article · Advances in Patient-Reported Outcomes
Anxiety and depression affect populations globally, yet standard mental health assessments require verification when applied across culturally distinct groups. An evaluation of the PROMIS anxiety and depression scales was conducted with 450 adults across Ghana and Saudi Arabia using English and Arabic versions. Psychometric testing confirmed high internal consistency and structural validity for both instruments. Advanced assessment demonstrated configural, metric, scalar, and strict measurement invariance across the two countries, accompanied by minimal item-level bias. These outcomes confirm that the constructs are understood and measured equivalently in both populations, with high precision across varying levels of condition severity. The validated instruments provide dependable patient-reported outcome tools to support standardised mental health evaluation and inform culturally responsive interventions in these regions.
Standardised mental health tools often fail to account for cultural differences, leading to inaccurate diagnoses or skewed data. Demonstrating that the PROMIS scales operate equivalently in Ghana and Saudi Arabia ensures that clinicians and researchers can reliably measure depression and anxiety across borders. This consistency supports fairer health comparisons and helps organisations design culturally appropriate mental health interventions.
The validated scales offer an applied, tested measurement framework ready for use by healthcare providers, public health bodies, and clinical researchers operating in Ghana and Saudi Arabia. The instruments can be directly integrated into patient-reported outcome platforms, clinical trial protocols, and digital health screening applications requiring culturally robust assessment of anxiety and depression.
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Background Anxiety and depression are prevalent mental health conditions worldwide, yet their assessment across culturally distinct populations remains limited. The study examined the psychometric properties, cross-cultural validity, and measurement invariance of the PROMIS anxiety and depression scales among adults in Ghana and Saudi Arabia. Methods A cross-sectional study of 450 adults was conducted. Participants completed the PROMIS Anxiety and Depression Scales in English or Arabic. IRT evaluated item discrimination, difficulty, and measurement precision, while confirmatory factor analysis (CFA) assessed structural validity. Multi-group CFA examined measurement invariance across countries, and DIF analyses identified potential item-level bias. Results Both scales demonstrated high internal consistency (α = 0.87-0.91; ω = 0.88-0.92) and excellent structural validity (CFI/TLI ≥ 0.95; RMSEA ≤ 0.049; SRMR ≤ 0.040). Measurement invariance testing indicated configural, metric, scalar, and strict invariance, confirming that the constructs of anxiety and depression were interpreted equivalently across Ghanaian and Saudi Arabian samples. DIF analyses revealed minimal item bias, supporting fair cross-cultural comparisons. IRT-based marginal reliability values were high, reflecting precise measurement across the latent trait continuum. Conclusions The PROMIS anxiety and depression scales are reliable, structurally valid, and culturally equivalent for adults in Ghana and Saudi Arabia. These findings support their use for accurate cross-cultural assessment of anxiety and depression, enabling standardized patient-reported outcome measurement in diverse populations and informing culturally responsive mental health interventions.
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DOI: 10.1016/j.apro.2026.100346
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