Wang Fei, Wu Yunchou, Wang Suqi, Du Zhuoran, Wu Yibo
State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.
School of Psychology, Southwest University,Chongqing, China.
Gen Hosp Psychiatry. 2024 Mar-Apr;87:33-40. doi: 10.1016/j.genhosppsych.2024.01.010. Epub 2024 Jan 26.
Despite the relatively small number of items in the GAD-7, fewer items are increasingly sought to shorten testing time in large-scale mental health screenings. As a result, short forms based on the GAD-7, the GAD-2, and GAD-mini, have become popular. However, the GAD-2 and GAD-mini have reported lower diagnostic accuracy in some cultural contexts, implying that a validated short-form version of the GAD-7 may be lacking in large-scale cross-cultural anxiety screening. Based on this, to develop an optimal short form of the GAD-7 with cross-cultural stability, we utilized seven GAD-7 datasets from six different countries, totaling 47,484 participants. Five 2 to 6 item short forms of the GAD were constructed using the Riskslim machine learning algorithm. We evaluated the diagnostic accuracy of the GAD-7 short forms in the training and test sets based on the coefficient of determination(R) and area under the curve(AUC) metrics, and the results showed that GAD-R2 performed poorly in some cultures, and all of the 3 to 6 item short forms of the GAD performed good in cross-cultural diagnostic rates, with the GAD-R6 showing the highest diagnostic accuracy in all cultures; GAD-R3 outperformed GAD-R2, GAD-2, and GAD-mini in all cultures; GAD-R3 had higher generalizability across cultures and special populations; Given that the GAD-R3 was shorter and nearly as accurate as the GAD-R6, we recommend the use of the GAD-R3 in clinical studies and epidemiologic investigations. And we recommend the optimal actual cutoff value of 15 for GAD-R3. Overall, we recommend GAD-R3 as the short-form version of GAD-7 in cross-cultural studies. However, the 2-item GAD scale is also optimal for the short-form version in clinical practice.
尽管广泛性焦虑障碍量表（GAD-7）中的条目数量相对较少，但在大规模心理健康筛查中，人们越来越希望通过更少的条目来缩短测试时间。因此，基于GAD-7的简化版，如GAD-2和GAD-mini，变得很受欢迎。然而，在某些文化背景下，GAD-2和GAD-mini的诊断准确性较低，这意味着在大规模跨文化焦虑筛查中，可能缺乏经过验证的GAD-7简化版。基于此，为了开发一种具有跨文化稳定性的最佳GAD-7简化版，我们使用了来自六个不同国家的七个GAD-7数据集，共有47484名参与者。使用Riskslim机器学习算法构建了五个包含2至6个条目的GAD简化版。我们基于决定系数（R）和曲线下面积（AUC）指标评估了GAD-7简化版在训练集和测试集中的诊断准确性，结果表明GAD-R2在某些文化中表现不佳，所有3至6个条目的GAD简化版在跨文化诊断率方面表现良好，其中GAD-R6在所有文化中显示出最高的诊断准确性；GAD-R3在所有文化中均优于GAD-R2、GAD-2和GAD-mini；GAD-R3在不同文化和特殊人群中具有更高的通用性；鉴于GAD-R3更简短且诊断准确性与GAD-R6相近，我们建议在临床研究和流行病学调查中使用GAD-R3。并且我们建议GAD-R3的最佳实际临界值为15。总体而言，我们推荐GAD-R3作为跨文化研究中GAD-7的简化版。然而，在临床实践中，2条目GAD量表也是简化版的最佳选择。
