Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7) among Pregnant Women
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OBJECTIVE: Generalized anxiety disorder (GAD) during pregnancy is associated with several adverse maternal and perinatal outcomes. A reliable and valid screening tool for GAD should lead to earlier detection and treatment. Among pregnant Peruvian women, a brief screening tool, the GAD-7, has not been validated. This study aims to evaluate the reliability and validity of the GAD-7. METHODS: Of 2,978 women who attended their first perinatal care visit and had the GAD-7 screening, 946 had a Composite International Diagnostic Interview (CIDI). The Cronbach's alpha was calculated to examine the reliability. We assessed the criterion validity by calculating operating characteristics. The construct validity was evaluated using factor analysis and association with health status on the CIDI. The cross-cultural validity was explored using the Rasch Rating Scale Model (RSM). RESULTS: The reliability of the GAD-7 was good (Cronbach's alpha = 0.89). A cutoff score of 7 or higher, maximizing the Youden Index, yielded a sensitivity of 73.3% and a specificity of 67.3%. One-factor structure of the GAD-7 was confirmed by exploratory and confirmatory factor analysis. Concurrent validity was supported by the evidence that higher GAD-7 scores were associated with poor self-rated physical and mental health. The Rasch RSM further confirmed the cross-cultural validity of the GAD-7. CONCLUSION: The results suggest that the Spanish-language version of the GAD-7 may be used as a screening tool for pregnant Peruvian women. The GAD-7 has good reliability, factorial validity, and concurrent validity. The optimal cutoff score obtained by maximizing the Youden Index should be considered cautiously; women who screened positive may require further investigation to confirm GAD diagnosis.
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The Generalized Anxiety Disorder Screener 7-item is considered a reliable screening tool among pregnant Latinas.
“The Generalized Anxiety Disorder Screener 7-item (GAD-7; Spitzer et al., 2006) assessed symptoms and severity of generalized anxiety and is considered a reliable screening tool among pregnant Latinas (Zhong et al., 2015).”
From Exposure Therapy Acceptability Among Pregnant Latinas With Anxiety: A Qualitative Content Analysis (2025) · cites this paper as Zhong et al., 2015
The Discussion reports that the Spanish-language GAD-7 was a reliable screening measure in pregnant Peruvian women assessed during early pregnancy. The claim broadens that finding to pregnant Latinas generally; the paper calls for validation across other regions and Spanish-speaking populations. (LLM, conf=0.86)
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- Authors
- Zhong, Q.-Y., Gelaye, B., Zaslavsky, A. M., Fann, J. R., Rondon, M. B., Sánchez, S. E., & Williams, M. A.
- Affiliations
- Harvard University (US)
- University of Washington (US)
- Peruvian University of Applied Sciences (PE)
- Corresponding author
- Zhong, Qiu-Yue
- Gelaye, Bizu
- Zaslavsky, Alan M.
- Fann, Jesse R.
- Sánchez, Sixto E.
- Williams, Michelle A.
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-04-27
- Volume
- 10
- Issue
- 4
- Pages
- e0125096
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4411061
- OpenAlex
- W2077680141
- Cited by
- 297
- References
- 78
- Citations by year
- 2026: 23 · 2025: 33 · 2024: 39 · 2023: 42 · 2022: 45 · 2021: 58 · 2020: 20 · 2019: 14 · 2018: 13 · 2017: 4 · 2016: 3 · 2015: 2 · 2013: 1
- FWCI
- 7.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Repositorio Académico UPC (Universidad Peruana de Ciencias Aplicadas) (submittedVersion, cc-by)
- Funders
- National Institutes of Health (R01-HD)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD059835)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- 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
- Keywords
- Generalized Anxiety Disorder-7, GAD-7, generalized anxiety disorder, pregnancy, anxiety screening, psychometric validation, Spanish translation, Peruvian women, diagnostic thresholds, Rasch model, cross-cultural validity, factor structure, maternal mental health
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Cross-Sectional Studies, Cross-Cultural Comparison, Female, Humans, Interview, Psychological, Middle Aged, Peru, Pregnancy, Pregnancy Complications, Psychiatric Status Rating Scales, Reproducibility of Results, Young Adult
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