{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T07:02:35Z","timestamp":1780038155213,"version":"3.53.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82560663"],"award-info":[{"award-number":["82560663"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Patient Health Questionnaire-4 (PHQ-4) consists of the first two items of the Patient Health Questionnaire-9 (PHQ-9) and the first two items of the Generalized Anxiety Disorder-7 (GAD-7). To date, no studies have examined the psychometric properties of this PHQ-4 in a Chinese community sample using modern measurement theory. This study aims to conduct a preliminary psychometric evaluation of the PHQ-4 among community adults based on modern measurement theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Chinese version of the combined PHQ-9 and GAD-7 scale (termed the PHQ-16) was used to assess depression and anxiety symptoms among community-dwelling adults residing in rural areas of Yunnan Province, based on the follow up survey of the China Multi-Ethnic Cohort. We selected the items from the PHQ-16 based on the original structure of the PHQ-4 to form a 4-item scale and refer to it as a \u201cPHQ-4-like\u201d scale. The reliability of the PHQ-16 and the PHQ-4-like scale was evaluated using multivariate generalizability theory (MGT). The validity of the PHQ-4-like scale was evaluated using item response theory (IRT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on MGT, reducing the number of items in the PHQ-16 from 16 to 4 decreased the composite generalizability coefficient from 0.906 to 0.719 and the composite reliability index from 0.894 to 0.693. However, when the first two items of the PHQ-9 and the first two items of the GAD-7 were combined to form a four-item scale (the PHQ-4-like scale), the composite generalizability coefficient and composite reliability index were 0.818 and 0.815, respectively. Both the PHQ-9 and the GAD-7 exhibited monotonically increasing threshold parameters. Items 1, 2, 4, and 6 of the PHQ-9 and items 2 and 3 of the GAD-7 showed high discrimination parameters. High average information values were observed for items 1, 2, and 4 of the PHQ-9 and items 2, 3, and 4 of the GAD-7.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The PHQ-4-like scale demonstrated satisfactory reliability and validity in this rural Chinese community sample. However, the PHQ-4 screening performance requires criterion validation. Regarding the anxiety dimension of this scale, it may also be worthwhile to consider combining items 2 and 3 from the GAD-7.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1827821","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T06:11:37Z","timestamp":1780035097000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychometric evaluation of a four-item scale derived from the PHQ-9 and GAD-7 among community adults based on multivariate generalizability theory and item response theory"],"prefix":"10.3389","volume":"17","author":[{"given":"Nan","family":"Cheng","sequence":"first","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]},{"name":"Yunnan Provincial Key Laboratory of Public Health and Biosafety","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chongwei","family":"Song","sequence":"additional","affiliation":[{"name":"Yunnan Provincial Center for Disease Control and Prevention","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]},{"name":"Yunnan Provincial Key Laboratory of Public Health and Biosafety","place":["Kunming, China"]},{"name":"Yunnan Provincial Center for Disease Control and Prevention","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiali","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]},{"name":"Yunnan Provincial Key Laboratory of Public Health and Biosafety","place":["Kunming, China"]},{"name":"Yunnan Provincial Hospital of Infectious Diseases, Kunming","place":["China, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiqi","family":"Tang","sequence":"additional","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]},{"name":"Yunnan Provincial Key Laboratory of Public Health and Biosafety","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shifan","family":"He","sequence":"additional","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]},{"name":"Yunnan Provincial Key Laboratory of Public Health and Biosafety","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dejue","family":"Men","sequence":"additional","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]},{"name":"Yunnan Provincial Key Laboratory of Public Health and Biosafety","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinglin","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]},{"name":"Yunnan Provincial Key Laboratory of Public Health and Biosafety","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxiu","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]},{"name":"Yunnan Provincial Key Laboratory of Public Health and Biosafety","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianzhong","family":"Yin","sequence":"additional","affiliation":[{"name":"Yunnan Provincial Key Laboratory of Public Health and Biosafety","place":["Kunming, China"]},{"name":"School of Public Health, Dali University","place":["Dali, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Meng","sequence":"additional","affiliation":[{"name":"School of Public Health, Kunming Medical University","place":["Kunming, China"]},{"name":"Yunnan Provincial Key Laboratory of Public Health and Biosafety","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"B1","first-page":"22","volume-title":"The Basics of Item Response Theory.","author":"Baker","year":"2001"},{"key":"B2","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1177\/0091217420978005","article-title":"Prevalence of depression, anxiety and stress in china during COVID-19 pandemic: A systematic review with meta-analysis.","volume":"56","author":"Bareeqa","year":"2021","journal-title":"Int. J. Psychiatry Med."},{"key":"B3","volume-title":"Manual for mGENOVA (version 2.1).","author":"Brennan","year":"2001"},{"key":"B4","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.psyneuen.2016.04.019","article-title":"Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis.","volume":"70","author":"Buchberger","year":"2016","journal-title":"Psychoneuroendocrinology"},{"key":"B5","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/S0140-6736(19)30934-1","article-title":"New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis.","volume":"394","author":"Charlson","year":"2019","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","first-page":"687589","DOI":"10.3389\/fpsyg.2021.687589","article-title":"A generalizability analysis of the meaning in life questionnaire for Chinese adolescents.","volume":"12","author":"Chen","year":"2021","journal-title":"Front. Psychol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"110970","DOI":"10.1016\/j.jpsychores.2022.110970","article-title":"Validation of the Patient Health Questionnaire-4 (PHQ-4) to screen for depression and anxiety in the Greek general population.","volume":"160","author":"Christodoulaki","year":"2022","journal-title":"J. Psychosom. Res."},{"key":"B8","doi-asserted-by":"publisher","first-page":"II28","DOI":"10.1097\/00005650-200009002-00007","article-title":"Item response theory and health outcomes measurement in the 21st century.","volume":"38","author":"Hays","year":"2000","journal-title":"Med. Care"},{"key":"B9","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1186\/1471-244X-14-205","article-title":"Standardization of the Colombian version of the PHQ-4 in the general population.","volume":"14","author":"Kocalevent","year":"2014","journal-title":"BMC Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure.","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1097\/01.MLR.0000093487.78664.3C","article-title":"The patient health questionnaire-2: Validity of a two-item depression screener.","volume":"41","author":"Kroenke","year":"2003","journal-title":"Med. Care"},{"key":"B12","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1176\/appi.psy.50.6.613","article-title":"An ultra-brief screening scale for anxiety and depression: The PHQ-4.","volume":"50","author":"Kroenke","year":"2009","journal-title":"Psychosomatics"},{"key":"B13","doi-asserted-by":"publisher","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection.","volume":"146","author":"Kroenke","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s12144-022-02833-5","article-title":"The factor structure and measurement invariance of the PHQ-4 and the prevalence of depression and anxiety in a Southeast Asian context amid the COVID-19 pandemic.","author":"Mendoza","year":"2022","journal-title":"Curr. Psychol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1186\/s12955-017-0664-2","article-title":"Reliability analysis of the Chinese version of the Functional Assessment of Cancer Therapy - Leukemia (FACT-Leu) scale based on multivariate generalizability theory.","volume":"15","author":"Meng","year":"2017","journal-title":"Health Qual. Life Outcomes"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.cptl.2019.10.001","article-title":"Guidance for high-stakes testing within pharmacy educational assessment.","volume":"12","author":"Peeters","year":"2020","journal-title":"Curr. Pharm. Teach. Learn."},{"key":"B17","doi-asserted-by":"publisher","first-page":"116","DOI":"10.16138\/j.1673-6087.2021.02.010","article-title":"Reliability and validity of the ultra-brief screening scale for depression and anxiety in outpatients clinics of community healthcare centers.","volume":"16","author":"Qian","year":"2021","journal-title":"Intern. Med. Concepts Pract."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.1016\/j.jclinepi.2007.03.010","article-title":"Application of generalizability theory confirmed lower reliability of the standard gamble than the feeling thermometer.","volume":"60","author":"Sch\u00fcnemann","year":"2007","journal-title":"J. Clin. Epidemiol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1111\/nyas.12738","article-title":"The interface of depression and cardiovascular disease: Therapeutic implications.","volume":"1345","author":"Seligman","year":"2015","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"B20","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1023\/B:QURE.0000018486.91360.00","article-title":"The World Health Organization\u2019s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group.","volume":"13","author":"Skevington","year":"2004","journal-title":"Qual. Life Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"4629","DOI":"10.2147\/PRBM.S435356","article-title":"Development and psychometric properties of work information anxiety questionnaire.","volume":"16","author":"Song","year":"2023","journal-title":"Psychol. Res. Behav. Manag."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7.","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1093\/ije\/dyu038","article-title":"The global prevalence of common mental disorders: A systematic review and meta-analysis 1980-2013.","volume":"43","author":"Steel","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"104136","DOI":"10.1016\/j.ajp.2024.104136","article-title":"Core items selection and psychometric properties of the adult attention-deficit hyperactivity disorder self-report scale-Chinese short version (ASRS-CSV).","volume":"99","author":"Tang","year":"2024","journal-title":"Asian J. Psychiatr."},{"key":"B25","doi-asserted-by":"publisher","first-page":"104647","DOI":"10.1016\/j.ajp.2025.104647","article-title":"The Chinese Shorten Version of the Autism-Spectrum Quotient (AQ-CSV): Simplification and evaluation of psychometric properties.","volume":"111","author":"Xu","year":"2025","journal-title":"Asian J. Psychiatr."},{"key":"B26","doi-asserted-by":"publisher","first-page":"648755","DOI":"10.3389\/fpsyt.2021.648755","article-title":"Reliability, validity, and measurement invariance of the general anxiety disorder scale among Chinese medical university students.","volume":"12","author":"Zhang","year":"2021","journal-title":"Front. Psychiatry"},{"key":"B27","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1093\/ije\/dyaa185","article-title":"Cohort profile: The China Multi-Ethnic Cohort (CMEC) study.","volume":"50","author":"Zhao","year":"2021","journal-title":"Int. J. Epidemiol."},{"key":"B28","volume-title":"Generalizability Theory and Its Applications.","author":"Zhi Ming","year":"2003"},{"key":"B29","doi-asserted-by":"publisher","first-page":"121624","DOI":"10.1016\/j.jad.2026.121624","article-title":"Development and psychometric validation of the Adolescent Self-Harm Risk Assessment (ASRA) Scale: A multi-dimensional approach.","volume":"405","author":"Zhou","year":"2026","journal-title":"J. Affect. Disord."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1827821\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T06:11:39Z","timestamp":1780035099000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1827821\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":29,"alternative-id":["10.3389\/fpsyg.2026.1827821"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1827821","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,29]]},"article-number":"1827821"}}