Abstract
Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about negative social evaluation, panicking, and harm from others. The result is inactivity and isolation. Behavioural avoidance tasks (BATs) provide an objective assessment of avoidance and in situ anxiety but are challenging to administer and lack standardisation. Our aim was to draw on the principles of BATs to develop a self-report measure of agoraphobia symptoms. The scale was developed with 194 patients with agoraphobia in the context of psychosis, 427 individuals in the general population with high levels of agoraphobia, and 1094 individuals with low levels of agoraphobia. Factor analysis, item response theory, and receiver operating characteristic analyses were used. Validity was assessed against a BAT, actigraphy data, and an existing agoraphobia measure. Test-retest reliability was assessed with 264 participants. An eight-item questionnaire with avoidance and distress response scales was developed. The avoidance and distress scales each had an excellent model fit and reliably assessed agoraphobic symptoms across the severity spectrum. All items were highly discriminative (avoidance: a = 1.24-5.43; distress: a = 1.60-5.48), indicating that small increases in agoraphobic symptoms led to a high probability of item endorsement. The scale demonstrated good internal reliability, test-retest reliability, and validity. The Oxford Agoraphobic Avoidance Scale has excellent psychometric properties. Clinical cut-offs and score ranges are provided. This precise assessment tool may help focus attention on the clinically important problem of agoraphobic avoidance.
Highlights
For many people with mental health problems it can be a challenge to step out of the front door
This paper reports the development of an easy to use self-report measure of agoraphobic avoidance in psychosis based on the principles of behavioural avoidance tasks (BATs)
The structural validity of this unidimensional solution was further demonstrated in the complete participant group (N = 1715), where model fit was good for both the distress (χ2 = 180.3, df = 20, p < 0.001, comparative Fit Index (CFI) = 0.975, Tucker–Lewis index (TLI) = 0.965, Root Mean Square Error of Approximation (RMSEA) = 0.068, SRMR = 0.021) and the avoidance (χ2 = 64.6, df = 20, p < 0.001, CFI = 0.997, TLI = 0.995, RMSEA = 0.036, SRMR = 0.032) scores
Summary
For many people with mental health problems it can be a challenge to step out of the front door. Everyday activities – catching a bus, shopping locally, walking down the street – are avoided This type of withdrawal from everyday life is a common feature of depression (Kennedy, Foy, Sherazi, McDonough, & McKeon, 2007), psychosis (Freeman, Taylor, Molodynski, & Waite, 2019a), anxiety disorders (Saris, Aghajani, van der Werff, van der Wee, & Penninx, 2017), and post-traumatic stress disorder (PTSD; Zayfert, DeViva, and Hofmann, 2005). Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. The avoidance and distress scales each had an excellent model fit and reliably assessed agoraphobic symptoms across the severity spectrum. Clinical cut-offs and score ranges are provided This precise assessment tool may help focus attention on the clinically important problem of agoraphobic avoidance
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