Abstract
Objective
To assess the diagnostic and clinical utility of the 2-item Generalized Anxiety Disorder
Scale (GAD-2) for screening anxiety symptoms in individuals with multiple sclerosis
(MS).
Design
Cross-sectional.
Setting
University-affiliated MS neurology and rehabilitation center.
Participants
The sample comprised adults (N=99) (ages 19-72; mean ± SD=46.2±13.0; 75% women) with a physician-confirmed MS diagnosis who were receiving care in
a university-affiliated MS center. Disease durations ranged from 1 to 37 years (mean
± SD=10.7±8.4).
Interventions
Not applicable.
Main Outcome Measures
Participants completed the 7-item Generalized Anxiety Disorder Scale (GAD-7) and GAD-2.
Internal consistency was calculated for both measures. Area under the receiver operating
characteristics curve (AUC), the 95% confidence interval for the AUC, and Youden’s
J were calculated to determine the optimal GAD-2 cutoff score for identifying clinically
significant anxiety symptoms, as defined by the previously validated GAD-7 cutoff
score of ≥8.
Results
Internal consistency was excellent for the GAD-7 (Cronbach α=.91) and acceptable for
the GAD-2 (α=.77), and the measures were highly correlated (r=.94). The GAD-2 had excellent overall accuracy for identifying clinically significant
anxiety symptoms (AUC=0.97; 95% confidence interval, 0.94-1.00). A GAD-2 cutoff score
of ≥3 provided an optimal balance of good sensitivity (0.87) and excellent specificity
(0.92) for detecting clinically significant anxiety symptoms. Alternatively, a cutoff
score of ≥2 provided excellent sensitivity (1.00) and fair specificity (0.76).
Conclusions
The GAD-2 is a clinically useful and psychometrically valid tool for screening anxiety
symptoms in MS rehabilitation and neurology care settings. Importantly, this tool
has the potential to identify individuals with MS who are at risk for anxiety disorders
and who may benefit from rehabilitation psychology interventions to ultimately improve
functioning and quality of life.
Keywords
List of abbreviations:
AUC (area under the curve), GAD-2 (Generalized Anxiety Disorder Scale-2 (GAD-2)), GAD-7 (Generalized Anxiety Disorder Scale-7), HADS (Hospital Anxiety and Depression Scale), MS (multiple sclerosis), PHQ (Patient Health Questionnaire), SCID-I (Structured Clinical Interview for DSM-IV-TR Axis I Disorders)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 02, 2018
Footnotes
Supported by a pilot grant from the Consortium of MS Centers, Beier (PI). The corresponding author is supported by a grant from the National Institutes of Health (grant no. K23HD086154), Hughes (PI).
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
