- Language of administration did not affect PHQ-9 or GAD-7 scores; test-retest and cross-language reliability were high (0.89 to 0.95).
- Extreme PHQ-9 and GAD-7 cutoffs (≥15 to ≥18) were specific (0.90 to 0.98) and moderately sensitive (0.40 to 0.70) to invalid symptom report.
- PHQ-9 and GAD-7 can assess symptoms and flag non-credible reporting, but symptom validity sensitivity is limited; symptom and performance validity are distinct.
Arch Clin Neuropsychol. 2026 Sep 9;41(7):acag074. doi: 10.1093/arclin/acag074.
ABSTRACT
BACKGROUND: Despite increasing linguistic diversity in the US, little is known about the effects of limited English proficiency on psychiatric symptom report.
METHOD: Cuban university students were randomly assigned to control (n = 51) or experimental malingering (expMAL) condition (n = 25). The Patient Health Questionnaire (PHQ)-9 and Generalized Anxiety Disorder (GAD)-7 were administered in both English and Spanish. Classification accuracy was calculated using expMAL status and psychometrically defined symptom/performance validity as criteria.
RESULTS: PHQ-9 and GAD-7 scores did not differ as a function of language. Test-retest reliability/cross-language equivalence was high (0.89-0.95). Extreme scores (≥15 to ≥18) were sensitive (0.40-0.70) and specific (0.90-0.98) to invalid symptom report, but insensitive (0.11-0.26) to invalid performance.
CONCLUSIONS: Basic English proficiency may be sufficient to measure anxiety and depression in culturally diverse examinees. The PHQ-9 and GAD-7 have potential for dual use: they simultaneously measure anxiety/depression and non-credible symptom report. However, their symptom validity test function is limited by relatively low sensitivity. Symptom and performance validity were psychometrically distinct constructs.
PMID:42782181 | DOI:10.1093/arclin/acag074
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