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ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Adolescent and Young Adult Psychiatry
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1571753
This article is part of the Research Topic Adolescent Emotional Disorders and Suicide Self-Harm Crisis Intervention View all 9 articles
A Comparative Study of Anxiety Symptoms in Chinese and Rwandan Adolescents: A Measurement Invariance Study of the GAD-7 Scale
Provisionally accepted
Lisa Cynthia NIWENAHISEMO 1,2*
Qi Zhang 1,2
Wo Wang 2,3
Dandan Geng 2,3 He-Yan Xu 2,3
Jinhui Hu 1,2
Lingli Ma 1,2
Jianyu Tan 1,2
Yiting Kong 1,2 Su Hong 2,4*
Li Kuang 1,2*- 1 Department of Psychiatry, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 2 Psychiatric Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 3 Department of psychiatry, the University-town Hospital of Chongqing Medical University, Chongqing, China
- 4 Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Cultural factors and assessment methods significantly influence how anxiety symptoms are expressed and reported. However, few cross-cultural studies have employed culturally appropriate and validated tools, and even fewer have provided substantial comparisons across different groups. This study aimed to assess the measurement invariance of the GAD-7 scale across Chinese and Rwandese adolescents, enabling reliable cross-cultural comparisons. This study included 2017 Chinese adolescents and 1813 Rwandan adolescents. Cronbach's alpha, exploratory factor analysis and Confirmatory factor analysis were assessed verify the validity of the GAD-7 scale across the two groups. Measurement invariance testing was employed to investigate the cross-cultural equivalence. GAD-7 demonstrated good psychometric properties, confirmatory factor analysis supported a one-factor model for the GAD-7 in both samples, with varied model fit indices. Measurement invariance testing confirmed configural and metric invariance but found partial scalar invariance. Latent mean comparison indicated a trend towards higher anxiety levels in Rwandan adolescents compared to Chinese adolescents, though not statistically significant (z = 0.02, d = 0.033, p = 0.98). The GAD-7's reliability in measuring generalized anxiety in both Chinese and Rwandese adolescents and its cross-cultural construct validity were confirmed. However, partial scalar invariance suggests that while the GAD-7 effectively detects anxiety symptoms, the severity of reported symptoms may not be directly comparable across the two cultures due to response patterns and possible linguistic factors. These findings underscore the importance of culturally sensitive instruments for accurately capturing anxiety symptoms in diverse populations and broaden evidence on reliable symptom screening and treatment effectiveness monitoring scales in different cultures.
Keywords: Anxiety, Generalized Anxiety Disorder-7 (GAD-7), cultural differences, adolescents, Measurement invariance, cross-cultural comparison
Received: 06 Feb 2025; Accepted: 07 Apr 2025.
Copyright: © 2025 NIWENAHISEMO, Zhang, Wang, Geng, Xu, Hu, Ma, Tan, Kong, Hong and Kuang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Lisa Cynthia NIWENAHISEMO, Department of Psychiatry, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Su Hong, Psychiatric Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Li Kuang, Department of Psychiatry, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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