The Patient Health Questionnaire–4: Factor Structure, Measurement Invariance, Latent Profile Analysis of Anxiety and Depressive Symptoms and Screening Results in Polish Adults

Abstract

A screening assessment of anxiety and depressive symptoms is of great importance for preventing mental health problems. The current study aimed to (a) examine the factor structure, measurement invariance, reliability, and temporal stability of the Polish version of the Patient Health Questionnaire–4 (PHQ–4) developed for measuring anxiety and depressive symptoms, (b) estimate the prevalence of these symptoms in different age and gender groups from February to July 2022, and (c) identify latent subpopulations of females and males based on their anxiety and depressive symptom levels. The sample included 2557 Polish adults (1730 females, 811 males, and 16 non-binary individuals) aged 18–78 (M = 27.18, SD = 12.29). The Polish version of the PHQ–4 was used. Multi-group confirmatory factor analysis and latent profile analysis (LPA) were carried out. The Polish version of the PHQ–4 had an intended two-factor structure, was invariant across age and gender categories, and in general, displayed strong psychometric properties. Based on the cut-off scores for the anxiety and depression subscales of ≥3, more than half of females and males in three age groups (aged 18–29, 30–44, and 45–59) were screened positively for anxiety and/or depression, and more than one-third of females aged 60–78 and males aged 60–76 were screened positively for both disorders. We distinguished (by LPA) and described four subpopulations common for both females and males. We identified risk groups for mental disorders (females, males aged 30–44, non-binary and younger people in general, as well as unemployed, less educated, and single people). The prevalence of probable anxiety and depressive disorders in the Polish population is extremely high. It is necessary to provide further mental health monitoring.