Diagnostic Performance of the Japanese Version of the GAD-7 in Primary Care and Comparing its Accuracy with Other Language Versions
Main Article Content
Abstract
Objective: This research examines the diagnostic performance of the Japanese version of the GAD-7 (J-GAD-7) based on analysis of two independent studies. The first assesses the accuracy of the J-GAD-7 in identifying generalized anxiety disorder (GAD) in primary care (Study 1). Next, a meta-analysis of diagnostic accuracy studies in five language versions of the GAD-7 (English, Spanish, Dutch, Turkish, and German) is conducted (Study 2), the results of which are compared with those of the J-GAD-7.
Methods:In Study 1, subjects (n=161; male=55, female=106) returned the self-rating questionnaire (J-GAD-7) to their health care professional within 48 hours and underwent a diagnostic evaluation interview based on the Japanese version of M.I.N.I-Plus. Most (n=151) also responded to the SF-8, and there were negligible missing data in either set of questionnaires. Of the 161 participants, 63 were diagnosed as suffering GAD. The meta-analysis of diagnostic test accuracy (MA-DTA) conducted in Study 2 focused on identifying GAD at the optimal cut-off value 10 using integration of the eight selected studies.
Results: The optimal cut-off value for the J-GAD-7 (Study 1) was determined as ≥10, which displayed sensitivity of 70.6 %, specificity of 93.5 %, and positive likelihood ratio of 10.9. The area under the ROC curve (AUC) was 0.939, with an SE of 0.019 (P <0.0001). Stratum-specific likelihood ratios (SSLRs) of the J-GAD-7 scores of 0-4, 5-9, 10-14, and 15-21 for GAD were 0.04 (95% CI: 0.01-0.14), 1.17 (95% CI: 0.68-2.01), 10.94 (95% CI: 4.29-27.8), and 10.94 (95% CI: 3.00-39.8), respectively. Findings of the Kruskal-Wallis test showed a significant relationship between the severity of the J-GAD-7 and MCS of the SF-8 (χ2=71.73, df=3, p ≤0.0001). In Study 2, sensitivity was 0.754 (95%CI :0.604 - 0.861), specificity was 0.816, and AUC was 0.828. The heterogeneity τ2 was 0.709 (95% CI: 0.064-1.626) for sensitivity and 1.153 (95% CI: 0.264-2.332) for specificity.
Conclusions: The Japanese version of the GAD-7 was validated as an adequate tool for identifying GAD in primary care. Moreover, its performance at the optimal cut-off value 10 was equivalent to that of the MA-DTA for five other language versions.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. O’Connor E, Henninger M, Perdue L, Coppola EL, Thomas R, Gaynes BN (2023). Screening for Depression, Anxiety, and Suicide Risk in Adults: A Systematic Evidence Review for the US Preventive Services Task Force. Evidence Synthesis No. 223. Agency for Healthcare Research and Quality, AHRQ publication 22-05295-EF-
3. Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 2: 12-month prevalence DSM-IV/WMH-CIDI disorders by sex and cohort
4. Wittchen HU (2002). Generalized anxiety and depression in primary care: prevalence, recognition, and management. Depression and Anxiety ,16:162–171. doi:10.1002/da.10065
5. Muramatsu K (2021). Prevalence and Comorbidity of Anxiety and Depressive Disorders in Studies of PRIME-MD and PHQ (Patient Health Questionnaire) in Japan. Anxiety Disorders - The New Achievements, Edited by Vladimir V. Kalinin, Cicek Hocaoglu and Shafizan Mohamed. Chapter 7, pp93-106. doi: 10.5772/intechopen.97218
6. Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 1: Lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort
7. Misri S, Abizadeh J, Sanders S, Swift E (2015). Perinatal generalized anxiety disorder: assessment and treatment. J Women’s Health (Larchmt), 24(9): 762-770. doi:10.1089/jwh.2014.5150
8. Ahn JK, Kim Y, Choi KH. The Psychometric Properties and Clinical Utility of the Korean Version of GAD-7 and GAD-2. Front Psychiatry. 2019;10:127. doi:https://dx.doi.org/10.3389/fpsyt.2019.00127
9. Kujanpaa T, Ylisaukko-Oja T, Jokelainen J, et al. Prevalence of anxiety disorders among Finnish primary care high utilizers and validation of Finnish translation of GAD-7 and GAD-2 screening tools. Scand J Prim Health Care. Jun 2014;32(2):78-83. doi:https://dx.doi.org/10.3109/02813432.2014.920597
10. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. May 22 2006;166(10):1092-7. doi:https://doi.org/10.1001/archinte.166.10.1092
11. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Jama. 1999/11/24 ed1999. p. 1737-44
12. Muramatsu K, Muramatsu Y, Miyaoka H et al: Validation and utility of a Japanese version of the GAD-7. PANMINERVA MEDICA 20th World Congress on Psychosomatic Medicine Abstracts Book, 51 (Suppl 1 to No 3):79, 2009.
13. Sheehan DV, Lecrubier Y, Sheehan, KH, Sheehan, HK, Amorim P, Janavas J et al (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 59 (suppl.20), 22–33.
14. Fukuhara S, Suzukamo Y. Manual of the SF-8 Japanese Version. Institute for Health Outcomes & Process Evaluation Research; Kyoto. 2004.
15. Otsubo T, Tanaka K, Koda R, Shinoda J, Sano N, Tanaka S et al (2005). Reliability and validity of Japanese version of the Mini-International Neuropsychiatric Interview. Psychiatry and Clinical Neuroscience. 59:517–26.
16. Fukuhara S, Ware JE Jr, Kosinski M, Wada S, Gandek B (1998). Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey. J Clin Epidemiol. 51:1045-53
17. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV. 4th Edition (2000). American Psychiatric Association; Washington DC.
18. World Health Organization. International Classification of Diseases (ICD)(1992). Geneva.
19. World Health Organization. The composite international diagnostic interview (CIDI). (1990) Geneva.
20. Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Sheehan HK et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.) - a short diagnostic structured interview: reliability and validity according to the CIDI (1997). European Psychiatry, 12: 224–31.
21. Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL et al (1984). The NIMH Epidemiologic Catchment Area Program: historical context, major objectives and study population characteristics. Archives of General Psychiatry, 41:934–41.
22. Kessler RC, McGonagle KM, Zhao S, Nelson M, Hughes S, Eshleman H et al. Lifetime and12-month prevalence of DSM-III-R psychiatric disorders in the US: results from the National Comorbidity Survey (1994). Archives of General Psychiatry,51:8–20
23. Furukawa TA, Strauss S, Bucher HC, Guyatt G - diagnostic tests. Guyatt G, Drummond R, Meade MO, Cook DJ - editors. Users' guides to the medical literature: a manual for evidence-based practice (2008). 2nd edition. New York: The McGraw-Hill Companies, Inc.
24. Plummer F, Manea L , Trepel D, McMillan D (2016). Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic meta-analysis. General Hospital Psychiatry, 39:24–31. http://dx.doi.org/10.1016/j.genhosppsych.2015.11.005
25. hiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al (2011). QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med,155:529–36.
26. Salameh JP, Bossuyt PM, McGrath TA, et al (2020). Preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA): explanation, elaboration, and checklist. BMJ 2020;370:m2632. doi:10.1136/bmj.m2632
27. Christensen H, Batterham PJ, Grant JB, Griffiths KM, Mackinnon AJ. A population study comparing screening performance of prototypes for depression and anxiety with standard scales. BMC Med Res Methodol (2011). http://dx.doi.org/10.1186/ 1471-2288-11-154.
28. Delgadillo J, Payne S, Gilbody S, Godfrey C, Gore S, Jessop D, et al (2012). Brief case finding tools for anxiety disorders: validation of GAD-7 and GAD-2 in addictions treatment. Drug Alcohol Depend,125:37–42.
29. Donker T, van Straten A, Marks I, Cuijpers P (2011). Quick and easy self-rating of Generalized Anxiety Disorder: validity of the Dutch web-based GAD-7, GAD-2 and GAD-SI. Psychiatry Res,188:58–64.
30. Garcia-Campayo J, Zamorano E, Ruiz MA, Pardo A, Perez-Paramo M, Lopez Gomez V, et al (2010). Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health Qual Life Outcomes.1186/ http://dx.doi.org/10.1477-7525-8-8.
31. Kertz S, Bigda-Peyton J, Bjorgvinsson T (2013). Validity of the Generalized Anxiety Disorder- 7 Scale in an acute psychiatric sample. Clin Psychol Psychother, 20:456-464.
32. Konkan R, Senormanci O, Guclu O, Aydin E, Sungur MZ (2013). Validity and reliability study for the Turkish adaptation of the Generalized Anxiety Disorder-7 (GAD-7) scale. Arch Neuropsychiatry, 50:53–8.
33. Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Lowe B (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med.146:317–25.
34. Wild B, Eckl A, Herzog W, Niehoff D, Lechner S, Maatouk I, et al (2014). Assessing Generalized Anxiety Disorder in elderly people using the GAD-7 and GAD-2 scales: results of a validation study. Am J Geriatric Psychiatry, 22:1029–38.
35. Negeri ZF, Levis B, Sun Y,1 He C, Krishnan A et al (2021). Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression: updated systematic review and individual participant data meta-analysis. BMJ, 374: n2183. http://dx.doi.org/10.1136/bmj.n2183
36. Macaskill P, Gatsonis C, Deeks JJ, et al. Analyzing and Presenting Results (2010). In: Deeks JJ, Bossuyt PM, Gatsonis C, eds. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0. Cochrane Collaboration.