Jordan Medical Journal, Volume 56, No.3 2022
DOI: https://doi.org/10.35516/jmj.v56i3.362
© 2022 DSR Publishers ∕ The University of Jordan. All Rights Reserved.
1
Department of Basic Medical Sciences, Faculty of Medicine, The Hashemite University,
P.O. Box 330127, Zarqa 13133, Jordan
2
Limestone University, Gaffney, South Carolina, United States of America
Corresponding author: msysalman@yahoo.com
ORCID: 0000-0001-8991-1270
Patient Health Questionnaire-9 and Generalized Anxiety
Discorders-7: Arabic Version Reliability in Jordan
Mustafa S. Yousuf
1
, Heather L. Harvey
2
, Aiman S. Al Sharei
1
,
Khaled A. Albakri
1
, Yasmeen J. Alabdallat
1
Abstract
Background: Depression and anxiety are common mental disorders that are often missed in primary
healthcare settings due to the lack of diagnosis criteria. Using valid and reliable easy-to-use
instruments can overcome this problem. Aims: To translate and culturally adapt the Patient Health
Questionnaire-9 (PHQ9) and the Generalized Anxiety Disorders-7 (GAD7) instruments into Arabic,
determine the reliability of these translated versions, and compare them with previous attempts.
Methods: Forward and blind back-translation was used to translate the instruments into Arabic. An
online version was created and sent to medical school students at the Hashemite University, Jordan.
For each instrument, internal consistency reliability and inter-item correlation were calculated. For
each item, the mean, standard deviation, item-total correlation, and value of Cronbach’s alpha if the
item was deleted were determined. Analysis was performed using IBM SPSS version 25.
Results: There were 256 respondents to the translated instruments. The average age was 18.85 and
61% were females. The alpha for the PHQ9 was 0.876, with an average inter-item correlation of
0.444. Removal of any of the nine items decreased the value of alpha. The GAD7 had an alpha of
0.895 with an average inter-item correlation of 0.551. Deletion of any item decreased the internal
consistency reliability of the instrument. Conclusion: Using an efficient translation process that was
both accurate and culturally sensitive enabled the construction of Arabic versions of the PHQ9 and the
GAD7 scales that had high internal consistency reliability and good inter-item correlation.
Keywords: Anxiety, depression, generalized anxiety disorders-7, internal consistency reliability,
patient health questionnaire-9, translation.
(J Med J 2022; Vol. 56 (3):250-260)
Received Accepted
January, 15, 2021 November, 25, 2021
Introduction
Depression and anxiety are globally the two
most common mental health illnesses [1–2]. In
the context of the COVID-19 pandemic, the
incidence of these disorders increased, which
expanded their prevalence [3]. This increase may
have occurred due to the lockdown [4] and was
evident among health care workers [5–6] and
students [7–8]. Because of this, the early and
accurate diagnosis of such disorders is essential.
Patients suffering from physical illnesses
often refer to primary health care for the initial
management of their conditions. Although
attempts to integrate mental health into
primary health care have been made [9–10],
various barriers against such efforts still exist