Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample

The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric properties of these questionnaires, to provide normative values, and to investigate associations with sociodemographic factors, quality of life, psyc...

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Published in:	Journal of affective disorders Vol. 210; pp. 338 - 344
Main Authors:	Hinz, Andreas, Klein, Annette M., Brähler, Elmar, Glaesmer, Heide, Luck, Tobias, Riedel-Heller, Steffi G., Wirkner, Kerstin, Hilbert, Anja
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01.03.2017
Subjects:	Adolescent Adult Age Distribution Aged Aged, 80 and over Alcohol Drinking - psychology Anxiety Anxiety Disorders - diagnosis Anxiety Disorders - epidemiology Anxiety Disorders - psychology Cross-Sectional Studies Epidemiology Female General population Germany - epidemiology Humans Male Middle Aged Normative values Patient Health Questionnaire - standards Psychiatry Psychometrics - instrumentation Quality of Life Risk Factors Sex Distribution Smoking - psychology Socioeconomic Factors Stress Disorders, Traumatic, Acute Surveys and Questionnaires Young Adult Normative values General population Anxiety Epidemiology
ISSN:	0165-0327, 1573-2517
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Abstract	The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric properties of these questionnaires, to provide normative values, and to investigate associations with sociodemographic factors, quality of life, psychological variables, and behavioral factors. A German community sample (n=9721) with an age range of 18–80 years was surveyed using the GAD-7 and several other questionnaires. Confirmatory factor analyses confirmed the unidimensionality and measurement invariance of the GAD-7 across age and gender. Females were more anxious than males (mean scores: M=4.07 vs. M=3.01; effect size: d=0.33). There was no linear age trend. A total of 5.9% fulfilled the cut-off criterion of 10 and above. Anxiety was correlated with low quality of life, fatigue, low habitual optimism, physical complaints, sleep problems, low life satisfaction, low social support, low education, unemployment, and low income. Cigarette smoking and alcohol consumption were also associated with heightened anxiety, especially in women. When comparing the GAD-7 (7 items) with the ultra-short GAD-2 (2 items), the GAD-7 instrument was superior to the GAD-2 regarding several psychometric criteria. The response rate (33%) was low. Because of the cross-sectional character of the study, causal conclusions cannot be drawn. A further limitation is the lack of a gold standard for diagnosing anxiety. The GAD-7 can be recommended for use in clinical research and routine. •The study confirmed good psychometric properties of the GAD-7.•The psychometric quality of the GAD-7 is superior to that of the ultra-short GAD-2.•Women are more anxious than men, but there is no linear age trend in anxiety.•Anxiety is associated with alcohol consumption and cigarette smoking, especially in women.
AbstractList	Abstract Background The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric properties of these questionnaires, to provide normative values, and to investigate associations with sociodemographic factors, quality of life, psychological variables, and behavioral factors. Methods A German community sample ( n =9721) with an age range of 18–80 years was surveyed using the GAD-7 and several other questionnaires. Results Confirmatory factor analyses confirmed the unidimensionality and measurement invariance of the GAD-7 across age and gender. Females were more anxious than males (mean scores: M=4.07 vs. M=3.01; effect size: d =0.33). There was no linear age trend. A total of 5.9% fulfilled the cut-off criterion of 10 and above. Anxiety was correlated with low quality of life, fatigue, low habitual optimism, physical complaints, sleep problems, low life satisfaction, low social support, low education, unemployment, and low income. Cigarette smoking and alcohol consumption were also associated with heightened anxiety, especially in women. When comparing the GAD-7 (7 items) with the ultra-short GAD-2 (2 items), the GAD-7 instrument was superior to the GAD-2 regarding several psychometric criteria. Limitations The response rate (33%) was low. Because of the cross-sectional character of the study, causal conclusions cannot be drawn. A further limitation is the lack of a gold standard for diagnosing anxiety. Conclusions The GAD-7 can be recommended for use in clinical research and routine. The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric properties of these questionnaires, to provide normative values, and to investigate associations with sociodemographic factors, quality of life, psychological variables, and behavioral factors. A German community sample (n=9721) with an age range of 18-80 years was surveyed using the GAD-7 and several other questionnaires. Confirmatory factor analyses confirmed the unidimensionality and measurement invariance of the GAD-7 across age and gender. Females were more anxious than males (mean scores: M=4.07 vs. M=3.01; effect size: d=0.33). There was no linear age trend. A total of 5.9% fulfilled the cut-off criterion of 10 and above. Anxiety was correlated with low quality of life, fatigue, low habitual optimism, physical complaints, sleep problems, low life satisfaction, low social support, low education, unemployment, and low income. Cigarette smoking and alcohol consumption were also associated with heightened anxiety, especially in women. When comparing the GAD-7 (7 items) with the ultra-short GAD-2 (2 items), the GAD-7 instrument was superior to the GAD-2 regarding several psychometric criteria. The response rate (33%) was low. Because of the cross-sectional character of the study, causal conclusions cannot be drawn. A further limitation is the lack of a gold standard for diagnosing anxiety. The GAD-7 can be recommended for use in clinical research and routine. The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric properties of these questionnaires, to provide normative values, and to investigate associations with sociodemographic factors, quality of life, psychological variables, and behavioral factors. A German community sample (n=9721) with an age range of 18–80 years was surveyed using the GAD-7 and several other questionnaires. Confirmatory factor analyses confirmed the unidimensionality and measurement invariance of the GAD-7 across age and gender. Females were more anxious than males (mean scores: M=4.07 vs. M=3.01; effect size: d=0.33). There was no linear age trend. A total of 5.9% fulfilled the cut-off criterion of 10 and above. Anxiety was correlated with low quality of life, fatigue, low habitual optimism, physical complaints, sleep problems, low life satisfaction, low social support, low education, unemployment, and low income. Cigarette smoking and alcohol consumption were also associated with heightened anxiety, especially in women. When comparing the GAD-7 (7 items) with the ultra-short GAD-2 (2 items), the GAD-7 instrument was superior to the GAD-2 regarding several psychometric criteria. The response rate (33%) was low. Because of the cross-sectional character of the study, causal conclusions cannot be drawn. A further limitation is the lack of a gold standard for diagnosing anxiety. The GAD-7 can be recommended for use in clinical research and routine. •The study confirmed good psychometric properties of the GAD-7.•The psychometric quality of the GAD-7 is superior to that of the ultra-short GAD-2.•Women are more anxious than men, but there is no linear age trend in anxiety.•Anxiety is associated with alcohol consumption and cigarette smoking, especially in women. BACKGROUNDThe Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric properties of these questionnaires, to provide normative values, and to investigate associations with sociodemographic factors, quality of life, psychological variables, and behavioral factors.METHODSA German community sample (n=9721) with an age range of 18-80 years was surveyed using the GAD-7 and several other questionnaires.RESULTSConfirmatory factor analyses confirmed the unidimensionality and measurement invariance of the GAD-7 across age and gender. Females were more anxious than males (mean scores: M=4.07 vs. M=3.01; effect size: d=0.33). There was no linear age trend. A total of 5.9% fulfilled the cut-off criterion of 10 and above. Anxiety was correlated with low quality of life, fatigue, low habitual optimism, physical complaints, sleep problems, low life satisfaction, low social support, low education, unemployment, and low income. Cigarette smoking and alcohol consumption were also associated with heightened anxiety, especially in women. When comparing the GAD-7 (7 items) with the ultra-short GAD-2 (2 items), the GAD-7 instrument was superior to the GAD-2 regarding several psychometric criteria.LIMITATIONSThe response rate (33%) was low. Because of the cross-sectional character of the study, causal conclusions cannot be drawn. A further limitation is the lack of a gold standard for diagnosing anxiety.CONCLUSIONSThe GAD-7 can be recommended for use in clinical research and routine.
Author	Klein, Annette M. Wirkner, Kerstin Riedel-Heller, Steffi G. Hilbert, Anja Glaesmer, Heide Luck, Tobias Brähler, Elmar Hinz, Andreas
Author_xml	– sequence: 1 givenname: Andreas surname: Hinz fullname: Hinz, Andreas email: Andreas.Hinz@medizin.uni-leipzig.de organization: Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany – sequence: 2 givenname: Annette M. surname: Klein fullname: Klein, Annette M. organization: Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Leipzig, Germany – sequence: 3 givenname: Elmar surname: Brähler fullname: Brähler, Elmar organization: Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany – sequence: 4 givenname: Heide surname: Glaesmer fullname: Glaesmer, Heide organization: Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany – sequence: 5 givenname: Tobias surname: Luck fullname: Luck, Tobias organization: Institute of Social Medicine, Occupational Health, and Public Health, University of Leipzig, Leipzig, Germany – sequence: 6 givenname: Steffi G. surname: Riedel-Heller fullname: Riedel-Heller, Steffi G. organization: Institute of Social Medicine, Occupational Health, and Public Health, University of Leipzig, Leipzig, Germany – sequence: 7 givenname: Kerstin surname: Wirkner fullname: Wirkner, Kerstin organization: LIFE – Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany – sequence: 8 givenname: Anja surname: Hilbert fullname: Hilbert, Anja organization: Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/28088111$$D View this record in MEDLINE/PubMed
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Snippet	The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric... Abstract Background The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test... BACKGROUNDThe Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test...
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SubjectTerms	Adolescent Adult Age Distribution Aged Aged, 80 and over Alcohol Drinking - psychology Anxiety Anxiety Disorders - diagnosis Anxiety Disorders - epidemiology Anxiety Disorders - psychology Cross-Sectional Studies Epidemiology Female General population Germany - epidemiology Humans Male Middle Aged Normative values Patient Health Questionnaire - standards Psychiatry Psychometrics - instrumentation Quality of Life Risk Factors Sex Distribution Smoking - psychology Socioeconomic Factors Stress Disorders, Traumatic, Acute Surveys and Questionnaires Young Adult
Title	Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample
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