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Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7)
Abstract
Background Effective treatment requires regular follow-up and monitoring of symptoms. We investigated sensitivity to change and minimal clinically important difference of the Generalized Anxiety Disorder Scale (GAD-7).Methods This study included all participants from a multisite trial of chronic depression. Baseline and follow-up (12 and 48 weeks) data were used to assess treatment response. Effect sizes (ES) and standardized response means (SRM) of pre- and post-GAD-7 mean changes were calculated for subgroups of patients, who did or did not improve according to ratings in the Hamilton Rating Scale for Depression (HRSD-24).Results N = 261 patients were included in the analyses. In the subgroup of patients who improved according to HRSD-24, GAD-7 scores were significantly lower after 12 weeks (t = -6.31, df = 120, p < .001; ES = -0.51, SRM = -0.57), and 48 weeks of treatment (t = -12.68, df = 141, p < .001; ES = -1.0, SRM = -1.7), when compared to admission. In the group who worsened, GAD-7 scores were significantly higher after 12 weeks (t = 2.96, df = 41, p = .005; ES = 0.30, SRM = 0.46), and increased after 48 weeks (t = 1.99, df = 21, p = .059; ES = 0.37, SRM = 0.43), when compared to baseline. The unchanged group showed no significant difference between baseline and follow-up. MCID was estimated 4 points on the GAD-7 total score.Limitations Confirmation of these findings and further investigation of the GAD-7 in populations and trials focusing on anxiety-specific treatment is highly recommended.Conclusions Results show that the GAD-7 is sensitive to detect change in psychopathology over the course of treatment.
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“The minimal clinically important difference for GAD-7 was 3.8; the clinically relevant change was ≥4 points [51].”
From Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial (2021) · cites this paper as [51]
In the citing paper
“This change met the level of minimal clinical important difference (MCID), which is estimated at 4 points on the GAD-7 total score [30].”
From The Psychosocial Impact of COVID-19 on Older Adults with Cancer: A Rapid Review (2022) · cites this paper as [30]
In the citing paper
“which is estimated at 4 points on the GAD-7 total score [30].”
From The Psychosocial Impact of COVID-19 on Older Adults with Cancer: A Rapid Review (2022) · cites this paper as [30]
In the citing paper
“Anxiety will be measured with the 7-item Generalized Anxiety Disorder Scale (GAD-7; range, 0–21; higher scores indicate greater severity) [25].”
In the citing paper
“As noted above, we observed clinically meaningful improvements in both anxiety and depression, with reductions in GAD-7 (− 5.04) and PHQ-9 (− 5.64) higher than the MCID for both conditions (3.8 and 5, respectively) [66, 67].”
From Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study (2022) · cites this paper as [66]
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“The GAD-7 has gradually become a widely used measurement tool in populations with different characteristics, especially adult populations, and showed satisfactory reliability and validity [17,18].”
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“90) by Week 3, which is considered a clinically meaningful improvement in anxiety symptoms [41].”
Background
Metadata
- Authors
- Toussaint, A., Hüsing, P., Gumz, A., Wingenfeld, K., Härter, M., Schramm, E., & Löwe, B.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- Charité – Universitätsmedizin Berlin (DE)
- University of Freiburg (DE)
- Corresponding author
- Toussaint, Anne
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 265
- Pages
- 395-401
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W3000661394
- Cited by
- 641
- References
- 68
- Citations by year
- 2026: 134 · 2025: 138 · 2024: 113 · 2023: 99 · 2022: 68 · 2021: 59 · 2020: 30
- FWCI
- 61.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- 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
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- GAD-7, Generalized Anxiety Disorder Scale, anxiety symptoms, chronic depression, sensitivity to change, minimal clinically important difference, standardized response mean, treatment response monitoring, Hamilton Depression Rating Scale
- MeSH terms
- Minimal Clinically Important Difference, Patient Health Questionnaire, Anxiety Disorders, Depression, Humans, Treatment Outcome
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