TheFEAR: a rapid screening instrument for generalized anxiety in elderly primary care attenders

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Abstract
Objective. To develop a shorter version of the Anxiety Disorder Scale (ADS) for use as a rapid screening instrument in primary care. Design. Two‐stage screening design. Primary care attenders aged 65 and over were screened for generalized anxiety in the surgery with the 11‐item generalized anxiety subscale of the ADS (ADS GA), a selected subsample then proceeding to a clinical validation interview. Interventions. None. Main outcome measures. Scores on the ADS GA, non‐hierarchical ICD‐10 caseness for generalized anxiety established by brief clinical interview by an old age psychiatrist. Results. The prevalence rate of generalized anxiety was 16% using the established cutpoint and showed an age‐related decline. A cutpoint of 2–3/11 appeared to give optimal performance in this small sample (sensitivity 85%, specificity 77%, positive predictive value 52%), suggesting that 36% of elderly general practice attenders might be diagnosed as having generalized anxiety. A reduced four‐item version gave a predicted sensitivity of 77%, a specificity of 83% and a positive predictive value of 63% (cutpoint 1–2/4). Conclusions. A four‐item version of the ADS GA, the FEAR (frequency of anxiety; enduring nature of anxiety; alcohol or sedative use; restlessness or fidgeting), has potential as a rapid screening instrument for use in primary care. Copyright © 1999 John Wiley & Sons, Ltd.

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