Concurrent validity of the anxiety symptom-scale compared to two well-being scales: results from the Lolland-Falster health study

Abstract

Objective

To examine the concurrent validity of the Anxiety Symptom-scale against two well-being scales, the Cantril Ladder (CL) and World Health Organization Well-Being Index (WHO-5), to test the algorithm defining anxiety against these scales, and identify cut-off points for the Anxiety Symptom-scale sum score.

Subjects

14,405 adult respondents completing all psychometric questions in the Lolland Falster Health Study.

Method

Receiver operating characteristic analyses comparing Anxiety Symptom-scale WHO-5 and CL.

Results

2.5% of respondents had an anxiety disorder (3% female and 2% male) according to the Anxiety Symptom-scale algorithm. The area under the curve (AUC) was 0.87 for CL and 0.90 for WHO-5 (using inverse scores), indicating high concordance with anxiety disorder as identified by the scale. A score solely ≥2 on item 10 is a relevant cut off to low wellbeing. Anxiety disorder covers a broad range on the scale’s sum score, with 3 to 4 indicating low well-being in this population sample and a sensitivity of 0.85 − 0.99 against CL and WHO-5.

Conclusion

The Anxiety Symptom-scale is a sensitive and valid instrument for the identification of patients in low well-being with symptoms of anxiety. A score ≥2 on the functional impact (Item 10) of all symptoms is a relevant indicator of anxiety associated with low well-being in this sample. A higher Anxiety Symptom-scale sum score is coherent with lower well-being, though without specific cut-off points. Further validation of the Anxiety Symptom-scale in a clinical setting is recommended.

Keywords:

• Anxiety symptom-scale
• anxiety disorders
• psychometrics
• the cantril ladder
• WHO-5
• population study

Acknowledgements

The Lolland-Falster Health Study (LOFUS), Nykøbing Falster Hospital, Denmark, is a collaboration between Region Zealand, Nykøbing Falster Hospital, and Lolland and Guldborgsund municipalities. The authors are grateful to LOFUS for making the LOFUS data available for the present study. However, LOFUS bears no responsibility for the data analysis conducted or the data interpretation presented in this paper.

Ethical approval

Region Zealand’s Ethical Committee on health Research (sJ-421) and the Danish Data protection Agency (REG-24-2015) approved the Lolland-Falster Health Study.

Disclosure statement

All authors declare no conflict of interests.

Data availability statement

Data are subject to third party restrictions managed by The Lolland-Falster Health Study.

Additional information

Funding

No funding is received

Notes on contributors

Aake Packness

Kaj Sparle Christensen, PhD, professor at the Institute of Public Health at Aarhus University, senior researcher at the Research Unit for General Practice in Aarhus, and general practitioner in Aarhus. His research focuses on diagnosis and treatment of mental disorders in primary care settings.

Kaj Sparle Christensen

Kaj Sparle Christensen, PhD, professor at the Institute of Public Health at Aarhus University, senior researcher at the Research Unit for General Practice in Aarhus, and general practitioner in Aarhus. His research focuses on diagnosis and treatment of mental disorders in primary care settings.

Erik Simonsen

Erik Simonsen, PhD, dr.h.c., Professor of Department of Clinical Medicine, University of Copenhagen, Director of Research Unit, Mental Health services East, Psychiatry, Region Zealand, Denmark