{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:45:16Z","timestamp":1787028316082,"version":"build-2736575974"},"reference-count":35,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T00:00:00Z","timestamp":1603065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Perinatal anxiety and depression are common complications during pregnancy. The purpose of this study was to examine the item characteristics, reliability, validity, and factorial structure of the four-item Patient Health Questionnaire-4 (PHQ-4) and to determine the associations between scale scores and sociodemographic factors in a sample of pregnant women from Spain. Method: A total of 845 pregnant women were recruited from two public hospitals in Spain between 2014 and 2016. Participants completed a self-report questionnaire that included Patient Health Questionnaire-4, including the two-item Patient Health Questionnaire and the two-item Generalized Anxiety Disorder Screener. Results: Exploratory and confirmatory factor analysis and scale inter-correlations between the PHQ-4 and PHQ-9 revealed that the PHQ-4 has a bivariate structure and adequately assesses the dimensions of antenatal anxiety and depression. Conclusion: The PHQ-4 is a reliable and valid instrument to screen for depression and anxiety during pregnancy. The PHQ-4 is an ultra-brief measure that can be used to screen for antenatal depression and anxiety to prevent the negative consequences associated with these mental health conditions among mothers and infants.<\/jats:p>","DOI":"10.3390\/ijerph17207583","type":"journal-article","created":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T09:36:28Z","timestamp":1603100188000},"page":"7583","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["The Psychometric Properties of the Patient Health Questionnaire-4 for Pregnant Women"],"prefix":"10.3390","volume":"17","author":[{"given":"Mar\u00eda de la Fe","family":"Rodr\u00edguez-Mu\u00f1oz","sequence":"first","affiliation":[{"name":"Department of Psychology, Universidad Nacional de Educaci\u00f3n a Distancia (UNED), 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Ruiz-Segovia","sequence":"additional","affiliation":[{"name":"Department of Psychology, Universidad Nacional de Educaci\u00f3n a Distancia (UNED), 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Soto-Balbuena","sequence":"additional","affiliation":[{"name":"Deparment of Gynecology and Obstetrics, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huynh-Nhu","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Psychology, George Washington University, Washington, DC 20052, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Eugenia","family":"Olivares-Crespo","sequence":"additional","affiliation":[{"name":"Deparment of Gynecology and Obstetrics, Instituto de Salud de la Mujer Jos\u00e9 Botella Llusi\u00e1, Hospital Cl\u00ednico San Carlos, Faculty of Medicine Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Izquierdo-M\u00e9ndez","sequence":"additional","affiliation":[{"name":"Deparment of Gynecology and Obstetrics, Instituto de Salud de la Mujer Jos\u00e9 Botella Llusi\u00e1, Hospital Cl\u00ednico San Carlos, Faculty of Medicine Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Caparr\u00f3s-Gonz\u00e1lez, R.A., and Rodr\u00edguez Mu\u00f1oz, M.F. (2020). Depresi\u00f3n posparto paterna: Visibilidad e influencia en la salud infantil. [Paternal postpartum depression: Visibility and influence on child health]. Cl\u00ednica Salud.","DOI":"10.5093\/clysa2020a10"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jad.2015.12.005","article-title":"Lifetime costs of perinatal anxiety and depression","volume":"192","author":"Bauer","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1067\/mob.2003.336","article-title":"Point prevalence of psychiatric disorders during the second trimester of pregnancy: A population-based study","volume":"189","author":"Andersson","year":"2003","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1016\/S0924-9338(10)71375-4","article-title":"Prevalence, incidence, recurrence and new onset of depression durin pregnancy. Results from the perinatal depression-research & screening unit (PND-RESCU) study","volume":"25","author":"Banti","year":"2010","journal-title":"Eur. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1136\/jech.2007.063016","article-title":"Factors related to depression during pregnancy: Are there gender differences?","volume":"62","author":"Artazcoz","year":"2008","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.ejogrb.2017.06.009","article-title":"Feasibility of screening and prevalence of prenatal depression in an obstetric setting in Spain","volume":"215","author":"Le","year":"2017","journal-title":"Eur. J. Obs. Gynecol. Reprod. Biol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1192\/bjp.bp.116.187179","article-title":"Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis","volume":"210","author":"Dennis","year":"2017","journal-title":"Br. J. Psychiatry"},{"key":"ref_8","first-page":"257","article-title":"Incidence, prevalence and risk factors related to anxiety symptoms during pregnancy","volume":"30","author":"Ferrer","year":"2018","journal-title":"Psicothema"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.infbeh.2010.09.008","article-title":"Prenatal depression effects on early development: A review","volume":"34","author":"Field","year":"2011","journal-title":"Infant Behav. Dev."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Zhong, Q., Gelaye, B., Zaslavsky, A., Fann, J., Ronden, M., S\u00e1nchez, S., and Williams, M. (2015). Diagnostic validity of the generalized anxiety disorder-7 (GAD-7) among pregnant women. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0125096"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"V\u00e1zquez, M.B., and M\u00edguez, M.C. (2020). Spanish brief version of the Pregnancy Related Anxiety Questionnaire: PRAQ-20. Cl\u00ednica Salud.","DOI":"10.5093\/clysa2020a22"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/YCO.0b013e3283503680","article-title":"Anxiety, depression and stress in pregnancy: Implications for mothers, children, research, and practice","volume":"25","author":"Dunkel","year":"2012","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref_13","unstructured":"Garcia-Esteve, L., and Vald\u00e9s, M. (2017). Manual de Psiquiatr\u00eda Perinatal: Gu\u00eda Para el Manejo de los Trastornos Mentales Durante el Embarazo, Postparto y Lactancia. [Perinatal Psychiatry Manual: Guide for the Management of Mental Disorders during Pregnancy, Postpartum and Lactation], Panamericana."},{"key":"ref_14","first-page":"147","article-title":"Postpartum Depression Screening Scale Short Form: Is it possible to use it for antenatal depression?","volume":"29","author":"Izquierdo","year":"2018","journal-title":"Cl\u00ednica Salud"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.midw.2018.03.011","article-title":"The structure of the Patient Health Questionnaire-9 in pregnant women in Spain","volume":"62","author":"Le","year":"2018","journal-title":"Midwifery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jpsychores.2004.09.006","article-title":"Detecting and monitoring depression with a two-item questionnaire (PHQ-2)","volume":"58","author":"Kroenke","year":"2005","journal-title":"J. Psychosom. Res."},{"key":"ref_17","first-page":"1","article-title":"PHQ-2 como primer instrumento de cribado de la depresi\u00f3n prenatal","volume":"91","author":"Castelao","year":"2017","journal-title":"Rev. Espa\u00f1ola Salud P\u00fablica"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.genhosppsych.2010.04.011","article-title":"Do the PHQ-8 and the PHQ-2 accurately screen for depressive disorders in a sample of pregnant women?","volume":"32","author":"Smith","year":"2010","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","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":"ref_20","doi-asserted-by":"crossref","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":"ref_21","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jad.2009.06.019","article-title":"A 4-item measure of depression and anxiety: Validation and standardization of the patient health questionnaire-4 (PHQ-4) in the general population","volume":"122","author":"Wahl","year":"2010","journal-title":"J. Affect. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1177\/2380084419846447","article-title":"Predicting Persistent Orofacial Pain: The role of illness perceptions, anxiety, and depression","volume":"5","author":"Penlington","year":"2020","journal-title":"JDR Clin. Transl. Res."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Barrera, A.Z., Moh, Y.S., Nichols, A., and Le, H.N. The factor reliability and convergent validity of the patient health questionnaire-4 among an international sample of pregnant women. J. Womens Health, 2020.","DOI":"10.1089\/jwh.2020.8320"},{"key":"ref_24","first-page":"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":"ref_25","doi-asserted-by":"crossref","unstructured":"Koncalevent, R., Finck, C., Jimenez-Leal, W., Sautier, L., and Hinz, A. (2014). Standardization of the Colombian version of the PHQ-4 in the general population. BMC Psychiatry, 14.","DOI":"10.1186\/1471-244X-14-205"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1177\/0739986315608126","article-title":"Psychometrics evaluation of the patient health questionnaire-4 in Hispanic Americans","volume":"37","author":"Mills","year":"2015","journal-title":"Hisp. J. Behav. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Wubetu, A.D., Habte, S., and Dagne, K. (2019). Prevalence of risky alcohol use behavior and associated factors in pregnant antenatal care attendees in Debre Berhan, Ethiopia, 2018. BMC Psychiatry, 19.","DOI":"10.1186\/s12888-019-2225-1"},{"key":"ref_28","doi-asserted-by":"crossref","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":"ref_29","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jad.2015.08.054","article-title":"Sociodemographic, pregnancy, obstetric, and postnatal predictors of postpartum stress, anxiety and depression in new mothers","volume":"188","author":"Clout","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jad.2018.01.030","article-title":"A computerized version of the Patient Health Questionnaire-4 as an ultra-brief screening tool to detect emotional disorders in primary care","volume":"234","author":"Medrano","year":"2018","journal-title":"J. Affect. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jad.2015.11.014","article-title":"Identifying the women at risk of antenatal anxiety and depression: A systematic review","volume":"191","author":"Biaggi","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_32","first-page":"5","article-title":"Risk factors for depressive symptoms during pregnancy: A systematic review","volume":"202","author":"Lancaster","year":"2010","journal-title":"J. Gen. Intern. Med."},{"key":"ref_33","unstructured":"NICE (2020, September 01). Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance. Available online: https:\/\/www.nice.org.uk\/guidance\/cg192."},{"key":"ref_34","unstructured":"ACOG (2015). Screening for Perinatal Depression. Obstet. Gynecol., 132, e208\u2013e212."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s00737-014-0425-8","article-title":"The Perinatal Anxiety Screening Scale: Development and preliminary validation","volume":"17","author":"Somerville","year":"2014","journal-title":"Arch. Womens Ment. Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/20\/7583\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:23:38Z","timestamp":1760178218000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/20\/7583"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,19]]},"references-count":35,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["ijerph17207583"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17207583","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,19]]}}}