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Psychometric Evaluation of an Arabic Version of the PHQ-4 Based on a Representative Survey of Syrian Refugees

Article type: Published article


Background: This study addresses the need for methodologically sound, brief screening procedures (e. g., the PHQ-4) which need to be validated for refugees in their native languages. Method: A cohort of Syrian refugees in the state of Lower Saxony was investigated with the PHQ-4 translated into Standard Arabic language by a professional translation bureau. Based on representative data, the prevalence of anxiety and depressive disorders was estimated among refugees. N=864 persons of mainly male sex (68%) answered with a mean age of M=31.5 (SD=9.3 years, ranging from 16 to 93 years). Results: Internal consistency was good (PHQ-2, respectively GAD-2: alpha=0.76/0.83; women alpha=0.76/0.83; men: alpha=0.76/0.83). Confirmatory factor analyses revealed good to excellent fit: RMSEA=0,068 [95%-KI: 0.028, 0.117], TLI=0.971, CFI=0.995. Measurement invariance was demonstrated for sex. The prevalence of depression was 20%, which corresponds to results reported for the German population; generalized anxiety was moderately higher in the Syrian sample (19.3 vs. 15.2%). Discussion: The Arabic version of the PHQ-4 is an ultra-short and valid screening procedure suitable for refugees from Arabic countries. The finding that the prevalence of depression and anxiety symptoms was moderate may be due to the sample composition, which comprised predominantly young men. Given the often traumatic circumstances of their flight, additional symptoms beyond the scope of this study (esp. PTSD) can be expected.

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Kliem, S., et al., [Psychometric Evaluation of an Arabic Version of the PHQ-4 Based on a Representative Survey of Syrian Refugees]. Psychother Psychosom Med Psychol, 2016. 66(9-10): p. 385-392.


Methods Condition Gender Age Country Setting Sample size
Syrian refugees Both 16 - 93 Germany
Commuinty 864

Number of items

4 items


Measure does not require training

Required time

Less than 5 min

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Articles last updated: March 2020