Skip to main content
Top
Published in: Health and Quality of Life Outcomes 1/2015

Open Access 01-12-2015 | Research

Reliability and validity of the Portuguese version of the Generalized Anxiety Disorder (GAD-7) scale

Authors: Tiago V Sousa, Vânia Viveiros, Maria V Chai, Filipe L Vicente, Gustavo Jesus, Maria J Carnot, Ana C Gordo, Pedro L Ferreira

Published in: Health and Quality of Life Outcomes | Issue 1/2015

Login to get access

Abstract

Background

Generalized anxiety disorder has a strong impact on health-related quality of life. For this reason, it seems relevant to develop strategies allowing early diagnoses in order to promote appropriate treatments. The objective of this study was to culturally adapt and validate the GAD-7 for the Portuguese patients with generalized anxiety disorder.

Methods

For the cultural adaptation of the Portuguese version of the GAD-7 scale we started with a previous translation made by Mapi Institute and decided to perform a clinical review followed by a cognitive debriefing with patients. Once piloted, this version was then tested in a larger sample for feasibility and reliability (1-week test-retest). Construct validity was assessed by the relationship between GAD-7 and socio-demographic and clinical variables. Its unidimensionality was tested by principal component factor analysis. Criterion validity was assessed by comparing GAD-7 scores with those obtained by HADS, and EQ-5D. STAI was mainly used as a screening indicator for patient inclusion.

Results

GAD-7 was considered feasible with a mean completion time of 2.3 minutes and no major floor or ceiling effects. We found an excellent Cronbach’s alpha internal consistency score (0.880) and the test-retest and interclass correlation coefficients were also very good. Regarding the construct validity, younger patients, those with higher education, employed and without anxiety symptoms revealed lower GAD-7 scores, meaning better health. The unidimensionality of GAD-7 index was also confirmed by principal component factor analysis. At last, GAD-7 was significantly correlated with other health outcome indices and the classification levels created by it and by HADS showed to be dependent.

Conclusion

The excellent metric properties confirmed the cultural adaptation and validity of GAD-7 into Portuguese population, allowing the clinicians an early detection and treatment of these patients.
Literature
1.
go back to reference Andrews G, Hobbs MJ, Borkovec TD, Beesdo K, Craske MG, Heimberg RG, et al. Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V. Depress Anxiety. 2010;27(2):134–47.CrossRefPubMed Andrews G, Hobbs MJ, Borkovec TD, Beesdo K, Craske MG, Heimberg RG, et al. Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V. Depress Anxiety. 2010;27(2):134–47.CrossRefPubMed
2.
go back to reference Behar E, DiMarco ID, Hekler EB, Mohlman J, Staples AM. Current theoretical models of generalized anxiety disorder (GAD): conceptual review and treatment implications. J Anxiety Disord. 2009;23(8):1011–23.CrossRefPubMed Behar E, DiMarco ID, Hekler EB, Mohlman J, Staples AM. Current theoretical models of generalized anxiety disorder (GAD): conceptual review and treatment implications. J Anxiety Disord. 2009;23(8):1011–23.CrossRefPubMed
3.
go back to reference García-Campayo J, Zamorano E, Ruiz MA, Pardo A, Pérez-Páramo M, López-Gómez V, et al. Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health Qual Life Outcomes. 2010;8:8.CrossRefPubMedCentralPubMed García-Campayo J, Zamorano E, Ruiz MA, Pardo A, Pérez-Páramo M, López-Gómez V, et al. Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health Qual Life Outcomes. 2010;8:8.CrossRefPubMedCentralPubMed
4.
go back to reference Weisberg RB. Overview of generalized anxiety disorder: Epidemiology, presentation, and course. J Clin Psychiatry. 2009;70(2):4–9.CrossRefPubMed Weisberg RB. Overview of generalized anxiety disorder: Epidemiology, presentation, and course. J Clin Psychiatry. 2009;70(2):4–9.CrossRefPubMed
5.
go back to reference American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1980. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1980.
6.
go back to reference American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1987. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1987.
7.
go back to reference American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
8.
go back to reference American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Rev. Washington, DC. 2000. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Rev. Washington, DC. 2000.
9.
go back to reference Sadock BJ, Sadock VA. Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry. 9th ed. Philadelphia: Lippincott, Williams and Wilkins; 2003. p. 632. Sadock BJ, Sadock VA. Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry. 9th ed. Philadelphia: Lippincott, Williams and Wilkins; 2003. p. 632.
10.
go back to reference García-Campayo J, Zamorano E, Ruiz MA, Pérez-Páramo M, López-Gómez V, Rejas J. The assessment of generalized anxiety disorder: psychometric validation of the Spanish version of the self-administered GAD-2 scale in daily medical practice. Health Qual Life Outcomes. 2012;10:114.CrossRefPubMedCentralPubMed García-Campayo J, Zamorano E, Ruiz MA, Pérez-Páramo M, López-Gómez V, Rejas J. The assessment of generalized anxiety disorder: psychometric validation of the Spanish version of the self-administered GAD-2 scale in daily medical practice. Health Qual Life Outcomes. 2012;10:114.CrossRefPubMedCentralPubMed
11.
go back to reference Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.CrossRefPubMed Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.CrossRefPubMed
12.
go back to reference de Caldas Almeida JM, Xavier M. [National epidemiological study of mental health]. Lisbon: Faculdade de Ciências Médicas, Universidade Nova de Lisboa; 2013. de Caldas Almeida JM, Xavier M. [National epidemiological study of mental health]. Lisbon: Faculdade de Ciências Médicas, Universidade Nova de Lisboa; 2013.
13.
go back to reference Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: diagnosis and treatment. BMJ. 2012;345:1–6.CrossRef Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: diagnosis and treatment. BMJ. 2012;345:1–6.CrossRef
14.
go back to reference Yonkers KA, Dyck IR, Warschaw M, Keller MB. Factors predicting the clinical course of generalized of anxiety disorder. Brit J Psychiat. 2000;176:544–9.CrossRefPubMed Yonkers KA, Dyck IR, Warschaw M, Keller MB. Factors predicting the clinical course of generalized of anxiety disorder. Brit J Psychiat. 2000;176:544–9.CrossRefPubMed
15.
go back to reference Wittchen HU, Kessler RC, Beesdo K, Krause P, Hofler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry. 2002;63 Suppl 8:24–34.PubMed Wittchen HU, Kessler RC, Beesdo K, Krause P, Hofler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry. 2002;63 Suppl 8:24–34.PubMed
16.
go back to reference Bereza BG, Machado M, Einarson TR. Systematic review and quality assessment of economic evaluations and quality-of-life studies related to generalized anxiety disorder. Clin Ther. 2009;31(6):1279–308.CrossRefPubMed Bereza BG, Machado M, Einarson TR. Systematic review and quality assessment of economic evaluations and quality-of-life studies related to generalized anxiety disorder. Clin Ther. 2009;31(6):1279–308.CrossRefPubMed
17.
go back to reference Hoffman DL, Dukes EM, Wittchen HU. Human and economic burden of generalized anxiety disorder. Depress Anxiety. 2008;25(1):72–90.CrossRefPubMed Hoffman DL, Dukes EM, Wittchen HU. Human and economic burden of generalized anxiety disorder. Depress Anxiety. 2008;25(1):72–90.CrossRefPubMed
18.
go back to reference Surtees PG, Wainwright NW, Khaw KT, Day NE. Functional health status, chronic medical conditions and disorders of mood. Br J Psychiatry. 2003;183:299–303.CrossRefPubMed Surtees PG, Wainwright NW, Khaw KT, Day NE. Functional health status, chronic medical conditions and disorders of mood. Br J Psychiatry. 2003;183:299–303.CrossRefPubMed
19.
go back to reference Stein D. Comorbidity in generalized anxiety disorder: Impact and implications. J Clin Psychiatry. 2001;62(1):29–36.PubMed Stein D. Comorbidity in generalized anxiety disorder: Impact and implications. J Clin Psychiatry. 2001;62(1):29–36.PubMed
20.
go back to reference Telles-Correia D, Barbosa A. Anxiety and depression in medicine: models and measurement. Acta Med Port. 2009;22(1):89–98.PubMed Telles-Correia D, Barbosa A. Anxiety and depression in medicine: models and measurement. Acta Med Port. 2009;22(1):89–98.PubMed
21.
go back to reference Spitzer RL, Kroenke K, Williams JB, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Arch Intern Med. 2006;166(10):1092–7.CrossRefPubMed Spitzer RL, Kroenke K, Williams JB, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Arch Intern Med. 2006;166(10):1092–7.CrossRefPubMed
22.
go back to reference Swinson RP. The GAD-7 scale was accurate for diagnosing generalised anxiety disorder. Evid Based Med. 2006;11(6):184.CrossRefPubMed Swinson RP. The GAD-7 scale was accurate for diagnosing generalised anxiety disorder. Evid Based Med. 2006;11(6):184.CrossRefPubMed
23.
go back to reference Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.CrossRefPubMed Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.CrossRefPubMed
24.
go back to reference Acquadro C, Jambon B, Ellis D, Marquis P. Language and translation issues. In: Spilker B, editor. Quality of Life and Parmacoeconomics in Clinical Trrials. Philadelphia: Lippincott-Raven Publishers; 1996. p. 575–85. Acquadro C, Jambon B, Ellis D, Marquis P. Language and translation issues. In: Spilker B, editor. Quality of Life and Parmacoeconomics in Clinical Trrials. Philadelphia: Lippincott-Raven Publishers; 1996. p. 575–85.
25.
go back to reference Acquadro C, Conway K, Giroudet C, Mear I. Linguistic Validation Manual for Health Outcome Assessments. Lyon: Mapi Institute; 2012. Acquadro C, Conway K, Giroudet C, Mear I. Linguistic Validation Manual for Health Outcome Assessments. Lyon: Mapi Institute; 2012.
26.
go back to reference De Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in Medicine. Cambridge: Cambridge University Press; 2011.CrossRef De Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in Medicine. Cambridge: Cambridge University Press; 2011.CrossRef
27.
go back to reference Chronbach LJ. Coefficient alpha and the internal structure of tests. Phyc. 1951;16:297–334. Chronbach LJ. Coefficient alpha and the internal structure of tests. Phyc. 1951;16:297–334.
28.
go back to reference Ferreira LN, Ferreira PL, Pereira LN, Oppe M. EQ-5D Portuguese population norms. Qual Life Res. 2014;23(2):425–30.CrossRefPubMed Ferreira LN, Ferreira PL, Pereira LN, Oppe M. EQ-5D Portuguese population norms. Qual Life Res. 2014;23(2):425–30.CrossRefPubMed
29.
go back to reference Ferreira LN, Ferreira PL, Pereira LN, Oppe M. The valuation of the EQ-5D in Portugal. Qual Life Res. 2014;23(2):413–23.CrossRefPubMed Ferreira LN, Ferreira PL, Pereira LN, Oppe M. The valuation of the EQ-5D in Portugal. Qual Life Res. 2014;23(2):413–23.CrossRefPubMed
30.
go back to reference Ferreira PL, Ferreira LN, Pereira LN. How consistent are health utility values? Qual Life Res. 2008;17(7):1031–42.CrossRefPubMed Ferreira PL, Ferreira LN, Pereira LN. How consistent are health utility values? Qual Life Res. 2008;17(7):1031–42.CrossRefPubMed
31.
go back to reference Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed
32.
go back to reference Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M. Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychol Health Med. 2007;12(2):225–35.CrossRefPubMed Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M. Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychol Health Med. 2007;12(2):225–35.CrossRefPubMed
33.
go back to reference Spielberger CD, Gorssuch RL, Lushene PR, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press, Inc; 1983. Spielberger CD, Gorssuch RL, Lushene PR, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press, Inc; 1983.
34.
go back to reference Lisboa JV, Augusto MG, Ferreira PL. Applied statistics to management. Porto: Vida Económica; 2012. Lisboa JV, Augusto MG, Ferreira PL. Applied statistics to management. Porto: Vida Económica; 2012.
35.
go back to reference Andlin-Sobocki P, Wittchen HU. Cost of affective disorders in Europe. Eur J Neurol. 2005;12(1):34–8.CrossRefPubMed Andlin-Sobocki P, Wittchen HU. Cost of affective disorders in Europe. Eur J Neurol. 2005;12(1):34–8.CrossRefPubMed
36.
go back to reference Souêtre E, Lozet H, Cimarosti I, Martin P, Chignon JM, Adès J, et al. Cost of anxiety disorders: impact of comorbidity. J Psychosom Res. 1994;38 Suppl 1:151–60.CrossRefPubMed Souêtre E, Lozet H, Cimarosti I, Martin P, Chignon JM, Adès J, et al. Cost of anxiety disorders: impact of comorbidity. J Psychosom Res. 1994;38 Suppl 1:151–60.CrossRefPubMed
37.
go back to reference Candilis PJ, Pollack MH. The hidden costs of untreated anxiety disorders. Harv Rev Psychiatry. 1997;5:40–2.CrossRefPubMed Candilis PJ, Pollack MH. The hidden costs of untreated anxiety disorders. Harv Rev Psychiatry. 1997;5:40–2.CrossRefPubMed
Metadata
Title
Reliability and validity of the Portuguese version of the Generalized Anxiety Disorder (GAD-7) scale
Authors
Tiago V Sousa
Vânia Viveiros
Maria V Chai
Filipe L Vicente
Gustavo Jesus
Maria J Carnot
Ana C Gordo
Pedro L Ferreira
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2015
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-015-0244-2

Other articles of this Issue 1/2015

Health and Quality of Life Outcomes 1/2015 Go to the issue