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Screening for Anxiety Symptoms With the Generalized Anxiety Disorder-2 Versus Generalized Anxiety Disorder-7 in
Alison Marshall1, Michael C Kaufman2, Christina Murphy3
1Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pennsylvania.
Background:
To assess the accuracy of the Generalized Anxiety Disorder-2 (GAD-2) Scale for screening anxiety symptoms in children with headache and epilepsy.
Methods:
Single-center and large-scale assessment of the two-item GAD-2 as compared to the seven-item Generalized Anxiety Disorder-7 (GAD-7) to screen for moderate-severe anxiety symptoms in children undergoing follow-up neurology appointments.
Results:
The GAD-7 was fully completed for 3960 of 6060 (65%) encounters. Anxiety symptoms were moderate in 534 (13%) encounters and severe in 337 (9%) encounters. The GAD-2 and GAD-7 were very strongly correlated (spearman's rho 0.91; P < 0.001). When assessing moderate-severe anxiety symptoms based on the GAD-7, a GAD-2 score of ≥3 yielded an area under the receiver operating characteristics curve of 0.96, sensitivity 89%, specificity 91%, positive predictive value 74%, and negative predictive value 97%. If assessment stopped with the GAD-2 at the ≥3 cutoff, then 74% of encounters would be considered not to have anxiety symptoms and would not complete additional questions, but 11% of encounters with moderate-severe anxiety symptoms would not be identified, including 0.6% of patients with severe anxiety symptoms.
Conclusions:
Anxiety symptoms were common. Use of the GAD-2 would reduce the number of questions needing completion compared to the GAD-7 for 74% of patients but would fail to identify 11% of patients with moderate-severe anxiety symptoms, including 0.6% of patients with severe anxiety symptoms. These data indicate that the use of the GAD-2 may be appropriate as a briefer alternative to the GAD-7 which may be ideal in clinical settings with a substantial questionnaire burden.
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