Validation of the Patient Health Questionnaire‐4 for longitudinal mental health evaluation in elite Para athletes

Abstract

IntroductionDespite the increasing amount of research regarding mental health in elite athletes in recent years, athletes with impairments are hardly represented. Due to this lack of data and the significant need of athlete specific mental health screening tools, a continuous mental health monitoring within elite Para athletes was implemented.ObjectivesValidation of the Patient Health Questionnaire‐4 (PHQ‐4) as a suitable tool for continuous mental health evaluation in elite Para athletes.DesignA 43‐week prospective observational cohort studySettingOnline questionnaire, provided weekly via web browser and mobile appParticipants78 Para athletes preparing for Paralympic Summer and Winter GamesInterventionNot applicableMain outcome measuresWeekly PHQ‐4 scores, stress level and mood.ResultsWith a mean weekly response rate of 82.7% (SD=8.0), 2149 PHQ‐4, 2159 stress level and 2153 mood assessments were completed. Mean PHQ‐4 score among all participating athletes was 1.2 (SD=1.8; 95% CI [1.1‐1.3]). Individual weekly scores ranged from zero to 12 and showed significant floor effects, with 54% of the scores being zero. PHQ‐4 scores were significantly higher among female athletes and team sport members (p<.001). Internal consistency of the PHQ‐4 was satisfying, Cronbach's α being 0.839. There were significant cross‐sectional as well as longitudinal correlations of PHQ‐4 and stress level as well as mood values (p<.001). 39.7% of all athletes (n=31) had at least one positive screen for mental health symptoms.ConclusionThe PHQ‐4 turned out to be a valid tool for mental health surveillance in elite Para athletes. Significant correlations of the PHQ‐4 and stress level as well as mood were shown. High weekly response rates among participating athletes indicated good acceptance of the program. The weekly monitoring allowed for the identification of individual fluctuations and could identify potential athletes at risk for mental health problems when combined with clinical follow‐up.This article is protected by copyright. All rights reserved.

Dimensionality and reliability of the online version of the Patient Health Questionnaire-4 (PHQ-4) in a large Colombian sample: Results from the PSY-COVID study

“…As in previous validations (Fong et al, 2023;Kocalevent et al, 2014;Löwe et al, 2010;Meidl et al, 2023;Mendoza et al, 2022), the two-factor structure of the PHQ-4 was invariant (configural, metric, and scalar) across gender, age, income level, education level, and region in this study, supporting hypothesis 2. Given the geographically based cultural heterogeneity of Colombia, regional invariance of PHQ-4 seems to be a particularly relevant finding.…”

“…Firstly, to examine the goodness-of-fit of the one-, two-, and bifactor model of the PHQ-4. In line with the evidence reported in previous studies (Cano-Vindel et al, 2018;Fong et al, 2023;Kocalevent et al, 2014;Kroenke et al, 2009;Löwe et al, 2010;Meidl et al, 2023;Mendoza et al, 2022), it was speculated that the two-factor correlated model would have a significantly better fit to the data than the other models (hypothesis 1). 2.…”

“…This ultra-brief self-report instrument combines two items of the PHQ-9 (Kroenke et al, 2001) and two items of the Generalized Anxiety Disorder (GAD-7; Spitzer et al, 2006). The psychometric properties of the PHQ-4 has been explored in clinical (Cano-Vindel et al, 2018;Ghaheri et al, 2020;Kroenke et al, 2009;Renovanz et al, 2019;Weihs et al, 2018) and nonclinical samples (Fong et al, 2023;Kazlauskas et al, 2023;Khubchandani et al, 2016;Kocalevent et al, 2014;Larionow & Mudło, 2023;Löwe et al, 2010;Meidl et al, 2023;Mendoza et al, 2022;Mills et al, 2015) in several countries (i.e., Colombia, Denmark, Ecuador, Germany, Greek, Iran, Korea, Philippines, Poland, Spain, and United States, among others), but mainly in paper-and-pencil format.…”

“…Fourthly, to explore the relationship between the PHQ-4 scores with socio-demographic characteristics of this sample. Based on the results from previous psychometric studies (Cano-Vindel et al, 2018;Fong et al, 2023;Kocalevent et al, 2014;Löwe et al, 2010;Meidl et al, 2023;Mendoza et al, 2022), it was expected that females, older individuals, those with lower incomes, employed, or with lower levels of education would exhibit higher depressive, anxiety, and psychological distress symptoms (hypothesis 4).…”