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The Trier Social Stress Test Protocol for Inducing Psychological Stress
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State-Trait Anxiety Inventory (STAI) for detecting anxiety disorders in adults.

Daniel Dümmler1,2, Stefanie Eck1, Alexander Hapfelmeier1,3

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The Cochrane Database of Systematic Reviews
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The State-Trait Anxiety Inventory (STAI) shows moderate accuracy for detecting anxiety disorders, but its low specificity raises concerns for screening. Shorter, validated questionnaires are preferred for initial anxiety disorder screening.

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Area of Science:

  • Psychiatry and Mental Health
  • Diagnostic Test Accuracy
  • Psychometric Evaluation

Background:

  • Anxiety disorders are common but often undiagnosed.
  • The State-Trait Anxiety Inventory (STAI) is a widely used self-report measure for anxiety severity.
  • STAI's utility for screening undiagnosed anxiety disorders requires evaluation.

Purpose of the Study:

  • To assess the diagnostic test accuracy (DTA) of the STAI for detecting any anxiety disorder (AAD) and generalized anxiety disorder (GAD) in adults.
  • To determine accuracy estimates across various STAI sum score cut-offs for both State Anxiety (STAI-S) and Trait Anxiety (STAI-T) subscales.

Main Methods:

  • A systematic review and meta-analysis of studies evaluating STAI's diagnostic accuracy.
  • Searches conducted across major databases (Embase, MEDLINE, PsycINFO) from 1990 to May 2024.
  • Included studies used structured interviews as reference standards; data analyzed using multiple thresholds model and summary receiver operating characteristic (SROC) curves.

Main Results:

  • Twelve studies with 2525 participants were included; most had high risk of bias and were conducted in specialized settings.
  • Summary accuracy (AUC) for STAI-S and STAI-T in detecting AAD was 0.78.
  • At common cut-offs (STAI-S ≥40, STAI-T ≥44), sensitivity was adequate (0.83 and 0.81, respectively), but specificity was low (0.55 and 0.60, respectively).

Conclusions:

  • Current evidence does not support confident judgment of STAI's accuracy for screening due to study limitations and generalizability concerns.
  • Moderate overall accuracy was observed, but low specificity suggests potential for misclassification, especially in low-prevalence populations.
  • STAI is not recommended as a first-choice screening instrument due to its length, purpose as a severity measure, and lack of clear screening guidance compared to shorter, validated alternatives.