{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T16:40:23Z","timestamp":1775666423186,"version":"3.50.1"},"reference-count":48,"publisher":"FapUNIFESP (SciELO)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cad. Sa\u00fade P\u00fablica"],"published-print":{"date-parts":[[2017,9,28]]},"abstract":"<jats:p>Abstract: The Generalized Anxiety Disorder 7-item (GAD-7) scale has been presented as a reliable and valid measure to assess generalized anxiety symptoms in several clinical settings and among the general population. However, some researches did not support the original one-dimensional structure of the GAD-7 tool. Our main aim was to examine the factor structure of GAD-7 comparing the one-factor model fit with a two-factor model (3 somatic nature symptoms and 4 cognitive-emotional nature symptoms) in a sample of college students. This validation study with data collected cross-sectionally included 1,031 Portuguese college students attending courses in the six schools of the Polytechnic Institute of Coimbra, Coimbra, Portugal. Measures included the GAD-7, Hospital Anxiety and Depression Scale (HADS) and the University Student Risk Behaviors Questionnaire. Confirmatory factor analysis (CFA) procedures confirmed that neither factor structure was well fitting. Thus, a modified single factor model allowing the error terms of items associated with relaxing difficulties and irritability to covary was an appropriate solution. Additionally, this factor structure revealed configural and metric invariance across gender. A good convergent validity was found by correlating global anxiety and depression. However, this measure showed a weak association with consumption behaviors. Our results are relevant to clinical practice, since the comprehensive approach to GAD-7 contributes to knowing generalized anxiety symptoms trajectory and their correlates within the university setting.<\/jats:p>","DOI":"10.1590\/0102-311x00212716","type":"journal-article","created":{"date-parts":[[2017,9,23]],"date-time":"2017-09-23T23:29:06Z","timestamp":1506209346000},"source":"Crossref","is-referenced-by-count":79,"title":["Factor structure and construct validity of the Generalized Anxiety Disorder 7-item (GAD-7) among Portuguese college students"],"prefix":"10.1590","volume":"33","author":[{"given":"Ana","family":"B\u00e1rtolo","sequence":"first","affiliation":[{"name":"Universidade de Aveiro, Portugal; Universidade de Aveiro, Portugal"}]},{"given":"Sara","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Universidade de Aveiro, Portugal"}]},{"given":"Anabela","family":"Pereira","sequence":"additional","affiliation":[{"name":"Universidade de Aveiro, Portugal; 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Coll Health"},{"key":"ref4","series-title":"Procedia: social and behavioral sciences","first-page":"490","volume-title":"The relationship between study anxiety and academic performance among engineering students","author":"Vitasari P","year":"2010"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/NMD.0b013e31827ab077","article-title":"Mental health in American colleges and universities variation across student subgroups and across campuses","volume":"201","author":"Eisenberg D","year":"2013","journal-title":"J Nerv Ment Dis"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1177\/070674370605100206","article-title":"Prevalence and incidence studies of anxiety disorders a systematic review of the literature","volume":"51","author":"Somers JM","year":"2006","journal-title":"Can J Psychiatry"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1192\/bjp.168.3.308","article-title":"Phenomenology and course of generalised anxiety disorder","volume":"168","author":"Yonkers KA","year":"1996","journal-title":"Br J Psychiatry"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1016\/j.janxdis.2009.07.011","article-title":"Quality of life impairment in generalized anxiety disorder, social phobia and panic disorder","volume":"23","author":"Barrera TL","year":"2009","journal-title":"J Anxiety Disord"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"247","DOI":"10.4088\/JCP.v67n0211","article-title":"Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders results from the National Epidemiologic Survey on Alcohol and Related Conditions","volume":"67","author":"Conway KP","year":"2006","journal-title":"J Clin Psychiatry"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1001\/archpsyc.61.8.807","article-title":"Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders results from the National Epidemiologic Survey on Alcohol and Related Conditions","volume":"61","author":"Grant BF","year":"2004","journal-title":"Arch Gen Psychiatry"},{"key":"ref11","first-page":"1092","article-title":"Anxiety disorders in primary care prevalence, impairment, comorbidity, and detection","volume":"166","author":"Spitzer RL","year":"2006","journal-title":"Arch Intern Med"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond AS","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"ref13","series-title":"Manual for the state-trait anxiety inventory","author":"Spielberger CD","year":"1983"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.psychres.2011.01.016","article-title":"Quick and easy self-rating of generalized anxiety disorder validity of the Dutch web-based GAD-7, GAD-2 and GAD-SI","volume":"188","author":"Donker T","year":"2011","journal-title":"Psychiatry Res"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1477-7525-8-8","article-title":"Cultural adaptation into Spanish of the Generalized Anxiety Disorder-7 (GAD-7) scale as a screening tool","volume":"8","author":"Garc\u00eda-Campayo J","year":"2010","journal-title":"Health Qual Life Outcomes"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1037\/a0036523","article-title":"The psychometric properties of the generalized anxiety disorder-7 scale in Hispanic Americans with English or Spanish language preference","volume":"20","author":"Mills SD","year":"2014","journal-title":"Cultur Divers Ethnic Minor Psychol"},{"key":"ref17","first-page":"367","article-title":"Factor structure, reliability, and item parametersof the Brazilian-Portuguese version of the GAD-7 questionnaire","volume":"24","author":"Moreno AL","year":"2016","journal-title":"Trends Psychol"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1093\/deafed\/ens040","article-title":"The British sign language versions of the Patient Health Questionnaire, the Generalized Anxiety Disorder 7-Item Scale, and the Work and Social Adjustment Scale","volume":"18","author":"Rogers KD","year":"2012","journal-title":"J Deaf Stud Deaf Educ"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12955-015-0244-2","article-title":"Reliability and validity of the Portuguese version of the Generalized Anxiety Disorder (GAD-7) Scale","volume":"13","author":"Sousa TV","year":"2015","journal-title":"Health Qual Life Outcomes"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.janxdis.2014.06.002","article-title":"Beyond generalized anxiety disorder psychometric properties of the GAD-7 in a heterogeneous psychiatric sample","volume":"28","author":"Beard C","year":"2014","journal-title":"J Anxiety 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Med"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.jpsychires.2011.03.006","article-title":"Gender differences in anxiety disorders prevalence, course of illness, comorbidity and burden of illness","volume":"45","author":"McLean CP","year":"2011","journal-title":"J Psychiatr Res"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0022-3999(01)00296-3","article-title":"The validity of the Hospital Anxiety and Depression Scale: an updated literature review","volume":"52","author":"Bjelland I","year":"2002","journal-title":"J Psychosom Res"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1477-7525-1-29","article-title":"The Hospital Anxiety And Depression Scale","volume":"1","author":"Snaith RP","year":"2003","journal-title":"Health Qual Life Outcomes"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/13548500500524088","article-title":"Validation study of a 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Dev"},{"key":"ref42","series-title":"MPlus user's guide","author":"Muthen BO","year":"2001"},{"key":"ref43","series-title":"Structural equation modeling","author":"Bowen NK","year":"2012"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1037\/1082-989X.1.2.130","article-title":"Power analysis and determination of sample size for covariance structure modeling","volume":"1","author":"MacCallum RC","year":"1996","journal-title":"Psychol Methods"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1037\/0021-9010.93.3.568","article-title":"Power and sensitivity of alternative fit indices in tests of measurement invariance","volume":"93","author":"Meade AW","year":"2008","journal-title":"J Appl Psychol"},{"key":"ref46","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/00019442-200501000-00006","article-title":"Depression and generalized anxiety disorder co-occurrence and longitudinal patterns in elderly 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