The FEAR: a rapid screening instrument for generalized anxiety in elderly primary care attenders

✍ Scribed by Christopher Krasucki; Pat Ryan; Turan Ertan; Robert Howard; James Lindesay; Anthony Mann

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 129 KB
• Volume: 14
• Category: Article
• ISSN: 0885-6230
• DOI: 10.1002/(sici)1099-1166(199901)14:1<60::aid-gps893>3.0.co;2-g

✦ Synopsis

Objective. To develop a shorter version of the Anxiety Disorder Scale (ADS) for use as a rapid screening instrument in primary care.

Design. Two-stage screening design. Primary care attenders aged 65 and over were screened for generalized anxiety in the surgery with the 11-item generalized anxiety subscale of the ADS (ADS GA), a selected subsample then proceeding to a clinical validation interview.

Interventions. None.

Main outcome measures. Scores on the ADS GA, non-hierarchical ICD-10 caseness for generalized anxiety established by brief clinical interview by an old age psychiatrist.

Results. The prevalence rate of generalized anxiety was 16% using the established cutpoint and showed an agerelated decline. A cutpoint of 2±3/11 appeared to give optimal performance in this small sample (sensitivity 85%, speci®city 77%, positive predictive value 52%), suggesting that 36% of elderly general practice attenders might be diagnosed as having generalized anxiety. A reduced four-item version gave a predicted sensitivity of 77%, a speci®city of 83% and a positive predictive value of 63% (cutpoint 1±2/4).

Conclusions. A four-item version of the ADS GA, the FEAR ( frequency of anxiety; enduring nature of anxiety; alcohol or sedative use; restlessness or ®dgeting), has potential as a rapid screening instrument for use in primary care.