Psychometric Properties of Persian Version of Patient Health Questionnaires-4 (PHQ-4) in Coronary Heart Disease Patients

Psychological factors, such as depression and anxiety are among the risk factors in coronary heart disease (CHD). Therefore, we need the necessary interventions in this field to quickly diagnose these disorders.

The aim of this study was to determine the psychometric properties of Patient Health questionnaires-4 (PHQ-4) as a screening tool for depression and anxiety in CHD patients in Iran.

In this study, 279 CHD patients completed PHQ-4, Patient Health questionnaires-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7) scale, and Beck depression inventory version-II (BDI-II). Semi-structured clinical interviews (SCID) based on DSM-5 were also used to diagnose depression and anxiety.

Cronbach’s alpha for PHQ-2, GAD-2, and PHQ-4 were reported to be 0.79, 0.75, and 0.78 respectively. The correlations of the PHQ-4 questionnaire with the BDI-II, GAD-7, GAD-2, PHQ-9, and PHQ-2 were found to be 0.72, 0.63, 0.85, 0.79, and 0.88 respectively. The results of fitting one-factor and two-factor models showed that the two-factor model has a more suitable fit. The optimal cut-off point of PHQ-4 ≥ 7 to measure depression and anxiety concurrently (sensitivity = 0.86, specificity = 0.90, and the area under the curve was 0.93 (CI = 0.90 - 0.96).

The PHQ-4 questionnaire is an appropriate tool for diagnosis of and screening for depression and anxiety in the population of CHD patients.