scispace - formally typeset

Journal ArticleDOI

A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7

22 May 2006-JAMA Internal Medicine (American Medical Association)-Vol. 166, Iss: 10, pp 1092-1097

AbstractBackground Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. Methods A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. Results A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. Conclusion The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

...read more

Citations
More filters

Journal ArticleDOI
TL;DR: A large primary carebased anxiety study is analyzed to ascertain commonalities among anxiety diagnoses that are traditionally considered to be discrete and to determine whether a single measure can be used as a first step, common metric.
Abstract: Anxiety is as common as depression; however, it has received less attention and is often undetected and undertreated. The authors administered a 7-item anxiety scale to 965 primary care patients, w...

2,355 citations


Journal ArticleDOI
Abstract: Background Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5–10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable. Methods Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales. Results The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is ≥10 on the parent scales (PHQ-9 and GAD-7) and ≥3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15. Conclusions The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization.

2,180 citations


Journal ArticleDOI
TL;DR: Evidence supports reliability and validity of the G AD-7 as a measure of anxiety in the general population and can be used to compare a subject's GAD-7 score with those determined from a general population reference group.
Abstract: Background:The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available.Objectives:To investigate reliability

1,860 citations


Journal ArticleDOI
TL;DR: The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders and has a substantial effect on functional status that was independent of depression.
Abstract: Background The most common mental disorders in both outpatient settings and the general population are depression and anxiety, which frequently coexist. Both of these disorders are associated with considerable disability. Objective When the disorders co-occur, the disability is even greater. Authors sought to test an ultra-brief screening tool for both. Method Validated two-item ultra-brief screeners for depression and anxiety were combined to constitute the Patient Health Questionnaire for Depression and Anxiety (the PHQ–4). Data were analyzed from 2,149 patients drawn from 15 primary-care clinics in the United States. Results Factor analysis confirmed two discrete factors (Depression and Anxiety) that explained 84% of the total variance. Increasing PHQ–4 scores were strongly associated with functional impairment, disability days, and healthcare use. Anxiety had a substantial effect on functional status that was independent of depression. Conclusion The PHQ–4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders.

1,549 citations


Journal ArticleDOI
TL;DR: This study identified a major mental health burden of the public during the COVID-19 outbreak as young people, people spending too much time thinking about the outbreak, and healthcare workers were at high risk of mental illness.
Abstract: China has been severely affected by Coronavirus Disease 2019(COVID-19) since December, 2019. We aimed to assess the mental health burden of Chinese public during the outbreak, and to explore the potential influence factors. Using a web-based cross-sectional survey, we collected data from 7,236 self-selected volunteers assessed with demographic information, COVID-19 related knowledge, generalized anxiety disorder (GAD), depressive symptoms, and sleep quality. The overall prevalence of GAD, depressive symptoms, and sleep quality of the public were 35.1%, 20.1%, and 18.2%, respectively. Younger people reported a significantly higher prevalence of GAD and depressive symptoms than older people. Compared with other occupational group, healthcare workers were more likely to have poor sleep quality. Multivariate logistic regression showed that age (< 35 years) and time spent focusing on the COVID-19 (≥ 3 hours per day) were associated with GAD, and healthcare workers were at high risk for poor sleep quality. Our study identified a major mental health burden of the public during the COVID-19 outbreak. Younger people, people spending too much time thinking about the outbreak, and healthcare workers were at high risk of mental illness. Continuous surveillance of the psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide.

1,340 citations


References
More filters

Journal ArticleDOI
TL;DR: A 36-item short-form survey designed for use in clinical practice and research, health policy evaluations, and general population surveys to survey health status in the Medical Outcomes Study is constructed.
Abstract: A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.

31,597 citations


Journal ArticleDOI
TL;DR: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity, which makes it a useful clinical and research tool.
Abstract: OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity.

19,000 citations


Journal ArticleDOI
TL;DR: Un nouvel inventaire auto-administre destine a mesurer l'anxiete pathologique, le «Beck Anxiety Cheklist» (BAI) est decrit, evalue et compare au «Hamilton Anxiety Rating Scale» (test avec lequel des correlations moderees sont trouvees).
Abstract: Un nouvel inventaire auto-administre destine a mesurer l'anxiete pathologique, le «Beck Anxiety Cheklist» (BAI) est decrit, evalue et compare au «Hamilton Anxiety Rating Scale» (test avec lequel des correlations moderees sont trouvees)

10,126 citations


Journal ArticleDOI
Max Hamilton1

7,639 citations


Journal ArticleDOI
TL;DR: HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population.
Abstract: Objective: To review the literature of the validity of the Hospital Anxiety and Depression Scale (HADS). Method: A review of the 747 identified papers that used HADS was performed to address the following questions: (I) How are the factor structure, discriminant validity and the internal consistency of HADS? (II) How does HADS perform as a case finder for anxiety disorders and depression? (III) How does HADS agree with other self-rating instruments used to rate anxiety and depression? Results: Most factor analyses demonstrated a twofactor solution in good accordance with the HADS subscales for Anxiety (HADS-A) and Depression (HADS-D), respectively. The correlations between the two subscales varied from .40 to .74 (mean .56). Cronbach’s alpha for HADS-A varied from .68 to .93 (mean .83) and for HADS-D from .67 to .90 (mean .82). In most studies an optimal balance between sensitivity and specificity was achieved when caseness was defined by a score of 8 or above on both HADS-A and HADS-D. The sensitivity and specificity for both HADS-A and HADS-D of approximately 0.80 were very similar to the sensitivity and specificity achieved by the General Health Questionnaire (GHQ). Correlations between HADS and other commonly used questionnaires were in the range .49 to .83. Conclusions: HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population. D 2002 Elsevier Science Inc. All rights reserved.

7,454 citations