Skip to main content
Top
Published in: Health and Quality of Life Outcomes 1/2012

Open Access 01-12-2012 | Research

The assessment of generalized anxiety disorder: psychometric validation of the Spanish version of the self-administered GAD-2 scale in daily medical practice

Authors: Javier García-Campayo, Enric Zamorano, Miguel A Ruiz, María Pérez-Páramo, Vanessa López-Gómez, Javier Rejas

Published in: Health and Quality of Life Outcomes | Issue 1/2012

Login to get access

Abstract

Aim

To psychometrically validate the Spanish version of the self-administered 2-item GAD-2 scale for screening probable patients with generalised anxiety disorder (GAD).

Methods

The GAD-2 was self-administered by patients diagnosed with GAD according to DSM-IV criteria and by age- and sex-matched controls who were recruited at random in mental health and primary care centres. Criteria validity was explored using ROC curve analysis, and sensitivity, specificity and positive and negative predictive values were determined for different cut-off values. Concurrent validity was also established using the HAM-A, HADS, and WHODAS II scales.

Results

The study sample consisted of 212 subjects (106 patients with GAD) with a mean age of 50.38 years (SD = 16.76). No items of the scale were left blank. Floor and ceiling effects were negligible. No patients with GAD had to be assisted to complete the questionnaire. Reliability (internal consistency) was high; Cronbach’s α = 0.875. A cut-off point of 3 showed adequate sensitivity (91.5%) and specificity (85.8%), with a statistically significant area under the curve (AUC = 0.937, p < 0.001), to distinguish GAD patients from controls. Concurrent validity was also high and significant with HAM-A (0.806, p < 0.001), HADS (anxiety domain, 0.825, p < 0.001) and WHO-DAS II (0.642, p < 0.001) scales.

Conclusion

The Spanish version of the GAD-2 scale has been shown to have appropriate psychometric properties to rapidly detect probable cases of GAD in the Spanish cultural context under routine clinical practice conditions.
Appendix
Available only for authorised users
Literature
1.
go back to reference Andlin-Sobocki P, Wittchen HU: Cost of affective disorders in Europe. Eur J Neurol 2005, 12: 34–43. 10.1111/j.1468-1331.2005.01195.xCrossRefPubMed Andlin-Sobocki P, Wittchen HU: Cost of affective disorders in Europe. Eur J Neurol 2005, 12: 34–43. 10.1111/j.1468-1331.2005.01195.xCrossRefPubMed
2.
go back to reference The ESEMeD/MHEDEA 2000 investigators: Prevalence of mental disorders in Europe: results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand 2004, 109: 21–27.CrossRef The ESEMeD/MHEDEA 2000 investigators: Prevalence of mental disorders in Europe: results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand 2004, 109: 21–27.CrossRef
3.
go back to reference Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B: Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007, 146: 317–325.CrossRefPubMed Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B: Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007, 146: 317–325.CrossRefPubMed
4.
go back to reference Wittchen HU: Generalized anxiety disorder: Prevalence, burden, and cost to society. Depress Anxiety 2002, 16: 162–171. 10.1002/da.10065CrossRefPubMed Wittchen HU: Generalized anxiety disorder: Prevalence, burden, and cost to society. Depress Anxiety 2002, 16: 162–171. 10.1002/da.10065CrossRefPubMed
5.
go back to reference Lobo A: Campos R Los trastornos de ansiedad en atención primaria. Madrid, EMISA; 1997. Lobo A: Campos R Los trastornos de ansiedad en atención primaria. Madrid, EMISA; 1997.
6.
go back to reference Goldberg D, Lecrubier Y: Form and frequency of mental disorders across centres. Mental illness in general health care: An international study. TB Üstün and N Sartorius. John Wiley & Sons on behalf of WHO, Chichester; 1995. Goldberg D, Lecrubier Y: Form and frequency of mental disorders across centres. Mental illness in general health care: An international study. TB Üstün and N Sartorius. John Wiley & Sons on behalf of WHO, Chichester; 1995.
7.
go back to reference Chocrón Bentata L, Vilalta Franch J, Legazpi Rodríguez I, Auquer K, Franch L: Prevalencia de Psicopatología en un centro de atención primaria. Aten Primaria 1995, 16: 586–590.PubMed Chocrón Bentata L, Vilalta Franch J, Legazpi Rodríguez I, Auquer K, Franch L: Prevalencia de Psicopatología en un centro de atención primaria. Aten Primaria 1995, 16: 586–590.PubMed
8.
go back to reference Kessler D, Lloyd K, Lewis G, Gray DP: Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. Br Med J 1999, 318: 436–439. 10.1136/bmj.318.7181.436CrossRef Kessler D, Lloyd K, Lewis G, Gray DP: Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. Br Med J 1999, 318: 436–439. 10.1136/bmj.318.7181.436CrossRef
9.
go back to reference Zimmerman M, Mattia JI: A self-report scale to help make psychiatric diagnoses: the psychiatric diagnostic screening questionnaire. Arch Gen Psychiatry 2001, 58: 787–794. 10.1001/archpsyc.58.8.787CrossRefPubMed Zimmerman M, Mattia JI: A self-report scale to help make psychiatric diagnoses: the psychiatric diagnostic screening questionnaire. Arch Gen Psychiatry 2001, 58: 787–794. 10.1001/archpsyc.58.8.787CrossRefPubMed
10.
go back to reference American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing Inc, Washington DC; 1994. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing Inc, Washington DC; 1994.
11.
go back to reference Andrews G, Hobbs MJ, Borkovec TD, Beesdo K, Craske MG, Heimberg RG, Rapee RM, Ruscio AM, Stanley MA: Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V. Depress Anxiety 2010, doi:10.1002/da.20658. Andrews G, Hobbs MJ, Borkovec TD, Beesdo K, Craske MG, Heimberg RG, Rapee RM, Ruscio AM, Stanley MA: Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V. Depress Anxiety 2010, doi:10.1002/da.20658.
12.
go back to reference World Health Organization: The ICD-10 Classification of mental and behavioral disorders. Clinical descriptions and diagnostic guidelines. WHO, Geneva; 1992. World Health Organization: The ICD-10 Classification of mental and behavioral disorders. Clinical descriptions and diagnostic guidelines. WHO, Geneva; 1992.
13.
go back to reference Mahe V, Valgo A: Long-term pharmacological treatment of generalized anxiety disorder. Int Clin Psychopharmacol 2000, 15: 99–105. 10.1097/00004850-200015020-00006CrossRefPubMed Mahe V, Valgo A: Long-term pharmacological treatment of generalized anxiety disorder. Int Clin Psychopharmacol 2000, 15: 99–105. 10.1097/00004850-200015020-00006CrossRefPubMed
14.
go back to reference Judd LL, Kessler RC, Paulus MP, Zeller PV, Wittchen HU, Kunovac JL: Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS). Acta Psychiatr Scan 1998, 393: 6–11.CrossRef Judd LL, Kessler RC, Paulus MP, Zeller PV, Wittchen HU, Kunovac JL: Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS). Acta Psychiatr Scan 1998, 393: 6–11.CrossRef
15.
go back to reference Stein D: Comorbidity in generalized anxiety disorder: impact and implications. J Clin Psychiatry 2001, 62: 29–36.PubMed Stein D: Comorbidity in generalized anxiety disorder: impact and implications. J Clin Psychiatry 2001, 62: 29–36.PubMed
16.
go back to reference Hamilton M: Diagnosis and Rating of Anxiety. Br J Psychiat Spec. Publ 1969, 3: 76–79. Hamilton M: Diagnosis and Rating of Anxiety. Br J Psychiat Spec. Publ 1969, 3: 76–79.
17.
go back to reference Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983, 67: 361–370. 10.1111/j.1600-0447.1983.tb09716.xCrossRefPubMed Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983, 67: 361–370. 10.1111/j.1600-0447.1983.tb09716.xCrossRefPubMed
18.
go back to reference Lipman RS, Covi L: Outpatient treatment of neurotic depression: medication and group psychotherapy. In Evaluation of Psychological Therapies. Edited by: Spitzer R, Klein D. Johns Hopkins University Press, Baltimore, MD; 1976:178–218. Lipman RS, Covi L: Outpatient treatment of neurotic depression: medication and group psychotherapy. In Evaluation of Psychological Therapies. Edited by: Spitzer R, Klein D. Johns Hopkins University Press, Baltimore, MD; 1976:178–218.
19.
go back to reference Snaith RP, et al.: The clinical anxiety scale: an instrument derived from the Hamilton anxiety scale. Br J Psychiatry 1982, 141: 518–523. 10.1192/bjp.141.5.518CrossRefPubMed Snaith RP, et al.: The clinical anxiety scale: an instrument derived from the Hamilton anxiety scale. Br J Psychiatry 1982, 141: 518–523. 10.1192/bjp.141.5.518CrossRefPubMed
20.
go back to reference Spielberger CD, et al.: Manual for the State-Trait Inventory. Consulting Psychological Press, Palo Alto; 1970. Spielberger CD, et al.: Manual for the State-Trait Inventory. Consulting Psychological Press, Palo Alto; 1970.
21.
go back to reference Newman M, Zuellig AR, Kachin KE, Constantino MJ, Przeworski A, Erickson T, Cashman-Mcgrath L: Preliminary reliability and validity of the generalized anxiety disorder questionnaire-iv: a revised self-report diagnostic measure of generalized anxiety disorder. Behav Ther 2002, 33: 215–233. 10.1016/S0005-7894(02)80026-0CrossRef Newman M, Zuellig AR, Kachin KE, Constantino MJ, Przeworski A, Erickson T, Cashman-Mcgrath L: Preliminary reliability and validity of the generalized anxiety disorder questionnaire-iv: a revised self-report diagnostic measure of generalized anxiety disorder. Behav Ther 2002, 33: 215–233. 10.1016/S0005-7894(02)80026-0CrossRef
22.
go back to reference Kessler RC, Andrews G, Mroczek D, Ustun B, Wittchen HU: The world health organization composite international diagnostic interview short-form (CIDI-SF). Int J Methods Psychiatr Res 1998, 7: 171–185. 10.1002/mpr.47CrossRef Kessler RC, Andrews G, Mroczek D, Ustun B, Wittchen HU: The world health organization composite international diagnostic interview short-form (CIDI-SF). Int J Methods Psychiatr Res 1998, 7: 171–185. 10.1002/mpr.47CrossRef
23.
go back to reference Spitzer RL, et al.: A brief measure for assessing generalized anxiety disorder. Arch Intern Med 2006, 166: 1092–1097. 10.1001/archinte.166.10.1092CrossRefPubMed Spitzer RL, et al.: A brief measure for assessing generalized anxiety disorder. Arch Intern Med 2006, 166: 1092–1097. 10.1001/archinte.166.10.1092CrossRefPubMed
24.
go back to reference García-Campayo JM, Zamorano E, Ruiz MA, Pardo A, Pérez-Páramo M, López-Gómez V, Freire O, Rejas J: Cultural adaptation into spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health Qual Life Outcomes 2010, 8: 8. 10.1186/1477-7525-8-8PubMedCentralCrossRefPubMed García-Campayo JM, Zamorano E, Ruiz MA, Pardo A, Pérez-Páramo M, López-Gómez V, Freire O, Rejas J: Cultural adaptation into spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health Qual Life Outcomes 2010, 8: 8. 10.1186/1477-7525-8-8PubMedCentralCrossRefPubMed
25.
go back to reference Donker T, van Straten A, Marks I, Cuijpers P: Quick and easy self-rating of generalized anxiety disorder: validity of the dutch web-based GAD-7, GAD-2 and GAD-SI. Psychiatry Res 2011, 188: 58–64. 10.1016/j.psychres.2011.01.016CrossRefPubMed Donker T, van Straten A, Marks I, Cuijpers P: Quick and easy self-rating of generalized anxiety disorder: validity of the dutch web-based GAD-7, GAD-2 and GAD-SI. Psychiatry Res 2011, 188: 58–64. 10.1016/j.psychres.2011.01.016CrossRefPubMed
26.
go back to reference Guillemin F, Bombardier C, Beaton D: Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 1993, 46: 1417–1432. 10.1016/0895-4356(93)90142-NCrossRefPubMed Guillemin F, Bombardier C, Beaton D: Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 1993, 46: 1417–1432. 10.1016/0895-4356(93)90142-NCrossRefPubMed
27.
go back to reference Ruiz MA, Rejas J: Calidad de vida y otras medidas de salud informadas por el paciente. In Farmacoeconomía e investigación de resultados en salud: principios y práctica. Edited by: Domínguez EA, Madrid SJ. Real Academia Nacional de Farmacia, ; 2002:115–160. Ruiz MA, Rejas J: Calidad de vida y otras medidas de salud informadas por el paciente. In Farmacoeconomía e investigación de resultados en salud: principios y práctica. Edited by: Domínguez EA, Madrid SJ. Real Academia Nacional de Farmacia, ; 2002:115–160.
28.
go back to reference Nunnally JC, Bernstein IJ: Teoría Psicométrica (3ª ed.). McGraw-Hill, México; 1995. Nunnally JC, Bernstein IJ: Teoría Psicométrica (3ª ed.). McGraw-Hill, México; 1995.
29.
go back to reference Rovienelli RJ, Hambleton RK: On the use of content specialists in the assessment of criterion-referenced test item validity. Tijdschrift voor Onderwijsresearch 1977, 1977: 49–60. Rovienelli RJ, Hambleton RK: On the use of content specialists in the assessment of criterion-referenced test item validity. Tijdschrift voor Onderwijsresearch 1977, 1977: 49–60.
30.
go back to reference Vázquez-Barquero JL, Vázquez Bourgón E, Herrera Castañedo S, Saiz J, et al.: Spanish version of the new World Health Organization Disability Assessment Schedule II (WHO-DAS-II): initial phase of development and pilot study. Cantabria disability work group. Actas Esp Psiquiatr 2000, 28: 77–87.PubMed Vázquez-Barquero JL, Vázquez Bourgón E, Herrera Castañedo S, Saiz J, et al.: Spanish version of the new World Health Organization Disability Assessment Schedule II (WHO-DAS-II): initial phase of development and pilot study. Cantabria disability work group. Actas Esp Psiquiatr 2000, 28: 77–87.PubMed
31.
go back to reference Lowe B, Decker O, Muller S, Brahler E, Schellberg D, Herzog W, et al.: Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Medical Care 2008, 46: 266–274. 10.1097/MLR.0b013e318160d093CrossRefPubMed Lowe B, Decker O, Muller S, Brahler E, Schellberg D, Herzog W, et al.: Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Medical Care 2008, 46: 266–274. 10.1097/MLR.0b013e318160d093CrossRefPubMed
32.
go back to reference Cronbach LJ: Coefficient alpha and the internal structure of tests. Psych 1951, 16: 297–34.CrossRef Cronbach LJ: Coefficient alpha and the internal structure of tests. Psych 1951, 16: 297–34.CrossRef
33.
go back to reference Muthén BO: Latent variable modeling in heterogeneous populations. Psychometrika 1989, 54: 557–586. 10.1007/BF02296397CrossRef Muthén BO: Latent variable modeling in heterogeneous populations. Psychometrika 1989, 54: 557–586. 10.1007/BF02296397CrossRef
34.
go back to reference Kano Y: Structural equation modeling for experimental data. In Structural Equation Modeling: Present and Future. Edited by: Cudeck R, Toit S, Sörbom D. Scientific Software International, Lincolnwood; 2001:381–402. Kano Y: Structural equation modeling for experimental data. In Structural Equation Modeling: Present and Future. Edited by: Cudeck R, Toit S, Sörbom D. Scientific Software International, Lincolnwood; 2001:381–402.
35.
go back to reference Hanley JA, McNeil BJ: A method of comparing areas under receiver operating characteristic curves defined from the same cases. Radilogy 1983, 148: 839–843. Hanley JA, McNeil BJ: A method of comparing areas under receiver operating characteristic curves defined from the same cases. Radilogy 1983, 148: 839–843.
36.
go back to reference IBM: IBM SPSS Statistics 19. Chicago IL; 2009. IBM: IBM SPSS Statistics 19. Chicago IL; 2009.
37.
go back to reference Arbuckle JL, Wothke W: IBM SPSS AMOS 18. Smallwaters Corporation, Meadville PA; 2009. Arbuckle JL, Wothke W: IBM SPSS AMOS 18. Smallwaters Corporation, Meadville PA; 2009.
38.
go back to reference Zimmerman M, Ruggero CJ, Chelminski I, Young D, Posternak MA, Friedman M, et al.: Developing brief scales for use in clinical practice: the reliability and validity of single-item self-report measures of depression symptom severity, psychosocial impairment due to depression, and quality of life. J Clin Psychiatry 2006, 67: 1536–1541. 10.4088/JCP.v67n1007CrossRefPubMed Zimmerman M, Ruggero CJ, Chelminski I, Young D, Posternak MA, Friedman M, et al.: Developing brief scales for use in clinical practice: the reliability and validity of single-item self-report measures of depression symptom severity, psychosocial impairment due to depression, and quality of life. J Clin Psychiatry 2006, 67: 1536–1541. 10.4088/JCP.v67n1007CrossRefPubMed
39.
go back to reference Mitchell AJ, Coyne JC: Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. Br J Gen Pract 2007, 57: 144–151.PubMedCentralPubMed Mitchell AJ, Coyne JC: Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. Br J Gen Pract 2007, 57: 144–151.PubMedCentralPubMed
40.
go back to reference Watson LC, Zimmerman S, Cohen LW, Dominik R: Practical depression screening in residential care/assisted living: five methods compared with gold standard diagnoses. Am J Geriatr Psychiatry 2009, 17: 556–564. 10.1097/JGP.0b013e31819b891cPubMedCentralCrossRefPubMed Watson LC, Zimmerman S, Cohen LW, Dominik R: Practical depression screening in residential care/assisted living: five methods compared with gold standard diagnoses. Am J Geriatr Psychiatry 2009, 17: 556–564. 10.1097/JGP.0b013e31819b891cPubMedCentralCrossRefPubMed
41.
go back to reference Henkel V, Mergl R, Coyne JC, Kohnen R, Möller HJ, Hegerl U: Screening for depression in primary care: will one or two items suffice? Eur Arch Psychiatry Clin Neurosci 2004, 254: 215–223.PubMed Henkel V, Mergl R, Coyne JC, Kohnen R, Möller HJ, Hegerl U: Screening for depression in primary care: will one or two items suffice? Eur Arch Psychiatry Clin Neurosci 2004, 254: 215–223.PubMed
42.
go back to reference Donker T, Van Straten A, Marks IM, Cuijpers P: A quick web screening questionnaire for common mental disorders: development and validation. J Med Internet Res 2009, 11: e19. 10.2196/jmir.1134PubMedCentralCrossRefPubMed Donker T, Van Straten A, Marks IM, Cuijpers P: A quick web screening questionnaire for common mental disorders: development and validation. J Med Internet Res 2009, 11: e19. 10.2196/jmir.1134PubMedCentralCrossRefPubMed
Metadata
Title
The assessment of generalized anxiety disorder: psychometric validation of the Spanish version of the self-administered GAD-2 scale in daily medical practice
Authors
Javier García-Campayo
Enric Zamorano
Miguel A Ruiz
María Pérez-Páramo
Vanessa López-Gómez
Javier Rejas
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2012
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/1477-7525-10-114

Other articles of this Issue 1/2012

Health and Quality of Life Outcomes 1/2012 Go to the issue