Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD, USA.
Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Bethesda, MD, USA.
Addiction. 2021 Nov;116(11):3055-3068. doi: 10.1111/add.15516. Epub 2021 Apr 27.
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.
简要焦虑量表（BSA）和状态-特质焦虑问卷 Y-2 版（STAI-Y-2）是用于评估临床环境中焦虑症状的自评量表。共病焦虑在酒精使用障碍（AUD）中很常见；然而，尚无研究评估 BSA 和 STAI-Y-2 与酒精治疗计划中焦虑的临床诊断工具相比的有效性。我们旨在研究 BSA 和 STAI-Y-2 预测 AUD 患者焦虑障碍临床诊断（通过 DSM 结构临床访谈 [SCID]）的有效性。
参与者在脱毒计划的第 2 天接受 BSA（n=1005）测试，在第 2 天至第 10 天之间接受 STAI-Y-2（n=483）测试。大约在第 10 天进行基于 SCID 的 AUD 和焦虑的临床诊断。
在美国马里兰州贝塞斯达国立卫生研究院（NIH）临床中心住院部寻求 AUD 治疗的个体（n=1010）。
纳入标准包括根据 DSM-IV-TR 目前诊断为酒精依赖（AD）或根据 DSM-5-RV 中度至重度 AUD，以及有可用的基线 BSA 和/或 STAI Y-2 数据。使用每个切点的敏感性、1 特异性和阳性及阴性预测值生成经验性接收者操作特征（ROC）曲线，以确定量表结果与 SCID 诊断的准确性。
BSA 在与焦虑的临床诊断相关时准确性较低，最佳切点为≥10 时曲线下面积（AUC）为 0.67。STAI-Y-2 与焦虑的临床诊断中度相关，最佳切点为≥51 时 AUC 为 0.70。当将创伤后应激障碍和强迫症从焦虑症分类中排除后，STAI-Y-2 的准确性增加（AUC=0.74）。
在患有酒精使用障碍的住院患者中，使用简要焦虑量表（BSA）和/或状态-特质焦虑问卷 Y-2 版（STAI-Y-2）似乎不能可靠替代焦虑障碍的临床诊断。BSA 和 STAI-Y-2 可以作为一种筛查工具来排除焦虑障碍的存在，而不是用于检测焦虑障碍。
