Although they are considered interchangeable, we know little about their equivalence in terms of identifying patients with probable clinical anxiety levels and whether they both reflect a common anxiety attribute. Both instruments are generic and commonly used for screening for anxiety in the general population, psychiatric and somatic patients, including cardiac patients and ICD patients. Since ICD-related anxiety seems to be more prevalent than shock anxiety, this study focused on two widely used generic anxiety scales, the (state) anxiety scales from the HADS and the STAI, referred to as the HADS-A and STAI-S, respectively. Recently, disease-specific measures were also developed, such as the Florida Shock Anxiety Scale (FSAS) and the ICD Patient Concerns questionnaire (ICDC) that tap into anxiety related to ICD shocks. Examples of generic measures include the Hospital Anxiety and Depression Scale (HADS), the Spielberger Trait-State Anxiety Inventory (STAI), the Beck Anxiety Inventory (BAI), and the Generalized Anxiety Disorder Scale (GAD-7). Generally, a distinction is made between generic and disease-specific anxiety measures. In order to identify ICD patients who suffer from anxiety and depression, it is paramount that we have appropriate and well-validated measures available with appropriate cutoffs and sensitivity and specificity. Distress has not only been associated with the development of posttraumatic stress disorder post implantation, but on its own or in combination with the distressed (Type D) personality profile also with increased risk for VTa’s and even mortality. Although the ICD is well accepted by the majority of patients, one in four patients experiences psychological distress post implantation, including anxiety and depression. The implantable cardioverter defibrillator (ICD) is the first line of treatment for life-threatening ventricular tachyarrhythmias (VTa’s) both as primary (patients who have an increased risk of experiencing VTa’s) and secondary prophylaxis (patients who have previously experienced VTa’s). Clinicians and researchers should be aware of the inequivalence when using these measures for screening and determining the prevalence of probable clinical anxiety levels. STAI-S and HADS-A reflect a common anxiety attribute, but using the recommended cutoff scores on the respective measures show very different prevalence rates and would classify patients as anxious with the STAI-S who would not be identified as such with the HADS-A. Bifactoring suggested that HADS-A and STAI-S largely tapped into the same generic anxiety attributes. A crosswalk table was generated with equivalent scores and cutoffs for the HADS-A and STAI-S, respectively. Results showed that the STAI-S produced a higher prevalence rate than the HADS-A (39% vs. Resultsĭata from 710 patients were included in the analyses. Secondary data from the WEBCARE trial and the MIDAS study were used for the current study, where patients implanted with a first-time implantable cardioverter defibrillator completed both the HADS-A and the STAI-S within 10 days post implant. Score and construct concordance were evaluated using equipercentile equating and bifactor modeling, respectively. Hence, we examined whether the two instruments are (i) equivalent with respect to determining the prevalence of probable clinical anxiety levels and (ii) reflect variation on a common anxiety attribute. ![]() ![]() The Hospital Anxiety and Depression Scale (HADS-A) and State-Trait Anxiety Inventory (STAI-S) are popular instruments for assessing anxiety and are considered interchangeable, although little is known about their equivalence.
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