+1 Recommend
1 collections
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Psychometric properties of the Patient Health Questionnaire-4 among Hong Kong young adults in 2021: Associations with meaning in life and suicidal ideation


      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.



          Young adults in Hong Kong are subject to elevated psychological distress given the societal stressors such as civil unrest and COVID-19 pandemic and suicide is a leading cause of death among them. The present study aimed to evaluate the psychometric properties and measurement invariance of the 4-item Patient Health Questionnaire-4 (PHQ-4) as a brief measure of psychological distress and its associations with meaning in life and suicidal ideation (SI) in young adults.

          Materials and methods

          A mobile survey recruited a large and random sample of 1,472 young adults (Mean age = 26.3 years, 51.8% males) in Hong Kong in 2021. The participants completed the PHQ-4 and Meaning in Life Questionnaire–short form (MLQ-SF) for presence of meaning in life (MIL), SI, COVID-19 impact, and exposure to suicide. Confirmatory factor analysis was conducted to examine the factorial validity, reliability, and measurement invariance of PHQ-4 and MLQ-SF across gender, age, and distress subgroups. Multigroup structural equation model evaluated and compared the direct and indirect effects of latent MIL factor on SI via latent PHQ-4 factor across distress groups.


          Both MIL and PHQ-4 supported a 1-factor model with good composite reliability (Ω = 0.80–0.86) and strong factor loadings (λ = 0.65–0.88). Both factors showed scalar invariance across gender, age, and distress groups. MIL showed significant and negative indirect effects ( αβ = −0.196, 95% CI = −0.254 to −0.144) on SI via PHQ-4. PHQ-4 showed a stronger mediating role between MIL and SI in the distress group (Δ = −0.146, 95% CI = −0.252 to −0.049) than the non-distress group. Higher MIL predicted higher likelihoods of help-seeking (Odds ratios = 1.46, 95% CI = 1.14–1.88).


          The present results support adequate psychometric properties in terms of factorial validity, reliability, convergent validity, and measurement invariance for the PHQ-4 in young adults in Hong Kong. The PHQ-4 demonstrated a substantial mediating role in the relationship between meaning in life and SI in the distress group. These findings support clinical relevance for using the PHQ-4 as a brief and valid measure of psychological distress in the Chinese context.

          Related collections

          Most cited references62

          • Record: found
          • Abstract: not found
          • Article: not found

          Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives

            • Record: found
            • Abstract: not found
            • Article: not found

            Evaluating Goodness-of-Fit Indexes for Testing Measurement Invariance

              • Record: found
              • Abstract: not found
              • Article: not found

              Sensitivity of Goodness of Fit Indexes to Lack of Measurement Invariance


                Author and article information

                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                09 March 2023
                : 14
                : 1138755
                [1] 1Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong , Pokfulam, Hong Kong SAR, China
                [2] 2Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong , Pokfulam, Hong Kong SAR, China
                [3] 3Centre for Suicide Research and Prevention, Faculty of Social Sciences, The University of Hong Kong , Pokfulam, Hong Kong SAR, China
                Author notes

                Edited by: Tjhin Wiguna, University of Indonesia, Indonesia

                Reviewed by: Alessandra Costanza, University of Geneva, Switzerland; Lu Qinghua, Shandong Mental Health Center, China

                *Correspondence: Paul S. F. Yip, sfpyip@ 123456hku.hk

                This article was submitted to Adolescent and Young Adult Psychiatry, a section of the journal Frontiers in Psychiatry

                Copyright © 2023 Fong, Ho and Yip.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                : 06 January 2023
                : 23 February 2023
                Page count
                Figures: 1, Tables: 5, Equations: 0, References: 62, Pages: 10, Words: 7579
                Funded by: Research Grants Council, University Grants Committee, doi 10.13039/501100002920;
                Award ID: General Research Fund (GRF/HKU 17606521)
                Award ID: Collaborative Research Fund (C7151-20GF)
                This study was supported by the Hong Kong Jockey Club Charities Trust, the General Research Fund grant (GRF/HKU 17606521) and the Collaborative Research Fund (C7151-20GF) of the Research Grants Council. The funding organization had no role in the study design, collection, analysis and interpretation of data, in the writing of the manuscript, and in the decision to submit the manuscript for publication.
                Original Research

                Clinical Psychology & Psychiatry
                measurement invariance,mediation,psychological distress,meaning in life,patient health questionnaire-4 (phq-4),suicidal ideation,young adults,scale validation


                Comment on this article