Key messages
Currently, there are shorter questionnaires for screening for anxiety disorders in adults, which might be worth considering before using the Beck Anxiety Inventory (BAI). At present, it remains unclear whether the BAI should be used to detect anxiety disorders in adults, as:
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the number of studies included in our analyses was small;
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the quality of studies was limited; and
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most studies included populations from diverse specialised clinical settings with different co-existing illnesses.
Why is early detection of anxiety disorders important?
Although anxiety disorders are common, they often go undetected, even in people who would benefit from treatment. Because of this, some experts suggest screening for anxiety. Other experts do not support screening because it can falsely show an anxiety disorder when it is not there (known as a 'false positive'), or miss people with anxiety (known as 'false negative'). False positive results can take resources away from those who need them most, and may cause unnecessary worry, further testing and treatment, while false negative results can delay treatment. The term 'any anxiety disorder' (AAD) covers different mental health conditions. These include, amongst others, 'generalised anxiety disorder' (GAD) and 'panic disorder' (PD).
What is the Beck Anxiety Inventory?
The Beck Anxiety Inventory (BAI) is a questionnaire. Originally, its developers created it for measuring the severity of anxiety, but it is also used in screening studies. People answer 21 questions, each on a scale from 0 to 3. After answering all questions, the scores are summed up to get a total score ranging from 0 to 63. A total score equal to or above a certain value (the so-called cut-off) suggests that an anxiety disorder is likely. For the BAI, the cut-off ≥ 16 is frequently used. The use of BAI allows for simple and quick results. Individuals with high BAI scores can be referred for further action.
What did we want to find out?
We wanted to find out how well the BAI can tell whether an adult has an anxiety disorder or not.
What did we do?
We searched for studies that used BAI to detect anxiety. Then we combined the results across these studies.
What did we find?
This review included the results of ten studies that had information on the BAI in detecting AAD (our most important analysis), eight studies that provided information on GAD and four studies on PD. Overall, 14 studies with 6232 participants were included in this review. Nine studies came from diverse specialised clinical settings, two from non-clinical settings and three from mixed settings.
• The combined results showed that if the BAI is administered to a group of 1000 individuals and 270 of them have confirmed AAD:
• Of the 241 individuals who tested positive for AAD, 95 would be falsely labelled as having AAD (false positives).
• Of the 759 individuals who tested negative, 124 would be falsely labelled as not having AAD (false negatives).
What are the limitations of the evidence?
The studies were very diverse, with only a few studies per analysis, and the study quality was limited, meaning we were not certain of the results. Also, some individuals in the studies had anxiety before they filled in the BAI, or this information was not available. Therefore, some studies included people who took part in the study but do not represent the people who should get screened.
What does this mean?
As the study data were limited, we could not be sure if the BAI is a good screening test. The results mainly reflect the use of BAI in diverse specialised clinical settings. However, we do not fully understand whether BAI works better for certain people or in specific settings. Currently, there are shorter questionnaires that have been developed for screening for anxiety disorders, which might be worth considering first.
How up to date is this evidence?
The evidence is up-to-date to 12 July 2024.
Lire le résumé complet
Despite being highly prevalent mental health conditions, anxiety disorders frequently go undiagnosed. The Beck Anxiety Inventory (BAI) is a widely used self-report scale for measuring the severity of anxiety, which has also been used for anxiety screening.
Objectifs
To assess the test accuracy of the Beck Anxiety Inventory (BAI) in adults against structured or semi-structured diagnostic interviews for the following target conditions: any anxiety disorder (AAD), generalised anxiety disorder (GAD), and panic disorder (PD).
Secondary objectives:
- To explore sources of heterogeneity according to setting, the prevalence of anxiety disorders, the reference standard and the risk of bias.
- To investigate how test accuracy changes with the test threshold.
Stratégie de recherche documentaire
We searched Embase, MEDLINE, PubMed-not-MEDLINE subset and PsycINFO from 1990 to 12 July 2024. We checked the reference lists of included studies and review articles. We searched for errata or retractions of included studies via PubMed or Embase. We also checked relevant journal publishers’ websites and conducted a search on the Retraction Watch database (retractiondatabase.org).
Critères de sélection
Studies that included adults presenting with reasons unrelated to mental distress were eligible for this review. These studies involved the administration of the BAI alongside structured or semi-structured diagnostic interviews, allowing for the generation of 2 x 2 tables. We excluded case-control studies and studies with a time gap exceeding four weeks between administering the index test and the reference standard.
Recueil et analyse des données
At least two reviewers independently decided on the eligibility of the articles, extracted the data and assessed the methodological quality of the included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. For each target condition, we present the sensitivity and specificity of each study along with 95% confidence intervals (CIs). We used the multiple thresholds model to obtain the summary test accuracy estimates of all available cut-offs.
Résultats principaux
We identified 14 studies encompassing data from 6232 participants that were available for the analyses. Ten studies contributed to the analysis of the BAI for detecting AAD, eight for GAD, and four for PD. The median prevalence of AAD, GAD and PD was 0.27, 0.12 and 0.10, respectively. Nine studies were conducted in diverse specialised clinical settings, two in non-clinical, and three in mixed settings.
A considerable number of studies showed a high or unclear risk of bias in the domains of patient selection (n = 7), index test (n = 8) and flow and timing (n = 8). A major applicability concern was the presence of prediagnosed anxiety prior to undergoing BAI or the fact that this information may not have been collected.
According to the multiple thresholds model, the BAI had a summary sensitivity of 0.54 (95% CI 0.43 to 0.64) and a specificity of 0.87 (95% CI 0.78 to 0.92) in detecting AAD at the cut-off ≥ 16. The summary sensitivity was 0.72 (95% CI 0.65 to 0.78) and the specificity 0.80 (95% CI 0.71 to 0.87) for detecting GAD, and the summary sensitivity was 0.72 (95% CI 0.50 to 0.87) and specificity was 0.77 (95% CI 0.55 to 0.90) for detecting PD. The area under the multiple thresholds summary receiver operating characteristic (mtsROC) curve (AUC) was 0.76 (95% CI 0.72 to 0.80) for detecting AAD, 0.83 (95% CI 0.80 to 0.86) for GAD and 0.80 (95% CI 0.74 to 0.87) for PD. A formal investigation of heterogeneity was not feasible due to the limited number of included studies.
Conclusions des auteurs
The conclusions that can be drawn from this review are restricted due to the clinical heterogeneity, and limited quality and quantity of the included studies. Furthermore, the sources of heterogeneity remain incompletely understood. Given these limitations and the existence of shorter developed questionnaires (specifically for screening purposes), the utility of the BAI for detecting anxiety disorders is currently uncertain.
Financement
This Cochrane Review was funded by the German Federal Ministry of Education and Research (Grant Number: 01KG2105).
Enregistrement
Protocol (2022): doi.org/10.1002/14651858.CD015292
