The Validity of the State-Trait Anxiety Inventory and the Brief Scale for Anxiety in an Inpatient Sample with Alcohol Use Disorder

BACKGROUND AND AIMS: 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.DESIGN: Participants were administered the BSA (n = 1,005) on day 2 and the STAI-Y-2 (n = 483) between day 2 and 10 of the detoxification program. SCID-based clinical diagnoses of AUD and anxiety were made approximately on day 10.SETTING AND PARTICIPANTS: Individuals seeking treatment for AUD admitted to an inpatient unit at the National Institutes of Health (NIH) Clinical Center in Bethesda, Maryland, USA (n = 1010).MEASUREMENTS: 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.FINDINGS: 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.CONCLUSIONS: 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.