title: Internal validity of an anxiety disorder screening instrument across five ethnic groups.
abstract: We tested the factor structure of the National Anxiety Disorder Screening Day instrument (n=14860) within five ethnic groups (White, Black, Hispanic, Asian, Native American). Conducted yearly across the US, the screening is meant to detect five common anxiety syndromes. Factor analyses often fail to confirm the validity of assessment tools' structures, and this is especially likely for minority ethnic groups. If symptoms cluster differently across ethnic groups, criteria for conventional DSM-IV disorders are less likely to be met, leaving significant distress unlabeled and under-detected in minority groups. Exploratory and confirmatory factor analyses established that the items clustered into the six expected factors (one for each disorder plus agoraphobia). This six-factor model fit the data very well for Whites and not significantly worse for each other group. However, small areas of the model did not appear to fit as well for some groups. After taking these areas into account, the data still clearly suggest more prevalent PTSD symptoms in the Black, Hispanic and Native American groups in our sample. Additional studies are warranted to examine the model's external validity, generalizability to more culturally distinct groups, and overlap with other culture-specific syndromes.
authors.affiliation: Center for Health Care Evaluation (MDP 152), Department of Veterans Affairs and Stanford University School of Medicine, Menlo Park, CA 94025, USA. jennifer.ritsher@med.va.gov
authors.forename: Jennifer Boyd
authors.initials: JB
authors.lastname: Ritsher
authors.forename: Elmer L
authors.initials: EL
authors.lastname: Struening
authors.forename: Fred
authors.initials: F
authors.lastname: Hellman
authors.forename: Mary
authors.initials: M
authors.lastname: Guardino
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology* / Q000523:psychology; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011594:Psychometrics; D012016:Reference Values; D015203:Reproducibility of Results; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data