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Validation of a Briefer Anxiety Screening Tool for Use in Pediatric Cardiology Clinics
Sidra Ahmad1, Keneisha Sinclair-McBride2, Erica H Lee2
1Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
A brief anxiety screening tool, the Pediatric-Reported Outcomes Measurement Information System Pediatric Anxiety (PROMIS-Anx), is valid for children with pediatric heart disease (PHD). This tool aids in early anxiety detection in cardiology clinics.
Area of Science:
- Pediatric Cardiology
- Child Psychology
- Anxiety Screening
Background:
- Anxiety disorders are prevalent in children with pediatric heart disease (PHD).
- The standard Screen for Child Anxiety Related Emotional Disorders (SCARED) tool is too lengthy for routine clinical use.
- A shorter screening tool is needed for efficient anxiety assessment in pediatric cardiology settings.
Purpose of the Study:
- To assess the concurrent validity of the Pediatric-Reported Outcomes Measurement Information System Pediatric Anxiety (PROMIS-Anx) tool.
- To compare PROMIS-Anx with the established SCARED screening tool in children with PHD.
- To establish PROMIS-Anx as a viable brief screening instrument for anxiety in this population.
Main Methods:
- Children (7.5 to <18 years) with PHD and their caregivers completed both PROMIS-Anx and SCARED.
- Data were collected between January 2020 and August 2022 during routine cardiology clinic visits.
- Spearman correlation coefficient (rs) analyzed score associations, and Youden index identified a PROMIS-Anx cut point.
Main Results:
- Anxiety was identified in 36.0% of children via SCARED.
- PROMIS-Anx and SCARED scores showed high correlation in children (rs = 0.76) and moderate correlation in caregivers (rs = 0.58).
- A PROMIS-Anx score >30 was established as a threshold for significant anxiety symptoms.
Conclusions:
- The PROMIS-Anx tool demonstrates strong concurrent validity with SCARED, especially when completed by the child.
- PROMIS-Anx is a suitable brief screening tool for identifying anxiety in children with PHD.
- Routine use of PROMIS-Anx in cardiology clinics can facilitate earlier anxiety diagnosis and treatment.
Background:
Anxiety disorders are common in pediatric heart disease (PHD), including congenital, arrhythmic, and acquired heart disease. The standard screening tool, Screen for Child Anxiety Related Emotional Disorders (SCARED), is too lengthy to complete in a busy pediatric cardiology clinic.
Objectives:
This study assessed the concurrent validity of a briefer tool, Pediatric-Reported Outcomes Measurement Information System Pediatric Anxiety (PROMIS-Anx), relative to SCARED in children with PHD.
Methods:
Children, aged 7.5 to <18 years, with PHD and their caregivers both completed PROMIS-Anx and SCARED between January 2020 and August 2022 during cardiology clinic visits. Association of PROMIS-Anx and SCARED scores were analyzed using Spearman correlation coefficient (rs), and a cut point was developed for PROMIS-Anx in children and their caregivers using Youden index.
Results:
Among 144 child/caregiver pairs, anxiety was present in 36.0% of children by SCARED. Scores on SCARED and PROMIS-Anx were higher in females, adolescents, and those with known behavioral health disorders, but were not associated with cardiac disease severity, race, or ethnicity. SCARED and PROMIS-Anx scores were highly correlated in children (rs = 0.76, P < 0.001), and slightly less so in caregivers (rs = 0.58, P < 0.001), both reaching statistical significance. A PROMIS-Anx score of >30 was identified as a threshold for significant anxiety symptoms based on SCARED.
Conclusions:
PROMIS-Anx scores correlate with SCARED across the range of scores, particularly when completed by the child. Routine screening for anxiety in cardiology clinic, with a brief tool such as PROMIS-Anx, can promote earlier identification and treatment of anxiety in children with PHD.
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