title: Assessing generalized anxiety disorder in elderly people using the GAD-7 and GAD-2 scales: results of a validation study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the validity of the seven-item Generalized Anxiety Disorder scale (GAD-7) and its two core items (GAD-2) for detecting GAD in elderly people.
  
  
  METHODS
  A criterion-standard study was performed between May and December of 2010 on a general elderly population living at home. A subsample of 438 elderly persons (ages 58-82) of the large population-based German ESTHER study was included in the study. The GAD-7 was administered to participants as part of a home visit. A telephone-administered structured clinical interview was subsequently conducted by a blinded interviewer. The structured clinical (SCID) interview diagnosis of GAD constituted the criterion standard to determine sensitivity and specificity of the GAD-7 and the GAD-2 scales.
  
  
  RESULTS
  Twenty-seven participants met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for current GAD according to the SCID interview (6.2%; 95% confidence interval [CI]: 3.9%-8.2%). For the GAD-7, a cut point of five or greater appeared to be optimal for detecting GAD. At this cut point the sensitivity of the GAD-7 was 0.63 and the specificity was 0.9. Correspondingly, the optimal cut point for the GAD-2 was two or greater with a sensitivity of 0.67 and a specificity of 0.90. The areas under the curve were 0.88 (95% CI: 0.83-0.93) for the GAD-7 and 0.87 (95% CI: 0.80-0.94) for the GAD-2. The increased scores on both GAD scales were strongly associated with mental health related quality of life (p <0.0001).
  
  
  CONCLUSIONS
  Our results establish the validity of both the GAD-7 and the GAD-2 in elderly persons. Results of this study show that the recommended cut points of the GAD-7 and the GAD-2 for detecting GAD should be lowered for the elderly general population.
authors.affiliation: Departments of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany. Electronic address: beate.wild@med.uni-heidelberg.de.
authors.forename: Beate
authors.initials: B
authors.lastname: Wild
authors.affiliation: Departments of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Eckl
authors.affiliation: Departments of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.affiliation: Departments of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Niehoff
authors.affiliation: Departments of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Lechner
authors.affiliation: Departments of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Imad
authors.initials: I
authors.lastname: Maatouk
authors.affiliation: Departments of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Schellberg
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Müller
authors.affiliation: Department of Psychosomatics and Psychotherapy, Medical University Hospital, Hamburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Löwe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011788:Quality of Life; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
keywords: GAD-7 scale; Generalized anxiety disorder; elderly; validation