Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza Centre, P.O Box 1462, Mwanza, Tanzania.
Sauti Project, Jhpiego Tanzania - an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania.
BMC Psychiatry. 2020 Jun 19;20(1):321. doi: 10.1186/s12888-020-02735-5.
Literature suggests that most mental disorders have their onset in childhood and adolescence, but go undiagnosed until adulthood. Shorter versions of the screening tools such as the Patient Health Questionnaire with four items (PHQ-4) may help to improve screening coverage. This study assessed the psychometric properties of the PHQ-4 in screening for core symptoms of depression and anxiety among out of school adolescent girls and young women (AGYW).
This is a cross-sectional analysis of data from a cluster randomized controlled trial conducted among AGYW between June and July 2018 in North-West Tanzania. Two thousand four hundred twenty-six out-of-school AGYW aged 15 to 23 years were included. Data were collected on tablets using audio computer-assisted self-interviews (ACASI). Cronbach's α was used to measure the reliability of the PHQ-4 while confirmatory factor analysis (CFA) and principal components analysis (PCA) were used for construct validity assessment. In CFA, three criteria were used to assess how well the model fits the data: Standardized Root Mean Square Residual (SRMR), the Comparative Fit Index (CFI), the Root Mean Square Error of Approximation (RMSEA) and 90% confidence interval for RMSEA.
Of the 2426 participants, 33.8 and 35.5% screened positive for core symptoms of anxiety (GAD-2 ≥ 3) and depression (PHQ-2 ≥ 3), respectively. Cronbach's α of the PHQ-4 was 0.81. Both items-correlation and corrected items-correlation of the PHQ-4 had total correlations above 0.5 (p < 0.01). CFA showed that all items loaded significantly onto the single factor, and loadings were strong, ranging from 0.67 to 0.77 (p < 0.01). CFA indicates that the PHQ-4 scale stand for a unidimensional construct with good model fit (CFI = 0.995, SRMR = 0.013, RMSEA = 0.054 and 90% CI for RMSEA (0.031-0.079)). PCA confirmed two distinct components; GAD-2 (anxiety) and PHQ-2 (depression). Those who reported having suicidal thoughts and social function problems had significantly higher scores on PHQ-2, GAD-2, and PHQ-4 screening items (p < 0.01).
The findings suggest that the PHQ-4 scale can reliably and validly screen for core symptoms of depression and anxiety among out of school AGYW. This tool is short and easy to administer. Thus, the PHQ-4 scale can be very useful in screening for anxiety and depression symptoms in the community, primary health facilities, research and programmatic settings.
文献表明，大多数精神障碍都在儿童和青少年时期发病，但直到成年后才被诊断出来。较短版本的筛选工具，如包含四个项目的患者健康问卷（PHQ-4），可能有助于提高筛选的覆盖率。本研究评估了 PHQ-4 在筛查辍学青少年女孩和年轻女性（AGYW）核心抑郁和焦虑症状方面的心理测量特性。
这是一项横断面分析，对 2018 年 6 月至 7 月在坦桑尼亚西北部对 AGYW 进行的一项集群随机对照试验的数据进行了分析。共纳入了 2426 名 15 至 23 岁的辍学 AGYW。使用平板电脑通过音频计算机辅助自我访谈（ACASI）收集数据。克朗巴赫的α用于衡量 PHQ-4 的可靠性，而验证性因素分析（CFA）和主成分分析（PCA）用于评估结构有效性。在 CFA 中，使用了三个标准来评估模型与数据的拟合程度：标准化根均方残差（SRMR）、比较拟合指数（CFI）、近似根均方误差（RMSEA）和 RMSEA 的 90%置信区间。
在 2426 名参与者中，分别有 33.8%和 35.5%的人对焦虑症（GAD-2≥3）和抑郁症（PHQ-2≥3）的核心症状呈阳性。PHQ-4 的克朗巴赫的α为 0.81。PHQ-4 的两个项目相关和校正项目相关的总相关均高于 0.5（p<0.01）。CFA 表明，所有项目都显著加载到单个因素上，且负荷较强，范围在 0.67 至 0.77（p<0.01）。CFA 表明 PHQ-4 量表代表了一个具有良好模型拟合度的单一维度结构（CFI=0.995、SRMR=0.013、RMSEA=0.054 和 RMSEA 的 90%置信区间（0.031-0.079））。PCA 证实了两个不同的成分；GAD-2（焦虑）和 PHQ-2（抑郁）。那些报告有自杀念头和社会功能问题的人在 PHQ-2、GAD-2 和 PHQ-4 筛查项目上的得分明显更高（p<0.01）。
研究结果表明，PHQ-4 量表可用于可靠和有效地筛查辍学 AGYW 的核心抑郁和焦虑症状。该工具简短易用。因此，PHQ-4 量表在社区、初级卫生保健机构、研究和规划环境中筛查焦虑和抑郁症状非常有用。
