Generalised anxiety disorder in adolescents in Ghana: Examination of the psychometric properties of the Generalised Anxiety Disorder-7 scale

Samuel Adjorlolo

doi:10.4102/ajopa.v1i0.10

Abstract

The Generalised Anxiety Disorder-7 (GAD-7) is a self-report scale used to assess general anxiety symptoms. Although the GAD-7 has been found to be a valid scale among adults, studies examining its psychometric properties among adolescents in high-income countries are notably limited and particularly non-existent in low- and middle-income countries. The current study addresses this lacuna by investigating the factorial validity, construct validity, internal consistency and discriminant accuracy of the GAD-7. Data were collected from 553 adolescents (boys = 231; average age = 16.85) recruited from a senior high school in Ghana, a sub-Saharan African country, using cross-sectional self-report methodology. The result supports a unidimensional structure of the GAD-7 that was invariant across gender. The GAD-7 correlates significantly with measures of anxiety, suicidal tendencies and mental well-being, suggesting construct validity. The internal consistency of the GAD-7, based on the mean inter-item correlation value of 0.24 and Cronbach’s a = 0.69, is adequate. The GAD-7 similarly discriminated between individuals at high risk of suicidal tendencies and depression from those with low or no risk, with area under curve values of 0.71 and 0.70, respectively. The GAD-7 is a reliable and valid measure to screen for generalised anxiety disorder among adolescents in Ghana.

Highlights

Adolescents are highly prone to developing a range of mental health problems, including generalised anxiety disorder (GAD) which is characterised by excessive, uncontrollable, irrational anxiety and worry (APA, 2013; Wittchen, Zhao, Kessler, & Eaton, 1994)
The factor structure of the Generalised Anxiety Disorder-7 (GAD-7) is stable in the present sample, given that it was not data-driven
The unidimensional structure of the GAD-7 was invariant for boys and girls, suggesting that the same or similar relationships can be expected between the GAD and its indicators for boys and girls (Doi et al, 2018)

Summary

Introduction

Adolescents are highly prone to developing a range of mental health problems, including generalised anxiety disorder (GAD) which is characterised by excessive, uncontrollable, irrational anxiety and worry (APA, 2013; Wittchen, Zhao, Kessler, & Eaton, 1994). The foregoing notwithstanding, many adolescents with GAD, in low- and middleincome countries (LMICs), are often undetected and untreated (Kroenke, Spitzer, Williams, Monahan, & Löwe, 2007; Lieb, Becker, & Altamura, 2005) mainly because of the lack of reliable and valid screening and assessment measures (Owen, Baig, Abbo, & Baheretibeb, 2016; Tran et al, 2018) This development has contributed greatly to the widening of mental health treatment gap (Owen et al, 2016), as well as lack of data on the burden of mental health problems in LMIC (Cortina, Sodha, Fazel, & Ramchandani, 2012; Tran et al, 2018)

Methods

Discussion

Conclusion