Comparison of the GAD-7 and ImPACT symptom cluster scores in measuring anxiety among college athletes

Abstract

Assessing the needs of mental health among college athletes is important given the prevalence rates, stigma, and complications that may arise after experiencing a concussion. Utilizing the General Anxiety Disorder- 7 (GAD-7) as an independent measure of anxiety at concussion baseline evaluation was explored among Division II collegiate athletes (n=568), which also included the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) symptom clusters. ImPACT symptom clusters can be divided into four cluster (affective, cognitive, physical/somatic, and sleep) encompassing a 22-item self-report questionnaire. Simple linear regressions revealed that GAD-7 total score was significantly predicted by all four ImPACT symptom clusters. The cognitive cluster was the best predictor of GAD-7 total score (R 2 = 0.21, p < .001), followed by the affective cluster (R 2 = 0.19, p < .001), sleep cluster (R 2 = 0.11, p < .001), and physical cluster (R 2 = 0.10, p < .001). Most athletes did not endorse any anxiety (94.5%). However, 31 athletes (5.5%) fell above the cut-off score of 5 or more for anxiety. Of those athletes, sleep cluster was the best predictor of their GAD-7 total score. Meanwhile, within the group of 31 athletes, 13 of them endorsed 0 items on the ImPACT affective symptom cluster but fell above the cut-off on the GAD-7, 4 also endorsed scores below the cut-off on the PHQ-9. In conclusion, the incorporation of an independent face-valid anxiety screener such as the GAD-7 at concussion baseline evaluations is supported, as 41% of athletes would have been “missed” by ImPACT’s affective symptom cluster alone.