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Depressive and anxiety symptoms
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Psychological distress was assessed using the validated ultra-brief instruments Patient Health Questionnaire-2 (PHQ-2) for depressive symptoms and Generalized Anxiety Disorder-2 (GAD-2) scale for symptoms of anxiety. For both scales, a cutoff score of ≥ 3 (range, 0–6) indicates a clinical level of symptom burden [34]. Cronbach’s alpha coefficients for the PHQ-2 and GAD-2 scales were 0.76 and 0.76, respectively, indicating satisfactory internal consistency.
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