Generalized Anxiety Disorder 7-Item Scale and Templer’s Death Anxiety Scale in Iranian Inpatients with COVID-19: Evaluation of Psychometric Properties and Diagnostic Accuracy

Abstract

Background: During the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, anxiety has always been with patients. Objectives: It is necessary to obtain a valid instrument for the evaluation and screening of patients with anxiety. The current study attempted to evaluate the sensitivity and specificity and provide the clinical cut-off scores for the Death Anxiety Scale (DAS) and Generalized Anxiety Disorder 7-Item (GAD-7) Scale in hospitalized patients diagnosed with COVID-19 in Iran. Methods: This diagnostic accuracy study was carried out for 4 months on 150 hospitalized patients diagnosed with COVID-19 to evaluate generalized anxiety disorder and death anxiety. Cronbach’s alpha was used to evaluate reliability. For the determination of the presence of anxiety disorders, the Structured Clinical Interview with hospitalized subjects was conducted by a psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition diagnostic criteria. Results: The Cronbach’s alpha coefficients for the GAD-7 Scale and DAS questionnaires were observed to be 0.88 and 0.74, respectively, confirming their reliability. Based on cut-off scores with the best balance, the sensitivity and specificity of the GAD-7 Scale questionnaire were 61.9% and 86.9%, respectively. Moreover, the sensitivity and specificity values related to the DAS questionnaire were 47.8% and 73.8%, respectively. The values for the area under the curve were 0.75 and 0.63 for the GAD-7 Scale and DAS, respectively. With this scoring method, those who scored higher than 8 and 7 in the GAD-7 Scale and DAS questionnaires were considered patients, respectively. Moreover, in these two tests, higher levels of generalized anxiety and death anxiety were reported in female patients. Conclusions: The GAD-7 Scale and DAS both showed adequate psychometric properties and diagnostic accuracy; therefore, they are applicable for anxiety screening in patients with COVID-19. It will likely take a few years to bring the virus under control worldwide. Iran’s Ministry of Health should implement exact psychological interventions during hospitalization and after discharge to prevent the adverse mental health consequences of COVID-19.