Anxiety, Depression, and Associated Factors in Clinical Psychologists: Psychometric Evaluation of the PHQ-4

Abstract The Patient Health Questionnaire-4 (PHQ-4) is a widely used tool for screening symptoms of depression and anxiety. Its psychometric properties in clinical psychologists, a group particularly susceptible to psychological distress, have not been extensively studied. This study aims to evaluate the psychometric properties of the PHQ-4 among clinical psychologists in Mexico and to identify sociodemographic variables associated with anxiety and depression. Data were collected from 212 clinical psychologists through an online survey. The PHQ-4’s factor structure was assessed using confirmatory factor analysis (CFA). Sociodemographic variables were analyzed for their association with anxiety and depression levels. CFA supported a two-factor model (anxiety and depression) over a unidimensional model, with excellent fit indices. Internal consistency was adequate for both the anxiety (ω = 0.78) and depression (ω = 0.82) subscales. Male psychologists and those with greater confidence in their clinical skills reported significantly lower levels of anxiety and depression. No significant associations were found for age, psychotherapy history, or clinical supervision. The PHQ-4 is a reliable and valid measure for assessing anxiety and depression in Mexican clinical psychologists. Confidence in clinical skills appears to be a key protective factor against psychological distress. Interventions to enhance clinical skills and self-efficacy could improve mental health outcomes in this population.