BackgroundThe four-item Patient Health Questionnaire-4 (PHQ-4) is a widely used screening measure for depression and anxiety. ObjectivesThis study aimed to test factor structure and measurement invariance in an adult sample of the general population across seven European countries. MethodA total sample of 9230 adults, 71.3 % female, Mage = 44.35 (SD = 14.11) from seven countries (Austria, Croatia, Georgia, Germany, Lithuania, Portugal, and Sweden) participated in the study. We applied confirmatory factor analysis (CFA) to examine the factor structure and measurement invariance testing to evaluate measurement equivalence across countries, gender, and age groups. ResultsThe CFA yielded that a two-factor PHQ-4 model with separate depression and anxiety factors had the best fit. Partial scalar measurement invariance was established across different groups based on gender, age, and country. ConclusionsThe PHQ-4 is a valid and reliable measure that can be applied to screen for depression and anxiety in the general population. LimitationsThe limitation of the study includes the sampling, which resulted in the sample structure with the majority of females, predominantly of high education and from urban communities.