Assessing anxiety in high-altitude Tibetan communities: validation of a Tibetan version GAD-7

To translate the Generalized Anxiety Disorder-7 (GAD-7) scale into Tibetan and evaluate its psychometric properties for assessing anxiety symptoms of the Tibetan communities living in high altitudes.

Following a standardized translation and cross-cultural adaptation procedure, the Tibetan GAD-7 was administered to 583 adults recruited via convenience sampling in Tibetan areas. Its reliability was assessed using Cronbach's alpha and item-total correlations. Construct validity was examined using Exploratory Factor Analysis (EFA, n = 290) and Confirmatory Factor Analysis (CFA, n = 293) by randomly splitting the sample into two halves. Group differences in GAD-7 scores across sociodemographic variables were analyzed using t-tests and Analysis of Variance (ANOVA).

The Tibetan GAD-7 demonstrated acceptable internal consistency (Cronbach's α = 0.70). EFA suggested a two-factor structure, which was further supported by CFA, showing a significantly better model fit (CFI = 0.90, TLI = 0.82, RMSEA = 0.09) than a one-factor model (CFI = 0.71, TLI = 0.57, RMSEA = 0.14). Significant group differences were also found, with females, urban residents, and individuals with lower household income reporting higher anxiety scores.

The Tibetan version of the GAD-7 shows acceptable reliability and validity as a screening tool for generalized anxiety symptoms in high-altitude Tibetan populations. Its use can facilitate early identification of anxiety in this underserved, culturally distinct community with limited mental health resources.