پیش بینی اختلالات اضطرابی با استفاده از پرسشنامه اضطراب حالتی - خصلتی برای نوجوانان چند قومیتی

The purpose of this study was to determine the validity of the State–Trait Anxiety Inventory (STAI) in predicting DSM-III-R anxiety disorders based on the Diagnostic Interview Schedule for Children (DISC, Version 2.3) and using Asian/Pacific Islander adolescents. An overall prevalence rate of 9.19% for generalized anxiety disorder, overanxious disorder, or social phobia was consistent with past studies. As hypothesized, STAI negatively worded (i.e., Factor 2) items were better predictors than positively stated (i.e., Factor 1) items. The STAI State mean was a better predictor of concurrent DISC anxiety disorders as compared to STAI State Factors 1 or 2. In contrast, the STAI Trait Factor 2 (negatively worded) composite was the best predictor for nonconcurrent DISC anxiety disorders as compared to STAI Trait Factor 1 or the overall STAI Trait subscale. Satisfactory predictive-validity values were obtained when using the STAI State mean and Trait Factor 2 composite. Implications of these findings are discussed, including using the STAI as a screening measure for ethnically diverse adolescents.

Anxiety disorders are some of the most frequently occurring problems for school-aged children and adolescents Bernstein & Borchardt, 1991 and Kashani & Orvaschel, 1990. For example, based on a review of 16 international studies of children and adolescents (ages 6–17 years) conducted since 1986, Costello and Angold (1995) reported prevalences ranging from 5.7% to 17.7% with half of the investigations obtaining rates above 10%. Similar rates have been obtained in more recent studies (e.g., Shaffer et al., 1996). These are very high rates suggesting that a very large proportion of children and adolescents with anxiety disorders are not being identified and provided appropriate services. For example, in the United States, not more than 1% of the kindergarten to 12th-grade population have been identified under the Individuals with Disabilities Education Act (IDEA) as having an “emotional disturbance” (U.S. Department of Education, 1998). The discrepancy between rates of anxiety disorders and the 1% who have been identified with an emotional disturbance under IDEA is further magnified by the fact that the category of emotional disturbance includes many other emotional–behavioral disorders, including externalizing problems (e.g., oppositional defiant disorder, conduct disorder). This underestimation of anxiety disorders is likely due to several factors, including: (1) teachers—the primary source of referral for IDEA evaluations Galagan, 1985, Lloyd et al., 1991 and Ysseldyke et al., 1997—tend to make referrals due to externalizing behaviors Algozzine & Ysseldyke, 1986 and Pearcy et al., 1993 and (2) parents tend to report lower rates or levels of anxiety in their children as compared to self-reports by the children themselves Bernstein & Borchardt, 1991, Kashani & Orvaschel, 1990 and Orvaschel & Weissman, 1986. These issues highlight the need for screening and treatment programs in school environments and community samples. One of the first steps in such a process is the development and use of effective self-report screening and assessment instruments that are reliable and valid for the population in question (Stallings & March, 1995). Although many anxiety inventories are currently available (Stallings & March, 1995), their application to specific populations remains questionable given that not all instruments have been validated for all children and adolescents. A major factor of consideration is whether anxiety inventories can be used as screening devices for different cultures (e.g., Friedman, 1997). Although anxiety is said to be universal across all cultures Good & Kleinman, 1985, Guarnaccia, 1997, Spielberger & Diaz-Guerrero, 1976, Spielberger & Diaz-Guerrero, 1983 and Spielberger & Diaz-Guerrero, 1986, the contexts in which it is experienced, the interpretations of its meaning, and the responses to it are, like those of other emotions, strongly influenced by cultural beliefs and practices (Kirmayer, Young, & Hayton, 1995, p. 504; see also Guarnaccia, 1997, Malpass & Poortinga, 1986 and Manson, 1996. Attention to these types of cultural issues have increased in the past few decades regarding anxiety as well as other psychological disorders (e.g., American Psychiatric Association, 1994, Gaw, 1993, Lonner & Ibrahim, 1989 and Mezzich et al., 1996), with particular interest in Asian/Pacific Islanders (e.g., Caudill & Lin, 1969, Lebra, 1972, McDermott et al., 1980, Tseng & McDermott, 1981 and Tseng & Streltzer, 1997). Such growing interest nationally is warranted given the recent projected increases in the proportion of minorities. For example, based on the 1980 and 1990 census data, the proportion of Caucasians decreased while the percentage of all major minority groups increased. The largest increase in proportion was found for Asian/Pacific Islanders with over a twofold increase in just 10 years (see Barringer, Gardner, & Levin, 1993). By the middle of the 21st century, the projection is that the US will no longer have a Caucasian majority (Mezzich et al., 1996). With focus on the Asian/Pacific Islander population, particular concern is noted on the health of Native Hawaiians (“Hawaiians” hereafter), the indigenous inhabitants of the Hawaiian Islands, given that numerous studies have shown Hawaiians to suffer from far more problems associated with socioeconomic status (SES), education, psychological adjustment, and health than other major ethnic groups in Hawaii (e.g., Alu Like, 1985, Department of Business, Economic Development and Tourism, State of Hawaii, 1997, Department of the Attorney General, State of Hawaii, 1997, Kamehameha Schools/Bernice Pauahi Bishop Estate, 1993, Office of Assessment Technology, 1987, Office of Hawaiian Affairs, 1998 and Tsark et al., 1998). Unfortunately, the topic of anxiety has been a severely underresearched area for Hawaiians and ethnically diverse non-Hawaiians of all ages who reside in Hawaii. 1.1. Purpose The overall purpose of the present study was to determine the validity of a standardized anxiety inventory in predicting anxiety disorders in Native Hawaiian versus non-Hawaiian adolescents living in Hawaii. Related to this aim was the goal of ascertaining the role that demographic variables play in the use of a standardized inventory as a screener of anxiety disorders. These demographic variables were ethnicity (Hawaiian vs. non-Hawaiian), gender, grade level (9th to 12th), main wage earners' educational attainment, and main wage earners' employment status—the latter two being measures of SES. The State–Trait Anxiety Inventory (STAI, Form X; Spielberger, Gorsuch, & Lushene, 1970) was used to predict the absence or presence of DSM-III-R (American Psychiatric Association, 1987) anxiety disorders based on the Diagnostic Interview Schedule for Children (DISC, Version 2.3; Shaffer et al., 1996). The STAI, Form X (Spielberger et al., 1970), was utilized given its previous research foundation with other cross-cultural populations and its inclusion in the large-scale study of the Native Hawaiian Mental Health Research Development Program (NHMHRDP). Although the research foundation of using the STAI as a screener for adolescents of Asian/Pacific Islander ancestry was nonexistent, and other studies using adults reported mixed findings (e.g., Kabacoff, Segal, Hersen, & van Hasselt, 1997), the theoretical constructs of the STAI appeared to have potential utility in the prediction of anxiety disorders. In particular, the STAI is composed of State and Trait subscales. “State anxiety (A-State) is conceptualized as a transitory emotional state or condition of the human organism that is characterized by subjective, consciously perceived feelings of tension and apprehension, and heightened autonomic nervous system activity” (Spielberger et al., 1970, p. 3). “Trait anxiety (A-Trait) refers to relatively stable individual differences in anxiety proneness, that is, to differences between people in the tendency to respond to situations perceived as threatening with elevations in A-State intensity” (p. 3). Both the State and Trait subscales consist of 20 items, some of which are positively worded (i.e., anxiety-absent) and the remaining negatively worded (i.e., anxiety-present). Spielberger, Vagg, Barker, Donham, and Westberry (1980) theorized that anxiety-absent items would be more sensitive to low levels of anxiety, whereas anxiety-present items would be more sensitive to high levels of anxiety. Previous research has demonstrated a relatively robust four-factor solution to the 40 STAI items: State anxiety-absent (State Factor 1), State anxiety-present (State Factor 2), Trait anxiety-absent (Trait Factor 1), and Trait anxiety-present (Trait Factor 2) (see for a review, Hishinuma, Miyamote, Nishimura, Nahulu, Andrade, et al., 2000). This four-factor solution was generally confirmed with the present population of adolescents from Hawaii (Hishinuma, Miyamote, Nishimura, Nahulu, Andrade, et al., 2000). Examination of the four factors as well as demographic variables is necessary in the present study because differential results have been obtained as a function of the type of STAI composite (Hishinuma, Miyamoto, Nishimura, & Nahulu, 2000). For example, a significant main effect of ethnicity was obtained on the overall State and Trait measures, with subsequent t tests indicating that Japanese adolescents scored significantly lower than Hawaiian high school students. However, when the other three demographic variables (i.e., gender, grade level, main wage earners' education) were simultaneously considered in the prediction model, ethnicity was no longer a significant predictor of overall STAI scores. In general, females scored higher than males, and the higher the main wage earners' educational attainment, the lower the STAI scores. In addition, two interaction effects were statistically significant. First, the difference between females and males (with females having higher levels of anxiety than males) was larger for State Factor 1 as compared to State Factor 2, but the reverse was found for the Trait factors (i.e., larger female–male difference was found for Factor 2 as compared to Factor 1). Second, the Japanese adolescents scored lower on State Factor 1 than the Hawaiian, Caucasian, and “other” ethnic groups (the latter was composed of high school students who were neither full-/part-Hawaiian, Caucasian, Japanese, nor Filipino). However, on State Factor 2, the Japanese and Caucasians scored significantly lower than the Hawaiians. Therefore, with reverse scoring taken into account, the Caucasian adolescents scored relatively high on anxiety for the positively worded items, but scored relatively low on anxiety for the negatively worded items. The DISC (Version 2.3; Shaffer et al., 1996) served as the criterion for anxiety disorders. A proportion of the participants were administered the STAI and DISC on the same day (i.e., concurrently), while the remaining students were administered the DISC some time after the STAI (i.e., nonconcurrently). 1.2. Hypotheses Three central hypotheses were examined. First, the STAI composites will significantly predict the presence and absence of DISC anxiety disorders, with the possibility that Factor 2 (anxiety-present) composites will be better predictors given their supposed sensitivity to high levels of anxiety. Second, the State composites (as compared to Trait measures) will better predict DISC anxiety disorders when the administration of the STAI and DISC was concurrent. In contrast, the Trait composites (as compared to State measures) will better predict DISC anxiety disorders under nonconcurrent administration procedures. Third, after STAI composites are entered into the prediction model, demographic variables will be statistically significant in predicting unique variance in DISC anxiety disorders. However, a substantial amount of unique variance will not be accounted for by the demographic variables, including ethnicity (i.e., Hawaiian vs. non-Hawaiian).