The Patient Health Questionnaire-4 (PHQ-4) as aBrief Screening Tool for Anxiety and Depression: A Study of Iranian Samples

The aims of the present study were (a) to develop a Farsi version of the Patient Health Questionnaire-4 (PHQ-4), (b) to explore correlations between anxiety and depression with psychological well-being, mental health, and happiness, and (c) to investigate gender-related differences. A sample of 488 individuals representing the general population of Iran completed the PHQ-4, the World Health Organization-Five Well-Being Index, the Self-Rating Scale of Mental Health, and the Self-Rating Scale of Happiness. The PHQ-4 demonstrated good internal consistency, with a Cronbach’s alpha of .86. Using principal components analysis (PCA) with varimax rotation, one factor was extracted and labeled “Anxious/Depressed.” Exploratory factor analysis suggested that the scale supports both a one-factor and a two-factor structure. Confirmatory factor analysis further demonstrated that the PHQ-4 had good fit indices for both models, and Cronbach’s alpha remained high in both cases. Additionally, PHQ-4 scores were negatively correlated with psychological well-being, mental health, and happiness, supporting the validity of the scale. No statistically significant gender differences were found in PHQ-4 scores. Overall, the PHQ-4 exhibited strong psychometric properties in this sample from the general Iranian population. This study provides evidence for the effectiveness of the Farsi version of the PHQ-4 in assessing anxiety and depression symptoms among Iranian community residents.