https://doi.org/10.4081/hls.2026.16059
The Urdu GAD-7: recognising prior validation in subsequent research
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Accepted: 10 August 2026
Published: 11 September 2026
Dear Editor,
We read with interest the recent article on the cross-cultural adaptation and psychometric validation of the Urdu version of Generalised Anxiety Disorder – 7 (GAD-7).1
Psychometric validation is rarely completed in a single study. Each subsequent investigation strengthens the evidence by evaluating different populations, methods, or measurement properties, and expands the instrument’s clinical applicability.
Against this background, we wish to highlight the development of the Urdu GAD-7. Ahmad et al. (2017) reported one of the earliest structured translation and validation studies of the GAD-7, using a formal six-step translation methodology in a national sample spanning four provinces of Pakistan, capturing diverse regional dialects of Urdu.2,3 The study established a unidimensional factor structure (EFA eigenvalue=5.18, accounting for 64.8% of variance), high internal consistency (Cronbach's α=0.92), and split-half reliability (r=0.82), alongside convergent and discriminant validity. Our study followed a structured multistep translation process involving forward translations, reconciliation, back-translation, multidisciplinary expert review, language expert evaluation, pilot testing, and psychometric validation in a multicentre Pakistani sample.3-6[...]
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1. Khan A, Madihie A, Ali I. Cross cultural adaptation and psychometric validation of the Generalized Anxiety Disorder Assessment-7 for Urdu-speaking clinical populations. Healthc Low-resour S 2026; doi:10.4081/hls.2026.14309. Correction: Healthc Low-resour S 2026; doi: 10.4081/hls.2026.15923 DOI: https://doi.org/10.4081/hls.2026.14309
2. Ahmad S, Hussain S, Shah FS, Akhtar F. Urdu translation and validation of GAD-7: a screening and rating tool for anxiety symptoms in primary health care. J Pak Med Assoc 2017;67:1536-40.
3. World Health Organization. Process of translation and adaptation of instruments. Geneva: World Health Organization; 2016. Available from: https://www.who.int/publications/i/item/process-of-translation-and-adaptation-of-instruments
4. Koller M, Aaronson NK, Blazeby J, et al. Translation procedures for standardised quality of life questionnaires: The European Organisation for Research and Treatment of Cancer (EORTC) approach. Eur J Cancer 2007;43:1810-20. DOI: https://doi.org/10.1016/j.ejca.2007.05.029
5. Wild D, Grove A, Martin M, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health 2005;8:94-104. DOI: https://doi.org/10.1111/j.1524-4733.2005.04054.x
6. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res 2010;19:539-49. DOI: https://doi.org/10.1007/s11136-010-9606-8
7. Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract 2011;17:268-74. DOI: https://doi.org/10.1111/j.1365-2753.2010.01434.x
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CRediT authorship contribution
Sabih Ahmad, conceived the letter, drafted the initial manuscript, and coordinated the revision process; Sadiq Hussain, contributed critical feedback, assisted with revising the manuscript for important intellectual content, and approved the final version; Farrukh Akhtar, contributed critical feedback, assisted with revising the manuscript for important intellectual content, and approved the final version.
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Data Availability Statement
This is a commentary letter to the editor and does not generate or analyze new datasets. All references to previously published literature are cited accordingly.
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