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)

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.

The Current State and Validity of Digital Assessment Tools for Psychiatry: Systematic Review

“…Most of the studies included participants from primary care services or the general population (18/28, 64% [ 20 , 22 - 25 , 28 , 32 , 35 , 37 - 45 , 47 ]). This was followed by the inclusion of participants from secondary care or specialist services, including psychiatric outpatients (12/28, 43% [ 20 , 27 , 29 - 31 , 33 - 35 , 38 , 45 - 47 ]). Of the 28 studies, 6 (21%) included university students [ 21 , 23 - 26 , 36 ], whereas 4 (14%) purposely recruited nonpsychiatric controls [ 29 - 31 , 33 ].…”

“…Of the 28 studies, 6 (21%) were conducted in the Netherlands [ 23 - 25 , 38 , 45 , 46 ], and 4 (14%) took place in Spain [ 21 , 22 , 39 , 42 ]. The remaining 6 studies (6/28, 21%) were conducted in Australia (1/28, 4%) [ 40 ], China (1/28, 4%) [ 26 ], Denmark (1/28, 4%) [ 41 ], South Korea (2/28, 7%) [ 35 , 47 ], and Thailand (1/28, 4%) [ 36 ].…”

“…A total of 12 studies (12/28, 43%) focused on the identification of GAD [ 21 - 23 , 25 , 31 , 32 , 34 , 35 , 38 - 40 , 43 ], comprising a total of 9 unique tools. The most popular assessments were the digitized version of the GAD–7, with sensitivity and specificity values ranging from 0.75 to 0.87 and 0.55 to 0.78, respectively [ 23 , 25 , 34 , 39 ].…”

“…Furthermore, GAD was also assessed using the Mental Health Screening Tool for Anxiety Disorders [ 35 ], which demonstrated excellent diagnostic accuracy (sensitivity=0.98, specificity=0.80, AUC=0.95). The tool comprises 11 questions based on existing questionnaires and diagnostic criteria, focus group interviews with patients with GAD, and an expert panel.…”

“…A total of 9 studies (9/28, 32%) [ 21 - 23 , 25 , 34 , 36 , 39 , 44 , 46 ] did not provide enough information regarding their sample and sampling procedures. Similarly, risk of bias was an issue when considering index test administration, with 10 studies (10/28, 36%) [ 21 , 24 - 28 , 35 , 36 , 40 , 47 ] showing high risk of bias, which was primarily due to the studies not using a prespecified threshold. A total of 13 studies (13/28, 46%) [ 20 , 22 , 29 - 31 , 33 , 34 , 38 , 42 - 46 ] failed to provide enough information regarding the index test administration.…”