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The factor structure and use of the PHQ-4 among high school learners in selected South African districts

Published online by Cambridge University Press:  26 August 2025

S. Mashegoane ,
J. O. August ,
V. Baloyi ,
L. D. M. Lebeloane ,
M. Makhubela  and
K. P. Moalusi
S. Mashegoane*
Affiliation:
Psychology, University of Limpopo, Polokwane
J. O. August
Affiliation:
Psychology, Nelson Mandeal University, Qheberha
V. Baloyi
Affiliation:
Psychology, University of Venda, Thohoyandou
L. D. M. Lebeloane
Affiliation:
Further Teacher Education
M. Makhubela
Affiliation:
Psychology, University of Limpopo, Polokwane
K. P. Moalusi
Affiliation:
Industrial and Organisational Psychology, University of South Africa, Tshwane, South Africa
*
*Corresponding author.

Abstract

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Introduction

In this study, the scale’s psychometric properties are estimated among South African high school learners during a period of the coronavirus-19 crisis. The study was a cross-sectional design. The data were collected from 1603 high school learners in four South African districts. The PHQ-4 was administered for data collection, and was anchored from 0 (not at all) to 3 (nearly every day) over a two-week period, with higher scores indicating the extent of symptom severity (Kroenke et al., 2009).

Objectives

The study sought to validate the PHQ-4 among South African school learners in various South African districts, and tested a model that included the PHQ-4 to investigate the obtaned factor structure’s usefulness.

Methods

Useful questionnaires were collected from 1562 high school learners within a cross-sectional design. Grades 10 to 12 learners completed the PHQ-4 from March to May 2022.

Results

Confirmatory Factor Analysis (CFA) was conducted to validate the factor structure of the scale. CFA results show that all PHQ-4 items load onto a single factor. The factor structure reported in this study is unique. Whilst the PHQ-4 is commonly considered to measure anxiety and depression, the results suggest that the scale measures a unidimensional, psychological distress factor among the learners. The total score of the PHQ-4, characterized as psychological distress, could be predicated by associated factors, although the coefficients obtained were statistically significant but weak. The PHQ-4 was predicted by the Perceived Vulnerability and the Germ Aversion subscales but not the Fear of COVID-19 scale in girls. But the PHQ-4 was predicted by the Fear of COVID-19 scale and not the Perceived Vulnerability and the Germ Aversion subscales among boys.

Conclusions

Contrary to existing studies, the PHQ-4 did not consist of 2 factors. Evidence from the current study suggests that it should be used as a unidimensional, single factor scale. The PHQ-4 total scores of girls and boys were predicted by different factors, suggesting that gender should be considered an important factor when using the PHQ-4 in reseaerch.

Disclosure of Interest

None Declared

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Type
Abstract
Information
European Psychiatry , Volume 68 , Special Issue S1: Abstracts of the 33rd European Congress of Psychiatry , April 2025 , pp. S626
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of European Psychiatric Association
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