A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
TL;DR: In this article, a 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity, and increasing scores on the scale were strongly associated with multiple domains of functional impairment.
Abstract: Background 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.
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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...
3,090 citations
TL;DR: In this article, 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.
2,765 citations
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
2,730 citations
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.
2,404 citations
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.
2,343 citations
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TL;DR: A meta-analysis of high-quality studies published from 1990-1998 on the efficacy of manualized psychotherapies for depression, panic disorder, and generalized anxiety disorder suggests that a substantial proportion of patients with panic improve and remain improved.
Abstract: The authors report a meta-analysis of high-quality studies published from 1990-1998 on the efficacy of manualized psychotherapies for depression, panic disorder, and generalized anxiety disorder (GAD) that bear on the clinical utility and external validity of empirically supported therapies. The results suggest that a substantial proportion of patients with panic improve and remain improved; that treatments for depression and GAD produce impressive short-term effects: that most patients in treatment for depression and GAD do not improve and remain improved at clinically meaningful follow-up intervals: and that screening procedures used in many studies raise questions about generalizability, particularly in light of a systematic relation across studies between exclusion rates and outcome. The data suggest the importance of reporting, in both clinical trials and meta-analyses, a range of outcome indices that provide a more comprehensive, multidimensional portrait of treatment effects and their generalizability. These include exclusion rates, percent improved, percent recovered, percent who remained improved or recovered at follow-up, percent seeking additional treatment at follow-up, and data on both completer and intent-to-treat samples.
665 citations
01 Jan 2002
TL;DR: In this article, Antony et al. present measures for generalized and specific phobias and measures for anxiety disorders in older adults, including OCD, panic disorder and agoraphobia.
Abstract: Part 1: General Issues in the Assessment of Anxiety Disorders. 1. Assessment of Anxiety and the Anxiety Disorders: An Overview M.M. Antony. 2. Behavioral Assessment of Anxiety Disorders B.F. Chorpita, A.A. Taylor. 3. Psychophysiological Assessment of Anxiety: Tales from the Heart A.R. Yartz, L.W. Hawk, Jr. 4. Biological Challenges in the Assessment of Anxiety Disorders J.P. Forsyth, M. Karekla. 5. Cultural Issues in the Assessment of Anxiety Disorders S. Friedman. 6. Assessment of Anxiety Disorders in Older Adults: Current Concerns, Future Prospects J.G. Beck, M.A. Stanley. Part 2: Assessment Strategies for Anxiety Disorders. 7. Measures for Anxiety and Related Constructs L. Roemer. 8. Panic Disorder and Agoraphobia: A Brief Overview and Guide to Assessment R.E. McCabe. 9. Measures for Panic Disorders and Agoraphobia M.M. Antony. 10. Specific Phobia: A Brief Overview and Guide to Assessment M.M. Antony. 11. Measures for Specific Phobia M.M. Antony. 12. Social Phobia: A Brief Overview and Guide to Assessment S.M. Orsillo, C. Hammond. 13. Measures for Social Phobia S.M. Orsillo. 14. Generalized Anxiety Disorder: A Brief Overview and Guide to Assessment L. Roemer, E. Medaglia. 15. Measures for Generalized Anxiety Disorder L. Roemer. 16. Obsessive Compulsive Disorder: A Brief Overview and Guide to Assessment L.J. Summerfeldt. 17. Measures for Obsessive Compulsive Disorder M.M. Antony. 18. Acute Stress Disorder and Posttraumatic Stress Disorder: A Brief Overview and Guide to Assessment S.M. Orsillo, et al. 19. Measures for Acute Stress Disorder and Posttraumatic Stress Disorder S.M. Orsillo. Appendices. Author Index.
420 citations
TL;DR: Primary care patients with more than one mental disorder are common and highly disabled, and only patients with major depressive disorder, bipolar disorder, phobias, and substance use disorders had significantly increased disability, as measured by the Sheehan Disability Scale.
Abstract: OBJECTIVE: This article examines social and occupational disability associated with several DSM-IV mental disorders in a group of adult primary care outpatients. METHOD: The subjects were 1,001 primary care patients (aged 18–70 years) in a large health maintenance organization. Data on each patient's sociodemographic characteristics and functional disability, including scores on the Sheehan Disability Scale, were collected at the time of a medical visit. A structured diagnostic interview for current DSM-IV disorders was then completed by a mental health professional over the telephone within 4 days of the visit. RESULTS: The most prevalent disorders were phobias (7.7%), major depressive disorder (7.3%), alcohol use disorders (5.2%), generalized anxiety disorder (3.7%), and panic disorder (3.0%). A total of 8.3% of the patients met the criteria for more than one mental disorder. The proportion of patients with co-occurring mental disorders varied by index disorder from 50.0% (alcohol use disorder) to 89.2%...
386 citations
TL;DR: The results indicate that most of the PDSQ subscales were able to achieve the goal of good sensitivity, high negative predictive value, and high positive and negative predictive values, so that most noncases on the measure are indeed noncases.
Abstract: Background The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong, self-report scale designed to screen for the most common DSM-IV Axis I disorders encountered in outpatient mental health settings. In the present report, we describe the diagnostic performance (sensitivity, specificity, and positive and negative predictive values) of the PDSQ in an outpatient setting. Methods Six hundred thirty psychiatric outpatients presenting for treatment were evaluated with the Structured Clinical Interview for DSM-IV after completing the PDSQ. Patients arrived approximately 20 minutes before the scheduled time of the appointment to complete the scale. Diagnostic raters were blind to responses on the scale. Results The PDSQ's subscales' diagnostic performance varied in a predictable manner according to the cutoff score—as the threshold for case identification increased, subscale sensitivity decreased and specificity increased. Mean subscale sensitivities of 80%, 85%, and 90% resulted in mean subscale specificities of 78%, 73%, and 66%, respectively, and negative predictive values of 95%, 96%, and 97%. Receiver operating curves were determined for each subscale and all areas under the curve were significant. Conclusions The PDSQ is a diagnostic aid designed to be used in clinical practice to facilitate the efficiency of conducting initial diagnostic evaluations. From a clinical perspective, it is most important that a diagnostic aid have good sensitivity, so that most cases are detected, and high negative predictive value, so that most noncases on the measure are indeed noncases. Our results indicate that most of the PDSQ subscales were able to achieve this goal.
357 citations
TL;DR: Telephone administration of the PHQ-9 seems to be a reliable procedure for assessing depression in PC, and its internal consistency was high and close to the self-administered one.
Abstract: BACKGROUND: Telephone assessment of depression for research purposes is increasingly being used. The Patient Health Questionnaire 9-item depression module (PHQ-9) is a well-validated, brief, self-reported, diagnostic, and severity measure of depression designed for use in primary care (PC). To our knowledge, there are no available data regarding its validity when administered over the telephone. OBJECTIVE: The aims of the present study were to evaluate agreement between self-administered and telephone-administered PHQ-9, to investigate possible systematic bias, and to evaluate the internal consistency of the telephone-administered PHQ-9. METHODS: Three hundred and forty-six participants from two PC centers were assessed twice with the PHQ-9. Participants were divided into 4 groups according to administration procedure order and administration procedure of the PHQ-9: Self-administered/Telephone-administered; Telephone-administered/Self-administered; Telephone-administered/Telephone-administered; and Self-administered/Self-administered. The first 2 groups served for analyzing the procedural validity of telephone-administered PHQ-9. The last 2 allowed a test-retest reliability analysis of both self- and telephone-administered PHQ-9. Intraclass correlation coefficient (ICC) and weighted κ (for each item) were calculated as measures of concordance. Additionally, Pearson’s correlation coefficient, Student’s t-test, and Cronbach’s α were analyzed. RESULTS: Intraclass correlation coefficient and weighted κ between both administration procedures were excellent, revealing a strong concordance between telephone- and self-administered PHQ-9. A small and clinically nonsignificant tendency was observed toward lower scores for the telephone-administered PHQ-9. The internal consistency of the telephone-administered PHQ-9 was high and close to the self-administered one. CONCLUSIONS: Telephone and in-person assessments by means of the PHQ-9 yield similar results. Thus, telephone administration of the PHQ-9 seems to be a reliable procedure for assessing depression in PC.
338 citations