Abstract
The GAD-7 is a practical and short self-report measure that has been widely utilized for the screening of generalized anxiety disorder (GAD), a severe form of anxiety disorder that is difficult to identify. Previous studies have investigated the GAD-7 in different settings and various cultures, but often without reporting important internal validity-related indices. To determine the psychometric properties of the GAD-7, the present study examined the internal consistency, convergent validity, underlying factor structure and item discrimination using both Classical Test Theory (CTT) and Item-Response Theory (IRT) models, within both a clinical and a non-clinical sample from Romania. A total of 747 participants, of whom 181 were clinical patients and 566 recruited from the general population, completed the Romanian version of the GAD-7, the Depression, Anxiety, and Stress Scale–21 (DASS-21), and the State-Trait Anxiety Inventory (STAI). CFA results confirmed that a modified one-factor model was an acceptable solution for the clinical sample. The internal consistency of the scale was satisfactory for both samples. The GAD-7 strongly correlated with the three subscales of the DASS-21 and exhibited moderate correlations with the STAI, confirming convergent validity. Keywords: GAD-7; Psychometric properties; Adaptation; IRT; DASS-21; STAI
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References
Ahn, J. K., Kim, Y., & Choi, K. H. (2019). The Psychometric Properties and Clinical Utility of the Korean Version of GAD-7 and GAD-2. Frontiers in Psychiatry, 10, 127. https://doi.org/10.3389/fpsyt.2019.00127.
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders. III-R).
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. IV).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. V).
Beck, A. T., & Steer, R. A. (1993). Beck anxiety Inventory Manual. Psychological Corporation.
De Man, J., Absetz, P., Sathish, T., Desloge, A., Haregu, T., Oldenburg, B., Johnson, L. C. M., Thankappan, K. R., & Williams, E. D. (2021). Are the PHQ-9 and GAD-7 suitable for Use in India? A psychometric analysis. Frontiers in Psychology, 12, 676398. https://doi.org/10.3389/fpsyg.2021.676398.
Dhira, T. A., Rahman, M. A., Sarker, A. R., & Mehareen, J. (2021). Validity and reliability of the generalized anxiety Disorder-7 (GAD-7) among university students of Bangladesh. Plos One, 16(12), e0261590. https://doi.org/10.1371/journal.pone.0261590.
Donker, T., van Straten, A., Marks, I., & Cuijpers, P. (2011). Quick and easy self-rating of generalized anxiety disorder: Validity of the dutch web-based GAD-7, GAD-2 and GAD-SI. Psychiatry Research, 188(1), 58–64. https://doi.org/10.1016/j.psychres.2011.01.016.
Franco-Jimenez, R. A., & Nunez-Magallanes, A. (2022). Psychometric Properties of the GAD-7, GAD-2, and GAD-Mini in peruvian College students. Propositos Y Representaciones, 10(1), e1437. https://doi.org/10.20511/pyr2022.v10n1.1437.
Garcia-Campayo, J., Zamorano, E., Ruiz, M. A., Pardo, A., Perez-Paramo, M., Lopez-Gomez, V., Freire, O., & Rejas, J. (2010). Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health and Quality of Life Outcomes, 8, 8. https://doi.org/10.1186/1477-7525-8-8.
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x.
Hinz, A., Klein, A. M., Braehler, E., Glaesmer, H., Luck, T., Riedel-Heller, S. G., Wirkner, K., & Hilbert, A. (2017). Psychometric evaluation of the generalized anxiety disorder screener GAD-7, based on a large german general population sample. Journal of Affective Disorders, 210, 338–344. https://doi.org/10.1016/j.jad.2016.12.012.
Johnson, S. U., Ulvenes, P. G., Øktedalen, T., & Hoffart, A. (2019). Psychometric Properties of the General anxiety disorder 7-Item (GAD-7) scale in a Heterogeneous Psychiatric Sample. Frontiers in Psychology, 10, 1713. https://doi.org/10.3389/fpsyg.2019.01713.
Jordan, P., Shedden-Mora, M. C., & Löwe, B. (2017). Psychometric analysis of the generalized anxiety disorder scale (GAD-7) in primary care using modern item response theory. PloS One, 12(8), e0182162. https://doi.org/10.1371/journal.pone.0182162.
Kertz, S., Bigda-Peyton, J., & Bjorgvinsson, T. (2013). Validity of the generalized anxiety Disorder-7 scale in an Acute Psychiatric Sample. Clinical Psychology & Psychotherapy, 20(5), 456–464. https://doi.org/10.1002/cpp.1802.
Kline, R. B. (2010). Principles and practice of structural equation modeling. Guilford Press.
Konkan, R., Senormanci, O., Guclu, O., Aydin, E., & Sungur, M. Z. (2013). Validity and reliability study for the turkish adaptation of the generalized anxiety Disorder-7 (GAD-7)scale. Noropsikiyatri Arsivi-Archives of Neuropsychiatry, 50(1), 53–58. https://doi.org/10.4274/npa.y6308.
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety Disorders in Primary Care: Prevalence, impairment, Comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325. https://doi.org/10.7326/0003-4819-146-5-200703060-00004.
Kujanpää, T., Ylisaukko-Oja, T., Jokelainen, J., Hirsikangas, S., Kanste, O., Kyngäs, H., & Timonen, M. (2014). Prevalence of anxiety disorders among finnish primary care high utilizers and validation of finnish translation of GAD-7 and GAD-2 screening tools. Scandinavian Journal of Primary Health Care, 32(2), 78–83. https://doi.org/10.3109/02813432.2014.920597.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression anxiety stress scales (2nd ed.). Psychology Foundation.
Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Medical Care, 46(3), 266–274. https://doi.org/10.1097/MLR.0b013e318160d093.
Nyongesa, M. K., Mwangi, P., Koot, H. M., Cuijpers, P., Newton, C. R. J. C., & Abubakar, A. (2020). The reliability, validity and factorial structure of the Swahili version of the 7-item generalized anxiety disorder scale (GAD-7) among adults living with HIV from Kilifi, Kenya. Annals of General Psychiatry, 19(1), 62. https://doi.org/10.1186/s12991-020-00312-4.
Patriquin, M. A., & Mathew, S. J. (2017). The neurobiological mechanisms of generalized anxiety disorder and chronic stress. Chronic Stress, 1, 2470547017703993. https://doi.org/10.1177/2470547017703993.
Putnick, D. L., & Bornstein, M. H. (2016). Measurement Invariance Conventions and reporting: The state of the art and future directions for Psychological Research. Developmental Review: DR, 41, 71–90. https://doi.org/10.1016/j.dr.2016.06.004.
Sawaya, H., Atoui, M., Hamadeh, A., Zeinoun, P., & Nahas, Z. (2016). Adaptation and initial validation of the Patient Health Questionnaire-9 (PHQ-9) and the generalized anxiety Disorder-7 questionnaire (GAD-7) in an arabic speaking lebanese psychiatric outpatient sample. Psychiatry Research, 239, 245–252. https://doi.org/10.1016/j.psychres.2016.03.030.
Sousa, T. V., Viveiros, V., Chai, M. V., Vicente, F. L., Jesus, G., Carnot, M. J., Gordo, A. C., & Ferreira, P. L. (2015). Reliability and validity of the portuguese version of the generalized anxiety disorder (GAD-7) scale. Health and Quality of Life Outcomes, 13, 50. https://doi.org/10.1186/s12955-015-0244-2.
Spielberger, C. D., Gorsuch, R. L., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory. Consulting Psychologists Press.
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092.
Tong, X., An, D., McGonigal, A., Park, S. P., & Zhou, D. (2016). Validation of the generalized anxiety Disorder-7 (GAD-7) among chinese people with epilepsy. Epilepsy Research, 120, 31–36. https://doi.org/10.1016/j.eplepsyres.2015.11.019.
Williams, N. (2014). The GAD-7 questionnaire. Occupational Medicine, 64(3), 224. https://doi.org/10.1093/occmed/kqt161.
Woon, L. S., Hatta, S., & Norlaila, M. (2020). Factor structure of the malay-version generalized anxiety Disorder-7 (GAD-7) questionnaire among patients with diabetes Mellitus. Medicine and Health-Kuala Lumpur, 15(1), 208–217. https://doi.org/10.17576/MH.2020.1501.19.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.
Zinchuk, M., Kustov, G., Pashnin, E., Gersamia, A., Rider, F., Yakovlev, A., Voinova, N., Popova, S., Avedisova, A., & Guekht, A. (2021). Validation of the generalized anxiety Disorder-7 (GAD-7) in russian people with epilepsy. Epilepsy & Behavior, 123, 108269. https://doi.org/10.1016/j.yebeh.2021.108269.
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The original authors of the GAD-7 (Spitzer et al., 2006) have given written consent for using the GAD-7 in clinical research settings for the Romanian population, and have provided us with the authorized Romanian version of the scale (i.e., the translation with a Linguistic Validation Certificate from MAPI Research Institute). The study was approved by the Ethical Committee of the University Emergency Hospital, Bucharest as well as by the County Emergency Clinical Hospital of T?rgu-Mure?, and County Emergency Hospital of Satu Mare.
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Cotiga, A.C., Zanfirescu, Ş.A., Iliescu, D. et al. Psychometric Characteristics of the Romanian Adaptation of the GAD-7. J Psychopathol Behav Assess 45, 691–701 (2023). https://doi.org/10.1007/s10862-023-10062-8
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DOI: https://doi.org/10.1007/s10862-023-10062-8