Psychometric properties of the experimental and modified EQ-HWB and EQ-HWB-9 in patients with anxiety and/or depression in China

Abstract

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 multicentre 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, GAD-7, PHQ-9, ReQoL-10, SWEMWBS), 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 PHQ-9 and GAD-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 ICC 0.72–0.73). EQ-HWB items loaded on five factors (mental health and cognition, positive wellbeing, physical health, pain and discomfort, 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 wellbeing in Chinese patients with anxiety and/or depression. Results support the potential usefulness of the two instruments for cross-sectoral decision-making in anxiety and/or depression.