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      Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool

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          Abstract

          Background

          Generalized anxiety disorder (GAD) is a prevalent mental health condition which is underestimated worldwide. This study carried out the cultural adaptation into Spanish of the 7-item self-administered GAD-7 scale, which is used to identify probable patients with GAD.

          Methods

          The adaptation was performed by an expert panel using a conceptual equivalence process, including forward and backward translations in duplicate. Content validity was assessed by interrater agreement. Criteria validity was explored using ROC curve analysis, and sensitivity, specificity, predictive positive value and negative value for different cut-off values were determined. Concurrent validity was also explored using the HAM-A, HADS, and WHO-DAS-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). Average completion time was 2'30''. No items of the scale were left blank. Floor and ceiling effects were negligible. No patients with GAD had to be assisted to fill in the questionnaire. The scale was shown to be one-dimensional through factor analysis (explained variance = 72%). A cut-off point of 10 showed adequate values of sensitivity (86.8%) and specificity (93.4%), with AUC being statistically significant [AUC = 0.957-0.985); p < 0.001]. The scale significantly correlated with HAM-A (0.852, p < 0.001), HADS (anxiety domain, 0.903, p < 0.001), and WHO-DAS II (0.696, p > 0.001).

          Limitations

          Elderly people, particularly those very old, may need some help to complete the scale.

          Conclusion

          After the cultural adaptation process, a Spanish version of the GAD-7 scale was obtained. The validity of its content and the relevance and adequacy of items in the Spanish cultural context were confirmed.

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          Most cited references16

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          Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

          To describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. A representative random sample of non-institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older (n = 21425) were interviewed between January 2001 and August 2003. DSM-IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12-month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.
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            Exploratory factor analysis: its role in item analysis.

            R Gorsuch (1997)
            The special characteristics of items-low reliability, confounds by minor, unwanted covariance, and the likelihood of a general factor-and better understanding of factor analysis means that the default procedure of many statistical packages (Little Jiffy) is no longer adequate for exploratory item factor analysis. It produces too many factors and precludes a general factor even when that means the factors extracted are nonreplicable. More appropriate procedures that reduce these problems are presented, along with how to select the sample, sample size required, and how to select items for scales. Proposed scales can be evaluated by their correlations with the factors; a new procedure for doing so eliminates the biased values produced by correlating them with either total or factor scores. The role of exploratory factor analysis relative to cluster analysis and confirmatory factor analysis is noted.
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              The European Study of the Epidemiology of Mental Disorders (ESEMeD) project: an epidemiological basis for informing mental health policies in Europe.

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                Author and article information

                Journal
                Health Qual Life Outcomes
                Health and Quality of Life Outcomes
                BioMed Central
                1477-7525
                2010
                20 January 2010
                : 8
                : 8
                Affiliations
                [1 ]Department of Psychiatry, Hospital Universitario Miguel Servet, Zaragoza, Spain
                [2 ]ISCIII- REDIAPP, Red de Investigación en Actividades Preventivas y Promoción de la Salud, Zaragoza, Spain
                [3 ]Sant Antoni de Vilamajor Primary Care Health Center, ABS Alt Mogent, Barcelona, Spain
                [4 ]Department of Methodology, School of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
                [5 ]EACCOS Research Group, Madrid, Spain
                [6 ]Neuroscience Department, Medical Unit, Pfizer Spain, Alcobendas (Madrid), Spain
                [7 ]Health Outcomes Research Department, Medical Unit, Pfizer Spain, Alcobendas (Madrid), Spain
                Article
                1477-7525-8-8
                10.1186/1477-7525-8-8
                2831043
                20089179
                030ae9b9-e989-44d3-8727-0f59a8d4f562
                Copyright ©2010 García-Campayo et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 September 2009
                : 20 January 2010
                Categories
                Research

                Health & Social care
                Health & Social care

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