title: Levels of state and trait anxiety in patients referred to ophthalmology by primary care clinicians: a cross sectional study.
abstract: OBJECTIVE
  There is a high level of over-referral from primary eye care leading to significant numbers of people without ocular pathology (false positives) being referred to secondary eye care. The present study used a psychometric instrument to determine whether there is a psychological burden on patients due to referral to secondary eye care, and used Rasch analysis to convert the data from an ordinal to an interval scale.
  
  
  METHODS
  Cross sectional study.
  
  
  METHODS
  322 participants and 80 control participants.
  
  
  METHODS
  State (i.e. current) and trait (i.e. propensity to) anxiety were measured in a group of patients referred to a hospital eye department in the UK and in a control group who have had a sight test but were not referred. Response category analysis plus infit and outfit Rasch statistics and person separation indices were used to determine the usefulness of individual items and the response categories. Principal components analysis was used to determine dimensionality.
  
  
  METHODS
  Levels of state and trait anxiety measured using the State-Trait Anxiety Inventory.
  
  
  RESULTS
  State anxiety scores were significantly higher in the patients referred to secondary eye care than the controls (p<0.04), but similar for trait anxiety (p>0.1). Rasch analysis highlighted that the questionnaire results needed to be split into "anxiety-absent" and "anxiety-present" items for both state and trait anxiety, but both subscales showed the same profile of results between patients and controls.
  
  
  CONCLUSIONS
  State anxiety was shown to be higher in patients referred to secondary eye care than the controls, and at similar levels to people with moderate to high perceived susceptibility to breast cancer. This suggests that referral from primary to secondary eye care can result in a significant psychological burden on some patients.
authors.affiliation: Bradford School of Optometry and Vision Science, Bradford, United Kingdom. chris@chrisdavey.co.uk
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Davey
authors.forename: Clare
authors.initials: C
authors.lastname: Harley
authors.forename: David B
authors.initials: DB
authors.lastname: Elliott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology; D011320:Primary Health Care; D025341:Principal Component Analysis; D011594:Psychometrics; D012017:Referral and Consultation