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Diagnostic and Clinical Utility of the GAD-2 for Screening Anxiety Symptoms in Individuals With Multiple Sclerosis

  • Abbey J. Hughes
    Correspondence
    Corresponding author Abbey J. Hughes, PhD, Department of Physical Medicine and Rehabilitation, Division for Rehabilitation Psychology and Neuropsychology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps Room 174, Baltimore, MD 21287.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Division for Rehabilitation Psychology and Neuropsychology, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Katherine M. Dunn
    Affiliations
    Department of Physical Medicine and Rehabilitation, Division for Rehabilitation Psychology and Neuropsychology, Johns Hopkins University School of Medicine, Baltimore, MD

    Department of Psychology, Loyola University Maryland, Baltimore, MD
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  • Trisha Chaffee
    Affiliations
    Department of Physical Medicine and Rehabilitation, Division for Rehabilitation Psychology and Neuropsychology, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Jagriti (Jackie) Bhattarai
    Affiliations
    Department of Physical Medicine and Rehabilitation, Division for Rehabilitation Psychology and Neuropsychology, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Meghan Beier
    Affiliations
    Department of Physical Medicine and Rehabilitation, Division for Rehabilitation Psychology and Neuropsychology, Johns Hopkins University School of Medicine, Baltimore, MD
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      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)
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