A Systematic Review of the Psychometric Properties of the Patient Health Questionnaire-4 in Clinical and Nonclinical Populations

Mental health symptoms and discrimination among immigrant and US-born Hispanic or Latino adults during the COVID-19 pandemic

BACKGROUND

Mental health symptoms are highly stigmatized, potentially increasing the risk of experiencing discrimination, particularly within minoritized communities such as Hispanic or Latino populations. Thus, stigmatizing views of mental health symptoms may exacerbate exposure to experiencing discrimination, including xenophobia. The Hispanic or Latino population has increasingly been vulnerable to mental health symptoms since the COVID-19 pandemic and has historically faced persistent discrimination. However, few studies have explored associations between mental health symptoms and discrimination, especially when accounting for and stratifying by birthplace. This study estimates the prevalence of discrimination by mental health symptoms among Hispanic or Latino individuals in the United States (US). It also examines the associations between mental health symptoms and discrimination, stratified by birthplace.

METHODS

A national online cross-sectional survey was distributed between May 13, 2021, and January 9, 2022, among US adults (N = 5,413). The analytical sample included Hispanic or Latino individuals (n = 1,126) who were US-born (n = 625) and foreign-born (n = 501). Chi-square tests were used to assess bivariate differences in everyday discrimination (measured with the Everyday Discrimination Scale). Polytomous logistic regressions were conducted to examine everyday discrimination and its correlates, adjusting for sociodemographic factors.

RESULTS

A higher proportion of Hispanic or Latino individuals reported experiencing discrimination daily or weekly (38.19%) compared to monthly (16.25%). Discrimination was more frequently reported among US-born individuals as well as those with anxiety, depression, anxiety/depression, and a higher level of loneliness. Foreign-born individuals were significantly less likely to experience discrimination compared to their US-born counterparts. Anxiety/depression and loneliness were associated with higher risks of experiencing discrimination. In analyses stratified by birthplace, loneliness was a significant risk factor for discrimination among both groups. Anxiety/depression was a significant risk factor only among US-born individuals.

CONCLUSIONS

Mental health symptoms and birthplace were significantly associated with experiences of discrimination among Hispanic or Latino individuals, with more pronounced risks for US-born individuals. These findings highlight birthplace-related disparities and broader disparities in mental health and discrimination within the growing US Hispanic or Latino population. More research should explore potential mechanisms for bidirectional associations between mental health symptoms and discrimination among minoritized communities.

Wellbeing Dynamics Across Cultures During the Pandemic: A Five-Country Exploration

Wellbeing levels have been a global concern during the COVID-19 pandemic, but there is a lack of attention to invariance questions that allow a robust examination of wellbeing dynamics across cultures. Questions of temporal stability that are crucial for examining the impact of the pandemic on wellbeing have received even less attention. Some studies suggested that measures may not be stable after the onset of the pandemic. We examine invariance parameters, the factorial structure and variability of wellbeing variables (life satisfaction, pandemic worries, anxiety and depression screenings) across five different cultural contexts from 2020 to 2022 (N = 4387, total observations = 13,161). A three-factor model separating life satisfaction, worry and distress performed best in terms of model fit and parsimony. We observed scalar invariance across times and identified little variability of wellbeing measures during the pandemic, suggesting that wellbeing levels remained stable during the pandemic in each of the countries sampled. In contrast, we only identified metric invariance across countries at each time point, and found a weakening of correlations between life satisfaction and a depressive/anxious symptoms scale in lower income countries. We discuss implications of our findings for discussions of wellbeing dynamics.

Mental Health and Care Utilization Among Sexual and Gender Minority Youth by Race and Ethnicity

PURPOSE

Existing literature has provided limited and inconsistent findings regarding disparities in mental health and mental health care utilization among racial and ethnic subgroups of sexual and gender minority adolescents (SGMA). This study aimed to investigate racial and ethnic disparities in mental health and care utilization among SGMA.

METHODS

Data from a large national sample of SGMA who participated in the 2022 Lesbian, Gay, Bisexual, Transgender and Queer National Teen Survey (N = 9,691) were analyzed. Symptoms of depression and anxiety were assessed using the patient health questionnaire-4. Mental health care utilization was classified as follow: (1) received; (2) wished for but not received (indicating unmet mental health care needs); and (3) neither wished for nor received.

RESULTS

Compared to White SGMA, Black/African American SGMA were less likely to report anxiety symptoms (adjusted prevalence ratio = 0.89, 95% confidence intervals [CIs] = 0.82-0.97). No significant racial and ethnic differences in depression symptoms were observed among SGMA. Regarding mental health care utilization, Asian or Asian American (adjusted relative risk ratio [ARRR] = 2.07, 95% CIs = 1.62-2.64), Black/African American (ARRR = 1.80, 95% CIs = 1.41-2.28), and Hispanic/Latino SGMA (ARRR = 1.32, 95% CIs = 1.16-1.51) were more likely to report unmet mental health care needs than White SGMA.

DISCUSSION

Despite the lack of major and consistent racial and ethnic differences in anxiety and depression symptoms documented in our sample, Asian or Asian American, Black/African American, and Hispanic/Latino SGMA were more likely to report unmet mental health care needs than their White counterparts. This finding highlights the need to address barriers to mental health care for racially and ethnically minoritized SGMA.

The Multifaceted Impact of the SARS-CoV-2 Pandemic on Sexual Health, Function, and Behaviors: Implications for Public Health: A Scoping Review

BACKGROUND

The SARS-CoV-2 pandemic had a significant impact on sexual health and human behavior, revealing a widespread decline in sexual function and behaviors.

OBJECTIVE

To summarize these findings and highlight their importance for public health, this article discusses the changes observed in sexual function and behavior during the pandemic, as well as potential explanations for these trends.

METHODS

This study followed the PRISMA-ScR guidelines, using the keyword search commands: "sexual function" AND ("SARS-CoV-2" OR "COVID-19" OR coronavirus) and "sexual behavior*" AND ("SARS-CoV-2" OR "COVID-19" OR coronavirus) in the Scopus and PubMed databases. The search was conducted on 10 March 2024, including articles published from January 2019 to March 2024. Inclusion criteria required studies focusing on sexual health/function during the SARS-CoV-2 pandemic, excluding non-English articles and non-adult populations. Studies were screened based on relevance, methodological rigor, and sample size, with data extraction focusing on sexual behavior/function metrics. Results were synthesized to identify trends and propose explanatory models.

RESULTS

While some individuals experienced reductions in sexual desire and activities, others reported increases, indicating varied individual responses to stressors such as a pandemic. Two hypotheses are presented to explain these changes: terror management theory and the dual control model of sexual response. The critical role of public health in addressing sexual health and well-being needs during a health crisis is discussed, emphasizing the importance of providing clear information, ensuring access to remote sexual health services, and reducing stigma. The need to integrate sexual health into the global response to future health crises is highlighted to ensure a comprehensive approach to human well-being.

CONCLUSIONS

This review shows the multifaceted impact of the pandemic and social distancing in people's sexual function and behaviors, underscoring the importance of considering sexual health as an integral part of the emergency health planning and response, to promote the physical and mental well-being of the population during crises such as the SARS-CoV-2 pandemic.

Effect of Noise Sensitivity on Mental Health: Mediating Role of Sleep Problems

OBJECTIVE

Noise sensitivity refers to an individual's general perception toward noise and may be associated with mental health and sleep. However, the effect of noise sensitivity on mental health requires further exploration. This study aimed to investigate the impact of noise sensitivity on mental health and the mediating role of sleep problems. Methods: We assessed 268 students from Shenzhen University, situated within 800 m of a construction site. We used the Weinstein Noise Sensitivity Scale-8, Patient Health Questionnaire-4, and Jenkins Sleep Scale-4 to assess noise sensitivity, depression, anxiety, and sleep quality. Results: Noise sensitivity was significantly and positively associated with anxiety, depression, and sleep problems (P < 0.01). Logistic regressions indicated that noise sensitivity positively predicted sleep problems (P = 0.011), anxiety, and depression (P = 0.014). The indirect effect of noise sensitivity on anxiety and depression through sleep problems accounted for 38.89% of the total effect (P = 0.268). Conclusion: Sleep problems serve as a mediating variable in the relationship between noise sensitivity and depression and anxiety. Future studies should explore additional variables that mediate the effect of noise sensitivity on mental health.

Does Meaning in Life Mediate Associations Between Suffering and Subsequent Mental Well-Being? Longitudinal Evidence From Two Non-Western Samples

Narrative accounts have documented the potential for suffering to degrade a person's well-being by undermining their sense of meaning in life, but few studies have investigated this among nonclinical samples living in non-Western contexts of the Global South. Leveraging data from a set of three-wave longitudinal studies with younger Indonesian (Study 1: Wave 1 [December 2020], Wave 2 [January 2021], Wave 3 [February 2021]; N = 620) and Colombian adults (Study 2: Wave 1 [August/September 2021], Wave 2 [October/November 2021], Wave 3 [February 2022]; N = 2626), the present research used causal mediation methods within a counterfactual framework to examine whether the associations between suffering (Wave 1) and subsequent anxiety symptoms, depression symptoms, and general mental health (Wave 3) are mediated by meaning in life (Wave 2). Mediation analyses in both studies provided some evidence indicating that overall suffering (Wave 1) is indirectly associated with worse subsequent mental well-being on all three outcomes (Wave 3) via lower meaning in life (Wave 2). Results were generally consistent with those found for overall suffering when the aspects of suffering were considered individually, although in Study 1 the evidence in support of mediation was stronger and more consistent for some aspects of suffering compared to others. Over both shorter (Study 1) and longer (Study 2) time lags, the findings suggest that meaning in life may be one of the mechanisms by which suffering degrades mental well-being. Practical implications for mitigating and transcending the deleterious effects of suffering on mental well-being are discussed.

The TikTok Addiction Scale: Development and validation

Background

There is an absence of valid and specific psychometric tools to assess TikTok addiction. Considering that the use of TikTok is increasing rapidly and the fact that TikTok addiction may be a different form of social media addiction, there is an urge for a valid tool to measure TikTok addiction.

Objective

To develop and validate a tool to measure TikTok addiction.

Methods

First, we performed an extensive literature review to create a pool of items to measure TikTok addiction. Then, we employed a panel of experts from different backgrounds to examine the content validity of the initial set of items. We examined face validity by performing cognitive interviews with TikTok users and calculating the item-level face validity index. Our study population included 429 adults who have been TikTok users for at least the last 12 months. We employed exploratory and confirmatory factor analysis to examine the construct validity of the TikTok Addiction Scale (TTAS). We examined the concurrent validity by using the Bergen Social Media Addiction Scale (BSMAS), the Patient Health Questionnaire-4 (PHQ-4), and the Big Five Inventory-10 (BFI-10). We used Cronbach's alpha, McDonald's Omega, Cohen's kappa, and intraclass correlation coefficient to examine reliability.

Results

We found that the TTAS is a six-factor 15-item scale with robust psychometric properties. Factor analysis revealed a six-factor structure, (1) salience, (2) mood modification, (3) tolerance, (4) withdrawal symptoms, (5) conflict, and (6) relapse, which accounted for 80.70% of the total variance. The concurrent validity of the TTAS was excellent since we found significant correlations between TTAS and BSMAS, PHQ-4, and BFI-10. Cronbach's alpha and McDonald's Omega for the TTAS were 0.911 and 0.914, respectively.

Conclusion

The TTAS appears to be a short, easy-to-use, and valid scale to measure TikTok addiction. Considering the limitations of our study, we recommend the translation and validation of the TTAS in other languages and populations to further examine the validity of the scale.

Depression and Quality of Life in Patients With Chronic Kidney Disease: A Mediation Analysis of Handgrip Strength and Demoralization

BACKGROUND

Chronic kidney disease (CKD) is a progressive disease impacting the physical function and mental health of sufferers. Depression is known to negatively impact quality of life, whereas handgrip strength and demoralization are important factors affecting physical and mental health. Lower handgrip strength has been associated with sarcopenia and higher risk of hospitalization in patients and higher workloads for nurse caregivers. Few studies have investigated the complex relations among these factors in patients with CKD.

PURPOSE

This study was designed to investigate the mediating effects of grip strength and demoralization on the relationship between depression and quality of life in patients with CKD.

METHODS

Two hundred fifty patients with CKD comprised the study sample. The hypotheses were tested using the PROCESS macro.

RESULTS

Depression was found to be negatively associated with handgrip strength and quality of life but positively associated with demoralization. The results indicate that both handgrip strength and demoralization mediate the association between depression and quality of life. Moreover, the results of multiple mediation model analysis showed handgrip strength and demoralization both play important roles in the link between depression and quality of life.

CONCLUSIONS

The results of this study indicate that handgrip strength and demoralization mediate the relationship between depression and quality of life in patients with CKD. Thus, increasing handgrip strength and decreasing demoralization levels may mitigate the impact of depression on quality of life. Therefore, nurses should better appreciate the importance of handgrip strength for patients with CKD and evaluate handgrip strength. Nurses should also develop physical and mental interventions to increase handgrip strength and decrease demoralization.

Validation and cutoff score for the single-item sleep quality scale

PURPOSE

The Sleep Quality Scale (SQS) is a popular single-item measure of sleep quality that has been used in research and clinical settings. The aim of the current paper is to validate the SQS and provide a cutoff score.

METHODS

We conducted two studies to validate the SQS and provide a cutoff score to simplify the interpretation of SQS scores. We collected data from 747 physicians and nurses working in Oman.

RESULTS

In Study 1, conducted during the first two weeks of April 2020, a significant positive relationship was observed between the SQS and The World Health Organization Wellbeing Index (r. = 0.90) and a significant negative relationship was found with the Generalized Anxiety Disorder scale (r = .88) and the Intolerance of Uncertainty Scale-12 (r = .88). In Study 2, conducted between October 12 and November 19, 2020, we proposed a cutoff score for the SQS using the Insomnia Severity Index cutoff score of ≥ 10. The estimated area under the receiver operating characteristics curve was 0.881 (95% CI = 0.84-0.92). A cutoff score of ≤ 6 was identified with a sensitivity of 87.50 (95% CI = 0.78-0.94), and a specificity of 74.10 (95% CI = 0.67-0.81).

CONCLUSIONS

The findings of this study suggest that the single-item SQS is valid and an acceptable substitute for longer scales for initial assessment of sleep quality. The suggested cutoff value should help in easily classifying individuals into poor sleepers and good sleepers.

Recovery of Comfort and Capability After Upper Extremity Fracture Is Predominantly Associated With Mindset: A Longitudinal Cohort From the United Kingdom

OBJECTIVES

To determine the relative influence of mindset and fracture severity on 9-month recovery trajectories of pain and capability after upper extremity fractures.

METHODS

DESIGN

Secondary use of longitudinal data.

SETTING

Single Level-1 trauma center in Oxford, United Kingdom.

PATIENT SELECTION

English-speaking adults with isolated proximal humerus, elbow, or distal radius fracture managed operatively or nonoperatively were included, and those with multiple fractures or cognitive deficit were excluded.

OUTCOME MEASURES AND COMPARISONS

Incapability (Quick-DASH) and pain intensity (11-point rating scale) were measured at baseline, 2-4 weeks, and 6-9 months after injury. Cluster analysis was used to identify statistical groupings of mindset (PROMIS Depression and Anxiety, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia) and fracture severity (low/moderate/high based on OTA/AO classification). The recovery trajectories of incapability and pain intensity for each mindset grouping were assessed, accounting for various fracture-related aspects.

RESULTS

Among 703 included patients (age 59 ± 21 years, 66% women, 16% high-energy injury), 4 statistical groupings with escalating levels of distress and unhelpful thoughts were identified (fracture severity was omitted considering it had no differentiating effect). Groups with less healthy mindset had a worse baseline incapability (group 2: β = 4.1, 3: β = 7.5, and 4: β = 17) and pain intensity (group 3: β = 0.70 and 4: β = 1.4) (P < 0.01). Higher fracture severity (β = 4.5), high-energy injury (β = 4.0), and nerve palsy (β = 8.1) were associated with worse baseline incapability (P < 0.01), and high-energy injury (β = 0.62) and nerve palsy (β = 0.76) with worse baseline pain intensity (P < 0.01). Groups 3 and 4 had a prolonged rate of recovery of incapability (β = 1.3, β = 7.0) and pain intensity (β = 0.19, β = 1.1) (P < 0.02).

CONCLUSIONS

Patients with higher levels of unhelpful thinking and feelings of distress regarding symptoms experienced worse recovery of pain and incapability, with a higher effect size than fracture location, fracture severity, high-energy injury, and nerve palsy. These findings underline the importance of anticipating and addressing mental health concerns during recovery from injury.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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

BACKGROUND

Anxiety and depression are psychiatric disorders that often coexist and share some features. Developing a simple and cost-effective 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 beneficial. 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

Confirmatory factor analysis (CFA) indicated that fit of the two-factor model of the PHQ-4 scores was modest (χ2/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 configural, metric, and scalar invariance were supported across sex. No significant difference was found 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 significantly and moderately-to-strongly 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-effective tool for assessing symptoms related to depression and anxiety. To evaluate the practical effectiveness 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 specific populations.

Longitudinal measurement invariance and psychometric properties of the Patient Health Questionnaire-Four in China

BACKGROUND

Depression and anxiety symptoms among medical students are often a concern. The Patient Health Questionnaire-Four (PHQ-4), an important tool for depression and anxiety screening, is commonly used and easy to administer. This study aimed to assess and update the longitudinal measurement invariance and psychometric properties of the simplified Chinese version.

METHODS

A three-wave longitudinal survey was conducted among healthcare students using the PHQ-4. Structural validity was based on one-factor, two-factor, and second-order factor models, construct validity was based on the Self-Rated Health Questionnaire (SRHQ), Sleep Quality Questionnaire (SQQ), and Rosenberg Self-Esteem Scale (RSES), and longitudinal measurement invariance (LMI), internal consistency, and test-retest reliability were based on structural consistency across three time points.

RESULTS

The results of the confirmatory factor analysis indicated that two-factor model was the best fit, and LMI was supported at three time points. Inter-factor, factor-total, and construct validity correlations of the PHQ-4 were acceptable. Additionally, Cronbach's alpha, McDonald's omega, and the intraclass correlation coefficient demonstrated acceptable/moderate to excellent reliability of the PHQ-4.

CONCLUSIONS

This study adds new longitudinal evidence that the Chinese version of the PHQ-4 has promising LMI and psychometric properties. Such data lends confidence to the routine and the expanded use of the PHQ-4 for routine screening of depression and anxiety in Chinese healthcare students.

Psychometric network analysis of the Patient Health Questionnaire-4 (PHQ-4) in Paraguayan general population

BACKGROUND

Depression and anxiety are two of the most prevalent and disabling mental disorders worldwide, both in the general population and in outpatient clinical settings.

OBJECTIVE

This study aimed to analyze the psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) based on network analysis metrics.

METHODS

A total of 911 Paraguayans (23.71% women and 76.29% men; mean age 31.25 years, SD = 10.63), selected by non-probabilistic convenience sampling, participated in the study. Network analysis was used to evaluate the internal structure, reliability, and measurement invariance between men and women.

RESULTS

The results revealed that the PHQ-4 is a unidimensional measure through Exploratory Graph Analysis (EGA). Reliability, through structural consistency, identified that 100% of the time, only a single dimension was obtained, and all items remained stable, as they were always replicated within the empirical dimension. The unidimensional structure has shown evidence of configural invariance; therefore, the network structure functioned equally among the different sex groups.

CONCLUSION

The PHQ-4 presented optimal preliminary evidence of validity based on its internal structure, reliability, and invariance between sexes. Therefore, it may be useful as an accurate and brief measure of anxiety and depressive symptoms in the Paraguayan context.

Zoo professionals and volunteers in the U.S: experiences and prevalence of burnout, mental health, and animal loss

Introduction

Burnout and mental health among animal care and health professionals (ACHPs) has received increasing attention in recent years. Despite rapid growth of research in this area, the wellbeing of individuals who work and/or volunteer in zoo settings has received minimal attention.

Method

An anonymous online survey was created to evaluate zoo staff and volunteers' experiences of animal-related loss, rates of professional fulfillment and burnout, mental health, perceived organizational support, and resilience. Participants included 1695 zoo professionals (72% ACHPs, 20% other staff) and volunteers (7%) who were recruited through relevant professional listservs and online platforms, and flyers on zoo grounds.

Results

ACHPs reported higher levels of anxiety, depression, and burnout and lower levels of professional fulfillment than other zoo staff and volunteers. The most common animal-related losses experienced by ACHPs in the past year were unexpected death (80%) and anticipated loss (74%), with more than half of these losses occurring within the past 3 months. ACHPs' reported bond with animals under their care was positively associated with depression and anxiety. Having a formal ritual or process following the death of an animal was positively associated with job fulfillment and perceived organizational support and negatively associated with depression and burnout-yet only 17% of participants in our sample indicated that their zoo had such a process or ritual.

Discussion

Our findings suggest that many ACHPs are struggling with burnout, anxiety, depression, and low rates of professional fulfilment and perceived organizational support. We recommend that zoos develop organizational plans that foster a culture which normalizes and validates grief/loss experiences and is proactive in responding to animal loss, related trauma, and other occupational stressors. The results of this research demonstrate the need for systemic changes within the zoo industry, for the betterment and welfare of both humans and the animals under their care.

Preliminary efficacy of a transdiagnostic parent-led internet-delivered intervention for children with anxiety and depressive symptoms: a pilot randomized controlled trial

BACKGROUND

There is extensive research indicating that transdiagnostic interventions are effective for adults and children with anxiety and depressive disorders; however, limited research has been conducted on the efficacy of such programs targeting parents of children with anxiety and depressive symptoms delivered via the Internet. This study aims to investigate the preliminary efficacy of a transdiagnostic Internet-delivered intervention for Romanian parents of children with elevated anxiety and depressive symptoms.

METHODS

We conducted a single-blinded pilot randomized controlled trial. Forty-two parents of children with anxiety and depressive symptoms (Mage = 39.79, 78.6% women) from Romania were randomly assigned to one of the two groups, to ParentKIT, an Internet-delivered intervention based on Rational Emotive and Behavioral Therapy (n = 21), or to a delayed treatment condition (waitlist group) (n = 21). ParentKIT consisted of a brief transdiagnostic intervention delivered through nine modules with therapist guidance.

RESULTS

A significant Group by Time effect was found for child emotional problems as reported by parents (Cohen's d = - 0.85) and for parental self-efficacy (Cohen's d = 0.71).

CONCLUSION

A transdiagnostic Internet-delivered intervention addressed to parents of children with elevated anxiety and depressive symptoms is a promising approach. Future research should include blind assessments as well as multiple outcome assessors and investigate the long-term efficacy of the intervention.

TRIAL REGISTRATION

NCT05341297.