The present study evaluated the psychometric properties of the Patient Health Questionnaire–4 (PHQ-4), a screener of psychological distress, in English- and Spanish-speaking Hispanic Americans. Hispanic American adults (N = 436) completed the PHQ-4, which yields two subscales (Anxiety and Depression) that can be summed to create a total score. Multiple-group confirmatory factor analysis was used to evaluate structural validity. The two-factor structure was the best fit to the data for both English- and Spanish-speaking Hispanic Americans, and items loaded equivalently across groups, demonstrating measurement invariance. Internal consistency reliability was good as measured by coefficient alpha. Construct validity was evidenced by significant expected relationships with perceived stress. These findings provide support for the reliability and validity of the PHQ-4 as a brief measure of psychological distress for English- or Spanish-speaking Hispanic Americans.
BentlerP. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238-246.
2.
CohenS.KamarckT.MermelsteinR. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385-396.
3.
DerogatisL. R. (1993). The Brief Symptom Inventory (BSI): Administration, scoring and procedures manual (3rd ed.). Minneapolis, MN: National Computer System.
4.
FloydF. J.WidamanK. F. (1995). Factor analysis in the development and refinement of clinical assessment instruments. Psychological Assessment, 7, 286-299.
5.
García-CampayoJ.ZamoranoE.RuizM. A.PardoA.Pérez-PáramoM.López-GómezV.. . . RejasJ. (2010). Cultural adaptation into Spanish of the Generalized Anxiety Disorder–7 (GAD-7) Scale as a screening tool. Health and Quality of Life Outcomes, 8, Article 8. doi:10.1186/1477-7525-8-8
6.
GerbingD. W.AndersonJ. C. (1992). Monte Carlo evaluations of goodness-of-fit indices for structural equation models. Sociological Methods Research, 21, 132-160.
7.
HenrichG.HerschbachP. (2000). Questions of Life Satisfaction: A short measure for assessing quality of life. European Journal of Psychological Assessment, 16, 150-159.
8.
HuL. T.BentlerP. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1-55.
9.
IBM. (2011). IBM SPSS Statistics for Windows, version 20.0. Armonk, NY: Author.
10.
KerperL.SpiesC. D.TillingerJ.WegscheiderK.SalzA.Weiss-GarlachE.. . . KrampeH. (2014). Screening for depression, anxiety, and general psychological distress in pre-operative surgical patients: A psychometric analysis of the Patient Health Questionnaire–4 (PHQ-4). Clinical Health Promotion, 4, 5-14.
11.
KroenkeK.SpitzerR. L.WilliamsJ. B. (2003). The Patient Health Questionnaire–2: Validity of a two-item depression screener. Medical Care, 41, 1284-1292.
12.
KroenkeK.SpitzerR. L.WilliamsJ. B.LoweB. (2009). An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics, 50, 613-621.
13.
KroenkeK.SpitzerR. L.WilliamsJ. B.MonahanP. O.LoweB. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 164, 317-325.
14.
LoweB.WahlI.RoseM.SpitzerC.GlaesmerH.WingeneldK.. . . BrahlerE. (2010). 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, 122, 86-95.
15.
MuthénL. K.MuthénB. O. (1998-2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Author.
RosenbergM. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.
18.
SatorraA.BentlerP. M. (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika, 66, 507-514.
19.
SchumacherJ.LeppertK.GunzelmannT.StaußB.BrahlerE. (2005). Resilienzskala—Ein Fragebogen zur Erfassung der psychischen Widerstandsfähigkeit als Personenmerkmal [Resilience Scale—A questionnaire to assess psychological resilience as personality trait]. Z f Klinische Psychologie, Psychiatrie und Psychotherapie, 53, 16-39.
SteigerJ. H. (1990). Structural model evaluation and modification: An interval estimation approach. Multivariate Behavioral Research, 25, 173-180.
22.
VandenbergR. J.LanceC. E. (2000). A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational Research Methods, 3, 4-70.
23.
WellsK. B.StewartA. L.HaysR. D.BurnamM. A.RogersW.DanielsM.. . . WareJ. (1987). The functioning and well-being of depressed patients: Results from the Medical Outcomes Study. The Journal of the American Medical Association, 262, 914-919.
