Application and Validation of the Beck Anxiety Inventory among Nepalese School Adolescents

Abstract

Anxiety is a common mental disorder (CMD) and it affects all the age groups including children and adolescents. Various scales and tools are available to screen and diagnose anxieties. Beck Anxiety Inventory (BAI) is a reliable tool recommended for 12- 80 years to screen panic to geriatric anxiety. It is also applied and validated among Nepalese adults for Generalised Anxiety Disorder (GAD). This study was aimed to apply and validate the Beck Anxiety Inventory (BAI) against school adolescents in Nepal. BAI is a 21-item self-reported scale having four-point Likert scale from “0” (Not at all) through “3” (Severely-I could barely stand it). The tool was translated into Nepali and back-translated into English and several iterations were done till the original meaning was obtained. The tool was concurrently validated against seven-item Generalized Anxiety Disorder scale (GAD-7) as a gold standard, which possesses only seven items and similar Likert scale. Descriptive, inferential including sensitivity, specificity and principal component analysis were performed for 2007 sample adolescents from 13 public and ten private schools of five development regions of the country. The prevalence of generalized anxiety was 34.78% and descriptive data revealed that the BAI and GAD-7 scores were positively skewed. The concurrent validity was moderate (ρ=0.58, p<0.001) and the BAI showed a good internal consistency (a=0.86). The cut-off of 13/14 showed acceptable sensitivity (70.9% ), specificity (73.1% ), and AUC (80.0% (95%CI; 77.4-82.5)) (p<0.001). The principal component analysis showed six-factor explaining 52.04 percent variance, instead of four-factor in most of the literatures. The Nepalese BAI-Adolescent is a valid tool for age group 13-19 years; if applied cautiously regarding the items three, six and thirteen. It can screen 80.0% of the generalized anxiety cases with 70.9 percent sensitivity and 73.1 percent specificity among students and hence recommended to use in schools.

Key words: Adolescent, application, anxiety, Beck, Nepalese, school, validation.