INTRODUCTION This review covers commonly used measures of anxiety. For this review, the author included measures that were 1) measures of general measures of anxiety and severity of anxiety symptoms, 2) administered by self-report, 3) used in rheumatologic populations, and 4) has evidence of adequate psychometric data. To maintain brevity, the majority of the measures reviewed here were selected to provide broad coverage of general symptoms of anxiety, and measures were excluded if they are intended to identify or characterize a specific Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorder ().
Specifically, this author excluded measures typically used to evaluate diagnostic criteria or features of specific anxiety disorders, such as panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and others. In addition, broader measures of psychiatric distress, including the Symptom Checklist-90, the General Health Questionnaire, and the Medical Outcomes Study Short Form 36 are not included in this review since they are included elsewhere in this special issue. However, subscales that have been used frequently in rheumatology as “stand-alone” measures, such as the anxiety scale of the Hospital Anxiety and Depression Scale, are included in this review. Importantly, the measures included in this review should not be interpreted as diagnostically significant for an anxiety disorder, even generalized anxiety disorder, but should be used to measure the presence of symptoms and to calibrate the severity of general symptoms of anxiety commonly occurring in rheumatic disease.
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The students’ Spielberger Test Anxiety Inventory-Trait (STAI) scores were categorized into low (20 to 40), moderate (41 to 50) and high (51 to 80). Generally, most students had moderate to low STAI scores. To appear in C.D. Spielberger & I.G. Sarason (Eds.) Stress and Anxiety. ' This report reviews the develonment of the Test Anxiety Scale. Point of view, it is Important to Identify the cognitive events that Influence.
The measures reviewed below include the State Trait Anxiety Index, the Beck Anxiety Inventory, and the anxiety subscale of the Hospital Anxiety and Depression Scale. In this review, the content and structure of each measure is presented (number of items, recall period, response options, presence of translations, and adaptations), the use in rheumatic disease when possible is discussed, and the psychometric properties of each measure, particularly when validated in any of the rheumatic diseases, is detailed. In addition, information regarding responsiveness of each measure to longitudinal change is presented, including responsiveness to change in rheumatology when available. Finally, a summary of the strengths and weaknesses specific to rheumatology is presented.
Score interpretation Range of scores for each subtest is 20–80, the higher score indicating greater anxiety. A cut point of 39–40 has been suggested to detect clinically significant symptoms for the S-Anxiety scale (,); however, other studies have suggested a higher cut score of 54–55 for older adults ().
Normative values are available in the manual () for adults, college students, and psychiatric samples. To this author's knowledge, no cut scores have been validated for rheumatic disease populations. Validity During test development, more than 10,000 adults and adolescents were tested. To optimize content validity, most items were selected from other anxiety measures on the basis of strong associations with the Taylor Manifest Anxiety Scale () and Cattell and Scheier's Anxiety Scale Questionnaire (); overall correlations between the STAI and these 2 measures were 0.73 and 0.85, respectively. In general, construct validity () of the STAI was somewhat limited in discriminating anxiety from depression, with some studies observing higher correlations between the T-Anxiety scale and measures of depression, as compared to other measures of anxiety (,). S-Anxiety validity was originally derived from testing in situations characterized by high state stress including classroom examinations, military training programs, etc.
Like other measures of anxiety, the STAI is also highly correlated with depression and, in some studies, the STAI did not differentiate anxious from depressed patients (). Similarly, while the STAI has not been formally validated in rheumatic disease, studies in rheumatology have similarly observed very high correlations among the STAI and measures of depression (e.g., r = 0.83) (). In some populations (elderly), the STAI has shown poor discriminant validity and did not differentiate persons with and without anxiety disorders (). Caveats and cautions Limitations include the limited availability of validation data specific to rheumatic disease. Additionally, there exists relatively poor validity of the scale, particularly the T-Anxiety subscale for differentiation anxious from depressed states. Further, because the intent of the T-Anxiety scale is to characterize a longstanding trait, clinicians and researchers should be mindful of this if seeking scales to detect change over a relatively short period of time. In general, for these purposes, many have opted to solely use the S-Anxiety subscale for the detection of longitudinal change.