Description/Samples/Epidemiologic Evidence

ANXIETY

o State vs. trait anxiety.

o Worry vs. emotionality. Worry refers to the cognitive component of the anxiety experience, whereas emotionality refers to the perceived arousal component of the anxiety experience. The two components are only poorly to moderately related to each other. Worry is substantially related to performance impairment whereas emotionality is almost unrelated to it.

Measures:

(1) State-Trait Anxiety Inventory (STAI; Spielberger, 1983), aka Spielberger Inventory Scales.

Self-report measure consists of 20 items to assess state anxiety & another 20 items to assess trait anxiety.

o Mittleman MA et al. (1995). Determinants of Myocardial Infarction Onset Study. Case crossover study design. 1623 patients interviewed 4 days post MI. RR of MI onset was associated with scores on Spielberger State Anxiety subscale.

o Thomas SA et al. (1997). Cardiac arrhythmia suppression trial (CAST). 348 patients w/asymptomatic ventricular arrhytmias after MI. Among men in the nonactive medication group, higher state anxiety (Spielberger) was associated with higher mortality.

o Paternini et al. (1999). Pop'n-based study of 1389 subjects aged 59 to 71 in Nantes, France. Trait anxiety (Spielberger) but not depression (CES-D) was associated with high blood pressure.

(2) Endler Multidimensional Anxiety Scales (EMAS; Endler, Edwards & Vitelli, 1991).

(3) Crown-Crisp Phobic Anxiety Index

o Haines et al. 1987. Northwick Park Heart Study followed 1457 initially healthy men for 10 yrs, found a strong association between anxiety as measured by Crown-Crisp index and fatal CHD.

o Kawachi et al. 1994a. Health Professionals Follow-up Study. Risk of fatal CHD increased with levels of phobic anxiety as measured by Crown-Crisp index.

(4) Worries Scale

Assess worry about 5 domains -- social conditions, health, financial, self-definition, aging.

o Kubzansky et al. (1997). Normative Aging Study. Worry about social conditions was associated with incident CHD.

(4) Zung Self-Raing Anxiety Scale (Zung, 1971)

(5) Framingham Tension Scale (Haynes et al., 1978; scale in Appendix)

7 items, primarily measures the frequency of feelings of anxiety, including somatic symptoms potentially related to anxiety. Items include having trouble relating, being bothered by nervousness or shaking, and being troubled by feelings of tenseness, tightness, or restlessness.

o Markovitz JH, Matthews KA, Wing, et al. 1991. A study of 468 middle-aged normotensive women found that those with more anxiety symptoms (Framingham Tension Scale) had greater increases in systolic BP during 3-yr follow-up.

o Markovitz JH, Matthews KA, Kannel et al. 1993. Anxiety levels (Framingham Tension Scale) predict incident HTN.

o Eaker, Pinsky, & Castelli, 1992. Framingham Study. 20-y follow-up of 749 initially healthy women. Anxiety symptoms (Framingham Tension Scale) were significantly assoc with MI & coronary death among homemakers but not among employed women.