Adaptation and initial validation of the Patient Health Questionnaire – 9 (PHQ-9) and the Generalized Anxiety Disorder – 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample
Abstract
The Patient Health Questionnaire - 9 (PHQ-9) and Generalized Anxiety Disorder - 7 (GAD-7) are short screening measures used in medical and community settings to assess depression and anxiety severity. The aim of this study is to translate the screening tools into Arabic and evaluate their psychometric properties in an Arabic-speaking Lebanese psychiatric outpatient sample. The patients completed the questionnaires, among others, prior to being evaluated by a clinical psychiatrist or psychologist. The scales' internal consistency and factor structure were measured and convergent and discriminant validity were established by comparing the scores with clinical diagnoses and the Psychiatric Diagnostic Screening Questionnaire - MDD subset (PDSQ - MDD). Results showed that the PHQ-9 and GAD-7 are reliable screening tools for depression and anxiety and their factor structures replicated those reported in the literature. Sensitivity and specificity analyses showed that the PHQ-9 is sensitive but not specific at capturing depressive symptoms when compared to clinician diagnoses whereas the GAD-7 was neither sensitive nor specific at capturing anxiety symptoms. The implications of these findings are discussed in reference to the scales themselves and the cultural specificity of the Lebanese population.
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The Arabic version of the Patient Health Questionnaire (PHQ-9) was previously validated in Lebanon.
“The Arabic version of PHQ-9 was previously validated in Lebanon [46].”
From Mindfulness among lebanese university students and its indirect effect between mental health and wellbeing (2023) · cites this paper as [46]
The PHQ-9 Turkish and Arabic versions have good psychometric properties.
“The Turkish and Arabic version of the scale has good psychometric properties (Sari et al., 2016;Sawaya et al., 2016).”
From "Doing What Matters in Times of Stress" to Decrease Psychological Distress During COVID-19: A Randomised Controlled Pilot Trial. (2022) · cites this paper as Sawaya et al., 2016
The PHQ-9 has been validated in the Lebanese population with a cut-off score of 10 or above indicating moderate depression.
“The PHQ-9 has been validated in the Lebanese population with a cut-off score of 10 or above indicating moderate depression [33].”
From Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials (2021) · cites this paper as [33]
The GAD-7 has been validated in the Lebanese population.
“The GAD-7 has been validated in the Lebanese population [33].”
From Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials (2021) · cites this paper as [33]
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- Authors
- Sawaya, H., Atoui, M., Hamadeh, A., Zeinoun, P., & Nahas, Z.
- Affiliations
- American University of Beirut Medical Center (LB)
- Corresponding author
- Nahas, Ziad
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2016-05
- Volume
- 239
- Pages
- 245-252
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2298911878
- Cited by
- 450
- References
- 86
- Citations by year
- 2026: 54 · 2025: 77 · 2024: 62 · 2023: 55 · 2022: 65 · 2021: 69 · 2020: 35 · 2019: 15 · 2018: 11 · 2017: 6 · 2016: 1
- FWCI
- 15.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- 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 › Social Psychology › Mental Health Treatment and Access
- Keywords
- PHQ-9, GAD-7, Arabic translation, depression screening, anxiety screening, psychometric validation, factor structure, sensitivity and specificity, psychiatric outpatients, Lebanese patients, cultural adaptation
- MeSH terms
- Adult, Anxiety Disorders, Major Depressive Disorder, Female, Humans, Lebanon, Male, Middle Aged, Outpatients, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Sensitivity and Specificity, Reproducibility of Results
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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