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Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample

Hinz, Andreas, Klein, Annette M., Brähler, Elmar, Glaesmer, Heide, Luck, Tobias, Riedel-Heller, Steffi G., Wirkner, Kerstin, Hilbert, Anja·2017·Journal of Affective Disorders

DOI 10.1016/j.jad.2016.12.012

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Abstract

Background The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric properties of these questionnaires, to provide normative values, and to investigate associations with sociodemographic factors, quality of life, psychological variables, and behavioral factors.Methods A German community sample (n=9721) with an age range of 18-80 years was surveyed using the GAD-7 and several other questionnaires.Results Confirmatory factor analyses confirmed the unidimensionality and measurement invariance of the GAD-7 across age and gender. Females were more anxious than males (mean scores: M=4.07 vs. M=3.01; effect size: d=0.33). There was no linear age trend. A total of 5.9% fulfilled the cut-off criterion of 10 and above. Anxiety was correlated with low quality of life, fatigue, low habitual optimism, physical complaints, sleep problems, low life satisfaction, low social support, low education, unemployment, and low income. Cigarette smoking and alcohol consumption were also associated with heightened anxiety, especially in women. When comparing the GAD-7 (7 items) with the ultra-short GAD-2 (2 items), the GAD-7 instrument was superior to the GAD-2 regarding several psychometric criteria.Limitations The response rate (33%) was low. Because of the cross-sectional character of the study, causal conclusions cannot be drawn. A further limitation is the lack of a gold standard for diagnosing anxiety.Conclusions The GAD-7 can be recommended for use in clinical research and routine.

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Authors: Hinz, A., Klein, A. M., Brähler, E., Glaesmer, H., Luck, T., Riedel-Heller, S. G., Wirkner, K., & Hilbert, A.
Affiliations: Leipzig University (DE)
Johannes Gutenberg University Mainz (DE)
Corresponding author: Hinz, Andreas
ORCID: Hinz, Andreas
Klein, Annette M.
Brähler, Elmar
Glaesmer, Heide
Luck, Tobias
Riedel-Heller, Steffi G.
Wirkner, Kerstin
Hilbert, Anja
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2017-03
Volume: 210
Pages: 338-344
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/j.jad.2016.12.012
OpenAlex: W2562471806
Cited by: 443
References: 43
Citations by year: 2026: 39 · 2025: 62 · 2024: 63 · 2023: 59 · 2022: 65 · 2021: 78 · 2020: 47 · 2019: 16 · 2018: 12 · 2017: 2
FWCI: 14.20
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Funders: European Union
European Regional Development Fund
Free State of Saxony (713-241202, 14505/2470, 14575/2470)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: GAD-7, GAD-2, generalized anxiety disorder, anxiety screening, psychometric properties, reference values, measurement invariance, sex differences in anxiety, quality of life, sleep disorders, social support, smoking, alcohol consumption, German general population
MeSH terms: Patient Health Questionnaire, Adolescent, Adult, Aged, Aged, 80 and over, Alcohol Drinking, Anxiety Disorders, Cross-Sectional Studies, Female, Germany, Humans, Male, Middle Aged, Psychometrics, Quality of Life, Surveys and Questionnaires, Risk Factors, Smoking, Socioeconomic Factors, Age Distribution, Sex Distribution, Stress Disorders, Traumatic, Acute, Young Adult

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Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample

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