Construct: General Anxiety Disorder Test Development Proposal: Step Two-Nursing Paper Examples


Generalized anxiety disorder (GAD) is a common subtype of anxiety disorder affecting people across all age groups. Current trends suggest a higher prevalence of GAD among younger people, with an estimated 6.8 million people affected in the USA. Therefore, the assessment of GAD is critical for initiating appropriate intervention measures. Consequently, this study reviews existing instruments for GAD assessment; Generalized Anxiety Disorder 7-item scale (GAD-7) and Hamilton Anxiety Rating Scale (HAM-A) (General Anxiety Disorder).

General Anxiety Disorder
General Anxiety Disorder

In addition, the Penn State Worry Questionnaire (PSWQ), Beck Anxiety Inventory (BAI) and State-Trait Anxiety Inventory (STAI), and the Overall Anxiety Severity and Impairment Scale (OASIS). Furthermore, the findings show that the existing GAD assessments have relative reliability and validity across various cultural and linguistic backgrounds and age groups. However, each of the existing instruments has some limitations, suggesting a need for developing a more robust instrument for GAD assessment (General Anxiety Disorder).

Construct: General Anxiety Disorder Test Development Proposal: Step Two

Anxiety disorders are pervasive psychiatric disorders in the United States. Anxiety has rapidly increased among younger and older adults in the last decade (Goodwin et al., 2020), with Generalised Anxiety Disorder (GAD) affecting more people, 3.1% of the population (6.8 million people) compared to other anxiety disorders (Anxiety and Depression Association Society of America [ADASA], n.d.) (General Anxiety Disorder).

GAD is the most common anxiety disorder among older adults and is frequently attributed to traumatic events. Consequently, a study by Milanak et al. (2013) showed that most veterans report increased mental healthcare utilization and antidepressant medication. In addition, experience GAD symptoms with a significant level of pain and worse emotional and general health.

GAD is characterized by excessive anxiety and worries about several activities or events for at least six months (Boland & Verduin, 2021). Affected individuals find it difficult to control worry, leading to somatic symptoms such as irritability, muscle tension, sleeplessness, and restlessness. Furthermore, GAD is associated with many other co-occurring mental disorders and physical illnesses (General Anxiety Disorder).

The most common disorders that co-occur with GAD include OCD, PTSD, and depression (ADASA, n.d.). Of these co-occurring mental disorders, PSTD has been chiefly associated with GAD diagnosis, resulting in severe impairment and more symptoms than those with GAD alone among veterans (Milanak et al., 2013).

GAD remain common among women compared to men across different age groups. Furthermore, these relationships highlight the need for improved recognition and assessment of GAD for effective treatment. Consequently, various instruments have been developed to assess GAD symptoms (General Anxiety Disorder).

Generalized Anxiety Disorder 7-item scale (GAD-7), Hamilton Anxiety Rating Scale (HAM-A), Penn State Worry Questionnaire (PSWQ), Beck Anxiety Inventory (BAI), and State-Trait Anxiety Inventory (STAI), and the Overall Anxiety Severity and Impairment Scale (OASIS). These instruments remain tested for validity and reliability for GAD across different populations (General Anxiety Disorder).

Generalized Anxiety Disorder 7-item scale (GAD-7)

GAD-7 is a self-report questionnaire for assessing the severity of anxiety and worry symptoms within two weeks. Consequently, GAD-7 consists of seven items, each scoring on a four-point Likert scale of 0 to 3 with a score ranging from 0 to 21. Moreover, higher scores reflect greater severity of anxiety and worry.GAD-7 has good construct validity and reliability (General Anxiety Disorder).

Löwe et al. (2008) validated and standardized GAD-7 in the general population. The study showed that GAD-7 has good reliability and validity as a screening tool for anxiety in the general population. Johnson et al. (2019) evaluated GAD-7’s psychometric properties. The evidence showed that the GAD-7 has excellent internal consistency, reliability, and construct validity.

General Anxiety Disorder
Generalized Anxiety Disorder 7

Hinz et al. (2018) demonstrated that GAD-7 has high sensitivity and specificity for GAD diagnosis. Furthermore, these studies justify the validity and reliability of GAD-7 as a screening tool for GAD symptoms among psychiatric patients and the general population. Nevertheless, GAD-7 is only an effective initial screening tool for GAD (General Anxiety Disorder).

Further evaluation of symptom measurements is needed to establish a definitive diagnosis (Rutter & Brown, 2017). A practitioner would conduct further assessment and evaluation for higher scores, such as clinical interviews, additional questionnaires, and relevant diagnostic procedures. A higher score may indicate co-occurring mental disorders such as depression or posttraumatic stress disorder (General Anxiety Disorder). 

Hamilton Anxiety Rating Scale (HAM-A)

HAM-A is a clinician-based questionnaire used to assess the severity of perceived anxiety symptoms (Thompson, 2015). Consequently, HAM-A consists of 14 items that evaluated somatic and psychological symptoms. Subsequently, sometimes, HAMA-A is used to evaluate the effectiveness of GAD treatments. Moreover, the reliability and validity of HAMA-A have been tested across age groups and cultures (General Anxiety Disorder).

HAM-A scales have sufficient concurrent validity and reliability with reasonable inter-rate and test-retest reliability (Rabinowitz et al., 2023). Consequently, therefore, the scale is acceptable and widely used in primary settings. Moreover, HAM-A has been criticized for its poor ability to provide standardized probe questions. Consequently, according to Boland & and Verduin (2021), HAM-A offers limited coverage of anxiety required for GAD diagnosis. Besides, the scale requires formal training to achieve higher reliability (General Anxiety Disorder).

Penn State Worry Questionnaire (PSWQ)

PSWQ is a self-report questionnaire that assesses the degree of worry in an individual. Consequently, PSWQ is widely used in a clinical setting as a well-validated measure for the frequency, intensity, and uncontrollability of worry in GAD patients (Johnco et al., 2022). Moreover, PSWQ is suboptimal for assessing the outcomes of late-onset GAD. Besides, the instrument can be standardized to evaluate the response and remission criteria to treatment and the effects of clinical practice. However, PSWQ is not a diagnostic scale (General Anxiety Disorder).

PSWQ has shown robust psychometric properties in nonclinical and clinical samples across different ages. Consequently, Wuthrich et al. (2014) established that PSWQ provides an accurate distinction between clinical and nonclinical status with higher specificity and sensitivity in the older population. Consequently, PSWQ has good internal consistency and convergent validity with other anxiety measures with modest test-retest reliability.

Furthermore, a cut-off score of 50 has been shown to accurately discriminate GAD with 90% specificity 82% sensitivity 70% specificity, and 78% sensitivity in nonclinical and clinical populations, respectively (Webb et al., 2008). Furthermore, validation with the Iranian sample showed that PSWQ has good reliability and construct validity among children and adolescents (Moghadasin et al., 2019). These findings suggest that PSWQ is an effective screening tool for worry

One significant limitation of PSWQ is the differences in factor structure in older and younger populations. Consequently, some studies have found that in older adults, the PSWQ appears to be unidimensional, with all of the items loading on a single factor (Wuthrich et al., 2014). Moreover, this contrasts with younger populations, where multidimensional factor structures have been identified. Therefore, PSWQ may not be as suitable for older adults, as it may not fully capture the unique worries and concerns more common in this population, such as health-related worries and concerns about retirement and social isolation.

Beck Anxiety Inventory (BAI)

BAI is a self-report questionnaire that assesses the severity of anxiety symptoms. Furthermore, BAI is often used in primary settings to evaluate the severity of anxiety in patients diagnosed with GAD. Subsequently, BAI has 21 items scored on a Likert-like scale of 0 to 3, with total scores ranging from 0 to 60 and a clinical cut-off score of 15. Consequently, BAI was primarily developed to distinguish between anxiety and depressive symptoms (General Anxiety Disorder).

BAI has good reliability and validity. Initial validations showed higher test-retest reliability and internal consistency of 0.84 and 0.93, respectively. Oh et al. (2018) demonstrated that BAI has high validity and reliability as an instrument for measuring the severity of general anxiety in nonclinical and nonclinical Korean samples. Ismail et al. (2022) showed that BAI has good psychometric properties, thus a reliable and valid screening instrument for anxiety with Malaysian samples.

However, BAI has been criticized for its inability to capture specific symptoms of GAD. Oh et al. (2018) argued that BAI often fails to identify the unique characteristics associated with anxiety disorders, thereby being unable to distinguish them from each other and depressive disorders in the primary care population.

Since GAD is often comorbid with other anxiety disorders with distinct profiles, the instrument may not capture specific symptoms related to GAD. Moreover, BAI only measures symptoms within the past week, limiting its ability to capture previously experienced anxiety symptoms. The instrument focuses on general symptoms of anxiety, which may not fully grasp the worry and rumination that are core features of GAD (General Anxiety Disorder).

State-Trait Anxiety Inventory (STAI)

STAI is a self-report questionnaire that measures the severity of anxiety in individuals diagnosed with GAD. STAI has 20-item answers in a 4-point Likert scale ranging from 1 to 4 that measures state and trait anxiety symptoms (Thomas & Cassady, 2021). State anxiety refers to anxious responses to specific situations, while train anxiety refers to anxiety as an individual’s characteristic.

Therefore, STAI is commonly used to measure the severity of anxiety associated with a momentary experience. Through a confirmatory factor analysis, Thomas & and Cassady (2021) showed that the two dimensions of STAI measurement, i.e., state anxiety and calmness demonstrated superior fit. Besides, STAI has excellent internal consistency and reliability among university students, high structural validity, and concurrent and divergent validity.

Nevertheless, STAI has limitations that should be noted when interpreting results. Although STAI measures both state and trait anxiety symptoms, which provide valuable information about an individual’s anxiety levels in different contexts, it can also make it challenging to distinguish the effects of state or trait-related anxiety on an individual screening result (Thomas & Cassady, 2021).

This may be particularly relevant in clinical settings where it is important to identify the specific factors contributing to an individual’s anxiety symptoms. Besides, STAI cannot fully capture the complexity of anxiety symptoms since it focuses on the cognitive and emotional aspects of anxiety. Although these aspects are crucial, they do not capture other symptoms that may be present with GAD disorder, such as physical health (General Anxiety Disorder).

The Overall Anxiety Severity and Impairment Scale (OASIS)

OASIS is a self-administered tool for assessing the severity and impairment of adults’ generalized anxiety disorder (GAD) symptoms (Sandora et al., 2021). The OASIS consists of five items that assess the frequency and intensity of anxiety symptoms and the degree of interference these symptoms have had on daily functioning in the past week. The OASIS also includes a global rating item that assesses overall anxiety severity on a scale from 0 to 8 (General Anxiety Disorder).

OASIS provides a brief and easy-to-administer measure for GAD symptoms. OASIS had good psychometric properties, i.e., high validity and reliability (Sandora et al., 2021). Besides, OASIS is sensitive to changes in anxiety levels over time. The validity and reliability have been tested across various cultures and age groups. OASIS has good reliability and validity among Iranian and Japanese populations (Farrahi et al., 2021; Ito et al., 2015). OASIS has excellent convergent validity and test-retest reliability (Sandora et al., 2021) (General Anxiety Disorder)

One limitation of the OASIS is its inability to provide information on cognitive and behavioral factors that underline GAD symptoms. Campell-Sills et al. (2021) argued that OASIS does not inquire about anxiety’s functional and behavioral outcomes. Therefore, OASIS has limited clinical assessment ability and should be used together with other assessment tools and clinical judgment to evaluate GAD comprehensively.


There has been a higher prevalence of GAD among young and older people. Considering the adverse health outcomes associated with GAD early and accurately is crucial in initiating targeted intervention measures. While the existing instruments have shown essential reliability and validity, they are not entirely dependable, as each has a significant limitation. Besides, given the increasing prevalence of GAD, a comprehensive and more accurate tool is needed to bridge this gap.


Anxiety and Depression Association Society of America. (No date). Anxiety Disorders – Facts & Statistics. Available at:  (Accessed 17 February 2023).

Boland, R., & Verduin, M. (2021). Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins.

Campbell-Sills, L., Norman, S. B., Craske, M. G., Sullivan, G., Lang, A. J., Chavira, D. A., … & Stein, M. B. (2009). Validation of a brief anxiety-related severity and impairment measure: the Overall Anxiety Severity and Impairment Scale (OASIS). Journal of Affective Disorders112(1-3), 92-101.

Farrahi, H., Gharraee, B., Oghabian, M. A., Pirmoradi, M. R., Najibi, S. M., & Batouli, S. A. H. (2021). Psychometric properties of the Persian version of the overall anxiety severity and impairment scale (OASIS). Iranian Journal of Psychiatry and Behavioral Sciences, 14(4).

Goodwin, R. D., Weinberger, A. H., Kim, J. H., Wu, M., & Galea, S. (2020). Trends in anxiety among adults in the United States, 2008–2018: Rapid increases among young adults. Journal of Psychiatric Research130, 441-446.

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. J. Affect. Disord. 210, 338–344. doi: 10.1016/j.jad.2016.12.012

Ismail, N. H., Jaafar, N. R. N., Woon, L. S. C., Ali, M. M., Dahlan, R., & Baharuddin, A. N. A. P. (2022). Psychometric properties of the Malay-version beck anxiety inventory among adolescent students in Malaysia. Frontiers in Psychiatry13.

Ito, M., Oe, Y., Kato, N., Nakajima, S., Fujisato, H., Miyamae, M., … & Norman, S. B. (2015). Validity and clinical interpretability of overall anxiety severity and impairment scale (OASIS). Journal of Affective Disorders, 170, 217-224.

Johnco, C., Wuthrich, V. M., Brenes, G. A., Wetherell, J. L., & Mohlman, J. (2022). Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire–Abbreviated (PSWQ-A). International Psychogeriatrics34(5), 489-501.

Johnson, S. U., Ulvenes, P. G., Øktedalen, T., & Hoffart, A. (2019). Psychometric properties of the general anxiety disorder 7-item (GAD-7) scale in a heterogeneous psychiatric sample. Frontiers in Psychology10, 1713.

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, 266-274.

Milanak, M. E., Gros, D. F., Magruder, K. M., Brawman-Mintzer, O., & Frueh, B. C. (2013). Prevalence and features of generalized anxiety disorder in Department of Veteran Affairs primary care settings. Psychiatry Research209(2), 173-179.

Moghadasin, M., Arjmand, F., & Mohammadkhani, S. M. (2019). Psychometric Properties and the Standardization of the Penn State Worry Questionnaire in 8–18-Year-Old Children and Adolescents. Journal of Applied Psychological Research10(3), 1-26.

Oh, H., Park, K., Yoon, S., Kim, Y., Lee, S. H., Choi, Y. Y., & Choi, K. H. (2018). Clinical utility of Beck Anxiety Inventory in clinical and nonclinical Korean samples. Frontiers in Psychiatry9, 666.

Rabinowitz, J., Williams, J. B., Hefting, N., Anderson, A., Brown, B., Fu, D. J., … & Schooler, N. R. (2023). Consistency checks to improve measurement with the Hamilton Rating Scale for Anxiety (HAM-A). Journal of Affective Disorders.

Rutter, L. A., & Brown, T. A. (2017). Psychometric properties of the generalized anxiety disorder scale-7 (GAD-7) in outpatients with anxiety and mood disorders. Journal of Psychopathology and Behavioral Assessment39, 140-146.

Sandora, J., Novak, L., Brnka, R., van Dijk, J. P., Tavel, P., & Malinakova, K. (2021). The abbreviated Overall Anxiety Severity and impairment scale (OASIS) and overall depression severity and impairment scale (ODSIS): Psychometric properties and evaluation of the Czech versions. International journal of environmental research and public health, 18(19), 10337.

Thomas, C. L., & Cassady, J. C. (2021). Validation of the State Version of the State-Trait Anxiety Inventory in a university sample. SAGE Open11(3), 21582440211031900.

Thompson, E. (2015). Hamilton rating scale for anxiety (HAM-A). Occupational Medicine65(7), 601-601.

Webb, S. A., Diefenbach, G., Wagener, P., Novy, D. M., Kunik, M., Rhoades, H. M., & Stanley, M. A. (2008). Comparison of self-report measures for identifying late-life generalized anxiety in primary care. Journal of Geriatric Psychiatry and Neurology21(4), 223-231.

Wuthrich, V. M., Johnco, C., & Knight, A. (2014). Comparison of the Penn State Worry Questionnaire (PSWQ) and abbreviated version (PSWQ-A) in a clinical and nonclinical population of older adults. Journal of Anxiety Disorders28(7), 657-663.

A Page will cost you $12, however, this varies with your deadline. 

We have a team of expert nursing writers ready to help with your nursing assignments. They will save you time, and improve your grades. 

Whatever your goals are, expect plagiarism-free works, on-time delivery, and 24/7 support from us.  

Here is your 15% off to get started. 

  • Place your order (Place Order
  • Click on Enter Promo Code after adding your instructions  
  • Insert your code –  Get20

All the Best, 

Cathy, CS