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Background:Given their applicability in diverse settings and for a wide range of purposes, the generalizability of self-report symptom measures is particularly important. An understudied factor in the development and validation of self-report measures is the degree to which they are difficult to comprehend. This study evaluated the difficulty of self-report measures of anxiety with respect to several domains, including formatting, length, and linguistic problems.Methods:Ninety-two evidence based measures of anxiety were evaluated for comprehension level.Results:The majority of anxiety measures included challenging elements of formatting, linguistic ability, and readability. Measures of obsessive–compulsive disorder were associated with the highest level of comprehension (i.e., greatest difficulty).Conclusions:The validity of self-report measures relies on the ability of respondents to understand the instructions and measure items. Factors related to the comprehension of self-report measures should be included among the basic psychometric properties in measure development and validation. Future research on the development of self-report measures that can be more broadly applicable across levels of education and literacy are of particular importance to research, clinical, and public health agendas. Depression and Anxiety, 2011. © 2011 Wiley-Liss, Inc.

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