Faces Scales for Anxiety and Anger: A National Study of Measurement Properties

Lisa Grossman Liu; David Russell; Meghan Reading Turchioe; Annie C Myers; Connie M Baker; Jyotishman Pathak; Ruth M Masterson Creber

doi:10.4088/JCP.21m14202

Faces Scales for Anxiety and Anger: A National Study of Measurement Properties

J Clin Psychiatry. 2022 Aug 8;83(5):21m14202. doi: 10.4088/JCP.21m14202.

Authors

Lisa Grossman Liu^{1

2}, David Russell³, Meghan Reading Turchioe⁴, Annie C Myers⁴, Connie M Baker⁵, Jyotishman Pathak⁴, Ruth M Masterson Creber⁴

Affiliations

¹ Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York.
² Corresponding author: Lisa Grossman Liu, MD, PhD, College of Physicians and Surgeons, Department of Biomedical Informatics, Columbia University, 622 W 168th St PH20, New York, NY 10032 (lvg2104@cumc.columbia.edu).
³ Department of Sociology, Appalachian State University, Boone, North Carolina.
⁴ Department of Population Health Sciences, Weill Cornell Medicine, New York, New York.
⁵ Wong-Baker FACES Foundation, Oklahoma City, Oklahoma.

PMID: 35950903
DOI: 10.4088/JCP.21m14202

Abstract

Importance: Faces scales are used worldwide to assess pain, but robust faces scales for anxiety and anger do not exist. These scales are urgently needed, because an estimated two-thirds of patients have difficulty reading written questionnaires.

Objective: To develop and evaluate measurement properties of faces scales to monitor two mental health symptoms in US adults (anxiety and anger) in accordance with the COnsensus-based Standards for health Measurement INstruments (COSMIN).

Methods: The development process included population identification, scale generation, and pretesting. The evaluation process included assessment of content validity, construct validity, criterion validity, test-retest reliability, and measurement error using 5 order-randomized, positively controlled online survey studies conducted between April and June 2020. We recruited national purposive samples of US adults representative on age, gender, and race. For each faces scale, participants assessed relevance, comprehensibility, and comprehensiveness (study 1, n = 300), strength-of-association (study 2, n = 300), convergent validity against the visual analog scale (VAS; study 3, n = 305), convergent validity against the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires (study 4, n = 1,000), and test-retest reliability and measurement error (study 5, n = 853).

Results: The anxiety and anger faces scales showed high relevance (95%-96%), comprehensibility (93%-97%), comprehensiveness (94%-97%), and strength-of-association (74%-96%). We found very high agreement with the VAS (ρ = 0.94-0.95) and high agreement with PROMIS questionnaires (ρ = 0.74-0.79). Scales showed adequate test-retest reliability (intraclass correlation = 0.70-0.78) and measurement error (standard error of measurement = 1.14-1.22).

Conclusions: Faces scales to monitor anxiety and anger show adequate measurement properties, including content validity, construct validity, criterion validity, test-retest reliability, and measurement error. The recommended use is non-diagnostic monitoring of anxiety and anger, particularly when mental health is an ancillary but important outcome of treatment.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Anger
Anxiety Disorders*
Anxiety* / diagnosis
Anxiety* / psychology
Humans
Psychometrics
Reproducibility of Results
Surveys and Questionnaires

Abstract

Publication types

MeSH terms

Grants and funding