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

Abstract

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. 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. 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). 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. 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. 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.