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Archived Comments for: Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial

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  1. About the use of GADS as outcome measure

    Enric Aragonès, IDIAP Jordi Gol

    25 January 2012

    The Goldberg¿s Anxiety and Depression Scales (GADS) are heteroapplied questionnaires that were derived by latent trait analysis from a standardized psychiatric research interview. They were designed and calibrated to aid general practitioners and other non-psychiatrists in the better recognition of anxiety and depression [1].
    These scales were translated and validated as screening tool in Spanish primary care patients by Monton et al. [2] Afterward, these scales were recommended as a screening test by the Program of Preventive Activities and Health Promotion (PAPPS) of the Spanish Society of Family and Community Medicine (semFYC) and they became widely known among Spanish GPs [3].
    However, in this research protocol the GADS anxiety sub-scale is proposed to use not as a tool for detection, but as a primary outcome measure by means of monitoring changes in anxiety severity.
    As far as we know, this questionnaire is not designed for this purpose and there are no studies examining its operability as an instrument to monitor the symptomatic progression of anxiety or depression symptoms. We have reviewed some systematic reviews of therapeutic interventions for anxiety disorders [4,5,6] and we have seen that there are no clinical trials using the GADS as an outcome measurement.
    We advocate using a well validated test to measure the clinical outcomes with reliability. Otherwise, this methodological error may cause difficulties to properly interpret the results of the evaluation, and also difficulties to pass the filters of editors and peer-reviewers when the authors want to publish their report.

    1. Goldberg D, Bridges K, Duncan-Jones P, Grayson D. Detecting anxiety and depressionin general medical settings. Br Med J 1988; 297:897-9.
    2. Montón C, Pérez-Echevarría MJ, Campos R, et al. Escalas de ansiedad y depresión de Goldberg: una guía de entrevista eficaz para la detección del malestar psíquico. Aten Primaria 1993; 12: 345-9.
    3. Tizón García JL, Buitrago Ramírez F, Ciurana Misol R, Chocrón Bentata L, Fernández Alonso C, García Campayo J, Montón Franco C, Redondo Granado MJ. Prevención de los trastornos de salud mental desde la atención primaria. Aten Primaria 2003;32(Supl 2):77-101.
    4. Hunot V, Churchill R, Silva de Lima M, Teixeira V. Psychological therapies for generalised anxiety disorder. Cochrane Database Syst Rev. 2007;(1):CD001848.
    5. Kapczinski F, Lima MS, Souza JS, Schmitt R. Antidepressants for generalized anxiety disorder. Cochrane Database Syst Rev. 2003;(2):CD003592.
    6. Depping A, Komossa K, Kissling W, Leucht S. Second-generation antipsychotics for anxiety disorders. Cochrane Database Syst Rev. 2010;(12):CD008120.

    Competing interests