Anxiety in Response to Sustaining Spinal Cord Injuries and Disorders: When Should Clinicians Be Concerned?

Area of Science:

• Psychiatry
• Rehabilitation Medicine
• Clinical Psychology

Background:

• Anxiety disorders are prevalent in the general population and may be elevated in persons with spinal cord injuries/disorders (PwSCI/D).
• Accurate screening tools are essential for early identification and intervention in PwSCI/D.
• The Generalized Anxiety Disorder-2 (GAD-2) and Generalized Anxiety Disorder-7 (GAD-7) are commonly used anxiety screening measures.

Purpose of the Study:

• To recommend an optimal cut-off score for the GAD-2 in PwSCI/D.
• To estimate the occurrence of anxiety symptoms in PwSCI/D using the GAD-7.
• To provide evidence-based screening recommendations for anxiety in this population.

Main Methods:

• Retrospective analysis of data from 909 PwSCI/D aged 18 years and older.
• Utilized data from inpatient rehabilitation and community sites.
• Employed Receiver Operating Characteristic (ROC) curve, sensitivity, and specificity analyses to determine optimal cut-off scores.

Main Results:

• Anxiety symptom occurrence was 21% using a GAD-7 cut-off of ≥8 and 15% using a GAD-7 cut-off of ≥10.
• An optimal sensitivity for the GAD-2 was identified at a score of ≥2 when a GAD-7 cut-off of ≥8 was used.
• These findings suggest a higher prevalence of anxiety in PwSCI/D compared to the general population.

Conclusions:

• A GAD-2 cut-off score of ≥2 is recommended for PwSCI/D to maximize sensitivity.
• A GAD-7 threshold of ≥8 is recommended to identify the maximum number of individuals with anxiety symptoms for further diagnostic interviews.
• These recommendations can improve the early detection and management of anxiety in PwSCI/D.