Psychometrics of the Korean Version of the screen for adult anxiety related disorders (SCAARED) – BMC Psychiatry

The aim of this study was to examine the reliability and validity of the SCAARED in a Korean community population. We showed that the internal consistency, test-retest reliability, and concurrent validity of the instrument were good. Additionally, the construct validity was proved by PAF analysis, which confirmed that the instrument was valid. Our results demonstrated good discriminant validity.

The internal consistency examined by the Cronbach’s alpha coefficients for the SCAARED total score, Somatic/Panic/Agoraphobia, Generalized anxiety, Separation anxiety, and Social anxiety score were excellent. The Cronbach’s alpha coefficients for the SCAARED total score reported in the validation study of the original, Spanish, Chinese, and Persian version of the SCAARED were 0.97, 0.91, 0.94, and 0.97, respectively, indicating that our result was comparable to these studies [15, 20,21,22]. The concurrent validity was shown by a significant correlation with the DASS-21, BAI, and STAI, which was comparable to the validation study of the Spanish version [20].

Construct validity of our study was assessed through factor analysis, identifying four factors (Somatic/Panic/Agoraphobia, General anxiety, Separation anxiety, Social anxiety) in the SCAARED, aligning with the dimensional structure of both the original and other versions of SCAARED [15, 20,21,22], corresponding to the four factors of the Screen for Child Anxiety Related Emotional Disorders (SCARED) [16]. However, 4 items (9, 18, 19, and 38) were assigned to different factors compared to the original SCAARED. Item 38, initially in the Somatic/Panic/Agoraphobia factor, moved to Social anxiety, also showing cross-loading on Separation anxiety. This reassignment is justified as the item addresses exposure to social situations and separation from loved ones. This trend was consistent with Spanish and Chinese validation studies, where item 38 loaded highest on Social anxiety [20, 22]. Items 9, originally under Somatic/Panic/Agoraphobia, showed the highest loading on Generalized anxiety, possibly due to the inherent overlap between anxiety disorders. Items 18 and 19, initially in the Panic Disorder factor, were reassigned to Separation anxiety, aligning with themes of high anxiety.

The discriminant validity of the Korean version of SCAARED, assessed using AUC values from the ROC curve, was found to be satisfactory. These results imply that the Korean version of SCAARED demonstrates a performance analogous to other versions of the SCAARED scales, including the original and Spanish versions [15, 20], suggesting its utility for screening anxiety disorders in the Korean adult population.

Other anxiety scales reflect the overall severity of anxiety, encompassing physical symptoms, cognitive symptoms, and associated depression [6,7,8, 10], making it challenging to obtain diagnostic information. Moreover, scales such as the Panic Disorder Severity Scale [31, 32], utilized in Korea, are designed to reflect the severity of specific disorders like panic disorder. Consequently, to categorize diagnoses, clinical assessments such as the SCID or MINI are delivered by trained clinicians [11, 14]. The SCAARED, on the other hand, offers diagnostic classification information and allows for the administration of survey assessments within a relatively brief period, presenting a significant advantage in clinical settings. Therefore, the usefulness of SCAARED includes assisting clinicians by providing an initial diagnostic impression, allowing them to focus more on additional questions necessary for diagnosing anxiety disorders. Furthermore, by providing community members and individuals seeking help with a diagnostic impression of which anxiety disorder they are likely experiencing, it enhances disease awareness and facilitates the process of seeking psychiatric treatment.

This study has several limitations. First, our study was based on a relatively small sample size, which might have resulted in an inadequate fit of the CFA, and thus we could not confirm the original factor structure suggested in the original version of the SCAARED [15]. Despite this, the congruence of factor structures observed in cross-cultural validations of the SCAARED [15, 20,21,22] provides provisional support for our findings. Nevertheless, future studies employing larger sample sizes are crucial for more definitive validation of the factor structures of the Korean version of the SCAARED. Second, since we based our study on a community sample interested in mental health services, concerns about generalizability arise. Participants were recruited as part of a study focused on mental health services addressing stress and anxiety. It is highly likely that individuals with a strong interest in mental health, especially those experiencing emotional depression or anxiety, were chosen as participants. Therefore, it can be understood that we recruited a community sample requiring mental health services rather than a general population. This is reflected in the fact that the mean scores for BAI, STAI, and DASS-21 are at a mild severity. However, there is an advantage in that we can identify the characteristics of help-seeking individuals since the study targeted people with a high interest in mental health services. Third, in this study, we did not gather information on psychiatric history or treatment. Therefore, we cannot determine the confirmed psychiatric characteristics of the community population. Finally, the absence of a clinical sample in our study precludes an assessment of diagnostic validity, requiring subsequent research to explore the utility of the Korean version of the SCAARED in clinical populations.

In conclusion, the analysis of the psychometric properties of the SCAARED indicates that this assessment tool demonstrates good reliability and validity for identifying adults with anxiety disorders in Korea. However, to address the limitations of our study, there is a need for evaluations with larger sample sizes and confirmed clinical populations, as well as other populations. Additionally, as the SCARED has not yet been validated in Korea, a validation study among child and adolescent populations is necessary. This would facilitate the comprehensive use of both instruments across various age groups, from childhood to adulthood, in both clinical and research settings.