Clinical utility of the GAD-7 in identifying anxiety disorders after traumatic brain injury

ABSTRACT

To determine if the GAD-7 provides incremental value, predicting a final diagnosis of an anxiety disorder after traumatic brain injury (TBI). Retrospective analysis of archival data of 100 patients with TBI, who underwent neuropsychological evaluation 1–12 months after injury. Receiver Operating Characteristic analysis determined the optimal cutoff point for clinically significant symptoms on the GAD−7. Hierarchical logistic regression analyses determined the relative contributions of premorbid psychiatric history, injury severity, and GAD−7 results in predicting a final diagnosis of anxiety disorder. GAD−7 cutoff point of ≥7 yielded the best combination of sensitivity and specificity regarding a final diagnosis of anxiety disorder. Within hierarchical logistic regression models, injury severity did not statistically significantly add to prior psychiatric history in predicting a final diagnosis of anxiety disorder. When GAD-7 was added, it made a statistically significant contribution in accounting for such a diagnosis and increased sensitivity from 71% to 91%. The GAD−7 holds diagnostic utility as a screening measure for anxiety disorders in patients with TBI. It should not be used in isolation but as part of a more comprehensive interview and history. The GAD−7 can benefit clinicians in assisting with timelier identification and treatment of symptoms of anxiety.

KEYWORDS:

• Traumatic brain injury
• GAD-7
• concussion
• premorbid mental health
• anxiety disorder

Data availability Statement

Our archival data are from a consecutive series of patients with TBI who underwent an outpatient neuropsychological evaluation at masked Hospital between July of 2016 and March of 2019. This original data was collected for clinical purposes as part of standard care, primarily as part of Centers for Medicare (CMS) reporting requirements. Our data is available to qualified researchers upon request.

Disclosure of interest

The authors report no conflict of interest. The authors appreciatively acknowledge the financial support of the Campbell Foundation (grant #MFB-JD 2019) and the Mary Free Bed Guild Fund (grant #191), without which the present study could not have been completed. The views expressed in the submitted article are his or her own and not an official position of the institution or funder.

Additional information

Funding

This work was supported by the Campbell Foundation [MFB-JD 2019]; Mary Free Bed Fund [191].