong, Ted C T-
dc.contributor.authorHo, Rainbow T H-
dc.contributor.authorYip, Paul S F-
dc.date.accessioned2023-09-28T04:59:34Z-
dc.date.available2023-09-28T04:59:34Z-
dc.date.issued2023-03-09-
dc.identifier.citationFrontiers in Psychiatry, 2023, v. 14-
dc.identifier.issn1664-0640-
dc.identifier.urihttp://hdl.handle.net/10722/331913-
dc.description.abstract<p><strong>Background:</strong> Young adults in Hong Kong are subject to elevated psychological distress given the societal stressors such as civil unrest and COVID-19 pandemic and suicide is a leading cause of death among them. The present study aimed to evaluate the psychometric properties and measurement invariance of the 4-item Patient Health Questionnaire-4 (PHQ-4) as a brief measure of psychological distress and its associations with meaning in life and suicidal ideation (SI) in young adults.</p><p><strong>Materials and methods:</strong> A mobile survey recruited a large and random sample of 1,472 young adults (Mean age = 26.3 years, 51.8% males) in Hong Kong in 2021. The participants completed the PHQ-4 and Meaning in Life Questionnaire–short form (MLQ-SF) for presence of meaning in life (MIL), SI, COVID-19 impact, and exposure to suicide. Confirmatory factor analysis was conducted to examine the factorial validity, reliability, and measurement invariance of PHQ-4 and MLQ-SF across gender, age, and distress subgroups. Multigroup structural equation model evaluated and compared the direct and indirect effects of latent MIL factor on SI <em>via</em> latent PHQ-4 factor across distress groups.</p><p><strong>Results:</strong> Both MIL and PHQ-4 supported a 1-factor model with good composite reliability (Ω = 0.80–0.86) and strong factor loadings (λ = 0.65–0.88). Both factors showed scalar invariance across gender, age, and distress groups. MIL showed significant and negative indirect effects (<em>αβ</em> = −0.196, 95% CI = −0.254 to −0.144) on SI <em>via</em> PHQ-4. PHQ-4 showed a stronger mediating role between MIL and SI in the distress group (Δ = −0.146, 95% CI = −0.252 to −0.049) than the non-distress group. Higher MIL predicted higher likelihoods of help-seeking (Odds ratios = 1.46, 95% CI = 1.14–1.88).</p><p><strong>Conclusion:</strong> The present results support adequate psychometric properties in terms of factorial validity, reliability, convergent validity, and measurement invariance for the PHQ-4 in young adults in Hong Kong. The PHQ-4 demonstrated a substantial mediating role in the relationship between meaning in life and SI in the distress group. These findings support clinical relevance for using the PHQ-4 as a brief and valid measure of psychological distress in the Chinese context.</p>-
dc.languageeng-
dc.publisherFrontiers Media-
dc.relation.ispartofFrontiers in Psychiatry-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectmeaning in life-
dc.subjectmeasurement invariance-
dc.subjectmediation-
dc.subjectPatient Health Questionnaire-4 (PHQ-4)-
dc.subjectpsychological distress-
dc.subjectscale validation-
dc.subjectsuicidal ideation-
dc.subjectyoung adults-
dc.titlePsychometric properties of the Patient Health Questionnaire-4 among Hong Kong young adults in 2021: Associations with meaning in life and suicidal ideation-
dc.typeArticle-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.3389/fpsyt.2023.1138755-
dc.identifier.scopuseid_2-s2.0-85150716899-
dc.identifier.volume14-
dc.identifier.eissn1664-0640-
dc.identifier.isiWOS:000954626100001-
dc.identifier.issnl1664-0640-

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