Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7) among Pregnant Women.
OBJECTIVE
Generalized anxiety disorder (GAD) during pregnancy is associated with several adverse maternal and perinatal outcomes. A reliable and valid screening tool for GAD should lead to earlier detection and treatment. Among pregnant Peruvian women, a brief screening tool, the GAD-7, has not been validated. This study aims to evaluate the reliability and validity of the GAD-7.


METHODS
Of 2,978 women who attended their first perinatal care visit and had the GAD-7 screening, 946 had a Composite International Diagnostic Interview (CIDI). The Cronbach's alpha was calculated to examine the reliability. We assessed the criterion validity by calculating operating characteristics. The construct validity was evaluated using factor analysis and association with health status on the CIDI. The cross-cultural validity was explored using the Rasch Rating Scale Model (RSM).


RESULTS
The reliability of the GAD-7 was good (Cronbach's alpha = 0.89). A cutoff score of 7 or higher, maximizing the Youden Index, yielded a sensitivity of 73.3% and a specificity of 67.3%. One-factor structure of the GAD-7 was confirmed by exploratory and confirmatory factor analysis. Concurrent validity was supported by the evidence that higher GAD-7 scores were associated with poor self-rated physical and mental health. The Rasch RSM further confirmed the cross-cultural validity of the GAD-7.


CONCLUSIONS
The results suggest that the Spanish-language version of the GAD-7 may be used as a screening tool for pregnant Peruvian women. The GAD-7 has good reliability, factorial validity, and concurrent validity. The optimal cutoff score obtained by maximizing the Youden Index should be considered cautiously; women who screened positive may require further investigation to confirm GAD diagnosis.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America.
Qiu-Yue
QY
Zhong
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America.
Bizu
B
Gelaye
Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America.
Alan M
AM
Zaslavsky
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America.
Jesse R
JR
Fann
Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru.
Marta B
MB
Rondon
Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Asociación Civil PROESA, Lima, Peru.
Sixto E
SE
Sánchez
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America.
Michelle A
MA
Williams
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000150:complications / Q000175:diagnosis*; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008875:Middle Aged; D010568:Peru; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D055815:Young Adult