Psychological symptoms.

Two measures were used. (1) The Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al., 2006) assessed anxiety symptoms experienced during the preceding two weeks. The GAD-7 consists of 7 items rated on a 4-point scale (0 = “not at all” to 3 = “nearly every day”). Items are summed for a total score that can range from 0 to 21, with higher scores indicating more severe anxiety symptoms. Cutoffs include mild = 5–9, moderate = 10–14, and severe = 15–21. Internal consistency reliability was α = .87.

(2)The Patient Health Questionnaire-9 (PHQ-9; Kroenke & Spitzer, 2002) assessed depression symptomology experienced during the preceding two weeks. The PHQ-9 consists of 9 items rated on a 4-point scale ranging from 0 (“not at all”) to 3 (“nearly every day”). Items are summed for a total score that can range from 0 to 27, with higher scores indicating more severe depression symptoms. Cutoffs are mild = 5–9, moderate = 10–14, moderately severe = 15–19, and severe = 20–27. Internal consistency reliability was α = .81.