Factorial Structure and Validity of Depression (PHQ-9) and Anxiety (GAD-7) Scales after Traumatic Brain Injury

Abstract

Background: The dimensionality of depression and anxiety instruments have recently been a source of controversy. Objectives and Design: In a European-wide sample of patients after Traumatic Brain Injury (TBI), we aim to examine the factorial structure, validity, and association of the Patient Health Questionnaire for depression (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) instruments. This study is based on longitudinal observational data. We conducted analyses of factorial structure and discriminant validity of outcomes six-months after TBI. We also examined the prevalence, co-occurrence, and changes of scores on the PHQ-9 and GAD-7 at 3-, 6-, and 12-month post-TBI assessments. Participants: At six-months post-TBI assessment, 2137 (738 (34.5%) women) participants completed the PHQ-9 and GAD-7 questionnaires. For the longitudinal analysis, we had 1922 participants (672 (35.0%) women). Results: The results of exploratory factor analysis suggested a general latent construct underlying both PHQ-9 and GAD-7 measures. Confirmatory factor analyses showed a slight improvement in the fit indices for the bifactorial model. The Omega hierarchical test clearly differentiated two subfactors of PHQ-9 and GAD-7 items over and above the underlying general factor; however, most of the variance (85.0%) was explained by the general factor and the explained variance of the subfactors was small. The PHQ-9 and GAD-7 performed similarly in detecting post-traumatic stress disorder (PTSD). As defined by conventional cut-offs, depression and anxiety have different prevalence rates in the sample. The scales also differed in their relationships with the short form of health survey (SF-36v2) subscales. The longitudinal analysis showed high stability of depression and anxiety symptoms: 49–67% of the post-TBI patients with comorbid depression and anxiety reported the persistence of the symptoms over time. Discussion: The factorial structure analysis favors a general latent construct underlying both depression and anxiety scales among patients after TBI. We discuss the implications our findings and future research directions.

A Role for the Amygdala in Impairments of Affective Behaviors Following Mild Traumatic Brain Injury

“…Male and female collegiate athletes (N = 84) with concussion (Vargas et al, 2015) Reading, memory and concentration using the (Teymoori et al, 2020) DID NOT TEST Depression and anxiety using the PHQ subsection for Anxiety and Depression (scores of 8 and 10 used as cutoff, respectively)…”

“…In addition, repeated traumatic events occurring during deployment results in strong, conditioned fear learning and expression of fear which may be the basis for the high risk of PTSD in this group (Glenn et al, 2017). Tests used to detect PTSD and their criteria are described in Tables 1 and 2. Depression, anxiety, and fear-related behaviors following mild TBI are comorbid conditions (Tables 1, 2; Jorge et al, 2004;Ellis et al, 2015;Mohammad Farris Iman Leong Bin Abdullah et al, 2018;Teymoori et al, 2020). A study of over 100 individuals with a mild TBI used a Structured Clinical Interview for DSM-IV axis I disorders to determine that 25% showed signs of depression and 14% had anxiety, with fear-evoked PTSD representing a major contributor to this anxiety.…”

Study on the relationship of depression, anxiety, lifestyle and eating habits to the severity of reflux esophagitis

“…Questionnaire surveys included demographic information, GERD questionnaire (GerdQ) [9] ,Patient Health Questionnaire (PHQ)-9 depression scale [10] and General Anxiety Disorder (GAD)-7 anxiety scale [10] .…”

“…The sum of the points was the patient's scale score, the total score was 0-27 points. 0-4 points was normal, 5-9 points was mild depression, 10-14 points was moderate depression, 15-27 points was severe depression [10] .…”

“…It mainly included 7 parts: feeling restless and irritable, uncontrollable worrying, worrying too much about things, nervousness and difficulty in relaxing, anxious and unable to sit still, becoming easily upset or irritated, and feeling that terrible things will happen. The total sum of points was the patient's scale score, the total score was 0-21 points, 0-4 points was normal, 5-9 points was mild anxiety, l0-l4 points was moderate anxiety, and 15-21 points was severe anxiety [10] .…”