Psychometric properties of the state part of the Spielberger State-Trait Anxiety Inventory (STAI) in geriatric patients.

BACKGROUND

A conspicuously high score on the state part of the State-Trait Anxiety Inventory (STAI) has been observed among geriatric inpatients who are neither demented nor critically ill; 43% of them had a sumscore that, according to Spielberger's criteria, would reflect clinically relevant anxiety symptoms.

OBJECTIVES

To explore the reasons for this high score.

METHODS

101 geriatric inpatients and 68 healthy controls of similar age, living at home and recruited through senior citizen centres participated in a controlled cross-sectional study.

RESULTS

High item-scores were more frequent on the symptom-negative items than on the symptom-positive items. Multi-group factor analysis produced two factors termed 'well-being' and 'nervousness', which had a moderate correlation (0.61). The intercept was much higher on 'well-being' than on 'nervousness', showing that a lack of well-being contributes significantly to the high score on the STAI. This confounds the sumscore. However, the geriatric inpatients nevertheless had a high score on the factor 'nervousness'. Female controls scored higher than males on both factors, whereas among the geriatric patients neither age nor gender related to them.

CONCLUSIONS

The STAI state sumscore is a biased indicator of anxiety in geriatric inpatients owing to confounding by well-being. The most important cause for the observed high score on the STAI state instrument in geriatric patients relates to a reduced well-being.