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A contribution to the French validation of the clinical anxiety scale amongst health care workers in Switzerland



Anxiety disorders are frequent but remain often underdiagnosed and undertreated. Hence, valid screening instruments are needed to enhance the diagnostic process. The Clinical Anxiety Scale (CAS) is a 25-item anxiety screening tool derived from the Hamilton Anxiety Scale (HAM-A). However, this scale is not available in French. The General anxiety disorder − 7 (GAD-7) scale, which has been validated in French, is a 7-item instrument with good psychometric properties. This study contributes to the validation of an adapted French version of the CAS, using the GAD-7 as the reference.


A forward-backward English-French-English translation of the CAS was performed according to standard practice. The French versions of the CAS and GAD-7 were completed by 127 French speaking healthcare professionals. CAS internal consistency was assessed using Crohnbach’s alpha, and test-retest reliability was tested after 15 days in a subsample of 30 subjects. Convergent validity with GAD-7 was assessed using Pearson’s correlation coefficient. Test-retest reliability was explored using one-way random effects model to calculate the intra-class correlation coefficient (ICC).


French CAS showed excellent internal consistency (Cronbach’s alpha 0.97), high convergent validity with GAD-7 (Pearson’s R 0.81, p < 0.001), and very good test-retest reliability (ICC = 0.97, 95% CI 0.93–0.98).


The proposed French version of the CAS showed high reliability and validity that need to be further investigated in different populations.

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Anxiety disorders i.e., experiencing symptoms of excessive fear and worry that result in behavioural disturbances, are leading mental health problems [1]. According to a recent epidemiological survey by Yang et al. [2] the number of persons newly diagnosed with anxiety disorders has increased over the last 30 years. Moreover, the burden of anxiety and major depressive disorders raised further during the COVID-19 pandemic [3].

Anxiety disorders are associated with adverse health outcomes, contribute to poor quality of life and increased mortality [4]. According to the Global Burden of Diseases 2019 Study, anxiety disorders are amongst the leading causes of disability, responsible for about 28.7 million disability-adjusted life years [5]. In Switzerland we are witnessing a rise in the incidence of psychological distress, and 11.9% of the women ant 7.5% in 2022, suffer from anxiety disorder [38].

Early diagnosis and intervention may reduce the disease burden and improve the quality of life of patients affected by anxiety [6]. Yet, despite the high prevalence and substantial disability associated with these disorders, they often remain underdiagnosed and undertreated [7,8,9]. Hence, there is a need for valid and accurate screening instruments to enhance the diagnostic process.

Several screening instruments have been developed to effectively identify patients with anxiety disorders, however only few are adapted for local languages and culture. The broadly used scales for anxiety (such as HAD or GAD7) have been validates in French population [3940], but none in the French speaking Switzerland.

One of the most widely used scale is the General Anxiety Disorder-7 (GAD-7), a seven-item instrument with good psychometric properties [42] (Cronbach’s alpha 0.92, test-retest reliability, intra-class correlation 0.83). The convergent validity of the GAD-7, was demonstrated by its correlations with two anxiety scales: the Beck Anxiety Inventory (r = 0.72) and the anxiety subscale of the Symptom Checklist-90 (r = 0.74) [13].

Since its development by Spitzer et al., GAD-7 has been validated in different populations such as psychiatric patients, patients from primary care clinics, patients affected by specific diseases or health problems such as epilepsy, heart failure, or traumatic brain injury, as well as in the general population [14,15,16,17,18,19,20]. GAD-7 is translated in more than 50 languages. The scale is short and easy to complete. The GAD-7 targets mainly the General Anxiety disorder and does not include specific features of other types of anxiety disorders such as panic, phobias, and post-traumatic stress disorders. Here, we selected the GAD-7 as our standard reference due to its high specificity and sensitivity for detecting anxiety [22]. This choice reduces the risk of potential bias stemming from the inclusion of psychotic symptoms or depression, as demonstrated in previous research with other scales as the SCL-90R [36]. Therefore, the GAD-7 is well-suited for identifying anxiety within a general population and aligns with the objectives of our study.

The Clinical Anxiety Scale (CAS) is a 25-item tool derived from the Hamilton Anxiety Scale (HAM-A). HAM-A is still used in clinical practice and in research and comprises items covering a wide range of anxiety including multiple somatic symptoms as well as some depressive symptoms. HAM-A contains 14 items, each scored on a scale of 0 (not present) to 4 (severe). This scoring system results in a total score range of 0 to 56, which reflects the varying intensity of anxiety symptoms However, some concerns have been raised on its inaccuracy in discriminating somatic anxiety from antidepressant side effects [10], and for its time-consuming and potentially unreliable administration by physicians [11, 27].

CAS is simpler in comparison to HAM-A. CAS comprises predefined questions without subscales, making it straightforward for self-administration, unlike HAM-A which need to be administered by a health care professional. It targets essentially anxiety symptoms, thus excluding the potential bias of questions related to depression. CAS assesses the level of anxiety arising from identified situations or events. Compared to GAD-7, CAS is longer and combines a wider range of questions concerning panic and phobia, and few somatic symptoms of anxiety [12]. Thus, CAS could be especially useful to detect specific types of anxiety rather than general anxiety disorder.

The psychometric properties of CAS established in the original validation article [12] are very good. CAS achieved a Cronbach Alpha Coefficient of 0.94. Its discriminant validity of 0.77 was better, compared to other scales (Index of Family Relations, General Contentment Scale, Psycho-Social Screening Package, Mobility Inventory Agoraphobia, and Michigan Alcoholism Screening Test). It is well correlated and has a good concurrent validity with the anxiety subscale (HAD-A) of the HAD (Hospital Anxiety Depression scale) (correlation coefficients 0.69–075), [31,32,33] and good temporal stability [34].

Despite these positive characteristics, CAS is only available in English. Furthermore, studies examining the factorial structure of this scale are lacking.

The aim of this study was to develop and validate a French version of the CAS, to examine the internal consistency, the factorial structure with principal component analysis, as well as to assess the construct validity using GAD-7 as a reference and evaluate its test-retest reliability.


Translation of the scale

Two bilingual experts performed a forward-backward English-French-English translation of the CAS. The two translated forms displayed very good similarity. The final version was reviewed by a bilingual psychologist and subsequently used in the study.

Procedure and participants

The CAS includes 25 items, with answers ranging from 1 (rarely) to 5 (very often). After reverse scoring of the positively formulated items, the final scores range from 0 to 100 with higher scores indicating higher anxiety. The final score was calculated according to the formula provided in the original CAS validation paper [21]. A cut-off of 30 or more defines clinically significant anxiety.” [12, 21].

The GAD-7 comprises 7 items and the global score ranges from 0 to 21, with higher scores indicating higher anxiety. A score of 8 or more is usually proposed to define clinically significant anxiety [22].

Although 142 subjects were eligible for the study, only 127 subjects were recruited as 15 refused to participate. All participants were health care professionals working in the Lausanne University Hospital (CHUV) in different divisions: geriatrics, internal medicine, and psychiatry. The inclusion criteria were age 18 years or older, native French speakers or fluent in French, agreeing to participate. The participants were recruited between 21st September 2021 and 02nd February 2022.

Data on participants’ age, gender, and professional role was collected. All the participants completed the two self-administrated scales (CAS and GAD-7), using individual paper questionnaires. The two scales, completed in random order [35], had an identical response rate.

CAS test-retest reliability was examined in 30 participants (24%) who were asked to complete again both questionnaires 15 [43] days after their initial assessment, the sample size needed was calculated according to Walter et al. [36]. The time needed for the self-administration of the two questionnaires was measured subsequently in six subjects.

Statistical analysis

The sample size was estimated according to Tabachnick et al. [23] - five subjects were needed to validate each item of the analysed scale, resulting in a sample size of 125 participants.

To evaluate the adequacy of the data for Factor Analysis, the Kaiser-Meyer-Olkin (KMO) Test and the Bartlett sphericity test were carried out. Subsequently, we carried out an exploratory principal components analysis with Varimax rotation with Kaiser normalization was performed on the responses to the 25 items of the CAS, to identify its factorial structure. Principal component and not factorial analyses was chosen because of the nature of the data obtained, the data did not exhibit clear underlying factors, and our goal was to capture as much variance as possible with a smaller number of variables. The Varimax rotation was chosen to avoid cross loadings on more than one dimension thus simplifying the factor structure and making each factor more interpretable in isolation. All CAS items were allowed to freely load during exploratory factor analysis to identify all factors present. Next, each factor loading was compared to determine the magnitude of difference. Differences in magnitude greater than 0.03 was set as the threshold for a stable factor structure [45].

The correlation between CAS and the GAD-7 was evaluated by Pearson’s correlation coefficient.

Test-retest reliability was assessed using a one-way random effects model to calculate the intraclass correlation coefficient (ICC), The intraclass correlation coefficient (ICC) is defined as a ratio of variability between subjects to the total variability including subject variability and error variability; as the error term decreases, the ICC moves from 0 to 1 indicating perfect reliability [24].

All the analyses were performed using SPSS 27.0 for Windows.


Overall, 127 of the 142 eligible health care professionals completed both questionnaires (response rate 89.4% for both instruments). Participants’ mean age was 35 ± 11 years, 61% were women, 45.6% were nurses, 22.0% physicians, 32.2% from other health professions (physical and occupational therapists, medical secretaries, medical and nurse students).

There was no significant difference in the CAS and GAD-7 scores between men and women as well as between the different professional categories (data not shown).

The mean time to complete the CAS and the GAD-7 were 120 s and 45 s, respectively.

The KMO (0.851) and the Bartlett sphericity tests (p < 0.001) indicated that the sample size was adequate and suitable for factor analyses.

The principal component factor analysis revealed seven principal components, however as there was only 1-item loading on the seventh factor (“I am free from senseless or unpleased thoughts”), the principal component analyses was carried out forcing the items on 6 loading according to Costello et al. [37].

This 6-factor structure of the CAS explained 66.83% of its total variance.

The first factor, which explained 27.3% of the variance, encompassed the seven positively formulated questions related to “not worrying”. Factor 2 which explain 17.12% of the variance had significant loadings on nine items related to Anxiety. Factor 3 significantly loaded on eight items associated to panic and phobia that explained 8.31% of the variance. Factor 4 included five items associated to Panic-Related Symptoms that explained 5.44% of the variance. Five items associated to Physical Symptoms loaded significantly on Factor 5 that explained 4.5% of the variance, and finally only four items associated to Antidepressant and Tranquilizer Use on Factor 6 that explained 4.2% of the total variance, respectively.

The result of our study supports a 6-factor structure of the CAS, each of which is associated with different components of anxiety. These factors can provide valuable insights into the multidimensional nature of anxiety, as follows: Factor 1: General Anxiety “I feel calm”; “I feel confident about the future”, “I feel relaxed and in control of myself”, “I feel generally anxious”. Factor 1 seems to be associated with general or non-specific feelings of anxiety. These items reflect a sense of overall anxiety or a lack of calmness and confidence about the future. This factor may capture a more generalized state of anxiety. Factor 2: Tension and Nervousness “I feel tense”; “I feel nervous”; “I feel nervousness or shakiness inside”. Factor 2 appears to be associated with feelings of tension and nervousness. These items reflect the psychological and physiological manifestations of anxiety. Factor 3: Fear and Avoidance: “I feel suddenly scared for no reason”; “I feel afraid to go out of my house alone”; “I feel afraid without good reason”; “Due to my fears, I unreasonably avoid certain animals, objects, or situations”. Factor 3 is associated with fear and avoidance behaviours. These items reflect unfounded fears and avoidance of various situations and objects, suggesting a specific type of anxiety related to phobias and avoidance behaviour.

Factor 4: Panic-Related Symptoms and Agoraphobia: “I have spells of terror or panic”; “I feel afraid in open spaces or in the streets”; “I feel afraid I will faint in public”; “I experience sudden attacks of panic which catch me by surprise”. Factor 4 appears to be related to panic-related symptoms and agoraphobia-like anxiety. These items represent experiences of sudden panic, fear in open spaces, and concerns about fainting in public. Factor 5: Physical Symptoms and Avoidance, “My hands, arms, or legs shake or tremble”; “I get upset easily or feel panicky unexpectedly”; “Due to my fears, I avoid being alone, whenever possible”. Factor 5 is associated with physical symptoms of anxiety, including trembling limbs and avoiding being alone due to fear. This factor may be related to social anxiety or specific phobias with physical symptoms. Factor 6: Medication Use, “I use tranquilizers or antidepressants to cope with my anxiety”; Factor 6 is primarily associated with the use of medication (tranquilizers or antidepressants) as a coping strategy for anxiety. This factor reflects a different aspect of managing anxiety.

The Varimax rotated component matrix (with Kaiser normalization) showed that most items had highest loading on the first (Not worrying: 0.80–0.91), second (Anxiety: 0.64–0.84) and third (Panic/Phobia: 0.57–0.83) factors (Table 1).

Table 1 Rotated Varimax factors structure of the French version of the CAS

Reliability and convergent validity

CAS internal consistency coefficient was 0.97 according to Cronbach’s alpha and test-retest reliability after 15 days showed very good [41] temporal stability (ICC = 0.966, 95% CI 0.93–0.98).

The CAS French version displayed a significant [44] convergent validity with GAD-7 both at baseline (Pearson r = 0.81, p < 0.001) and at 15-day follow-up (r = 0.86, p < 0.001).


The aim of our study was to develop and validate a French version of the CAS, to make it available for detection of anxiety in the French speaking population [25]. The results showed that this translated CAS version had high reliability and validity (Reliability coefficient value > 0.9, validity coefficient > 0.4).

An original contribution of the present study is to provide new insight on the factor structure of the CAS. Indeed, information on principal component analysis (PCA) is not available for the original English scale [21]. Contemporary studies using CAS are sparse and focused on the correlation with other anxiety scales.

The CAS, with its 6-factor structure, provides a comprehensive assessment of various components of anxiety, ranging from general anxiety and tension to specific fears, panic-related symptoms, and coping mechanisms. Understanding these factors can help clinicians and researchers better target and address the diverse aspects of anxiety in individuals.

Further analysis in different populations is needed to confirm the proposed this structure of the CAS and its French version.

The French CAS showed excellent reliability. Internal consistency was high, indicating it is highly homogeneous, as reported for the English version [21]. Similarly, test-retest reliability was also very high (r > 0.9) [41] the present study, emphasizing CAS stability over time in the absence of new events.

Further studies are welcome to investigate the sensitivity to changes of the French CAS amongst subjects developing new symptoms of anxiety.

Our results show an excellent convergent validity with the GAD-7 ( r = 0.81) thus confirming the link between the core symptoms of general anxiety disorders evaluated by the GAD-7 and the psychological and somatic symptoms of anxiety explored with the French CAS.

The initial validation of the scale was performed in a mixed population of subjects with and without a clinical diagnosis of anxiety or related disorders [21]. However, the present study differs as participants were health care workers, and the specific characteristics of this cohort, may limit the generalizability of our results, in particular the high homogeneity of the participant sample could potentially favor high correlation coefficients, thereby creating a limitation in the interpretation of the study results. Nevertheless, our results are consistent with other studies performed in the general population with different scales (HAD and STAI) [28,29,30]. Overall, 11.8% of the participants reached the cuff-off of CAS for anxiety, not dissimilar to those studies on the general population of the same age. Further research is needed to investigate the diagnostic validity of this instrument in subject affected by anxiety disorders.

Overall response rate for the questionnaire was high, however, the use of the scale in general population, not affected by anxiety, can also explain the high response rate.

A positive characteristic of the CAS is the self-administration and speed of completion that allow it to be used on a large scale in clinic. The present study is thus reassuring about the feasibility to use this CAS French version. In particular, the time needed to fill in the questionnaire was less than 3 min, confirming that this scale could likely be used in routine clinical practice by the general practitioner’s as well as in hospital setting, similarly to the English version. This is especially interesting when comparing to other, more time-consuming instruments such as the HAM-A [26].


The validation of the French version of the CAS allows clinicians to assess anxiety disorders in a quick and efficient manner. The instrument is well accepted and could be included in routine clinical practice. Further studies are needed to clinically validate this scale in different populations, including in older patients.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.



Clinical anxiety scale


General Anxiety Disorder- 7


Intra-class correlation coefficient


anxiety disorders


Hamilton anxiety scale


Hospital Anxiety


post-traumatic stress disorder




Principal component analysis


  1. Stein DJ, Scott KM, de Jonge P, Kessler RC. Epidemiology of anxiety disorders: from surveys to nosology and back. Dialogues Clin Neurosci. 2017;19:127–36.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yang X, Fang Y, Chen H, Zhang T, Yin X, Man J, Yang L, Lu M. Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the global burden of Disease Study 2019. Epidemiol Psychiatr Sci. 2021;30:e36.

    Article  PubMed  PubMed Central  Google Scholar 

  3. COVID-19 Mental Disorders Collaborators. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021;398:1700–12.

    Article  Google Scholar 

  4. Meier SM, Mattheisen M, Mors O, Mortensen PB, Laursen TM, Penninx BW. Increased mortality among people with anxiety disorders: total population study. Br J Psychiatry. 2016;209:216–21.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Murray CJL, Aravkin AY, Lim SS. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of Disease Study 2019. The Lancet. 2020;396:1223–49.

    Article  Google Scholar 

  6. Parmentier H, García-Campayo J, Prieto R. Comprehensive review of generalized anxiety disorder in primary care in Europe. Curr Med Res Opin. 2013;29:355–67.

    Article  PubMed  Google Scholar 

  7. Löwe B, Gräfe K, Zipfel S, Spitzer RL, Herrmann-Lingen C, Witte S, Herzog W. Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the hospital anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians’ diagnosis. J Psychosom Res. 2003;55:515–9.

    Article  PubMed  Google Scholar 

  8. Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146:317–25.

    Article  PubMed  Google Scholar 

  9. Kessler D, Lloyd K, Lewis G, Gray DP. Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ. 1999;318:436–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bruss GS, Gruenberg AM, Goldstein RD, Barber JP. Hamilton Anxiety Rating Scale Interview guide: joint interview and test-retest methods for interrater reliability. Psychiatry Res. 1994b;53:191–202.

    Article  PubMed  Google Scholar 

  11. Maier W, Buller R, Philipp M, Heuser I. The Hamilton anxiety scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord. 1988;14:61–8.

    Article  PubMed  Google Scholar 

  12. Snaith RP, Baugh SJ, Clayden AD, Husain A, Sipple MA. The clinical anxiety scale: an instrument derived from the Hamilton Anxiety Scale. Br J Psychiatry. 1982;141:518–23.

    Article  PubMed  Google Scholar 

  13. Jordan P, Shedden-Mora MC, Löwe B. Psychometric analysis of the generalized anxiety disorder scale (GAD-7) in primary care using modern item response theory. PLoS ONE. 2017;12:e0182162.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rutter LA, Brown TA. Psychometric properties of the generalized anxiety disorder Scale-7 (GAD-7) in outpatients with anxiety and Mood disorders. J Psychopathol Behav Assess. 2017;39:140–6.

    Article  PubMed  Google Scholar 

  15. Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Med Care. 2008;46:266–74.

    Article  PubMed  Google Scholar 

  16. Budikayanti A, Larasari A, Malik K, Syeban Z, Indrawati LA, Octaviana F. Screening of generalized anxiety disorder in patients with Epilepsy: using a Valid and Reliable Indonesian Version of generalized anxiety Disorder-7 (GAD-7). Neurol Res Int. 2019;2019:1–10.

    Article  Google Scholar 

  17. Morris R, Eccles A, Ryan B, Kneebone II. Prevalence of anxiety in people with aphasia after stroke. Aphasiology. 2017;31:1410–5.

    Article  Google Scholar 

  18. Hart T, Fann JR, Chervoneva I, Juengst SB, Rosenthal JA, Krellman JW, Dreer LE, Kroenke K. Prevalence, risk factors, and correlates of anxiety at 1 year after moderate to severe traumatic brain Injury. Arch Phys Med Rehabil. 2016;97:701–7.

    Article  PubMed  Google Scholar 

  19. Terrill AL, Hartoonian N, Beier M, Salem R, Alschuler K. The 7-Item generalized anxiety disorder scale as a Tool for Measuring generalized anxiety in multiple sclerosis. Int J MS Care. 2015;17:49–56.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tully PJ, Selkow T, Bengel J, Rafanelli C. A dynamic view of comorbid depression and generalized anxiety disorder symptom change in chronic heart failure: the discrete effects of cognitive behavioral therapy, exercise, and psychotropic medication. Disabil Rehabil. 2015;37:585–92.

    Article  PubMed  Google Scholar 

  21. Westhuis D, Thyer BA. Development and validation of the clinical anxiety scale: a Rapid Assessment Instrument for empirical practice. Educ Psychol Meas. 1989;49:153–63.

    Article  Google Scholar 

  22. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.

    Article  PubMed  Google Scholar 

  23. Tabachnick BG, Fidell LS, Ullman JB. 2019. Using multivariate statistics, Seventh edition. ed. Pearson, NY, NY.

  24. Green SB. A coefficient alpha for test-retest data. Psychol Methods. 2003;8:88–101.

    Article  PubMed  Google Scholar 

  25. Dürst A-V, Graf CE, Ruggiero C, Zekry D, Boccardi V, Monney L, Joss I, Vuilloud K, Vespignani G, Bosshard W, Mecocci P, Bula CJ, D’Amelio P. Fighting social isolation in times of pandemic COVID-19: the role of video calls for older hospitalized patients. Aging Clin Exp Res. 2022;34:2245–53.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Thompson E. Hamilton Rating Scale for Anxiety (HAM-A). OCCMED. 2015;65:601–1.

    Article  Google Scholar 

  27. Zimmerman M, Thompson JS, Diehl JM, Balling C, Kiefer R. Is the DSM-5 anxious distress specifier interview a valid measure of anxiety in patients with generalized anxiety disorder: a comparison to the Hamilton anxiety scale, Psychiatr.Research, Volume 286,2020, 112859,

  28. Hinz A. et Elmar Brähler. « Normative values for the Hospital Anxiety and Depression Scale (HADS) in the general German population ». Journal of Psychosomatic Research 71, no 2 (2011): 74–78.

  29. Hinz A, Herzberg PY, Lordick F, Weis J, Faller H, Brähler E, Härter M, Wegscheider K. Kristina Geue, et Anja Mehnert. « Age and Gender Differences in Anxiety and Depression in Cancer Patients Compared with the General Population ». European Journal of Cancer Care 28, no 5septembre (2019).

  30. van der Bij AK, Weerd Sde, Rolf JLM, Cikot, Eric AP, Steegers CC, Braspenning. « Validation of the Dutch Short Form of the State Scale of the Spielberger State-Trait Anxiety Inventory: Considerations for Usage in Screening Outcomes ». Public Health Genomics 6, no 2 (2003): 84–87.

  31. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and Depression Scale. J Psychosom Res. 2002;52:69–77.

    Article  PubMed  Google Scholar 

  32. Upadhyaya AK, Stanley I. Hospital anxiety depression scale. Br J Gen Pract. 1993;43:349–50.

    PubMed  PubMed Central  Google Scholar 

  33. Snaith R, Taylor C. Rating scales for depression and anxiety: a current perspective. Br J Clin Pharmacol. 1985;19. 17S-20S.

  34. Thyer BA, Westhuis D. Test-retest reliability of the clinical anxiety scale. Phobia Pract Res J. 1989;2(2):113–5. Test-retest reliability of the clinical anxiety scale.

    Google Scholar 

  35. Kalton G, Schuman H. The Effect of the Question on Survey Responses: A Review. Journal of the Royal Statistical Society. Series A (General), vol. 145, no. 1, 1982, pp. 42–73. JSTOR,

  36. Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med. 1998;17(1):101– 10.;2-e. PMID: 9463853.

  37. Costello AB, Osborne J. n.d. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis.

  38. OFS 2023-office federal des statistiques. (

  39. Bocéréan C, Dupret E. A validation study of the hospital anxiety and Depression Scale (HADS) in a large sample of French employees. BMC Psychiatry. 2014;14:354.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Micoulaud-Franchi J-A, Lagarde S, Barkate G, Dufournet B, Besancon C, Trébuchon-Da Fonseca A, Gavaret M, Bartolomei F, Bonini F, McGonigal A. Rapid detection of generalized anxiety disorder and major depression in epilepsy: validation of the GAD-7 as a complementary tool to the NDDI-E in a French sample. Epilepsy Behav. 2016;57:211–6.

    Article  PubMed  Google Scholar 

  41. Koo TK, Li MY. A Guideline of selecting and reporting Intraclass correlation coefficients for Reliability Research. J Chiropr Med. 2016;15:155–63.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Johnson SU, Ulvenes PG, Øktedalen T, Hoffart A. Psychometric properties of the General anxiety disorder 7-Item (GAD-7) scale in a Heterogeneous Psychiatric Sample. Front Psychol. 2019;10:1713.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Wyse AE. How days between tests impacts alternate forms reliability in computerized adaptive tests. Educ Psychol Meas. 2021;81:644–67.

    Article  PubMed  Google Scholar 

  44. Boslaugh S. and Paul Andrew Watters. 2008. Statistics in a Nutshell: A Desktop Quick Reference, ch. 7. Sebastopol, CA: O’Reilly Media. ISBN-13: 978-0596510497.

  45. Brown JD. Statistics Corner. Questions and answers about language testing statistics: principal components analysis and exploratory factor analysis—Definitions, differences, and choices. Volume 13. Shiken: JALT Testing & Evaluation SIG Newsletter; 2009a. pp. 26–30. 1.

    Google Scholar 

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Conceptualization, PD; Methodology, YA, ES, AVD, PD, CB; Formal Analysis, PD, YA; Investigation, YA, ES, FC, AVD; Data Curation, YA, ES, FC, AVD, PD.; Writing– Original Draft Preparation, PD, YA; Writing– Review & Editing, YA, ES, FC, AVD, CB, PD.; Supervision, PD, CB; Project Administration, PD. All authors read and approved the final manuscript.

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Correspondence to Yana Apostolova.

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We confirm that all methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from all subjects and/or their legal guardian(s). The Swiss Cantonal Ethical committee approved the study (substantial amendment to protocol 2020 − 01125, 13/09/2021).

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Apostolova, Y., Stamm, E., Cilla, F. et al. A contribution to the French validation of the clinical anxiety scale amongst health care workers in Switzerland. BMC Psychol 12, 42 (2024).

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