Morrison Corey, Mellins Claude A, Synder Clayton, Shea Eileen, Kluisza Luke, Robbins Reuben, Poku Ohemaa, Fisher Prudence, Abrams Elaine, Wiznia Andrew, Mufson Laura
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA.
Department of Psychiatry, Mental Health Data Science, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, USA.
J Mood Anxiety Disord. 2024 Sep;7. doi: 10.1016/j.xjmad.2024.100066. Epub 2024 Mar 30.
Generalized Anxiety Disorder (GAD) is prevalent among people with HIV and is associated with adverse health outcomes. This study investigates the suitability of the Generalized Anxiety Disorder Scale-7 item (GAD-7) screening tool and its 2-item (GAD-2) version for use in young adults with perinatally-acquired HIV (YAPHIV) and young adults perinatally exposed to HIV but uninfected (YAPHEU).
Data come from the 7th follow-up interview (FU7) from a longitudinal study of youth with PHIV and PHEU, first recruited when 9-16 years. The GAD-7 was administered along with a diagnostic psychiatric interview (DISC-IV). Receiver Operating Characteristic analysis assessed accuracy, sensitivity, and specificity of the GAD7 and GAD-2. Subgroup analyses considered HIV status, ethnicity, and race.
At FU7, participants (n = 204) were ages 20-29; 54% female; and the majority African-American and/or Latinx. 12% met diagnostic criteria for GAD. Recommended GAD-7 (>10) and GAD-2 (>3) cut-scores showed suboptimal sensitivity (0.52 and 0.48, respectively) and high specificity (0.91 and 0.90, respectively). Lowering cut-scores (GAD-7 >6 and GAD-2 >2) improved sensitivity (0.76 and 0.80) while sacrificing specificity (0.77 and 0.78). Stratified analyses by HIV status revealed similar accuracy in YAPHIV and YAPHEU. Race/ethnicity did not significantly affect cut-scores.
Anxiety disorders are common in YAPHIV, and efficient screening is essential. While the GAD-7 and GAD-2 show promise, recommended cut-scores may not be optimal. Lowering cut-scores may enhance sensitivity without losing clinical utility. Further research is needed to refine cut-scores based on demographic characteristics and in global contexts, ensuring effective anxiety screening in this population.
广泛性焦虑障碍（GAD）在感染艾滋病毒的人群中很普遍，并且与不良健康结果相关。本研究调查了广泛性焦虑障碍7项量表（GAD - 7）筛查工具及其2项版本（GAD - 2）在围产期感染艾滋病毒的年轻成年人（YAPHIV）和围产期暴露于艾滋病毒但未感染的年轻成年人（YAPHEU）中的适用性。
数据来自一项对感染艾滋病毒和暴露于艾滋病毒的青少年进行的纵向研究的第7次随访访谈（FU7），这些青少年首次招募时年龄在9至16岁。GAD - 7与诊断性精神科访谈（DISC - IV）一起进行。受试者工作特征分析评估了GAD7和GAD - 2的准确性、敏感性和特异性。亚组分析考虑了艾滋病毒状态、种族和族裔。
在FU7时，参与者（n = 204）年龄在20至29岁之间；54%为女性；大多数是非裔美国人和/或拉丁裔。12%符合GAD的诊断标准。推荐的GAD - 7（>10）和GAD - 2（>3）临界值显示敏感性欠佳（分别为0.52和0.48），特异性较高（分别为0.91和0.90）。降低临界值（GAD - 7 >6和GAD - 2 >2）可提高敏感性（0.76和0.80），但会牺牲特异性（0.77和0.78）。按艾滋病毒状态进行的分层分析显示，YAPHIV和YAPHEU的准确性相似。种族/族裔对临界值没有显著影响。
焦虑症在YAPHIV中很常见，有效的筛查至关重要。虽然GAD - 7和GAD - 2显示出前景，但推荐的临界值可能并非最佳。降低临界值可能会提高敏感性而不损失临床实用性。需要进一步研究根据人口统计学特征和全球背景优化临界值，以确保对该人群进行有效的焦虑症筛查。
