The advent of Electroconvulsive Therapy (ECT) as a potent treatment for severe psychiatric disorders such as major depression and treatment-resistant schizophrenia has been transformative in mental health care. However, despite its efficacy, ECT carries a significant psychological burden owing to the anxieties and fears associated with the procedure itself. A groundbreaking study conducted in Iran has now brought to light a culturally and linguistically validated instrument aimed at quantifying this very anxiety: the Farsi version of the Electroconvulsive Therapy-Related Anxiety Questionnaire (ERAQ).
The research, recently published in the esteemed journal BMC Psychiatry, meticulously details the psychometric validation of the ERAQ tailored for Farsi-speaking populations. This is a pivotal advancement because anxiety toward ECT can dramatically influence treatment adherence and outcomes, making reliable assessment tools indispensable for clinicians. The team behind this study embarked on a rigorous process to ensure that the translated ERAQ not only retained its original integrity but also resonated with the cultural nuances inherent in Iranian patients’ experiences.
Central to this research was the forward-backward translation methodology, a gold standard in cross-cultural questionnaire adaptation. This involved translating the questionnaire from English to Farsi and then back-translating it to English to identify discrepancies and ensure semantic equivalence. Moreover, the researchers engaged experts and patients alike to perform qualitative and quantitative face and content validity assessments, ensuring that the items were both comprehensible and relevant in the new linguistic context.
The backbone of the study was a robust sampling of 300 patients, equally split into two cohorts for exploratory and confirmatory factor analyses. These statistical strategies are crucial in establishing the underlying structure of the questionnaire and verifying its hypothesized dimensionality. In the first phase, exploratory factor analysis revealed the removal of one item due to insufficient factor loading, resulting in a refined 16-item instrument. These items clustered distinctly into three factors: life disruption, socio-physical disruption, and memory disruption, capturing the multi-faceted nature of ECT-related anxiety.
Confirmatory factor analysis further substantiated the proposed three-factor model, demonstrating excellent model fit indices. This statistical confirmation reassures mental health professionals that the Farsi ERAQ can reliably differentiate among the distinct anxiety domains experienced by patients undergoing or anticipating ECT. The nuanced understanding of these domains empowers clinicians to tailor interventions more precisely and mitigate the specific anxieties hampering treatment engagement.
Beyond construct validity, the study probed deeper into convergent and discriminant validity—a testament to the thoroughness of this psychometric investigation. Composite reliability and average variance extracted values confirmed that the questionnaire items coherently measure their intended constructs without excessive overlap. Additionally, the heterotrait-monotrait ratio validated the discriminant properties of the ERAQ, ensuring each factor captures a distinct aspect of anxiety without redundancy.
Reliability is as critical as validity in psychological measurement, and the Farsi ERAQ excelled in this domain as well. Both Cronbach’s alpha and McDonald’s omega coefficients exceeded acceptable thresholds, indicating strong internal consistency. In practical terms, this means the questionnaire’s items consistently reflect the anxiety traits they purport to measure, offering reliable data for clinical and research applications.
The implications of these findings transcend mere academic curiosity; they mark a substantial stride toward personalized mental health care for Iranian patients encountering ECT. By accurately assessing the specific anxieties related to ECT, healthcare teams can formulate targeted psychoeducational and supportive interventions, potentially improving treatment adherence and psychological wellbeing. Patients’ voices and experiences are intricately woven into this assessment framework, reflecting a patient-centered approach to psychiatric care.
Ecologically, the Farsi ERAQ fills a crucial void in non-English psychometric tools, addressing the chronic scarcity of localized assessment instruments in Middle Eastern mental health research. Cultural perceptions, stigma, and linguistic barriers often hinder effective psychiatric assessment, and tools like the ERAQ empower clinicians and researchers to circumvent these obstacles. This study sets a precedent for future translations and validations of mental health questionnaires into diverse languages and cultural contexts.
Moreover, the ERAQ’s multidimensional design underscores the intricate relationship between psychological and physiological experiences of anxiety in ECT. The factors encompassing life disruption and socio-physical disruption highlight how anxiety extends beyond fear of the procedure itself to broader impacts on daily functioning and social integration. Meanwhile, memory disruption anxiety reflects prevalent concerns about cognitive side effects—a critical dimension influencing patients’ anticipation and acceptance of ECT.
This study, conducted amidst the emerging mental health research landscape in Mashhad, Iran, illustrates the growing commitment to refining psychiatric tools through empirical rigor. The researchers’ approach combined advanced statistical modeling with culturally sensitive validation processes, an exemplar pathway for similar studies worldwide. They not only expanded the utility of the ERAQ but also elevated the discourse surrounding ECT-related anxiety assessment globally.
As mental health professionals continue to grapple with the challenge of providing compassionate and effective care, instruments like the Farsi ERAQ are invaluable. They offer an evidence-based lens through which complex emotional and cognitive reactions to controversial yet efficacious treatments can be understood and addressed comprehensively. This work heralds a new chapter in bridging the gap between procedural efficacy and patient psychological comfort.
In essence, this psychometric evaluation is more than a methodological exercise—it represents hope and progress for patients who face ECT with trepidation. The ability to measure and subsequently manage anxiety specific to ECT unveils possibilities for enhanced therapeutic alliances, improved treatment compliance, and ultimately, better mental health outcomes. Such advancements reiterate the critical role of culturally adaptive research instruments in global psychiatric practice.
As this study gains recognition, it is poised to inspire parallel efforts in other languages and regions, fostering a more inclusive and precise global understanding of ECT-related anxiety. This aligns with the broader movement toward personalized psychiatry, recognizing that mental health care must accommodate diverse cultural narratives and individual experiences. The Farsi ERAQ model serves not only Iranian populations but potentially provides a framework adaptable worldwide.
With its rigorous methodological design, comprehensive validation measures, and practical clinical relevance, the Farsi version of the Electroconvulsive Therapy-Related Anxiety Questionnaire sets a new benchmark in psychiatric measurement science. It exemplifies how culturally sensitive research combined with sophisticated statistical analysis can yield tools that directly enhance patient care and treatment outcomes in psychiatry.
Subject of Research: Psychometric validation of a Farsi-translated questionnaire assessing anxiety related to Electroconvulsive Therapy (ECT).
Article Title: Psychometric evaluation of the Farsi version of the electroconvulsive therapy related anxiety questionnaire.
Article References:
Mirhosseini, S., Sharif-Nia, H., Gharehbaghi, M. et al. Psychometric evaluation of the Farsi version of the electroconvulsive therapy related anxiety questionnaire. BMC Psychiatry 25, 729 (2025). https://doi.org/10.1186/s12888-025-07169-5
Image Credits: AI Generated
DOI: https://doi.org/10.1186/s12888-025-07169-5
