Validation of the Chinese version of patient health Questionnaire-4 among Chinese adolescents.

BACKGROUND

The incidence of mental health issues among adolescents, particularly anxiety and depression, is increasing in China. Given the large adolescent population and their increasing prevalence, there is an urgent need for a reliable screening tool. This study aimed to validate the Chinese version of the Patient Health Questionnaire (PHQ-4) among Chinese adolescents.

METHODS

From September 2022 to March 2024, a cross-sectional study was conducted at four middle schools in Jiangxi Province and Beijing, China, involving 8778 participants. The sample was split into exploratory factor analysis (EFA) and confirmatory factor analyses (CFA). A subset of 159 participants was used for test-re-test reliability, assessed using the intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) curve analysis was performed to determine this threshold.

RESULTS

The Chinese PHQ-4 showed good overall reliability, with Cronbach's α of 0.84 and McDonald's ω of 0.86. The EFA identified two factors, depression and anxiety, with factor loadings between 0.61 and 0.81. The CFA indicated an excellent model fit. The ICC was 0.87, indicating a strong test-retest reliability. The AUC was 0.940, with a 95 % CI of 0.936-0.945, demonstrating high discriminative ability. The optimal screening threshold was determined as 3.

LIMITATION

As a cross-sectional study, causal inferences are limited.

CONCLUSION

The Chinese PHQ-4 is a reliable and valid tool for screening anxiety and depression in Chinese adolescents, with a recommended cutoff score of 3.