Validation of generalized anxiety disorder-2 as a screening tool for generalized anxiety disorder in the primary health care setting: study protocol

Mohammad J. M. A. Tamimi, Anna R. Sharif, Saad T. Sedeeq, Ehab Hamed

Abstract

Background: Anxiety screening in primary care is crucial for the identification and management of the condition. The generalized anxiety disorder-2 (GAD-2) is an abridged version of the tool composed of the first two questions of the GAD-7 for screening for anxiety in the general adult population in primary care settings. Patients who score more than 3 points are further evaluated for anxiety. Although there is a growing body of literature documenting the psychometric properties of the GAD-2 against a structured interview and the GAD-7, no earlier studies have assessed the performance of the GAD-2 in Qatar. This cross-sectional study primarily aims to examine the sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of GAD-2 scores for detecting anxiety among patients attending PHCC in Qatar.

Methods: The study will employ a periodic cross-sectional study of electronic medical record data of adult patients attending the primary health care settings between January of 2017 and December of 2019. The study population will include all adult population with documented GAD-7 scores. We will exclude all patients with other mental health diagnoses, including mental disability, schizophrenia, and dementia.

Conclusions: GAD-2 questionnaire forms an easy to administer screening tool. The cut-off value in various international settings is set at a score of equal to or more than 3. The study will report on the diagnostic properties of GAD-2 scores against the documented diagnosis of anxiety by health care professionals. The result helps to tailor the cut-off value to its local settings.

Trial Registration: Trial registration number is PHCCDCR202003019.

Keywords

Generalized anxiety disorder, Psychometric properties, Health care professionals

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References

Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, Rahman A. No health without mental health. Lancet. 2007;370(9590):859-77.

Mechanic D. Barriers to help-seeking, detection, and adequate treatment for anxiety and mood disorders: Implications for health care policy. J Clin Psychiatr. 2007;68:20-6.

Newman MG, Llera SJ, Erickson TM, Przeworski A, Castonguay LG. Worry and generalized anxiety disorder: a review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment. Annu Rev Clin Psychol. 2013;9:275-97.

Diagnostic and Statistical Manual of Mental Disorders [DSM]. 4th ed. Text Revision; American Psychiatric Association. 2004.

Maron E, Nutt D. Biological markers of generalized anxiety disorder. Dialogues Clin Neurosci. 2017;19(2):147-58.

Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015;17(3):327-35.

Ghuloum S, Bener A, Burgut FT. Epidemiological survey of knowledge, attitudes, and health literacy concerning mental illness in a national community sample: a global burden. J Prim Care Comm Health. 2010;1:111-8.

Bener A, Guloum S. Gender differences in the knowledge, attitude and practice towards mental health illness in a rapidly developing Arab society. Int J Soc Psychiatr. 2011;57:480-6.

Gigantesco A, Palumbo G, Mirabella F, Pettinelli M, Morosini P. Prevalence of psychiatric disorders in an Italian Town: Low prevalence confirmed with two different interviews. Psychother Psychosom. 2006;75:170-6.

Leon AC, Olfson M, Broadhead WE, et al. prevalence of mental disorders in primary care. Implications for screening. Arch Fam Med. 1995;4(10):857-61.

Lieb R, Becker E, Altamura C. The epidemiology of generalized anxiety disorder in Europe. Eur Neuropsychopharmacol. 2005;15:445-52.

Fernandez A, Rubio-Valera M, Bellon JA, Pinto-Meza A, Luciano JV, Mendive JM, et al. recognition of anxiety disorders by the general practitioner: results from the DASMAP Study. Gen Hosp Psychiatr. 2012;34:227-33.

Stein MB, Sherbourne CD, Craske MG, Means-Christensen A, Bystritsky A, Katon W, et al. quality of care for primary care patients with anxiety disorders. Am J Psychiatr. 2004;161:2230-7.

Katon W, Roy-Byrne P. Anxiety disorders: efficient screening is the first step in improving outcomes. Ann Intern Med. 2007;146:390-1.

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092-7.

Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146:317-25.

Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Wolfgang H, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46.