Zhong Qiu-Yue, Gelaye Bizu, Zaslavsky Alan M, Fann Jesse R, Rondon Marta B, Sánchez Sixto E, Williams Michelle A
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America.
Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America.
PLoS One. 2015 Apr 27;10(4):e0125096. doi: 10.1371/journal.pone.0125096. eCollection 2015.
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.
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).
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.
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.
孕期广泛性焦虑障碍（GAD）与多种不良孕产妇及围产期结局相关。一种可靠且有效的GAD筛查工具应能实现更早的检测与治疗。在秘鲁孕妇中，一种简短的筛查工具——广泛性焦虑障碍量表7项（GAD - 7）尚未得到验证。本研究旨在评估GAD - 7的可靠性和有效性。
在2978名首次接受围产期护理访视并进行了GAD - 7筛查的女性中，946人接受了复合国际诊断访谈（CIDI）。计算克朗巴哈系数（Cronbach's alpha）以检验可靠性。通过计算操作特征来评估效标效度。使用因子分析以及与CIDI上健康状况的关联来评估结构效度。使用拉施评分量表模型（RSM）探索跨文化效度。
GAD - 7的可靠性良好（克朗巴哈系数 = 0.89）。以7分及以上作为截断分数，使约登指数最大化，灵敏度为73.3%，特异度为67.3%。探索性和验证性因子分析均证实了GAD - 7的单因素结构。更高的GAD - 7得分与自评身心健康状况较差相关，这一证据支持了同时效度。拉施RSM进一步证实了GAD - 7的跨文化效度。
结果表明，西班牙语版的GAD - 7可作为秘鲁孕妇的筛查工具。GAD - 7具有良好的可靠性、因子效度和同时效度。对于通过使约登指数最大化而获得的最佳截断分数应谨慎考虑；筛查呈阳性的女性可能需要进一步检查以确诊GAD。
