CHAPTER 63: BECK ANXIETY INVENTORY (BAI)

Description

The Beck Anxiety Inventory (BAI), by Beck, Epstein, Brown, and Steer (1988), is a 21-item self-report/interview questionnaire designed to quantify the symptoms of anxiety a person may be experiencing over the past week and has proved to be a valid indicator of conditions associated with anxiety across a number of patient populations. The theoretical basis of the measure is reflective of a somatic factor composed of 14 physical symptoms, such as numbness, feeling hot, and having difficulty breathing, and a subjective factor composed of 7 psychological symptoms, such as being unable to relax or being nervous. The BAI was originally developed out of a need to consolidate other anxiety inventories for use in psychiatric populations and to have a scale that could reliably discriminate anxiety from depression as well as to differentiate the various types of anxiety diagnostic groups, like those with panic or generalized anxiety disorder (Beck et al., 1988; Leentjens et al., 2008; Steer, 1993). Each of the BAI’s 21 items are scored along a 4-point Likert scale with answer choices ranging from 0 to 3. Total scores range from 0 to 63 with higher scores suggestive of more anxiety. The BAI can be completed in less than 10 minutes.

Psychometrics

A study of 75 older adults diagnosed with generalized anxiety disorder (GAD) found internal consistency to be α = 0.90, while for the normal control group it was 0.81 (Loebach-Wetherell & Gatz, 2005). Further results of the study determined that 2 items, fearing the worst and nervousness, were able to correctly distinguish 86.5% of patients with GAD and 93.8% of normal controls (Loebach-Wetherell & Gatz, 2005). The BAI was also found to have good internal consistency at α = 0.91 in an outpatient population (n=137, median age 41 years old) (Enns, Cox, Parker, & Guertin, 1998). The same study determined that a four-factor model proposed by Steer (1993) was best able to explain results when compared with other models and encompassed the subjective, neurophysiological, autonomic, and panic; while the mean BAI score of the study was 24.0 (SD = 12.7) (Enns et al., 1998). A study by Steer (2009) determined that the mean BAI total score was 21.42 (SD = 13.06) for an outpatient sample of 525 adults (M = 41, SD = l5) indicating that the sample was moderately anxious. An examination of 117 community-dwelling older adults, mean age 75 years, found that the correlation between the Geriatric Anxiety Scale and the BAI was 0.61 while the correlation between the BAI and the Geriatric Anxiety Inventory was only 0.36 (Yochim, Mueller, June, & Segal, 2011). A sample of 281 older adults who were either community-dwelling (82.6%) or living in a residential care facility (17.4%) determined the mean score to be 6.5 (SD = 7.2), indicating a minimal amount of anxiety; however, there was a trend for older subjects to score higher as well as females and those living in residential facilities vs those in the community.

Advantages

The BAI is a simple assessment both to administer and score and has a significant amount of research in support of its use in clinical practice. It is also a widely accepted measure of anxiety that has been translated into numerous languages signifying its cross-cultural relevance. Its use can also foster a common language throughout the health professions because it is considered by many to be a gold standard of its respective measurement properties.

Disadvantages

A study by Morin et al. (1999), comprising subjects > 75 years old, found that results were not easily explained using either the common two-factor model of cognitive or somatic or the four-factor model already discussed as a more complex six-factor solution, in which multiple subjective, motoric, and physiological dimensions of anxiety emerged in this sample. This suggests that clinicians and researchers need to be careful when interpreting scores of the BAI, which is not designed specifically for use with the elderly (the BAI is validated for persons 17 to 80 years old) because it contains several somatic items and it is known that somatic symptoms typically increase with age often reflecting underlying medical illnesses. The authors went on to suggest that it may be necessary to consider a differential weight system when computing a severity index of anxiety symptomatology for older adults.

Administration

During assessment the person reads a list of 21 common symptoms of anxiety and is asked to consider each and indicate whether he or she has been bothered by any of them during the past week and, if so, how much by numerically choosing the best answer from 4 possible choices (0 to 3). Items are then summed with score interpretation as follows: 0 to 21, very low anxiety; 22 to 35, moderate anxiety; and > 36 is a potential cause for concern.

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