Psychometric Validation and Cross-Cultural Adaptation of the Duke Anxiety-Depression Scale (DUKE-AD) in Persian-Speaking Older Adults

Clin Gerontol. 2025 Nov 4:1-14. doi: 10.1080/07317115.2025.2579844. Online ahead of print.

ABSTRACT

OBJECTIVES: Sub-threshold cases of depression and anxiety disorders in older adults are often undetected and undertreated. The 7-item Duke Anxiety-Depression Scale (DUKE-AD) assesses mental distress; this study evaluated the psychometric validity and cross-cultural applicability of its Persian version (DUKE-AD-PERSIAN).

METHODS: A cross-sectional study among 500 older adults assessed for content and face validity as measured by 20 experts, and estimated content validity ratio (CVR) and item-level content validity index (I-CVI). Exploratory and Confirmatory Factor Analyses (EFA, CFA) examined the factor structure.

RESULTS: Participants had a mean age of 70.62 ± 7.42 years and mean anxiety-depression score of 25.05 ± 22.39. The implemented EFA and CFA’s outputs (CMIN = 29.933, DF = 11, pvalue = 0.002, CMIN/DF = 2.721, RMSEA = 0.05 (95% CI: 0.034, 0.084), PNFI = 0.511, PCFI = 0.515, TLI = 0.969, IFI = 0/984, CFI = 0.984) supported unidimensionality of the scale. The estimated reliability and stability coefficients (Cronbach’s α = 0.98, ICC = 0.97) were acceptable.

CONCLUSIONS: Findings supported the reliability and validity of the Persian DUKE-AD as a brief self-report measure for assessing anxiety and depression in older adults.

CLINICAL IMPLICATIONS: The Persian DUKE-AD enables efficient screening of anxiety and depression symptoms among older adults, facilitating early intervention in primary care and community health settings.

PMID:41185935 | DOI:10.1080/07317115.2025.2579844