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Article

Psychometric Properties of the GAD-7 in Parents of Children with Chronic Conditions

by
Mark A. Ferro
*,
Melissa Elgie
and
Karina Tamkee
School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
*
Author to whom correspondence should be addressed.
Psychiatry Int. 2026, 7(2), 77; https://doi.org/10.3390/psychiatryint7020077
Submission received: 25 November 2025 / Revised: 5 February 2026 / Accepted: 20 March 2026 / Published: 10 April 2026
Versions Notes

Abstract

This study modeled the factor structure of the Generalized Anxiety Disorder-7 (GAD-7), quantified its internal consistency, tested for longitudinal invariance, and estimated associations with measures of depression, parent stress, family functioning, and child psychopathology. Data were from 200 parents enrolled in an on-going study of children with chronic health conditions recruited from a pediatric hospital. Exploratory and confirmatory factor analysis (CFA) modeled the GAD-7 factor structure, and multiple-group CFA tested longitudinal invariance over 48 months. A one-factor model showed the best fit to the data, and the omega hierarchical was 0.89 and 0.88 at baseline and 48 months, respectively. The GAD-7 demonstrated longitudinal invariance. Internal consistency was good at both assessments (α > 0.75). Correlations with other measures were significant and at least small in magnitude. Known-group validity (parents with vs. without depression) showed very large effects (d > 2.0). The GAD-7 is psychometrically robust in parents of children with chronic health conditions.

1. Introduction

Caring for a child with a chronic health condition (e.g., diabetes, epilepsy, juvenile arthritis) can be a source of stress for parents as they manage often complex care regimens, numerous lengthy medical appointments, dynamic family member roles and responsibilities, and potential parent–child conflict related to activity restriction and treatment adherence [1]. Given such challenges, parents of children with chronic conditions are often at increased risk for psychological distress [2], including anxiety disorders [3]. Understanding the mental health of these parents has important clinical implications—not only are symptoms of anxiety potentially impairing for parents [4], but evidence shows that parent anxiety has negative consequences on the physical, mental, and psychosocial health of offspring [5,6].
Screening the mental health of parents of children with chronic conditions is central to providing best-practice family centered pediatric health services [1]. One of the most common instruments for screening adult generalized anxiety is the GAD-7—a seven-item scale that assesses the affective and somatic symptoms that comprise the core features of generalized anxiety disorder as outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [7]. The GAD-7 has been shown to typically have a one-factor structure, though a two- or bi-factor structure has also been reported [8,9,10,11]. The GAD-7 has high internal consistency and test–retest reliability [7,9,10,12,13], and its validity has been demonstrated against structured diagnostic interviews [7,14]. Evidence shows the GAD-7 to be measurement invariant across key demographic characteristics including sex, age, and race/ethnicity, suggesting different adult groups interpret the items and construct similarly [13,15]. It has been shown to be sensitive to change, and its minimal clinically important difference has been established [16,17]. Combined, these findings have led the GAD-7 to be included as a core measure of mental health in the common metrics agenda [18,19].
Despite the impressive body of evidence supporting the validity and reliability of the GAD-7, there are no psychometric studies of the GAD-7 in samples of parents of children with chronic conditions, potentially limiting its clinical utility in this vulnerable population. This represents a key knowledge gap that warrants investigation. Chronic conditions in children are common, and the prevalence is increasing [20,21]. This suggests that a large proportion of parents in the population are at elevated risk for anxiety and, subsequently, their children for poorer health outcomes. Investigating the psychometric properties of the GAD-7 could position it as a core screening tool within primary and tertiary pediatric care settings to inform approaches to family centered care, including timely intervention (e.g., more comprehensive assessment, referral to allied health), surveillance monitoring, and treatment evaluation.
The aim of this study was to expand the psychometric evidence of the GAD-7 by investigating its validity and reliability in assessing symptoms of generalized anxiety among parents of children with chronic conditions. Specifically, this study modeled the factor structure of the GAD-7; quantified its reliability and validity in terms of internal consistency, measurement invariance over time, correlation with measures of depression, parent stress, family functioning, and child psychopathology; and estimated differences in GAD-7 scores between parents with versus without elevated depression scores. We hypothesized that the one-factor structure of the GAD-7 would best fit the data; longitudinal invariance would be established at the level of strong invariance; internal consistency would be good (α > 0.70); correlations with measures of depression and parent stress would be large (r ≥ 0.50), family functioning would be medium (r ≥ 0.30), and child psychopathology would be small (r ≥ 0.10); and differences in GAD-7 scores between parents with versus without elevated depression scores would be large (d ≥ 0.50).

2. Materials and Methods

2.1. Design and Sample

Data were from the Multimorbidity in Youth across the Life-course (MY LIFE) [22], a prospective study of children with chronic conditions. The methods for MY LIFE have been described in more detail elsewhere [22]. Briefly, children were recruited from outpatient clinics at a pediatric hospital in Canada and followed for 48 months (assessments at baseline, six, 12, 24, and 48 months). Children were included in MY LIFE if they were between the ages of 2 and 16 years at enrollment, they were diagnosed with a physical health condition that was chronic in nature (e.g., asthma, diabetes, epilepsy), and they and their parents had English language skills that allowed them to complete the study interviews and questionnaires. Physical health conditions were classified according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) [23].
Clinic nurses introduced this study to eligible families and invited them to speak with the research assistant after their appointment. For families interested in learning more about MY LIFE, the research assistant verified eligibility, described this study in further detail, and obtained written permission to contact them about formal enrollment in this study. The study coordinator then contacted parents by telephone to schedule a time for the baseline assessment. Data were collected using structured interviews and self-reported questionnaires on laptops (or paper for mail packages). Parent reports were collected for all participating children, and children 10 years of age or older completed self-reported assessments. Informed written consent was obtained from parents on behalf of themselves and all children. In addition, children aged 16 years provided informed written consent, and informed written assent was obtained from children between 7 and 15 years. Approval for this study was obtained from the Waterloo Human Research Ethics Board (31010; June 2017) and the Hamilton Integrated Research Ethics Board (2797; April 2017).
Of the n = 263 families recruited into MY LIFE, n = 63 (23.9%) did not complete the baseline and 48-month assessment and were excluded from these analyses. Analyses are based on complete data from n = 200 families (i.e., there were no missing data). Excluded families had a significantly lower proportion of parents who completed postsecondary education (57.1% vs. 82.0%, p < 0.01) and children who were female (34.9% vs. 51.5%, p = 0.02) and had children who were significantly older (10.6 vs. 9.1, p = 0.02) compared to included families (Table 1). There were no other differences between families included versus excluded in the analyses.

2.2. Measures

Generalized Anxiety Disorder-7. Parents completed the GAD-7 by responding to the frequency of the seven symptoms related to generalized anxiety [7]. Each symptom was preceded by the question “In the past two weeks, how often have you been bothered by…?” 1—feeling nervous, anxious, or on edge; 2—not being able to stop or control worrying; 3—worrying too much about different things; 4—trouble relaxing; 5—being so restless that it’s hard to sit still; 6—becoming easily annoyed or irritable; and 7—feeling afraid, as if something terrible might happen. Response options were rated on a four-point scale: 0 = not at all; 1 = several days; 2 = over half the days; and 3 = every day. Higher scores (range: 0 to 21) on the GAD-7 indicate more frequent symptoms.
Center for Epidemiological Studies Depression Scale. The Center for Epidemiological Studies Depression Scale (CES-D) [24] was completed by parents to measure symptoms of depression. The 20-item CES-D measures past-week symptoms across the domains of depressed affect, positive affect, somatic activity, and interpersonal relations using a four-point response scale: 0 = “rarely or none of the time (less than one day)”, 1 = “some or a little of the time (1–2 days)”, 2 = “occasionally or a moderate amount of time (3–4 days)”, and 3 = “most or all of the time (5–7)”. Total scores on the CES-D range from 0 to 60, such that higher scores indicate more symptom frequency or severity. A score of ≥ 16 on the CES-D represents a severity of symptoms indicative of clinical depression [25]. The CES-D has been extensively validated, including in samples of parents whose children have chronic conditions [26].
Parental Stress Scale. The 18-item Parental Stress Scale (PSS) assesses the extent to which individuals experience rewards, stressors, loss of control, and satisfaction in the context of being a parent [27]. Response options range from strongly disagree (1) to strongly agree (5). After recoding eight reverse-coded items, scores are summed to provide a total score ranging from 18 to 90. Higher scores on the PSS indicate more parental stress. The PSS has a record of use in parents of children with chronic conditions and robust psychometric properties across samples [26,27,28,29].
McMaster Family Assessment Device. The general functioning subscale of the McMaster Family Assessment Device (FAD) was used to assess communication, problem solving, behavioral control, affective responsiveness and involvement, and roles within families [30]. The 12 items are rated on a four-point scale of 0 (strongly agree) to 3 (strongly disagree), and positively worded items are reverse-coded such that higher scores indicate better family functioning. The FAD has solid psychometric properties in population and clinical samples of families [31,32].
Emotional Behavioural Scales–Brief. The emotional subscale (8 items) of the Emotional Behavioural Scales–Brief (EBS-B) was used to assess symptoms of affective and anxiety psychopathology in children [33]. Using a three-point response scale (0 = “never or not true”, 1 = “sometimes or somewhat true”, 2 = “often or very true”), children aged ≥ 10 years (n = 85) rated their symptoms over the past six months. Higher scores indicate a greater frequency or severity of symptoms. The EBS-B has been validated in population and clinical samples of children [33,34].

2.3. Statistical Analysis

Given evidence of uni- and multi-factor models of the GAD-7 [8,12,13,15,35,36,37] as well as the lack of evidence of its factor structure in parents of children with chronic conditions, exploratory factor analysis was used to identify competing models of the GAD-7 using baseline data. Given the ordinal response options to items comprising the GAD-7, exploratory factor models were estimated using the weighted least squares mean and variance-adjusted (WLSMV) with an oblique rotation of the factors. Models with one and two factors were estimated, and these factor structures were then replicated using confirmatory factor analysis to determine the best-fitting model. In addition to these first-order models, second-order and bi-factor models for models with two and three factors were also specified using confirmatory factor analysis. Model fit was estimated using the χ2 goodness-of-fit, root mean square error of approximation (RMSEA) and associated 90% confidence intervals (CIs), comparative fit index (CFI), and standardized root mean square residual (SRMR), whereby adequate fit was based on established thresholds [38,39,40]: χ2 p < 0.05, RMSEA ≤ 0.08, CFI ≥ 0.950, and SRMR < 0.080. Following previous reports [29], adequate model fit required at least three indices to meet their respective threshold, and parsimony was favored over more sophisticated models. If the initial model fit was poor, modification indices were reviewed and applied, if conceptually reasonable, and the model was re-estimated until fit was adequate. After the most appropriate model was selected, it was then fit to the 48-month data as the basis for testing longitudinal invariance.
Longitudinal invariance testing followed the confirmatory factor approach for ordinal outcomes, whereby increasingly stringent equality constraints were imposed between the two measurement occasions (i.e., baseline and 48 months) [41]. At the level of configural invariance, no equality constraints were specified on model parameters. Configural invariance tests whether the same underlying factor structure is observed at both measurement occasions. Next, weak invariance imposes equality constraints on item thresholds (τ). Invariance at this level provides evidence that the meaning of items that comprise the latent construct (in this case, symptoms of generalized anxiety) is the same over time. Weak invariance is a prerequisite for making valid longitudinal comparisons. Finally, strong invariance adds equality constraints to factor loadings (λ) in the model and, if established, suggests that individuals attribute the same meaning to the latent construct over time. When strong invariance is supported, mean item-level differences are explained by mean differences at the factor level.
Assessing longitudinal invariance was a two-step process. First, fit indices of the more constrained model were assessed using the above-specified thresholds. Second, changes in model fit indices were examined in reference to the following thresholds, which indicate a non-substantial worsening of fit: Δχ2 p ≥ 0.05, ΔRMSEA ≤ 0.015, ΔCFI ≥ −0.010, and ΔSRMR ≤ 0.030 [42,43]. Invariance was established if at least two change scores met these thresholds [32,44,45].
Evidence suggests that at least partial strong invariance is required for direct comparisons of scale scores over time (or across independent groups) [44]. Therefore, if results at any level of testing indicated non-invariance, modification indices were reviewed, and equality constraints were sequentially removed for non-invariant model parameters until fit and change in fit indices met specified thresholds. Simulation studies have shown that sample sizes of n = 200 had sufficient power (1 − β ≥ 0.80) for confirmatory factor models with as many as three factors, each with three indicators, and factor loadings of λ ≥ 0.65 [45].
After establishing longitudinal invariance of the GAD-7, additional psychometric properties of the scale at baseline and 48 months were assessed: internal consistency reliability was estimated using Cronbach α; convergent validity was estimated using Pearson correlation (r) with the CES-D, PSS, FAD, and EBS-B; and known-group validity was estimated using the t test of mean GAD-7 scores between parents with elevated (≥16) vs. low (<16) CES-D scores (differences were quantified using Cohen’s d). Data management and computation of descriptive statistics were performed using IBM SPSS 28. Factor analyses, including longitudinal invariance testing, were conducted using Mplus 8.8. Hypothesis tests were two-sided at α = 0.05.

3. Results

3.1. Sample Characteristics

At baseline, parents had a mean age of 40.3 (6.0) years, and n = 180 (90.0%) were female (Table 1). Parents were mostly White (n = 172, 86.0%) and partnered (n = 172, 86.0%), and most completed postsecondary education (n = 164, 82.0%). Nearly two-thirds of families had annual household incomes ≥ $90,000 (n = 125, 62.8%). At 48 months, a significantly larger proportion of the sample had annual household incomes ≥ $90,000 (n = 145, 72.5%, p < 0.01), depression scores on the CES-D increased (10.0 vs. 12.1, p < 0.01), and family functioning scores on the FAD decreased (28.3 vs. 27.0, p < 0.01). Child disability scores, as measured using the WHODAS 2.0, also decreased (19.2 vs. 17.0, p < 0.01).
There was no significant difference (t = 0.65, p = 0.518) in the GAD-7 scores between parents included (4.5 [4.3]) versus those excluded (4.9 [4.1]) from the analyses. Mean GAD-7 scores were not significantly different between baseline and 48 months (4.5 vs. 4.4, p = 0.84). Additional sample characteristics and comparisons are shown in Table 1.

3.2. Exploratory and Confirmatory Factor Models

Models with one, two, and three factors were specified with exploratory factor analysis. The exploratory model with three factors did not converge; fit indices of the one- and two-factor models are shown in Table 2. The factor structures of the one- and two-factor models were then specified using confirmatory factor analysis (Table 2). Both models initially showed inadequate model fit. Modification indices were reviewed, and correlations between the residuals of items one (nervous) and six (annoyed) (θ1.6) and items two (worrying) and seven (afraid) (θ2.7) were specified for the one-factor model, which improved model fit: χ2 = 19.16 (12), p = 0.085; RMSEA = 0.048 [0.000, 0.086]; CFI = 0.996; SRMR = 0.026. The omega hierarchical was 0.89.
For the two-factor model, correlations between the residuals of items two (worrying) and seven (afraid) (θ2.7) were specified: χ2 = 21.43 (12), p = 0.045; RMSEA = 0.063 [0.010, 0.105]; CFI = 0.994; SRMR = 0.029. The correlation between the two factors was very large (r = 0.86 [0.78, 0.94]), and the omega hierarchical was 0.86. Second-order and bi-factor models for confirmatory factor models with two and three factors were specified, but estimates could not be generated; the latent variable covariance matrix was not positive definite for these more sophisticated models. The one-factor model was selected for longitudinal invariance testing.
Fit indices for the one-factor model at 48 months were χ2 = 89.94 (14), p < 0.001; RMSEA = 0.165 [0.133, 0.198]; CFI = 0.909; SRMR = 0.096. Applying the same two correlations of item residuals from the baseline model improved fit: χ2 = 14.23 (12), p = 0.286; RMSEA = 0.030 [0.000, 0.081]; CFI = 0.997; SRMR = 0.035. The omega hierarchical was 0.88.

3.3. Longitudinal Invariance

The results of the tests for longitudinal invariance of the GAD-7 are shown in Table 3. In the configural invariance model, in which no parameter constraints were imposed over time, model fit was adequate, suggesting the same factor pattern in the GAD-7 at baseline and 48 months: χ2 = 188.23 (74), p < 0.001; RMSEA = 0.077 [0.063, 0.090]; CFI = 0.969; SRMR = 0.077. Initial fit of the weak invariance model was inadequate; modification indices suggested the release of constraints on the first threshold for items three to six (τ1.3; τ1.4; τ1.5; τ1.6) and the second threshold for item two (τ2.2) to improve model fit: χ2 = 250.01 (90), p < 0.001; RMSEA = 0.082 [0.070, 0.094]; CFI = 0.957; SRMR = 0.078. Changes in fit indices between the configural and modified weak invariance models met the criteria for establishing weak invariance: Δχ2 = 71.55 (16), p < 0.001; ΔRMSEA = 0.005; ΔCFI = −0.012; ΔSRMR = 0.001. Initial fit of the strong invariance model was also inadequate; constraints on factor loadings for item two and seven (λ2; λ7) were released, which improved model fit: χ2 = 215.49 (94), p < 0.001; RMSEA = 0.070 [0.058, 0.082]; CFI = 0.967; SRMR = 0.079. This modified model met the criteria for establishing strong invariance of the GAD-7 over time: Δχ2 = 3.00 (4), p = 0.558; ΔRMSEA = −0.012; ΔCFI = 0.010; ΔSRMR = 0.001.

3.4. Reliability and Validity

At baseline, internal consistency of the GAD-7 was α = 0.87. Correlations between the GAD-7 and CES-D (r = 0.81), PSS (r = 0.50), FAD (r = −0.28), and EBS-B (r = 0.23) ranged from small to very large in magnitude (p < 0.05 for all; Table 4). Mean scores on the GAD-7 were significantly higher (t = 14.9, p < 0.001) in parents with elevated CES-D scores (n = 50; 10.0 [4.1]) vs. parents with low CES-D scores (n = 150; 2.7 [2.5]). This difference was very large in magnitude (d = 2.4 [2.0, 2.8]).
At 48 months, internal consistency of the GAD-7 was α = 0.77. Correlations between the GAD-7 and CES-D (r = 0.80), PSS (r = 0.53), FAD (r = −0.26), and EBS-B (r = 0.22) were similar to those at baseline, ranging from small to very large in magnitude (p < 0.05 for all; Table 4). Mean scores on the GAD-7 were also significantly higher (t = 10.6, p < 0.001) in parents with elevated CES-D scores (n = 59; 9.1 [4.5]) vs. parents with low CES-D scores (n = 141; 2.5 [2.4]). The magnitude of this difference was very large (d = 2.1 [1.7, 2.4]).

4. Discussion

4.1. Summary of Findings

The findings from this study extend the psychometric properties of the GAD-7 as a valid and reliable measure of symptoms of generalized anxiety among parents of children with chronic conditions. There was support for a one-factor structure of the GAD-7, which was invariant over time; internal consistency reliability was acceptable based on established thresholds [46]; and scores were validated against measures of depression, parental stress, family functioning, and child psychopathology. GAD-7 scores were stable from baseline to the 48-month follow-up.
The one-factor model of the GAD-7 is consistent with previous reports in different adult populations [12,15,36,47,48], and the large omega hierarchical supports the use of a composite sum score in quantifying symptoms [37]. There was also evidence to support a two-factor model [8,13,35]; however, fit was somewhat worse compared to the one-factor model, and preference for model parsimony was specific a priori. In contrast, evidence from the current study did not replicate previous reports, which identified affective (items 1 to 3) and somatic (items 4 to 7) factors within the two-factor model of the GAD-7 [8,13,15]. That is, parents of children with chronic conditions may not delineate between these two latent constructs in their reports of generalized anxiety symptomatology. This may result from their caregiving context, whereby parents subsume somatic sequalae indistinguishable from the health conditions experienced by their children (e.g., pain and discomfort result in difficulty relaxing or becoming restless, frustration and annoyance from unknown prognoses or with treatment adherence) and apply this interpretive lens to their own symptoms. Future research can investigate this hypothesis by testing measurement invariance between parents of children with versus without chronic conditions.
Partial longitudinal invariance of the GAD-7 was demonstrated over 48-months, which is sufficient for latent mean comparisons over time [49]. This property of the GAD-7 is of particular importance to health professionals and individuals because establishing longitudinal invariance suggests that, for parents of children with chronic conditions, symptoms represent the same underlying construct—generalized anxiety—over time. Thus, changes in the GAD-7 scores are indicative of true change in symptoms and are not a function of differential interpretation of items over time. This finding positions the GAD-7 as a psychometrically robust measure for modeling the natural course of anxiety symptoms exhibited by parents of children with chronic conditions, knowledge which can then be used to identify critical periods of elevated risk for generalized anxiety disorder as well as evaluate treatment effectiveness for these individuals.
The GAD-7 demonstrated a linear change in correlation effect size from proximal (i.e., depression) to more distal constructs (i.e., child psychopathology), consistent with the hypothesis. The co-occurrence of anxiety and depression symptoms is well-established [50], and the findings also provide support for applying a composite measure of these symptoms to describe overall psychological distress among parents of children with chronic conditions [51]. From a research perspective, this is helpful in cases where sample sizes are small and the number of covariates in a model must be limited as well as to avoid collinearity between the GAD-7 and the CES-D (and likely other measures of these constructs). The findings are also consistent with previous reports of elevated symptoms of generalized anxiety, elevated parent stress, and poorer family functioning [52,53,54,55]. The modest correlation with the EBS-B is consistent with evidence from a systematic review showing that parental anxiety is associated with increased risk of emotional and behavioral difficulties in children [56].
Because of its brevity, low resource cost, and strong psychometric properties, the GAD-7 is a viable scale that can be used as part of a core set of measures in assessment screening for mental health problems among parents of children with chronic conditions. Its associations with measures of parent stress, family functioning, and child psychopathology suggest that screening for generalized anxiety in parents of children with chronic conditions should be adopted in the context of family centered models of pediatric health services [1]. Supporting parent mental health, with a focus on anxiety, has tangible impacts on individual [4,57,58,59] and child health outcomes [2,56,60] in this vulnerable population.

4.2. Limitations

The findings from this study should be considered in the context of its limitations. First, there were no additional measures of parent generalized anxiety with which to validate the GAD-7, a consequence of conducting a secondary data analysis. Second, the assessment schedule in MY LIFE did not permit an examination of test–retest reliability of the GAD-7. Third, it was not possible to test scoring thresholds on the GAD-7 that indicate clinically relevant symptomatology or to quantify the minimal clinically important difference of the GAD-7. Fourth, because participants were recruited from a single pediatric hospital, it is possible that the sample does not represent all parents of children with chronic conditions; however, a comparison with a population-based sample of these families suggests few sociodemographic differences [20]. Fifth, the sample size was not adequate to use a split-sample approach to estimate exploratory factor models. Sixth, selection bias may be present on account of differences in the education level between included and excluded participants. It is unclear if findings generalize to parents with lower educational attainment.

5. Conclusions

This study contributed to the knowledge base on the psychometric properties of the GAD-7 by generating novel evidence that the GAD-7 demonstrates acceptable validity and reliability in measuring symptoms of generalized anxiety disorder in parents of children with chronic conditions over time. Researchers and health professionals using the GAD-7 can be confident that changes in scores over time represent real differences in parent symptoms. Assessing parent mental health, with an emphasis on anxiety, with a psychometrically sound and efficient scale is critical in the provision of family centered pediatric services for these families. The GAD-7 satisfies these necessary conditions.

Author Contributions

Conceptualization, M.A.F.; Methodology, M.A.F.; Formal Analysis, M.A.F.; Investigation, M.A.F., M.E., K.T.; Data Curation, M.A.F.; Writing—Original Draft Preparation, M.A.F.; Writing—Review and Editing, M.E., K.T.; Funding Acquisition, M.A.F. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported by grants from the Canadian Institutes of Health Research (PJT-148602, PAV-190378, PJA-192200, PJT-195853). Mark Ferro is supported by the Canada Research Chairs Program.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Waterloo Human Research Ethics Board (protocol code: 31010; date of approval: June 2017) and the Hamilton Integrated Research Ethics Board (protocol code: 2797; date of approval: April 2017).

Informed Consent Statement

Informed consent was obtained from all subjects involved in this study. Informed written consent was obtained from parents on behalf of themselves and all children. In addition, children aged 16 years provided informed written consent, and informed written assent was obtained from children between 7 and 15 years.

Data Availability Statement

Public sharing of data is not available to protect participant privacy. Requests for data access can be made to the corresponding author.

Acknowledgments

The authors gratefully acknowledge the children, parents, hospital staff, and health professionals at McMaster Children’s Hospital without whose participation the MY LIFE study would not have been possible. We especially thank Jessica Zelman for coordinating the study.

Conflicts of Interest

We have no known conflicts of interest to disclose.

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Table 1. Characteristics of the study sample.
Table 1. Characteristics of the study sample.
CharacteristicExcluded (n = 63)Analytic (n = 200)P, Analytic Comparison *P, Temporal Comparison †
Baseline48 Months
Parent
 Age, years41.2 (8.1)40.3 (6.0)44.4 (6.0)0.45<0.01
 Female57 (90.5)180 (90.0)180 (90.0)0.91
 Born outside Canada8 (12.7)32 (16.0)32 (16.0)0.52
 Biological parent62 (98.4)196 (98.0)196 (98.0)0.83
 White60 (95.2)172 (86.0)172 (86.0)0.07
 Partnered56 (88.9)172 (86.0)175 (87.5)0.560.34
 Postsecondary graduate36 (57.1)164 (82.0)164 (82.0)<0.01
 Income ≥ $90,00032 (50.8)125 (62.8)145 (72.5)0.09<0.01
 Anxiety, GAD-74.9 (4.1)4.5 (4.3)4.4 (4.4)0.520.84
 Depression, CES-D12.7 (9.2)10.0 (9.6)12.1 (10.2)0.06<0.01
 Parenting stress, PSS34.9 (8.8)36.6 (8.9)36.3 (9.6)0.210.67
 Family functioning, FAD27.3 (5.7)28.3 (5.3)27.0 (6.7)0.20<0.01
Child
 Age, years10.6 (4.4)9.1 (4.1)13.2 (4.1)0.02<0.01
 Female22 (34.9)103 (51.5)103 (51.5)0.02
 Born outside Canada3 (4.8)12 (6.0)12 (6.0)0.71
 Illness duration, years4.8 (4.7)4.2 (3.8)8.3 (3.8)0.41<0.01
 Illness type 0.11
  Dermatological3 (4.8)20 (10.0)20 (10.0)
  Endocrine16 (25.4)22 (11.0)22 (11.0)
  Gastroenterological7 (11.1)27 (13.5)27 (13.5)
  Hematological7 (11.1)22 (11.0)22 (11.0)
  Neurological1 (1.6)11 (5.5)11 (5.5)
  Respiratory12 (19.1)42 (21.0)42 (21.0)
  Rheumatological17 (27.0)56 (28.0)56 (28.0)
Disability, WHODAS 2.019.5 (6.3)19.2 (6.9)17.0 (6.5)0.76<0.01
Note: Data are frequency (percentage) except for age, illness duration, disability, GAD-7, CES-D, parent stress, and family functioning, which are mean (standard deviation). * Excluded vs. included at baseline. † Baseline vs. 48 months.
Table 2. Exploratory and confirmatory factor models of the GAD-7.
Table 2. Exploratory and confirmatory factor models of the GAD-7.
Modelχ2 (df)RMSEA [90% CI]CFISRMR
Exploratory models
One factor84.00 (14), p < 0.0010.158 [0.126, 0.192]0.9550.084
Two factor37.47 (8), p < 0.0010.136 [0.094, 0.181]0.9810.061
  F1: 1, 3, 4, 5, 6
  F2: 2, 7
Confirmatory models
One factor84.00 (14), p < 0.0010.158 [0.126, 0.192]0.9550.055
One factor, modified *19.16 (12), p = 0.0850.048 [0.000, 0.086]0.9960.026
Two factor38.06 (13), p = 0.0010.098 [0.063, 0.135]0.9840.041
Two factor, modified †21.43 (12), p = 0.0450.063 [0.010, 0.105]0.9940.029
Note: CI, confidence interval. * Modification was the correlation of residuals for items 1 and 6 (θ1.6) and items 2 and 7 (θ2.7). † Modification was the correlation of residuals for items 2 and 7 (θ2.7).
Table 3. Longitudinal invariance of the GAD-7 over 48 months.
Table 3. Longitudinal invariance of the GAD-7 over 48 months.
Modelχ2 (df)RMSEA [90% CI]CFISRMRΔχ2 (df)ΔRMSEAΔCFIΔSRMR
Configural188.23 (74)
<0.001		0.077 [0.063, 0.090]0.9690.077----
Weak347.76 (95)
<0.001		0.101 [0.089, 0.112]0.9310.086180.21 (21)
<0.001		0.024−0.0380.009
Weak, modified *250.01 (90)
<0.001		0.082 [0.070, 0.094]0.9570.07871.55 (16)
<0.001		0.005−0.0120.001
Strong268.40 (96)
<0.001		0.083 [0.071, 0.094]0.9530.10032.74 (6)
<0.001		0.001−0.0040.022
Strong, modified †215.49 (94)
<0.001		0.070 [0.058, 0.082]0.9670.0793.00 (4)
0.558		−0.0120.0100.001
Note: CI, confidence interval. * Constraints on the first threshold for items three to six (τ1.3; τ1.4; τ1.5; τ1.6) and the second threshold for item two (τ2.2) were released. † Constraints on factor loadings for item two and seven (λ2; λ7) were released.
Table 4. Convergent validity of the GAD-7 at baseline and 48 months.
Table 4. Convergent validity of the GAD-7 at baseline and 48 months.
GAD-7CES-DPSSFADEBS-B
Baseline0.81 [0.75, 0.85]0.50 [0.39, 0.60]−0.28 [−0.41, −0.15]0.23 [0.02, 0.42]
48 months0.80 [0.74, 0.84]0.53 [0.42, 0.63]−0.26 [−0.38, −0.18]0.22 [0.01, 0.41]
Note: Data are r [95% confidence interval]. Correlations between the GAD-7 and EBS-B are based on the subsample of children age-eligible (i.e., ≥10 years) to provide self-reports (n = 85).
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Ferro, M.A.; Elgie, M.; Tamkee, K. Psychometric Properties of the GAD-7 in Parents of Children with Chronic Conditions. Psychiatry Int. 2026, 7, 77. https://doi.org/10.3390/psychiatryint7020077

AMA Style

Ferro MA, Elgie M, Tamkee K. Psychometric Properties of the GAD-7 in Parents of Children with Chronic Conditions. Psychiatry International. 2026; 7(2):77. https://doi.org/10.3390/psychiatryint7020077

Chicago/Turabian Style

Ferro, Mark A., Melissa Elgie, and Karina Tamkee. 2026. "Psychometric Properties of the GAD-7 in Parents of Children with Chronic Conditions" Psychiatry International 7, no. 2: 77. https://doi.org/10.3390/psychiatryint7020077

APA Style

Ferro, M. A., Elgie, M., & Tamkee, K. (2026). Psychometric Properties of the GAD-7 in Parents of Children with Chronic Conditions. Psychiatry International, 7(2), 77. https://doi.org/10.3390/psychiatryint7020077

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