GAD-7_ Test Completion and Review of Assessment Constructs (1)
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GAD-7: Test Completion and Review of Assessment Constructs
Michelle Wyatt
Capella University
COUN 5106
Stephanie L. Brooke-Werley, PhD, NCC
11/19/2023
Introduction
The GAD-7 assessment is a brief 7 item instrument that measures the severity of generalized anxiety disorder over the past two weeks. It was created to assess the severity of symptoms of GAD in the clinical and research context (Mossman et al., 2017). The following paper will explore the reliability and validity of the GAD-7 in students. The GAD-7 will be used in conjunction with other methods that measure anxiety symptoms to find correlation and test reliability and validity. School counselors do not diagnose, however, can administer assessments,
under the right certification, and following the ASCA ethical standards. Ethical considerations will be discussed from the school counselor’s point and whether this assessment is beneficial or necessary. A personal perspective and thoughts will also be shared on whether the instrument is the preferred method for measuring anxiety. Reliability and validity research and results will be provided along with statistical data, reviewing strengths and limitations. Personal Experience with Assessment Completion
Upon taking the assessment myself, it was very easy to navigate and score. The GAD-7 examines presenting symptoms of anxiety that a client has experienced in the past two weeks. Responses were rated on a Likert-scale (0=not at all, 1=several days, 2=more than half the days, and 3=most of the days) with scoring up to 21, which would indicate probable anxiety disorder (Capella University, 2023). The test also asked whether the problems made it difficult to do work, take care of things, or get along with people. After taking the quick questionnaire myself, I
received a high score which would indicate a probable anxiety disorder. It could be due to personal and situational factors like: high pressure at work, course load, motherhood, and
finances. I feel as though my anxiety heightened while reading the responses and reflecting on personal issues that I may have. It’s unknown if this would affect my results, and it’s possible that another measure may be taken to make further assessment. In my personal opinion, this instrument is great for a quick assessment to gain information to take the necessary steps for further treatment or counseling. Test Relevance
The seven-item Generalized Anxiety Disorder scale (GAD-7) was developed with the purpose of screening for, and assessing the severity of GAD symptoms in both clinical and research contexts (Dhira et al., 2021). Anxiety disorders are a collective group that include phobias, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), panic and
social anxiety disorder (Dhira et al., 2021). Anxiety is an unpleasant emotional state of mental uneasiness, nervousness, apprehension and obsession or concern about some uncertain events (Mbanuzuru et al., 2023). The development of the GAD-7 aimed to identify the severity of anxiety symptoms due to a limited number of measures in the clinical setting (Mossman et al., 2017). Assessments may be necessary for students dealing with anxiety in the school setting. This could be onset by the environment, peers, and academic expectations. Getting a better insight on their emotions, feelings, and concerns could help school counselors provide the right intervention to lessen anxiety symptoms and increase self-efficacy. School counselors administering an assessment, according to the ASCA (2022) standards under A.14 Evaluation, assessment, and interpretation, will consider their language, developmental age, competence level, and home language. School counselors must use valid and reliable research based
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assessments that are culturally appropriate and administered in their language preferred. They must be bias free and adhere to confidentiality, parental rights, and legality (ASCA, 2022). When assessing children it is important to look at demographics like age, gender, ethnic background, and cultural identity. In a school setting, it is beneficial to know their thoughts and feelings about school, peers, and academics. These are all factors that could lead to increased anxiety and knowing how to help them cope or manage. Being able to do a quick assessment could help take the next course of action that is suitable for the individual student. Reliability and Validity Evidence
Validation and reliability in assessments is important to show consistent accuracy of an instrument’s use across many demographics. Whiston (2016) states that the validation of an instrument provides indication whether an instrument measures accurately by an accumulation of
evidence. In a research study of Bangladesh students, a convenience sample of 677 university students, 51.40% male and 48.60% female, was collected using the GAD-7 in correlation to the Personal Health Questionnaire-9 (PHQ-9) and the Personal Health Questionnaire Anxiety-
Depression Scale (PHQ-ADS), focusing on exploratory and confirmatory factor analysis to test convergent validity (Dhira et al., 2021). Using Cronbach's x, Correlation between GAD-7 and PHQ-9 was 0.751 and 0.934 between GAD-7 and PHQ-ADS (Dhira et al., 2021). The items were
examined by item mean score and corrected item-total correlations using Cronbach’s to assess 𝑥
internal consistency and reliability (Dhira et al., 2021). Convergent validity was assessed with the correlation between the GaD-7, PHQ-9, and the PHQ-ADS using Pearson's correlation and its significance. This resulted in a 0.751 correlation between GAD-7 and PHQ-9 and a 0.934 correlation between GAD-7 and PHQ-ADS. Reliability coefficient showed an overall scale of
0.895, which is above the recommended. The results of the study showed that GAD-7 in conjunction with other instruments that scale anxiety symptoms, showed high reliability and validity.
Another study assessed adolescents with generalized anxiety disorder using GAD-7 and the Pediatric Anxiety Rating Scale (PARS). In the U.S., the pediatric population typically goes undiagnosed and untreated regardless of the prevalence of psychiatric conditions (15%) in children and adolescents (Mossman et al., 2017). A sample size of 40 outpatient youths, aged 12-
17 years old, were assessed using GAD-7 and the PARS evaluated using the Spearman correlation coefficients. Results showed a high correlation score between GAD-7 and PARS (
R
=0.65, p
<0.001). The strongest correlation was found between items 1 and 2: “feeling nervous,
anxious, or on edge”
(
R
=0.57, p
<0.05) and “worrying too much about different things” (
R
=0.54, p
<0.05) (Mossman et al., 2017)
.
Sriken et al. (2022) performed a study done with college students based on race and gender. A sample of 414 students aged 18-23, 66.7% women, 33.1% men, and 0.2% transgender,
and different ethnic backgrounds were given GAD-7 as well as 4 other instruments to test validity. External convergent validation was measured using the Highly Sensitive Person Scale (HPS) and the Center for Epidemiologic Studies Depression Scale (CESD-R), External divergent
validity was assessed by Alcohol Use Disorders Identification Test (AUDIT) and the Social Justice Scale (SJS) (Sriken et al., 2022). GAD-7 responses were validated using the SPSS 27 reliability, descriptive, and correlational procedures with a scoring of ¼ .80 or higher recommended. A good fit model was applied along with a chi-squared test with p>.05 (Sriken et al., 2022). Gad-7’s coefficient a was ¼.01 which indicates a high level of internal consistency of the sample.
Test Effectiveness
Some limitations of the study done on university students in Bangladesh are that the data collection was a relative population in terms of demographics and socioeconomic factors. Therefore, findings are not able to be generalized in diverse samples. Sensitivity and specificity also need to be explored in an academic setting. However, the validation of GAD-7 was successful, showed good convergent validity, and high internal consistency. GAD-7 could give early diagnosis and treatment which can lead to correct interventions. Limitations of GAD-7 in adolescents was generalizability due to a small sample size all done at one site (Mossman et al., 2017). The significance of GAD-7 reflects symptom severity in
adolescents and scores are correlated with anxiety symptoms rated by a clinical administrator. (Sriken et al., 2022) state limitations to their study due to the sample being university students versus a community sample. A major limitation was small sample sizes within cultural subgroups to measure invariance. This particular study did it use any other instruments in conjunction with GAD-7 which made it hard to determine if they would’ve yielded different results. A final limitation on this study was no diagnostic data. (Sriken et al., 2022) agree that this assessment is quick and can be used across all demographics, but believe there to be a bias toward social desirability. Conclusion
The use of GAD-7 for adolescents in the school setting can be useful for determining the correct course of treatment or counseling. A school counselor administering the assessment will abide by ethical standards and guidelines by using research-based tests and adhering to
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confidentiality. The results of GAD-7 have shown validity and reliability with correlation of other assessments that measure anxiety symptoms. My personal view of GAD-7 is that it is a free, easy to use tool that could serve as a mini exam for a school counselor to determine a course of action for students based on their responses. Results from the studies showed high reliability and validity of GAD-7, mainly with correlated use. References
ASCA. (2022). ASCA Ethical Standards for School Counselors
. American School Counselor Association. https://www.schoolcounselor.org/getmedia/44f30280-ffe8-4b41-
9ad8-f15909c3d164/EthicalStandards.pdf
Capella University. (2023). General Anxiety Disorder (GAD-7) Screener
. Generalized Anxiety Disorder Screener (GAD-7). https://www.tbh.org/sites/default/files/Generalized_Anxiety_Disorder_Screener_GAD7.p
df
Dhira, T. A., Rahman, M. A., Sarker, A. R., & Mehareen, J. (2021). Validity and reliability of the Generalized Anxiety Disorder-7 (GAD-7) among university students of Bangladesh. Plos one
, 16
(12). 10.1371/journal.pone.0261590
Lowe, B., Decker, O., Muller, S., Brahler, E., Schellberg, D., Herzog, W., & Herzberg, P.
Y. (2008). Validation and Standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the General Population. Medical Care
, 46
(3), 266-274. 10.1097/MLR.0b013e318160d093
Mbanuzuru, A. V., Uwakwe, R., Anyaoku, C. S., Ojimba, A. O., Mbanuzuru, M. C., Ezenyeaku, C. A., Chukwudinma, D., Okafor, C. N., & Okonkwo, U. P. (2023). Generalized anxiety disorder screening using gad-7 among in-school adolescents of anambra state, nigeria: a comparative study between urban and rural areas. Child and Adolescent Psychiatry and Mental Health
, 17
(91), 1-9. https://doi.org/10.1186/s13034-
023-00637-4
Mossman, S. A., Luft, M. J., Schroeder, H. K., Varney, S. T., Fleck, D. E., Barzman, D. H., Gilman, R., BelBello, M. P., & Strawn, J. R. (2017). The Generalized Anxiety Disorder 7-item scale in adolescents with generalized anxiety disorder: Signal detection
and validation. Annals of clinical psychiatry
, 29
(4), 227-234. https://pubmed.ncbi.nlm.nih.gov/29069107/
Sriken, J., Johnsen, S. T., Smith, H., Sherman, M. F., & Erford, B. T. (2022). Testing the Factorial Validity and Measurement Invariance of College Student Scores on the Generalized Anxiety Disorder (GAD-7) Scale Across Gender and Race. Measurement and Evaluation in Counseling and Development
, 55
(1), 1-16. https://doi.org/10.1080/07481756.2021.1902239
Whiston, S. (2016). Principles and Applications of Assessment in Counseling
. Cengage Learning.
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