Adapting the GAD-7 and PHQ-9 clinical measures for people with learning disabilities

Jennifer Breen

Research output: ThesisDoctoral Thesis

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People with intellectual disability continue to face barriers to accessing psychological support, due to a lack of ‘reasonable adjustments’ (NDTi, 2012). An issue to accessing IAPT has been that the standard clinical questionnaires used to measure recovery from depression (PHQ-9) and anxiety (GAD-7), can be difficult to use for many people with intellectual disabilities. Stage 1 of this research used a cognitive interviewing approach to investigate whether adaptations to the GAD-7 and the PHQ-9 help to make these measures more appropriate for use with adults with intellectual disabilities. Two rounds of such interviewing were completed with participants to evaluate the suggested modifications and develop final adapted versions of these measures. Stage 2 of the research investigated the initial psychometric properties of the adapted measures predominantly via investigations of validity and reliability, and comparisons to established measures in the intellectual disability population. Participants in Stage 1 suggested further adaptations to increase accessibility and indicated that the adapted measures are appropriate for use with adults with intellectual disability. Stage 2 demonstrated support for the adapted measures as helpful for assessing symptoms related to depression and anxiety in this population; the adapted PHQ-9 correlated with the established self-report GDS-LD (r = 0.80), had good internal consistency ( = 0.85) and the adapted GAD-7 correlated with the established self-report GAS-ID (r = 0.66) and had good internal consistency ( = 0.91). Thus, the current research project provides support that the adapted versions of the PHQ-9 and GAD-7 could be used in IAPT services to facilitate access for adults with intellectual disabilities as part of a set of reasonable adjustments.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
  • Theodore, Kate, Supervisor, External person
Award date1 Nov 2017
Publication statusUnpublished - 2017


  • intellectual disability
  • IAPT
  • GAD-7
  • PHQ-9
  • cognitive interview

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