In terms of differences in the BAI scores of anxious and depressed patients, a large difference was found in the original validation study, but in two later studies no difference was found. The results of earlier studies suggest a substantial overlap of the BAI with depressive symptoms, illustrated by a moderate correlation between the BAI and depression scales. Even though in primary care this might be of less importance than in research settings, it is important to know whether the BAI only measures anxiety or whether it is also sensitive to depressive symptomatology. Furthermore, none of the previous BAI studies have focused on primary care populations.Īnother presumed quality of the BAI is its ability to discriminate anxiety from depression. Remarkably, no study has specifically investigated the co-morbidity of anxiety disorders and how this influences BAI scores, even though co-morbidity occurs frequently. Either way, patients with panic disorder and patients with other anxiety disorders have been found to score significantly higher than patients with no anxiety disorder. The results of several studies have found that patients with panic disorder score higher on the BAI than patients with for example generalized anxiety disorder. However, the BAI has been disputed for its focus on psychophysiological symptoms linked to panic. Since its development, the BAI has been widely used in clinical research in mental health care, mainly as a measure of general anxiety. Considering its brevity, simplicity, and presumed ability to measure general anxiety, the Beck Anxiety Inventory (BAI) might be a good candidate for use as a severity indicator. However, extensive testing for different forms of anxiety is also not feasible during the short consultations in primary care. panic disorder or generalized anxiety disorder). General rating scales may not be specific enough to assess the severity of a specific anxiety disorder (i.e. However, we first have to determine which questionnaires can be used as severity indicators in primary care and what their characteristics are.Īs anxiety disorders differ in type and symptoms, assessing the severity of anxiety in general may be more difficult than assessing the severity of depression. For similar reasons the use of severity scales to assess anxiety symptoms in primary care might be advocated. Moreover, in some countries incentives are offered when a validated instrument is used at the start of and during the treatment of patients diagnosed with depression. higher prescription rates of antidepressant medication and increased referral to secondary care). Furthermore, when questionnaires to assess severity are used, higher severity scores are related to better care (i.e. With regard to depression, the use of severity indicators in primary care is supported by the results of studies showing that patients value the use of questionnaires as a supplement to the diagnosis made by their general practitioner and as evidence that their problems are taken seriously. To improve anxiety management, assessment of the severity of the anxiety (and subsequent monitoring) is recommended by researchers and also in clinical guidelines. In primary care, many patients present with anxiety symptoms but these are seldom systematically assessed. However, because the instrument seems to reflect the severity of depression as well, it is not a suitable instrument to discriminate between anxiety and depression in a primary care population. The results suggest that the BAI may be used as a severity indicator of anxiety in primary care patients with different anxiety disorders. Depressed and anxious patients did not differ significantly in their mean scores. BAI scores in patients with an anxiety disorder with a co-morbid anxiety disorder and in patients with an anxiety disorder with a co-morbid depressive disorder were significantly higher than BAI scores in patients with an anxiety disorder alone or patients with a depressive disorder alone. A significantly higher score was found for patients with panic disorder and agoraphobia compared to patients with agoraphobia only or social phobia only. Patients with any anxiety disorder had a significantly higher mean score than the controls. Regression analyses were used to compare the mean BAI scores of the different diagnostic groups and to correct for age and gender. Participants were 1601 primary care patients participating in the Netherlands Study of Depression and Anxiety (NESDA). This study focuses on the Beck Anxiety Inventory (BAI) as a severity indicator for anxiety in primary care patients with different anxiety disorders (social phobia, panic disorder with or without agoraphobia, agoraphobia or generalized anxiety disorder), depressive disorders or no disorder (controls). Appropriate management of anxiety disorders in primary care requires clinical assessment and monitoring of the severity of the anxiety.
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