Cross cultural adaptation and psychometric validation of the Generalized Anxiety Disorder Assessment-7 for Urdu-speaking clinical populations

Abstract

Anxiety disorders are a major public health concern in low- and middle-income countries due to the lack of culturally validated screening tools. Although the Generalized Anxiety Disorder Assessment-7 (GAD-7) is widely used, limited research exists on its cross-cultural psychometric validation in Pakistan. This study aimed to translate, culturally adapt, and psychometrically validate the GAD-7 in a Pakistani clinical population. Following a standard forward–reconciliation–backward translation procedure, the GAD-7 was translated into Urdu and reviewed by a multidisciplinary expert panel. The final version was administered to 267 participants. Exploratory and confirmatory factor analyses were conducted. Internal consistency and model fit indices were assessed. Criterion validity was evaluated using Receiver Operating Characteristic analysis. The adapted GAD-7 demonstrated high internal consistency (Cronbach’s α = 0.896). Confirmatory factor analysis indicated both models demonstrated excellent fit; however, one-factor model was retained as the more parsimonious solution. Factor loadings were statistically significant and within acceptable ranges. ROC analysis demonstrated excellent diagnostic accuracy (AUC = 0.970), with an optimal cutoff score of 10 yielding sensitivity of 98.6% and specificity of 81.4%. The Urdu GAD-7 is a reliable, valid, and clinically useful instrument for screening anxiety in Pakistani populations. While multidimensional representations may offer theoretical insight, the scale functions effectively as a unidimensional measure. The findings support its use in both clinical and research settings, particularly for early detection of anxiety in resource-limited contexts.