Should we be anxious when assessing anxiety using the Beck Anxiety Inventory in clinical insomnia patients?

doi:10.1016/j.jpsychires.2011.03.011

Journal of Psychiatric Research

Volume 45, Issue 9, September 2011, Pages 1243-1249

https://doi.org/10.1016/j.jpsychires.2011.03.011 Get rights and content

Abstract

Assessing for clinical levels of anxiety is crucial, as comorbid insomnias far outnumber primary insomnias (PI). Such assessment is complex since those with Anxiety Disorders (AD) and those with PI have overlapping symptoms. Because of this overlap, we need studies that examine the assessment of anxiety in clinical insomnia groups. Participants (N = 207) were classified as having insomnia: 1) without an anxiety disorder (I-ND), or 2) with an anxiety disorder (I-AD). Mean Beck Anxiety Inventory (BAI) item responses were compared using multivariate analysis of variance (MANOVA) and follow-up ANOVAs. As a validity check, a receiver operating characteristic (ROC) curve analysis was conducted to determine if the BAI suggested clinical cutoff was valid for identifying clinical levels of anxiety in this comorbid patient group. The I-ND had lower mean BAI scores than I-AD. There were significant group differences on 12 BAI items. The ROC curve analysis revealed the suggested BAI cutoff (≥16) had 55% sensitivity and 78% specificity. Although anxiety scores were highest in those with insomnia and an anxiety disorder, those with insomnia only had scores in the mild range for anxiety. Nine items did not distinguish between those insomnia sufferers with and without an anxiety disorder. Additionally, published cutoffs for the BAI were not optimal for identifying anxiety disorders in those with insomnia. Such limitations must be considered before using this measure in insomnia patient groups. In addition, the poor specificity and high number of overlapping symptoms between insomnia and anxiety highlight the diagnostic challenges facing clinicians.

Section snippets

Participants

Study participants were recruited at two collaborating medical centers: Duke University Medical Center, Durham, NC and Rush Medical Center, Chicago, IL. Each site has a sleep center with insomnia clinic, which includes physicians and psychologists who specialize in sleep medicine. Participants were those seeking insomnia treatment, as well as research volunteers recruited via advertisements. Eligible participants (N = 372) were recruited into a larger diagnostic insomnia parent study funded by

Results

Cronbach’s alpha was calculated as an index of the internal consistency of the BAI in an insomnia population. The internal consistency was found to be good with α = .89.

Discussion

The properties of a commonly used self-report measure of anxiety, the BAI, were examined in those with an insomnia diagnosis. In support of the validity of the measure, the mean BAI scores were highest in the anxiety-disordered group. Also, there were 12 BAI items that were useful for discriminating those with and without an AD. Most of these items were face-valid anxiety symptoms, such as an inability to relax, or feeling nervous, scared or terrified. It would seem that greater elevations on

Role of funding source

Funding for this study was provided by the National Sleep Foundation Pickwick Fellowship; Classifying Psychiatric, Medical, and Primary Insomnias (NIH R01, MH067057). NIH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Contributors

Jack Edinger, Colleen Carney and Andrew Krystal designed and implemented the studies from which data were collected for use in this study. Dr. Carney and Taryn Moss undertook the statistical analyses and, in collaboration with Andrea Harris, prepared the first draft of the manuscript. Dr. Edinger revised sections for the second draft and provided final edits.

Conflict of interest

None of the authors have any conflicts of interests to report, however, Dr. Edinger acts as a consultant for Philips/Respironics, Inc.; Sleep to Live, Inc. and has grant support from Philips/Respironics. Dr. Krystal acts as a consultant for Abbott, Actelion, Arena, Astellas, Axiom, AstraZeneca, BMS, Cephalon, Eisai, Eli Lilly, GlaxoSmithKline, Jazz, Johnson and Johnson, King, Merck, Neurocrine, Neurogen, Neuronetics, Novartis, Organon, Ortho-McNeil-Janssen, Pfizer, Respironics, Roche,

Acknowledgments

This research was supported by a Pickwick Fellowship Award (Dr. Carney) from the National Sleep Foundation and by the National Institute of Mental Health Grant No. R01, MH067057 (Dr. Edinger).

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Should we be anxious when assessing anxiety using the Beck Anxiety Inventory in clinical insomnia patients?

Abstract

Section snippets

Participants

Results

Discussion

Role of funding source

Contributors

Conflict of interest

Acknowledgments

Journal of Anxiety Disorders

Behavior Research and Therapy

Journal of Psychiatric Research

Behavior Research and Therapy

Behavior Therapy

Behavior Research and Therapy

Journal of Behavioral Therapy and Experimental Psychiatry

Journal of Psychiatric Research

Journal of Anxiety Disorders

Journal of Psychiatric Research

Journal of Anxiety Disorders

Diagnostic and statistical manual of mental disorders

An inventory for measuring clinical anxiety: psychometric properties

Journal of Consulting and Clinical Psychology

Beck Anxiety Inventory manual

Manual for Beck Depression Inventory II (BDI-II)

Caffeine use as a model of acute and chronic insomnia

Sleep

Recommendations for a standard research assessment of insomnia

Sleep

A psychometric evaluation of the Beck Depression Inventory-II

Psychological Assessment

The Duke structured interview for sleep disorders

Cognitive behavioural therapy for patients with primary insomnia or insomnia associated predominately with mixed psychiatric disorders: a randomized clinical trial

Sleep

Structured clinical interview for DSM-IV axis I disorders, clinician version (SCID-CV)