Skip to main content

Advertisement

Log in

Development and validation of a DSM-5-based generalized anxiety disorder self-report Scale: Investigating frequency and intensity rating differences

  • Published:
Current Psychology Aims and scope Submit manuscript

Abstract

There are limitations in the currently available measures for the assessment of generalized anxiety disorder (GAD). While changes have been made in the diagnostic criteria for GAD from DSM-IV to DSM-5, there are no scales which items correspond directly to DSM-5-based GAD symptomatology. Moreover, although recent studies support measuring both symptom frequency and intensity of mental disorders, most GAD measures assess only either symptom frequency or intensity, and there is no DSM-5-based self-report measure of GAD that assesses both. In order to address these limitations, two studies were conducted to develop and validate a new GAD self-report scale, the Generalized Anxiety Symptom Severity Inventory (GASSI), which measures symptom severity by assessing both the frequency and intensity of DSM-5-based GAD symptoms in samples of undergraduates and natural disaster survivors. Study 1 provides evidence for a one-factor summed frequency and intensity GAD score using exploratory factor analysis. GASSI was found to have good reliability and evidence of construct validity. Study 2 suggests that both frequency and intensity of symptoms are needed in assessing GAD severity based on the results of invariance testing. These findings have implications for the measurement of GAD symptoms, as well as in the development of interventions for GAD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA Publishing.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: APA Publishing.

    Google Scholar 

  • Arrieta, J., Aguerrebere, M., Raviola, G., Flores, H., Elliott, P., Espinosa, A., et al. (2017). Validity and utility of the patient health questionnaire (PHQ)-2 and PHQ-9 for screening and diagnosis of depression in rural Chiapas, Mexico: A cross-sectional Ssudy. Journal of Clinical Psychology, 73(9), 1076–1090.

    PubMed  PubMed Central  Google Scholar 

  • Axelsson, E., Andersson, E., Ljótsson, B., Wallhed Finn, D., & Hedman, E. (2016). The health preoccupation diagnostic interview: Inter-rater reliability of a structured interview for diagnostic assessment of DSM-5 somatic symptom disorder and illness anxiety disorder. Cognitive Behaviour Therapy, 45(4), 259–269.

    PubMed  Google Scholar 

  • Batterham, P. J., Sunderland, M., Carragher, N., Calear, A. L., Mackinnon, A. J., & Slade, T. (2016). The distress Questionnaire-5: Population screener for psychological distress was more accurate than the K6/K10. Journal of Clinical Epidemiology, 71, 35–42.

    PubMed  Google Scholar 

  • Blake, D., Weathers, F., Nagy, L., Kaloupek, D., Gusman, F., Charney, D., & Keane, T. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8(1), 75–90.

    PubMed  Google Scholar 

  • Bondolfi, G., Jermann, F., Weber Rouget, B., Gex-Fabry, M., McQuillan, A., Dupont-Willemin, A., Aubry, J. M., & Nguyen, C. (2010). Self- and clinician-rated Montgomery-Åsberg depression rating scale: Evaluation in clinical practice. Journal of Affective Disorders, 121, 268–272.

    PubMed  Google Scholar 

  • Brown, T. A. (2006). Confirmatory factor analysis for applied research. New York: The Guilford Press.

    Google Scholar 

  • Brown, T. A., & Barlow, D. H. (2014). Anxiety and related disorders interview schedule for DSM-5 (ADIS-5): Clinician manual. New York: Oxford.

    Google Scholar 

  • Byrne, B. M., Shavelson, R. J., & Muthén, B. O. (1989). Testing for the equivalence of factor covariance and mean structures: The issue of partial measurement invariance. Psychological Bulletin, 105, 456–466.

    Google Scholar 

  • Chang, C. H., Cella, D., Clarke, S., Heinemann, A. W., von Roenn, J. H., & Harvey, R. (2003). Should symptoms be scaled for intensity, frequency, or both? Palliative & Supportive Care, 1, 51–60.

    Google Scholar 

  • Christensen, K. S., Oernboel, E., Zatzick, D., & Russo, J. (2017). Screening for depression: Rasch analysis of the structural validity of the PHQ-9 in acutely injured trauma survivors. Journal of Psychosomatic Research, 97, 18–22.

    PubMed  Google Scholar 

  • Cody, M. W., Jones, J. M., Woodward, M. J., Simmons, C. A., & Gayle Beck, J. (2015). Correspondence between self-report measures and clinician assessments of psychopathology in female intimate partner violence survivors. Journal of Interpersonal Violence, 32(10), 1501–1523.

    PubMed  Google Scholar 

  • Çokluk, Ö., & Koçak, D. (2016). Using Horn’s parallel analysis method in exploratory factor analysis for determining the number of factors. Educational Sciences: Theory & Practice, 16, 537–551.

    Google Scholar 

  • Cole, D. A., Ciesla, J. A., & Steiger, J. H. (2007). The insidious effects of failing to include design-driven correlated residuals in latent-variable covariance structure analysis. Psychological Methods, 12(4), 381–398.

    PubMed  Google Scholar 

  • Cornelius, B. L., Groothoff, J. W., van der Klink, J. J., & Brouwer, S. (2013). The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants. BMC Public Health, 13(1), 128.

  • Elhai, J. D., Lindsay, B. M., Gray, M. J., Grubaugh, A. L., North, T. C., & Frueh, B. C. (2006). Examining the uniqueness of frequency and intensity symptom ratings in posttraumatic stress disorder assessment. The Journal of Nervous & Mental Disease, 194(12), 940–944.

    Google Scholar 

  • Elhai, J. D., Palmieri, P. A., Biehn, T. L., Frueh, B. C., & Magruder, K. M. (2010). Posttraumatic stress disorder's frequency and intensity ratings are associated with factor structure differences in military veterans. Psychological Assessment, 22(4), 723–728.

    PubMed  Google Scholar 

  • Farrer, L. M., Gulliver, A., Bennett, K., Fassnacht, D. B., & Griffiths, K. M. (2016). Demographic and psychosocial predictors of major depression and generalised anxiety disorder in Australian university students. BMC Psychiatry, 16(1), 241.

    PubMed  PubMed Central  Google Scholar 

  • First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2015). Structured clinical interview for DSM-5 disorders, clinician version (SCID-5-CV). Arlington: American Psychiatric Association.

    Google Scholar 

  • Fresco, D. M., Coles, M. E., Heimberg, R. G., Liebowitz, M. R., Hami, S., Stein, M. B., & Goetz, D. (2001). The Liebowitz social anxiety scale: A comparison of the psychometric properties of self-report and clinician-administered formats. Psychological Medicine, 31, 1025–1035.

    PubMed  Google Scholar 

  • Goldberg, D., McDowell, I., & Newell, C. (1972). General Health Questionnaire (GHQ), 12 item version, 20 item version, 30 item version, 60 item version [GHQ12, GHQ20, GHQ30, GHQ60]. Measuring health: A guide to rating scales and questionnaire, 225–236.

  • Goldberg, D. P., Prisciandaro, J. J., & Williams, P. (2012). The primary health care version of ICD-11: The detection of common mental disorders in general medical settings. General Hospital Psychiatry, 34(6), 665–670.

    PubMed  Google Scholar 

  • Goldmann, E., & Galea, S. (2014). Mental health consequences of disasters. Annual Review of Public Health, 35, 169–183.

    PubMed  Google Scholar 

  • Hambleton, R. K., & Jones, R. W. (2012). Comparison of classical test theory and item response theory and their applications to test development, Instructional Topics in Educational Measurement Series 16.

  • Hayton, J. C., Allen, D. G., & Scarpello, V. (2004). Factor retention decisions in exploratory factor analysis: A tutorial on parallel analysis. Organizational Research Methods, 7(2), 191–205.

    Google Scholar 

  • Hinz, A., Klein, A. M., Brähler, E., Glaesmer, H., Luck, T., Riedel-Heller, S. G., et al. (2017). Psychometric evaluation of the generalized anxiety disorder screener GAD-7, based on a large German general population sample. Journal of Affective Disorders, 210, 338–344.

    PubMed  Google Scholar 

  • Hobbs, M. J., Anderson, T. M., Slade, T., & Andrews, G. (2014). Structure of the DSM-5 generalized anxiety disorder criteria among a large community sample of worriers. Journal of Affective Disorders, 157, 18–24.

    PubMed  Google Scholar 

  • Hook, J. N., Hook, J. P., Davis, D. E., Worthington Jr., E. L., & Penberthy, J. K. (2010). Measuring sexual addiction and compulsivity: A critical review of instruments. Journal of Sex & Marital Therapy, 36, 227–260. https://doi.org/10.1080/00926231003719673.

    Article  Google Scholar 

  • Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3(4), 424–453.

    Google Scholar 

  • Kessler, R. C., Gruber, M., Hettema, J. M., Hwang, I., Sampson, N., & Yonkers, K. A. (2008). Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up. Psychological Medicine, 38(3), 365–374.

    PubMed  Google Scholar 

  • Kline, T. (2005). Psychological Testing: A Practical Approach to Design and Evaluation. Thousand Oaks: Sage Publications.

  • Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9—Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.

    PubMed  PubMed Central  Google Scholar 

  • Lamers, F., van Oppen, P., Comijs, H. C., Smit, J. H., Spinhoven, P., van Balkom, A. J. L. M., et al. (2011). Comorbidity patterns of anxiety and depressive disorders in a large cohort study. The Journal of Clinical Psychiatry, 72(03), 341–348.

    PubMed  Google Scholar 

  • Lenz, A. S., & Williams, R. T. (2014). Comparative efficacy between self-report and clinician-administered assessments of posttraumatic stress disorder symptoms across seven studies. Counseling Outcome Research & Evaluation, 5(2), 75–88.

    Google Scholar 

  • Liang, Y., Wang, L., & Yin, X. (2016). The factor structure of the 12-item general health questionnaire (GHQ-12) in young Chinese civil servants. Health and Quality of Life Outcomes, 14(1), 136.

  • Löwe, B., Decker, O., Müller, S., Brähler, 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.

  • Lundin, A., Hallgren, M., Theobald, H., Hellgren, C., & Torgén, M. (2016). Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population. Public Health, 136, 66–74.

  • McKenzie, D. P., Ikin, J. F., McFarlane, A. C., Creamer, M., Forbes, A. B., Kelsall, H. L., ... & Sim, M. R. (2004). Psychological health of Australian veterans of the 1991 Gulf War: an assessment using the SF-12, GHQ-12 and PCL-S. Psychological Medicine, 34(8), 1419–1430.

  • Moffitt, T. E., Harrington, H., Caspi, A., Kim-Cohen, J., Goldberg, D., Gregory, A. M., & Poulton, R. (2007). Depression and generalized anxiety disorder. Archives of General Psychiatry, 64(6), 651.

    PubMed  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (2013). Mplus version 7.11. Computer software. Los Angeles: Muthén & Muthén.

    Google Scholar 

  • Newman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman-McGrath, L. (2002). Preliminary reliability and validity of the generalized anxiety disorder questionnaire-IV: A revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33(2), 215–233.

    Google Scholar 

  • Omani-Samani, R., Maroufizadeh, S., Ghaheri, A., & Navid, B. (2018). Generalized anxiety Disorder-7 (GAD-7) in people with infertility: A reliability and validity study. Middle East Fertility Society Journal, 23(4), 446–449.

    Google Scholar 

  • Pimenta, F., Leal, I., Maroco, J., & Ramos, C. (2012). Menopause symptoms’ severity inventory (MSSI-38): Assessing the frequency and intensity of symptoms. Climacteric, 15(2), 143–152.

    PubMed  Google Scholar 

  • Reynolds, C. R., Richmond, B. O., & Löwe, P. A. (2003). The adult manifest anxiety scale–adult version (AMAS-A). Los Angeles: Western Psychological Services.

    Google Scholar 

  • Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2008). The factor structure and dimensional scoring of the generalized anxiety disorder questionnaire for DSM-IV. Assessment, 15(3), 343–350.

    PubMed  Google Scholar 

  • Romera, I., Fernández-Pérez, S., Montejo, Á. L., Caballero, F., Caballero, L., Arbesú, J. Á., … Gilaberte, I. (2010). Generalized anxiety disorder, with or without co-morbid major depressive disorder, in primary care: Prevalence of painful somatic symptoms, functioning and health status. Journal of Affective Disorders, 127(1–3), 160–168.

  • Ruiz, F. J., García-Beltrán, D. M., & Suárez-Falcón, J. C. (2017). General Health Questionnaire-12 validity in Colombia and factorial equivalence between clinical and nonclinical participants. Psychiatry Research, 256, 53–58.

  • Satorra, A., & Bentler, P. M. (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika, 66(4), 507–514.

    Google Scholar 

  • Sawaya, H., Atoui, M., Hamadeh, A., Zeinoun, P., & Nahas, Z. (2016). Adaptation and initial validation of the patient health questionnaire–9 (PHQ-9) and the generalized anxiety disorder–7 questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Research, 239, 245–252.

    PubMed  Google Scholar 

  • Schneider, S., & Stone, A. A. (2014). Distinguishing between frequency and intensity of health-related symptoms from diary assessments. Journal of Psychosomatic Research, 77(3), 205–212.

    PubMed  PubMed Central  Google Scholar 

  • Seedat, S., Fritelli, V., Oosthuizen, P., Emsley, R. A., & Stein, D. J. (2007). Measuring anxiety in patients with schizophrenia. The Journal of Nervous & Mental Disease, 195(4), 320–324.

    Google Scholar 

  • Sousa, T. V., Viveiros, V., Chai, M. V., Vicente, F. L., Jesus, G., Carnot, M. J., ... & Ferreira, P. L. (2015). Reliability and validity of the Portuguese version of the generalized anxiety disorder (GAD-7) scale. Health and Quality of Life Outcomes, 13(1), 50.

  • Spielberger, C. D. (1989). State-trait anxiety inventory: Bibliography (2nd ed.). Palo Alto: Consulting Psychologists Press.

    Google Scholar 

  • Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.

    PubMed  Google Scholar 

  • Stein, D. J., Fincham, D., Seedat, S., de Bodinat, C., & Ahokas, A. (2009). The DSM-IV-based generalized anxiety disorder severity scale: Preliminary validation using data from a trial of agomelatine versus placebo. The Journal of Nervous & Mental Disease, 197(6), 391–394.

    Google Scholar 

  • Sugiura, Y., & Sugiura, T. (2015). Emotional intensity reduces later generalized anxiety disorder symptoms when fear of anxiety and negative problem-solving appraisal are low. Behaviour Research and Therapy, 71, 27–33.

    PubMed  Google Scholar 

  • Toussaint, A., Murray, A. M., Voigt, K., Herzog, A., Gierk, B., Kroenke, K., ... & Löwe, B. (2016). Development and validation of the somatic symptom disorder–b criteria scale (SSD-12). Psychosomatic medicine, 78(1), 5–12.

  • Toussaint, A., Löwe, B., Brähler, E., & Jordan, P. (2017). The Somatic Symptom Disorder-B Criteria Scale (SSD-12): factorial structure, validity and population-based norms. Journal of Psychosomatic Research, 97, 9–17

  • Toussaint, A., Riedl, B., Kehrer, S., Schneider, A., Löwe, B., & Linde, K. (2017). Validity of the Somatic Symptom Disorder–b Criteria Scale (ssd-12) in primary care. Family Practice, 35(3), 342–347.

  • Van Lancker, A., Beeckman, D., Verhaeghe, S., Van Den Noortgate, N., Grypdonck, M., & Van Hecke, A. (2016). An instrument to collect data on frequency and intensity of symptoms in older palliative cancer patients: A development and validation study. European Journal of Oncology Nursing, 21, 38–47.

    PubMed  Google Scholar 

  • Weathers, F. W., Keane, T. M., & Davidson, J. R. T. (2001). Clinician-administered PTSD scale: A review of the first ten years of research. Depression and Anxiety, 13, 132–156.

    PubMed  Google Scholar 

  • Zhong, Q. Y., Gelaye, B., Zaslavsky, A. M., Fann, J. R., Rondon, M. B., Sánchez, S. E., & Williams, M. A. (2015). Diagnostic validity of the generalized anxiety Disorder-7 (GAD-7) among pregnant women. PLoS One, 10(4), e0125096.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ma. Jenina N. Nalipay.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mordeno, I.G., Nalipay, M.J.N., Luzano, J.G.C. et al. Development and validation of a DSM-5-based generalized anxiety disorder self-report Scale: Investigating frequency and intensity rating differences. Curr Psychol 40, 5247–5255 (2021). https://doi.org/10.1007/s12144-019-00475-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12144-019-00475-8

Keywords

Navigation