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The validity of the state-trait anxiety inventory and the brief scale for anxiety in an inpatient sample with alcohol use disorder

The validity of the state-trait anxiety inventory and the brief scale for anxiety in an inpatient sample with alcohol use disorder
The validity of the state-trait anxiety inventory and the brief scale for anxiety in an inpatient sample with alcohol use disorder
Background and Aims
The Brief Scale for Anxiety (BSA) and the State–Trait Anxiety Inventory Form Y‐2 (STAI‐Y‐2) are self‐report scales used to gauge anxiety symptoms in clinical settings. Co‐occuring anxiety is common in alcohol use disorder (AUD); however, no studies have assessed the validity of the BSA and STAI‐Y‐2 compared with a clinical diagnostic tool of anxiety in alcohol treatment programs. We aimed to examine the validity of the BSA and STAI‐Y‐2 to predict a clinical diagnosis of an anxiety disorder (via the Structured Clinical Interview for DSM [SCID]) in AUD patients.

Design
Participants were administered the BSA (n = 1005) on day 2 and the STAI‐Y‐2 (n = 483) between days 2 and 10 of the detoxification program. SCID‐based clinical diagnoses of AUD and anxiety were made approximately on day 10.

Setting and participants
Individuals seeking treatment for AUD admitted to an inpatient unit at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD, USA (n = 1010).

Measurements
Inclusion criteria included a current diagnosis of alcohol dependence (AD) according to DSM‐IV‐TR or moderate to severe AUD according to DSM‐5‐RV, as well as available baseline BSA and/or STAI Y‐2 data. Empirical receiver operating characteristic (ROC) curves were generated using estimates of sensitivity, 1‐specificity and positive and negative predictive values for each cut‐point to determine the accuracy of scale outcomes in relation to SCID diagnoses.

Findings
The BSA demonstrated low accuracy relative to a clinical diagnosis of anxiety with an area under the curve (AUC) of 0.67 at the optimal cut‐point of ≥ 10. The STAI‐Y‐2 had moderate accuracy relative to a clinical diagnosis of anxiety with an AUC of 0.70 at the optimal cut‐point of ≥ 51. The accuracy of the STAI‐Y‐2 increased (AUC = 0.74) when excluding post‐traumatic stress disorder and obsessive–compulsive disorder from anxiety disorder classification.

Conclusions
Use of the Brief Scale for Anxiety (BSA) and/or State–Trait Anxiety Inventory Form Y‐2 (STAI‐Y‐2) does not appear to be a reliable substitute for clinical diagnoses of anxiety disorder among inpatients with alcohol use disorder. The BSA and STAI‐Y‐2 could serve as a screening tool to reject the presence of anxiety disorders rather than for detecting an anxiety disorder.
alcohol use disorder, anxiety disorder, brief scale for anxiety, inpatient treatment, sensitivity and specificity, state-trait anxiety inventory
0965-2140
3055-3068
Shah, Navan N
c532ae45-569c-4c24-ba30-be897d5ca49f
Schwandt, Melanie L
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Hobden, Breanne
f3d9aa79-33f8-44f8-9ec6-84159aa430af
Baldwin, David S.
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Sinclair, Julia
be3e54d5-c6da-4950-b0ba-3cb8cdcab13c
Agabio, Roberta
8cda8991-4b16-45a9-9f0c-d9d2782b93c1
Leggio, Lorenzo
f4c540a5-75e0-47b0-bbbd-457aa9977f74
Shah, Navan N
c532ae45-569c-4c24-ba30-be897d5ca49f
Schwandt, Melanie L
d1e93c4c-661f-4452-89ae-63d8ee9ba3f2
Hobden, Breanne
f3d9aa79-33f8-44f8-9ec6-84159aa430af
Baldwin, David S.
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Sinclair, Julia
be3e54d5-c6da-4950-b0ba-3cb8cdcab13c
Agabio, Roberta
8cda8991-4b16-45a9-9f0c-d9d2782b93c1
Leggio, Lorenzo
f4c540a5-75e0-47b0-bbbd-457aa9977f74

Shah, Navan N, Schwandt, Melanie L, Hobden, Breanne, Baldwin, David S., Sinclair, Julia, Agabio, Roberta and Leggio, Lorenzo (2021) The validity of the state-trait anxiety inventory and the brief scale for anxiety in an inpatient sample with alcohol use disorder. Addiction, 116 (11), 3055-3068. (doi:10.1111/add.15516).

Record type: Article

Abstract

Background and Aims
The Brief Scale for Anxiety (BSA) and the State–Trait Anxiety Inventory Form Y‐2 (STAI‐Y‐2) are self‐report scales used to gauge anxiety symptoms in clinical settings. Co‐occuring anxiety is common in alcohol use disorder (AUD); however, no studies have assessed the validity of the BSA and STAI‐Y‐2 compared with a clinical diagnostic tool of anxiety in alcohol treatment programs. We aimed to examine the validity of the BSA and STAI‐Y‐2 to predict a clinical diagnosis of an anxiety disorder (via the Structured Clinical Interview for DSM [SCID]) in AUD patients.

Design
Participants were administered the BSA (n = 1005) on day 2 and the STAI‐Y‐2 (n = 483) between days 2 and 10 of the detoxification program. SCID‐based clinical diagnoses of AUD and anxiety were made approximately on day 10.

Setting and participants
Individuals seeking treatment for AUD admitted to an inpatient unit at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD, USA (n = 1010).

Measurements
Inclusion criteria included a current diagnosis of alcohol dependence (AD) according to DSM‐IV‐TR or moderate to severe AUD according to DSM‐5‐RV, as well as available baseline BSA and/or STAI Y‐2 data. Empirical receiver operating characteristic (ROC) curves were generated using estimates of sensitivity, 1‐specificity and positive and negative predictive values for each cut‐point to determine the accuracy of scale outcomes in relation to SCID diagnoses.

Findings
The BSA demonstrated low accuracy relative to a clinical diagnosis of anxiety with an area under the curve (AUC) of 0.67 at the optimal cut‐point of ≥ 10. The STAI‐Y‐2 had moderate accuracy relative to a clinical diagnosis of anxiety with an AUC of 0.70 at the optimal cut‐point of ≥ 51. The accuracy of the STAI‐Y‐2 increased (AUC = 0.74) when excluding post‐traumatic stress disorder and obsessive–compulsive disorder from anxiety disorder classification.

Conclusions
Use of the Brief Scale for Anxiety (BSA) and/or State–Trait Anxiety Inventory Form Y‐2 (STAI‐Y‐2) does not appear to be a reliable substitute for clinical diagnoses of anxiety disorder among inpatients with alcohol use disorder. The BSA and STAI‐Y‐2 could serve as a screening tool to reject the presence of anxiety disorders rather than for detecting an anxiety disorder.

Text
BSASTAI_AnxietyManuscript_Final R1 - Accepted Manuscript
Restricted to Repository staff only until 16 April 2022.
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More information

Accepted/In Press date: 16 April 2021
e-pub ahead of print date: 27 April 2021
Published date: 27 April 2021
Keywords: alcohol use disorder, anxiety disorder, brief scale for anxiety, inpatient treatment, sensitivity and specificity, state-trait anxiety inventory

Identifiers

Local EPrints ID: 448865
URI: http://eprints.soton.ac.uk/id/eprint/448865
ISSN: 0965-2140
PURE UUID: 5bc48f36-906f-447d-8582-22cfd60b2dd9
ORCID for David S. Baldwin: ORCID iD orcid.org/0000-0003-3343-0907
ORCID for Julia Sinclair: ORCID iD orcid.org/0000-0002-1905-2025

Catalogue record

Date deposited: 07 May 2021 16:31
Last modified: 26 Nov 2021 02:39

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Contributors

Author: Navan N Shah
Author: Melanie L Schwandt
Author: Breanne Hobden
Author: Julia Sinclair ORCID iD
Author: Roberta Agabio
Author: Lorenzo Leggio

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