title: Screening for anxiety disorders in patients with coronary artery disease.
abstract: BACKGROUND
  Anxiety disorders are prevalent and associated with poor prognosis in patients with coronary artery disease (CAD). However, studies examining screening of anxiety disorders in CAD patients are lacking. In the present study we evaluated the prevalence of anxiety disorders in patients with CAD and diagnostic utility of self-rating scales for screening of anxiety disorders.
  
  
  METHODS
  Five-hundred and twenty-three CAD patients not receiving psychotropic treatments at initiation of rehabilitation program completed self-rating scales (Hospital Anxiety and Depression Scale or HADS; Spielberger State-Anxiety Inventory or SSAI; and Spielberger Trait-Anxiety Inventory or STAI) and were interviewed for generalized anxiety disorder (GAD), social phobia, panic disorder and agoraphobia (Mini-International Neuropsychiatric Interview or MINI).
  
  
  RESULTS
  Thirty-eight (7%) patients were diagnosed with anxiety disorder(s), including GAD (5%), social phobia (2%), agoraphobia (1%) and panic disorder (1%). Areas under the ROC curve of the HADS Anxiety subscale (HADS-A), STAI and SSAI for screening of any anxiety disorder were .81, .80 and .72, respectively. Optimal cut-off values for screening of any anxiety disorders were ≥ 8 for the HADS-A (sensitivity = 82%; specificity = 76%; and positive predictive value (PPV) = 21%); ≥ 45 for the STAI (sensitivity = 89%; specificity = 56%; and PPV = 14%); and ≥ 40 for the SSAI (sensitivity = 84%; specificity = 55%; PPV = 13%). In a subgroup of patients (n = 340) scoring below the optimal major depressive disorder screening cut-off value of HADS-Depression subscale (score <5), the HADS-A, STAI and SSAI had moderate-high sensitivity (range from 69% to 89%) and low PPVs (≤ 22%) for GAD and any anxiety disorders.
  
  
  CONCLUSIONS
  Anxiety disorders are prevalent in CAD patients but can be reliably identified using self-rating scales. Anxiety self-rating scales had comparable sensitivities but the HADS-A had greater specificity and PPV when compared to the STAI and SSAI for screening of anxiety disorders. However, false positive rates were high, suggesting that patients with positive screening results should undergo psychiatric interview prior to initiating treatment for anxiety disorders and that routine use of anxiety self-rating scales for screening purposes can increase healthcare costs. Anxiety screening has incremental value to depression screening for identifying anxiety disorders.
authors.affiliation: Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania. a.bunevicius@yahoo.com
authors.forename: Adomas
authors.initials: A
authors.lastname: Bunevicius
authors.forename: Margarita
authors.initials: M
authors.lastname: Staniute
authors.forename: Julija
authors.initials: J
authors.lastname: Brozaitiene
authors.forename: Victor J M
authors.initials: VJ
authors.lastname: Pop
authors.forename: Julius
authors.initials: J
authors.lastname: Neverauskas
authors.forename: Robertas
authors.initials: R
authors.lastname: Bunevicius
mesh_terms: D001008:Anxiety Disorders / Q000150:complications / Q000175:diagnosis*; D003324:Coronary Artery Disease / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D016584:Panic Disorder / Q000150:complications / Q000175:diagnosis; D010698:Phobic Disorders / Q000150:complications / Q000175:diagnosis; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012647:Self-Assessment; D012680:Sensitivity and Specificity