STAI-T and HADS-A May Help Identify Anxiety in Refractory Mesial Temporal Lobe Epilepsy

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The prevalence of anxiety disorders in the overall sample was 11.7%, and each scale had a high negative predictive value.

The State-Trait Anxiety Inventory-Trait subscale (STAI-T) and Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) may be accurate screening tools for anxiety disorders in patients with drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). This is according to data published in a recent edition of the Journal of Affective Disorders.

A total of 103 consecutive patients with drug-resistant MTLE-HS were recruited. Neurologic examination, anamnesis, video-electroencephalogram analyses, and magnetic resonance imaging were used to make diagnoses in these patients. Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision criteria and International League Against Epilepsy Commission of Psychobiology classification were used for psychiatric interviews, which lasted 120 minutes and were administered to the patient alone and then with a caregiver. Additionally, researchers used the HADS-A and STAI-T psychometric diagnostic tests to gauge their effectiveness for identifying anxiety disorders in the patient population.

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For both the HADS-A and STAI-T scales, the areas under the curve were >0.7 (STAI-T = 0.8 [0.7-0.8]; HADS-A = 0.7 [0.6-0.8]). The researchers found a sensitivity of 80% (44.4-97.7) for a STAI-T cutoff point of ˃53 and the HADS-A cutoff point of ˃7. A specificity of 80% (66.9-86.9) and 60% (46.5-68.6) was found for the same STAI-T and HADS-A cutoff points. The prevalence of anxiety disorders in the overall sample was 11.7%, and each scale had a high negative predictive value (96% [87.1-99.0]). Low positive predictive values, including 30% (22.1-45.2) and 20% (15.0-27.2), were found for the STAI-T and HADS-A scales.

Limitations of the study include the small number of patient cases, the limited applicability of the findings to only drug-resistant MTLE-HS, and the lack of a structured psychiatric interview to make a psychiatric diagnosis.

“The implications for the HADS-A and STAI-T usefulness for anxiety disorders screening in patients with other epilepsies type deserve further investigations,” the researchers wrote. “If replicated in other populations, these findings may have relevance for the presurgical screening of anxiety disorders in drug resistant MTLE-HS patients who are candidates for epilepsy surgery.”


Zingano BL, Guarnieri R, Diaz AP, et al. Hospital anxiety and depression scale-anxiety subscale (HADS-A) and the state-trait anxiety inventory (STAI) accuracy for anxiety disorders detection in drug-resistant mesial temporal lobe epilepsy patients. J Affect Disord. 2018;246:452-457.