The FEAR: a rapid screening instrument for generalized anxiety in elderly primary care attenders

Int J Geriatr Psychiatry. 1999 Jan;14(1):60-8. doi: 10.1002/(sici)1099-1166(199901)14:1<60::aid-gps893>;2-g.


Objective: To develop a shorter version of the Anxiety Disorder Scale (ADS) for use as a rapid screening instrument in primary care.

Design: Two-stage screening design. Primary care attenders aged 65 and over were screened for generalized anxiety in the surgery with the 11-item generalized anxiety subscale of the ADS (ADS GA), a selected subsample then proceeding to a clinical validation interview.

Interventions: None.

Main outcome measures: Scores on the ADS GA, non-hierarchical ICD-10 caseness for generalized anxiety established by brief clinical interview by an old age psychiatrist.

Results: The prevalence rate of generalized anxiety was 16% using the established cutpoint and showed an age-related decline. A cutpoint of 2-3/11 appeared to give optimal performance in this small sample (sensitivity 85%, specificity 77%, positive predictive value 52%), suggesting that 36% of elderly general practice attenders might be diagnosed as having generalized anxiety. A reduced four-item version gave a predicted sensitivity of 77%, a specificity of 83% and a positive predictive value of 63% (cutpoint 1-2/4).

Conclusions: A four-item version of the ADS GA, the FEAR (frequency of anxiety; enduring nature of anxiety; alcohol or sedative use; restlessness or fidgeting), has potential as a rapid screening instrument for use in primary care.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging / psychology
  • Anxiety Disorders / diagnosis*
  • Cross-Sectional Studies
  • Female
  • Health Services for the Aged
  • Humans
  • Male
  • Mass Screening / methods*
  • Primary Health Care*
  • Psychiatric Status Rating Scales / standards*
  • Sensitivity and Specificity