Anxiety in Response to Sustaining Spinal Cord Injuries and Disorders: When Should Clinicians Be Concerned?

Jane Duff, Lucy C. Grant, Jennifer Coker, Kimberley R. Monden

Research output: Contribution to journalArticlepeer-review


Objective: To recommend a cut-off score for the brief 2-item Generalized Anxiety Disorder (GAD-2) measure for persons with spinal cord injuries/disorders (PwSCI/D) and to estimate anxiety occurrence within this population using the full 7-item Generalized Anxiety Disorder (GAD-7). Design: Multicenter retrospective analyses. Setting: One inpatient rehabilitation center and 2 community sites for PwSCI/D. Participants: PwSCI/D 18 years or older (N=909) were included for analysis using retrospectively collected GAD-2 and GAD-7 data. Interventions: Not applicable. Main Outcome Measure(s): Occurrence of anxiety symptoms were compared using cut-off scores of ≥8 and ≥10 on the GAD-7. A cut-off score recommendation for the GAD-2 was determined using ROC curve, and sensitivity and specificity analyses. Results: Occurrence of anxiety symptoms was 21% using a GAD-7 cut-off of ≥8 and 15% using a cut-off of ≥10. Analyses indicated optimal sensitivity for a GAD-2 score of ≥2 when a GAD-7 cut-off of ≥8 was used. Conclusions: Anxiety occurrence is elevated among PwSCI/D compared with the general population. For PwSCI/D, it is recommended that a cut-off score of ≥2 is used for the GAD-2 to maximize sensitivity and that a threshold of ≥8 is used for the GAD-7 to ensure the maximum number of individuals presenting with symptoms of anxiety are recognized for diagnostic interview. Study limitations are discussed.

Original languageEnglish (US)
Pages (from-to)1409-1417
Number of pages9
JournalArchives of Physical Medicine and Rehabilitation
Issue number9
StatePublished - Sep 2023

Bibliographical note

Funding Information:
No funding was received in relation to the current work, as data were retrospectively obtained. However, from a previous grant-based study, anonymized data from the Craig Hospital sample were supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) alongside the 4 collaborating institutes: 90SI5015 ( Craig Hospital ), 90SI5026 ( Kessler Foundation ), 90SI5022 ( Shirley Ryan AbilityLab ), 90SI5021 ( Spaulding Rehabilitation Hospital ), and 90SI5027 ( Texas Institute for Rehabilitation Research ).

Publisher Copyright:
© 2023 American Congress of Rehabilitation Medicine


  • Anxiety
  • Health Psychology
  • Psychometrics
  • Rehabilitation
  • Spinal cord injuries


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