Objective: Prevalence estimates of anxiety disorders and subsyndromal levels of anxiety symptoms are influenced negatively by uncertainties regarding the validity of rating scales supposed to measure anxiety, a tendency to lack of use of proper methodology in the development of such scales, and shortcomings of scales constructed for use in geriatric patients. There are conflicting prevalence figures regarding anxiety disorders in geriatric patients.
Design: To investigate the prevalence of anxiety and depressive disorders in geriatric in-patients, and to assess the functionality of the Spielberger`s State-Trait Anxiety Inventory (STAI) as a case-finding instrument compared to a clinical diagnostic interview regarding anxiety states and depressive disorders.
Materials and Methods: The data came from 68 non-demented nor terminally ill in-patients in a geriatric ward planned to be discharged home. Their mean age was 83.2 (range 64-96), and 75% were women. The DSM-IV-R clinical criteria served to diagnose anxiety and depressive disorders, and the 20 items state part of STAI instrument was used to rate current (state) anxiety. The clinical diagnostic interview and the STAI state interview were carried out by a psychiatrist in old age and a clinical specialist in psychiatric nursing, blinded to the other’s scoring, and for all patients both sessions were performed within one week. The STAI was factor analysed based upon polychoric correlations. This produced two factors which were named “Nervousness” (seven items) and “Well-being” (six items). The factors correlated moderately (0.61). A ROC curved was used to visualize the diagnostic validity of the STAI state sumscore grouped in ten bins
Results: The mean STAI sumscore was 39.2 among those diagnosed by the psychiatrist as having no anxiety/depressive disorders, while in the group diagnosed with such disorders (nine subjects, 13.2 %), the mean STAI sumscore was 55.9. Using a previously published cut-off value of 39/40 on the sumscore as an indicator for clinically significant anxiety symptoms, 33 (48.5%) appeared positive, but among those 24 were clinically negative. None, who had a STAI sumscore of 39 or less, were diagnosed clinically without anxiety/depressive disorders. On an ROC curve, where the AUC was 0.73, the cut-off value which gave fewest misclassifications appeared to be 57/58 on the STAI demonstrated that the STAI gave AUC=0.726. The ROC curves optimal cut-off (gold-standard) for caseness on the STAI instrument was 58.0.
Conclusion: The factor structure of the STAI state in geriatric patients indicates that the instrument is sensitive to both nervousness and wellbeing, and the validation against a diagnosis made by a psychiatrist demonstrates that the STAI also is sensitive to depressive symptomatology.
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