In a groundbreaking new study, researchers have explored the prevalence of anxiety symptoms within a diverse Ugandan population, shedding light on mental health in a region often underrepresented in psychiatric research. Utilizing culturally adapted tools, the study rigorously evaluated the psychometric properties of the Generalized Anxiety Disorder-7 scale (GAD-7), translated into two major Ugandan languages, Luganda and Runyoro. This effort marks one of the largest and most robust investigations into anxiety symptoms in sub-Saharan Africa, offering crucial insights into the measurement and incidence of anxiety disorders in this setting.
The study centered on the essential premise that mental health assessment tools require cultural and linguistic validation to yield meaningful data. The GAD-7, a widely used self-report instrument designed to screen for generalized anxiety disorder, had previously not undergone thorough testing in many African contexts. Recognizing the limitations of direct translations and the need for culturally specific expressions of anxiety, the research team meticulously translated the scale into Luganda and Runyoro, two languages extensively spoken in Uganda, ensuring that local idiomatic expressions and conceptual nuances were considered.
Data collection spanned the years 2021 to 2022 and was conducted through the African Medical and Behavioural Sciences Organization (AMBSO) Population Health Surveillance. This cohort study enlisted 4107 participants ranging in age from 13 to 80 years, with 2206 speaking Runyoro and 1901 speaking Luganda. The use of face-to-face interviews for administering the GAD-7 alongside the Patient Health Questionnaire-9 (PHQ-9) allowed for a comprehensive assessment of anxiety and depressive symptoms, while socio-demographic data further contextualized the findings within participants’ lived experiences.
One of the pivotal technical achievements of the study was the confirmatory factor analysis (CFA), which tested the hypothesized one-factor structure of the GAD-7 in both languages. The CFA results affirmed that the translated scales retained their structural integrity, indicated by fit indices such as RMSEA of 0.097 and high values for CFI and TLI metrics in both Runyoro and Luganda versions. These results signify that the core construct of generalized anxiety remains consistent across linguistic adaptations, validating the scale’s use in these populations.
In addition to structural validation, internal consistency was assessed using Revelle’s omega total and Cronbach’s alpha, standard measures of reliability in psychometrics. The Luganda version demonstrated excellent internal consistency with an omega total of 0.90, while the Runyoro version also showed commendable reliability with an omega total of 0.85. These figures highlight the scales’ robustness in capturing anxiety symptoms reliably in these Ugandan language contexts without degradation of measurement precision.
Concurrent validity, an evaluation of how well the GAD-7 correlates with related constructs, was examined via Pearson’s correlation with the PHQ-9, a validated depression screening tool. Both language versions exhibited strong positive correlations (r = 0.67 for Runyoro; r = 0.71 for Luganda), confirming that anxiety symptoms as measured by GAD-7 appropriately align with depression symptoms, underscoring the scale’s construct validity in this cultural setting.
An especially noteworthy finding from this extensive survey was the relatively low prevalence of probable anxiety disorders, with only 1.5% of participants scoring above the established GAD-7 cut-off of ≥10. This rate was stratified by gender, revealing a striking disparity: 0.5% among males and 2.2% among females. These figures suggest a lower burden of clinically relevant anxiety symptoms than might be expected, although the authors prudently caution that such findings may be influenced by underreporting or sample biases, particularly if individuals with more severe symptoms were less likely to participate.
The study’s nuanced conclusions emphasize the importance of culturally sensitive measurement tools while acknowledging limitations inherent to psychiatric epidemiology in low-resource settings. One hypothesis raised by the researchers is that the GAD-7, while psychometrically sound, might not capture all locally salient idioms and manifestations of anxiety, which could result in underestimation of the true clinical burden. Moreover, it is posited that social stigma and limited mental health literacy may further contribute to the low reported prevalence.
This research contributes significantly to the global mental health literature by presenting a validated, scalable tool for anxiety screening tailored to Ugandan populations. Given the increasing attention to mental health as a critical component of global health, these translations and validations enable public health professionals and clinicians in Uganda and similar contexts to better identify individuals in need of psychological support.
Furthermore, the large sample size and rigorous methodology elevate this study above many prior local validation attempts, providing a foundation for subsequent longitudinal and intervention-based research. Future work can build upon these findings to explore the nuanced relationship between anxiety symptoms, sociocultural variables, and health outcomes, as well as to refine screening instruments to encompass local idiomatic expressions more fully.
Given the rising awareness of mental health challenges globally, studies like this underscore that culturally relevant tools are indispensable for accurate diagnosis and monitoring. The work also highlights the necessity for comprehensive mental health infrastructure that spans from assessment to treatment, particularly in low- and middle-income countries where mental health services remain sparse.
In summary, this landmark Ugandan study affirms the efficacy of the GAD-7 scale adaptations and provides a valuable epidemiological snapshot of anxiety symptom prevalence, laying groundwork for improved mental health care delivery. While anxiety disorders appear relatively rare in this sample, the need for further clinical validation and culturally informed assessment remains critical to advancing the mental health agenda on the African continent.
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Subject of Research:
The prevalence of anxiety symptoms in a Ugandan population and the psychometric evaluation of the Generalized Anxiety Disorder-7 scale (GAD-7) translated into Luganda and Runyoro languages.
Article Title:
Prevalence of anxiety symptoms in a Ugandan population sample and psychometric properties of the Generalized Anxiety Disorder-7 scale (GAD-7) in Luganda and Runyoro
Article References:
Ziegel, L., da Silva, C.E., Bulamba, R. et al. Prevalence of anxiety symptoms in a Ugandan population sample and psychometric properties of the Generalized Anxiety Disorder-7 scale (GAD-7) in Luganda and Runyoro. BMC Psychiatry 25, 502 (2025). https://doi.org/10.1186/s12888-025-06944-8
DOI:
https://doi.org/10.1186/s12888-025-06944-8
