A Brief Online and Offline (Paper-and-Pencil) Screening Tool for Generalized Anxiety Disorder: The Final Phase in the Development and Validation of the Mental Health Screening Tool for Anxiety Disorders (MHS: A).

Shin-Hyang Kim,Seung-Hwan Lee,Seowon Yoon,Younyoung Choi,Kiho Park,Kee-Hong Choi

doi:10.3389/fpsyg.2021.639366

Abstract

Generalized anxiety disorder (GAD) can cause significant socioeconomic burden and daily life dysfunction; hence, therapeutic intervention through early detection is important. This study was the final stage of a 3-year anxiety screening tool development project that evaluated the psychometric properties and diagnostic screening utility of the Mental Health Screening Tool for Anxiety Disorders (MHS: A), which measures GAD. A total of 527 Koreans completed online and offline (i.e., paper-and pencil) versions of the MHS: A, Beck Anxiety Inventory (BAI), Generalized Anxiety Disorder-7 (GAD-7), and Penn State Worry Questionnaire (PSWQ). The participants had an average age of 38.6 years and included 340 (64.5%) females. Participants were also administered the Mini-International Neuropsychiatric Interview (MINI). Internal consistency, convergent/criterion validity, item characteristics, and test information were assessed based on the item response theory (IRT), and a factor analysis and cut-off score analyses were conducted. The MHS: A had good internal consistency and good convergent validity with other anxiety scales. The two versions (online/offline) of the MHS: A were nearly identical (r = 0.908). It had a one-factor structure and showed better diagnostic accuracy (online/offline: sensitivity = 0.98/0.90, specificity = 0.80/0.83) for GAD detection than the GAD-7 and BAI. The IRT analysis indicated that the MHS: A was most informative as a screening tool for GAD. The MHS: A can serve as a clinically useful screening tool for GAD in Korea. Furthermore, it can be administered both online and offline and can be flexibly used as a brief mental health screener, especially with the current rise in telehealth.

Highlights

The Lancet Global Mental Health series of articles and the World Health Organization (WHO) Mental Health Gap Action Program have highlighted the importance of preventive interventions in mental health (Lancet Global Mental Health Group, 2007; World Health Organization, 2008), emphasizing the need for early screening of mental disorders and the transference of patients to psychiatric professionals (Katon and Roy-Byrne, 2007; World Health Organization, 2008)
It is recommended that additional clinical interviews be performed or other screening tools be administered to diagnose anxiety disorders, rather than using the Generalized anxiety disorder (GAD)-7 alone (Jordan et al, 2017; Ahn et al, 2019)
The researchers of this study developed an item response theory (IRT)-based Mental Health Screening Tool for Anxiety Disorders (MHS: A) that reflects the item response characteristics of Koreans, which could serve as a foundation for constructing a computerized adaptive tests (CAT)-based test in the future

Summary

Introduction

The Lancet Global Mental Health series of articles and the World Health Organization (WHO) Mental Health Gap Action Program (mhGAP) have highlighted the importance of preventive interventions in mental health (Lancet Global Mental Health Group, 2007; World Health Organization, 2008), emphasizing the need for early screening of mental disorders and the transference of patients to psychiatric professionals (Katon and Roy-Byrne, 2007; World Health Organization, 2008). Generalized anxiety disorder (GAD) is commonly observed, with a prevalence of 1.6–7.3% in primary care and of 13% in psychiatric settings (Kessler et al, 2001; Lieb et al, 2005). The GAD-7 has been reported to have poor specificity in a psychiatric setting, despite being a good screening tool in primary care (Kertz et al, 2013; Beard and Björgvinsson, 2014), and it has repeatedly demonstrated a high false positive rate (Kertz et al, 2013; Beard and Björgvinsson, 2014; Ahn et al, 2019). It is recommended that additional clinical interviews be performed or other screening tools be administered to diagnose anxiety disorders, rather than using the GAD-7 alone (Jordan et al, 2017; Ahn et al, 2019)

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