Performance of the Patient Health Questionnaire-4 (PHQ-4) in four latin American countries: rethinking the dimensionality of the scale from the perspective of network psychometry

Background Anxiety and depression frequently co-occur and represent a major global mental health burden, highlighting the need for efficient and psychometrically sound screening tools. The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief instrument widely used across cultures; however, evidence regarding its internal structure and cross-cultural equivalence from a psychometric network perspective remains limited, particularly in Latin America. The study aims to investigate the psychometric properties of the PHQ-4 from the perspective of psychometric networks in four Latin American countries. Methods A total of 1,887 participants aged 18 to 40 years were included in the study, distributed across the following countries: Chile ( n = 353), Colombia ( n = 467), Ecuador ( n = 373), and Peru ( n = 499). Results The EGA analysis showed that the items form a single community composed of four nodes with large network loadings in all four countries. The UVA analysis demonstrated that all items are relevant to the network model in all the countries analyzed. Evidence of structural consistency and item stability was also found, with the items being stable and systematically organized into a single community across all countries. Furthermore, the bootEGA analysis demonstrated that the PHQ-4 exhibits metric invariance across countries. Conclusions The results of this study provide solid evidence of the psychometric performance of the PHQ-4 in the four countries studied. Therefore, a single-community structure is proposed to explain the internal structure of the PHQ-4.