Evidence map›Paper›PMID 42668360›Full record

ArticleBMC geriatrics2026

Psychometric properties and age- and gender-specific normative values of the Patient Health Questionnaire-4 among older adults aged 60 years and above.

Nikolay Dimitrov, Elmar Brähler, Andreas Hinz, Bjarne Schmalbach, Jörg M Fegert, Markus Zenger

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Article in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Nikolay DimitrovFaculty of Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany. dimitrov.nikolay.m@gmail.com.
Elmar BrählerClinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Johannes Gutenberg University Mainz, Mainz, D-55131, Germany.
Andreas HinzDepartment of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
Bjarne SchmalbachMedical Psychology & Medical Sociology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Jörg M FegertDepartment of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Ulm, Ulm, Germany.
Markus ZengerFaculty of Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMental health problems in older adults are often underrecognized despite their substantial impact on health and well-being. Brief, valid screening tools with age-specific normative data are needed for this growing population. This study examined the psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) and established age- and gender-specific normative values for adults aged 60 years and older in Germany.

methodsData were drawn from four nationally representative face-to-face household surveys conducted in Germany between 2021 and 2024. Four of the total 3,212 participants were excluded due to missing PHQ-4 responses, resulting in a final sample of N = 3,208. The psychometric properties of the Generalized Anxiety Disorder-2 (GAD-2), the Patient Health Questionnaire-2 (PHQ-2), and the Patient Health Questionnaire-4 (PHQ-4) were evaluated.

resultsThe PHQ-4 showed excellent internal consistency. The correlated two-factor model, distinguishing depression and anxiety symptoms, demonstrated excellent fit. Measurement invariance was supported across gender and age groups. Women reported higher overall psychological distress than men, mainly due to higher anxiety symptoms, and PHQ-4 scores were highest in the oldest age group. Convergent validity was supported by moderate to strong negative correlations with quality of life, resilience, sense of coherence, and well-being. Age- and gender-specific normative values were provided for the PHQ-2, GAD-2, and PHQ-4.

conclusionsThe PHQ-4 is a reliable and valid ultra-brief screening instrument for psychological distress. The age- and gender-specific normative values provided here may improve score interpretation for community-dwelling older adults in Germany and help identify individuals who may require further clinical assessment.

Indexed as

AnxietyDepressionPatient Health QuestionnairePsychometricsAgedAged, 80 and overAge FactorsFemaleGermanyHumansMaleMiddle AgedReference ValuesReproducibility of ResultsSex FactorsAnxietyDepressionGAD-2Normative valuesOlder adultsPHQ-2PHQ-4Psychometric properties

Identifiers

PMID42668360
PMCPMC13525647

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.