Psychometric Properties of the Experimental and Modified EQ-HWB and EQ-HWB-9 in Patients with Anxiety and/or Depression in China.

OBJECTIVES

We aimed to examine the psychometric properties of the EuroQol Health and Wellbeing (EQ-HWB) and its short form (EQ-HWB-9) in patients with anxiety and/or depression. A secondary objective was to assess the performance of item modifications proposed by the EQ-HWB developers after the initial version was published.

METHODS

A multicenter cross-sectional study included 900 patients with anxiety and/or depression in China. The survey included the modified 25-item EQ-HWB and the 12 experimental items that differ between the experimental (2022) and modified (2024) versions. EQ-HWB-9 responses were derived from the EQ-HWB (modified version, 2024). Psychometric evaluation included distributional characteristics, convergent validity (correlations with EQ-5D-5L, Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-9, Recovering Quality of Life-10, and Short Warwick-Edinburgh Mental Well-being Scale), known-groups validity, test-retest reliability, and exploratory cross-instrument dimensionality (principal component analysis).

RESULTS

No ceiling effect was observed (0.8% EQ-HWB, 2.4% EQ-HWB-9). The sleep (9.0%), anxiety (9.4%), and exhaustion (13.4%) items had the lowest ceilings. Convergent validity was strong, particularly with Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7 (items ≤ 0.78; scale ≤ 0.90). Known-groups validity showed large effect sizes across anxiety and depression severity groups. Test-retest reliability was good (item-level Gwet's AC2 0.60-0.97; instrument-level intraclass correlation coefficient 0.72-0.73). EQ-HWB items loaded on 5 factors (mental health and cognition, positive well-being, physical health, pain and discomfort, and social relationships). The differences in psychometric performance between the modified and experimental items varied across items.

CONCLUSION

The EQ-HWB/EQ-HWB-9 demonstrate good validity and reliability for assessing health and well-being in Chinese patients with anxiety and/or depression. Results support the potential usefulness of the 2 instruments for cross-sectoral decision making in anxiety and/or depression.