The challenges of assessing anxiety symptoms for adolescents and young adults in residential treatment: The BHS-Anxiety and the GAD-7 Scales

Anxiety symptoms are common, comorbid with other disorders, and damaging to well-being. High-quality assessment is necessary for detecting and monitoring these symptoms, especially within the context of residential treatment for psychiatric disorders. However, little is known about the psychometric accuracy of screening for anxiety symptoms within this severe, often comorbid sample. The current study examines the psychometric characteristics of two measures used in residential treatment: the Generalized Anxiety Disorder-7 (GAD-7) and the Behavioral Health Screen-Anxiety (BHS-Anxiety) scales. The sample included 5,639 adolescents and young adults admitted to residential psychiatric treatment in the United States. The sample was nearly all non-Hispanic White. Most (72.1%) were diagnosed with at least one DSM-5 anxiety disorder. Psychometric analyses revealed that the two measures were strongly correlated, and both showed good item discrimination, test information, and reliability. However, overlap with depressive symptoms was high, and classification accuracy based on preliminary anxiety diagnoses was low. The BHS-Anxiety scale showed measurement invariance across gender, age, and depression diagnosis groups, but the GAD-7 showed poor structural validity. Screening for highly comorbid symptoms within severe populations is difficult and understudied. High-quality measurement instruments, and innovative approaches to assessment, are needed to improve research and practice within residential treatment settings.