Evaluation of the Patient Health Questionnaire (PHQ) Stress Scale over the course of the pandemic in a large German general population sample

Abstract

Background The Patient Health Questionnaire stress scale (PHQ stress) is a brief 10-item measure of psychosocial stressors, including work, health, relationship, and financial concerns. This study examines changes in psychosocial stress during the COVID-19 pandemic and evaluates the scale's temporal stability and measurement invariance. Methods Longitudinal population-based data (N = 4412) were collected at three time points during the pandemic (baseline, 4 months later, and 1.5 years after baseline). Internal consistency was assessed using McDonald's omega, and temporal stability via Pearson correlations. Confirmatory factor analysis (CFA) was conducted to verify the unidimensional factor structure. A sensitivity analysis included pre-pandemic data (1.5 years before baseline). Results PHQ stress scores increased across the four time points. Internal consistency remained acceptable (ω = 0.77–0.79), with moderate temporal stability (r = 0.631–0.697). CFA supported a stable one-factor structure (CFI = 0.947, TLI = 0.932, RMSEA = 0.048, SRMR = 0.047). Conclusion The PHQ stress scale demonstrated adequate reliability and temporal stability in a longitudinal context. It effectively captured variations in stress influenced by major external events such as the pandemic and economic inflation.