Many people go through life suspecting that they may have a certain mental health condition, but never take the step of getting the opinion of a medical professional. This means that they may miss out on the care they need to truly thrive. If you're in this position, the first step to a formal diagnosis may be to take a self-report questionnaire for anxiety.
There are many self-report questionnaires available. Some aim to measure the presence of symptoms such as worry, while others try to take a fuller snapshot of the patient's mental health. We'll walk through some of the common options for anxiety disorders, as well as discussing the pros and cons of using self-report questionnaires.
Why use self-reporting for anxiety?
As the name suggests, self-report questionnaires involve patients reading through and responding to a set of questions without any assistance or interference from others. They're particularly common in the field of psychology, where they're used to identify signs and symptoms of certain disorders. This includes conditions such as depression and anxiety.
Self-reporting is just one tool used to diagnose anxiety. Medical professionals may also carry out a psychological evaluation, during which they'll speak to you about your thoughts, feelings and behaviours. They may also observe the way you act and note down any symptoms you appear to be exhibiting. When doing so, they'll compare this to the definitions in a diagnostic manual, such as DSM-5 or ICD-11.
Though self-report questionnaires are common, they're not infallible. We'll take a look at some of their key advantages and drawbacks below.
- Self-report questionnaires are low-cost, take little effort to administer, and can quickly be distributed to a large number of people.
- The patient need not be physically present, as questionnaires are easy to conduct online.
- They allow for generalisable findings as they result in the collection of quantitative data.
- Patients can be more accurate in describing their own symptoms than a third party observer.
- It's possible to collect data about scenarios that cannot easily or ethically be observed by a medical professional.
- Patients may give answers they feel are socially acceptable rather than telling the truth about their symptoms.
- The questionnaire may provide only a limited range of options that do not adequately describe the patient's experience.
- Some individuals are predisposed to answer ‘yes’ or ‘no’, regardless of the question.
- The questions themselves may be leading, or be designed according to the researcher's preconceived ideas.
- If questions are open-ended, then the subjective interpretation of the person analysing the data will affect how answers are categorised.
Types of self-report questionnaires for anxiety
With anxiety disorders being the most common type of mental health condition worldwide, numerous methods have emerged to diagnose them. This includes a plethora of self-report questionnaires for anxiety. Below, we'll take a look at some of the most commonly used examples.
One of the most common questionnaires used in the diagnosis of generalised anxiety disorder is GAD-7. The name is fairly self-explanatory: ‘GAD’ refers to the condition being tested for, while ‘7’ is the number of questions asked.
GAD-7 asks patients to describe their symptoms over the previous two weeks. Its focus is primarily on the psychological symptoms of GAD, including:
- Feeling nervous, anxious or on edge
- Not being able to stop or control worrying
- Worrying too much about different things
- Having trouble relaxing
- Being so restless that it is hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid, as if something awful might happen
Though GAD-7 is widely used today, it's actually a relatively recent addition to psychologists' arsenal. It was devised in 2006 in response to the fact that no ‘brief clinical measure’ had existed to diagnose generalised anxiety disorder. The high degree of sensitivity and specificity of GAD-7 have made it a popular choice not just for GAD itself, but also for other anxiety disorders, including PTSD, social anxiety disorder and panic disorder.
Beck Anxiety Inventory (BAI)
The Beck Anxiety Inventory was devised in the late 1980s by a team led by Aaron T. Beck, a psychiatrist often considered the founding father of cognitive behavioural therapy.
In contrast to the more recent GAD-7 measure, the BAI covers a much broader range of symptoms, with 21 different items in total. Many of these are physiological, including numbness or tingling, wobbliness in legs and feeling shaky or unsteady.
Patients completing the BAI are asked to rate how much each of the 21 symptoms has bothered them over the preceding month. They do so on a scale of zero to three, where zero means ‘not at all’, one means ‘mildly’, two means ‘moderately’ and three means ‘severely’. These scores are then totalled, with an overall score of 21 or less indicating low anxiety, 22–35 moderate anxiety, and 36 or above ‘potentially concerning levels’ of anxiety.
Points in BAI's favour include the speed at which it can be conducted and its strong correlation with previously existing measures of anxiety, such as the HAM-A. However, an often identified weakness of BAI is that it seems to measure depression as well as anxiety, a feature which could lead to unclear results.
Anxiety Severity Questionnaire (ASQ)
In 2019, a team from Massachusetts General Hospital attempted to improve upon the existing available screening tools by devising their own self-report questionnaire for anxiety. They named it the Anxiety Severity Questionnaire, and designed it to measure a “range of symptoms central to anxiety”.
A unique aspect of the ASQ is that it includes two subscales: one for the frequency of a given symptom, and another for its severity. This sets it apart from GAD-7, which measures only the former, and the BAI, which covers the latter.
The questionnaire itself consists of a simple table listing seventeen different symptoms associated with anxiety. It then asks the patient to think about their experience of each of them over the previous week and to give each two ratings from zero to ten. The first rating covers how “intense or bothersome” the symptom was, and the second pertains to how often they experienced it.
Despite collecting a large amount of data about the patient, its creators claim that it takes only two to three minutes to complete. As such, it offers a quicker path to diagnosis than clinician-administered measures such as HAM-A while maintaining reliability and consistency.
PROMIS Anxiety Short Form
Funded by the US National Institutes of Health, the Patient-Reported Outcomes Measurement Information System is a set of measures aiming to cover the assessment of “physical, mental, and social health”. This includes an item bank pertaining to anxiety, as well as a short form self-report questionnaire used for assessment purposes.
The PROMIS Anxiety Short Form covers the frequency of various symptoms associated with anxiety, much as GAD-7 does. There are, however, a few key differences.
Firstly, the questions used in PROMIS are slightly simpler and more direct, and do not roll related feelings into one question. For example, GAD-7 asks the patient a single question about if they have felt “nervous, anxious or on edge”. Meanwhile, PROMIS asks them three separate questions covering how often they would say “[they] felt nervous”, “[they] felt anxious” and “[they] felt tense”.
Meanwhile, while GAD-7 offers patients four choices to rate the frequency of a given symptom, PROMIS gives them five choices: never, rarely, sometimes, often or always. Additionally, where GAD-7 covers the previous two weeks, PROMIS only focuses on the last week.
Sport Anxiety Scale
While the above questionnaires are intended for a general audience, the Sport Anxiety Scale is specific to the trait anxiety that athletes may experience.
In the questionnaire, the patient states the degree to which they feel certain things before, during and after competing. For example, they will describe whether they feel self-doubt, if their heart races, or if they experience lapses in concentration. In each case, they rate the given scenario out of four, where one is ‘not at all’ and four is ‘very much so’.
While the SAS provides an overall trait anxiety score, it also includes three subscales: a worry score, a concentration disruption score, and a somatic trait anxiety score. These are obtained by adding up the scores for specific questions.
Questionnaires for other anxiety disorders and related conditions
The above examples represent just a small sample of the available self-report questionnaires for anxiety. Many other such measures exist, with each having its own focus. Some home in on one specific symptom, while others aim to diagnose a certain disorder rather than simply indicating the presence of anxiety.
Worry Domains Questionnaire
The Worry Domains Questionnaire assesses the patient across subscales covering five areas of worry. These are relationships, lack of confidence, aimless future, work incompetence and financial. It consists of asking patients how much they worry about 25 scenarios.
Though worry should not be conflated with anxiety, DSM-5 notes that “excessive worry […] about a number of events or activities” is a key feature of GAD. As such, this questionnaire can help to identify GAD as a possible diagnosis.
Penn State Worry Questionnaire
As with the Worry Domains Questionnaire, the Penn State Worry Questionnaire focuses on the trait of worrying. It contrasts with the above scale by presenting the patient with a series of 16 statements and asking them to state how “typical or characteristic” each is of them.
This questionnaire contains a mix of statements that are typically associated with worriers (e.g., “Many situations make me worry”) and those that are not (e.g., “I find it easy to dismiss worrisome thoughts”). As such, some statements have a 1–5 scale, while others have a 5–1 scale.
Yale-Brown Obsessive Compulsive Scale
The Yale-Brown Obsessive Compulsive Scale (or Y-BOCS) is a ten-item questionnaire designed to detect obsessive-compulsive disorder. The first five questions concern obsessions, while the latter five revolve around compulsions.
While each question is assessed with a numerical value from zero to four, the labels associated with each score differ from item to item. Additionally, patients are advised that they must experience both obsessions and compulsions to convert their score to a potential diagnosis. If both are present, then a score of 8–15 indicates mild OCD, 16–23 moderate OCD, 24–31 severe OCD, and 32–40 extreme OCD.
Padua Inventory Revised
Another scale used to assess obsessive-compulsive disorder is the Padua Inventory—Washington State University Revision. Where the Y-BOCS questionnaire above asks patients more general questions about their obsessions and compulsions, the Padua Inventory asks 39 different questions concerning specific situations or emotions.
To complete the questionnaire, patients must reply with the “degree of disturbance” that each scenario would cause them. This includes a number of subscales addressing contamination and washing, dressing and grooming, checking, thoughts of harm and impulses of harm.
Revised Impact of Events Scale (IES-r)
A measure used to diagnose PTSD is the Revised Impact of Events Scale. In this questionnaire, the patient considers a traumatic event in their life. They're then given a list of 22 different difficulties that the event may cause them to experience. They must then respond by rating how distressing each of them has been over the previous seven days from ‘not at all’ to ‘extremely’.
A score of 24 or more on the IES-r indicates that PTSD is a clinical concern, while 33 is considered ‘the best cutoff’ for a diagnosis. Scores of 37 or higher are deemed high enough to ‘suppress [one's] immune system's functioning’.
Liebowitz Social Anxiety Scale (LSAS)
The Liebowitz Social Anxiety Scale aims to assess the impact of social anxiety on a person's mental wellbeing and functioning. The patient completing the questionnaire is given twenty-four different situations to consider, such as eating in public or going to a party.
They then answer two questions for each item. Firstly, they rate the fear that the experience causes them: none, mild, moderate or severe. Next, they describe how often they would avoid doing the activity in question: never, occasionally, often or usually. At the end, they receive a score out of 144, with 95 or more indicating very severe social anxiety.
Self-report questionnaires for anxiety: summary
Completing a self-report questionnaire can help you to take a step closer to discovering issues that may be affecting your mental health. However, you shouldn't expect to simply choose any of the scales above and expect the same results. Each has their own focus, highlighting not just distinct disorders but individual aspects of those conditions. As such, choosing the right scale is just as crucial as the answers you provide.
Be aware that, while self-report questionnaires for anxiety can prove useful, only a medical professional can give an official diagnosis. If you're concerned, then be sure to get in touch with your GP, or contact the experts at ManageMinds.
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