Diagnostic and clinical utility of the GAD-2 for screening anxiety symptoms in individuals with multiple sclerosis

Publication date: Available online 30 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Abbey J. Hughes, Katherine M. Dunn, Trisha Chaffee, Jagriti (Jackie) Bhattarai, Meghan Beier
ObjectiveTo assess the diagnostic and clinical utility of the two-item Generalized Anxiety Disorder Scale (GAD-2) for screening anxiety symptoms in individuals with multiple sclerosis (MS).DesignCross-sectional.SettingUniversity-affiliated MS neurology and rehabilitation center.ParticipantsThe sample was comprised of 99 adults (ages 19 to 72; M = 46.2; SD = 13.0; 75% female) with a physician-confirmed MS diagnosis who were receiving care in a university-affiliated MS center. Disease durations ranged from 1 to 37 years (M = 10.7; SD = 8.4).InterventionsNot applicable.Main Outcome MeasuresParticipants completed the GAD-7 and GAD-2. Internal consistency was calculated for both measures. Area under the receiver operating characteristics curve (AUC), the 95% confidence interval for the AUC, and Youden's J were calculated to determine the optimal GAD-2 cut-off score for identifying clinically significant anxiety symptoms, as defined by the previously validated GAD-7 cut-off score of ≥ 8.ResultsInternal consistency was excellent for the GAD-7 (Cronbach α = .91) and acceptable for the GAD-2 (α = .77), and the measures were highly correlated (r = .94). The GAD-2 had excellent overall accuracy for identifying clinically significant anxiety symptoms (AUC = 0.97, 95% CI 0.94 – 1.00). A GAD-2 cut-off score of ≥ 3 provided an optimal balance of good sensitivity (0.87) and excellent specificity (0.92) for detecting clinically significant anxiety symptoms. Alternatively, a cut-off score of ≥ 2 provided excellent sensitivity (1.00) and fair specificity (0.76).ConclusionsThe GAD-2 is a clinically useful and psychometrically valid tool for screening anxiety symptoms in MS rehabilitation and neurology care settings. Importantly, this tool has the potential to identify individuals with MS who are at risk for anxiety disorders and who may benefit from rehabilitation psychology interventions to ultimately improve functioning and quality of life.



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