Psychometric Meta-Analysis of the English Version of the Beck Anxiety Inventory

The Beck Anxiety Inventory (BAI; Beck & Steer, 1993) is one of the most popular screening and outcome research instruments for measuring the construct of anxiety. Although most appropriate for use with psychiatric outpatients 17 years and older, it has been used in research studies with both clinical and nonclinical samples. Among counselors, the BAI is reported to be the ninth most commonly used instrument (C. H. Peterson, Lomas, Neukrug, & Bonner, 2014). Similarly, Neukrug, Peterson, Bonner, and Lomas (2013) reported that the BAI was the ninth most commonly taught instrument by counselor educators. The BAI is a popular screening and evaluation tool in clinical practice and is commonly used in anxiety treatment research as an outcome measure; thus, it is important for counselors to understand the psychometric characteristics that have accumulated over the past 2 decades related to this commonly used instrument. The BAI consists of 21 self-report items designed to measure the occurrence and severity of symptoms of anxiety disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). It was designed specifically to differentiate between anxiety and depression, although it should not be used alone for diagnostic purposes. As a copyrighted measure, it is available for purchase and is distributed by Pearson Assessments in both English and Spanish. The BAI takes about 5-10 minutes to administer (oral administration is about 10 minutes) and less than 5 minutes to score and interpret. The BAI total raw score is obtained by a simple sum of the 21 item scores, with respondents indicating how much they have been bothered by each symptom during the past week on a 4-point Likert-type scale, with 0 meaning not at all, 1 meaning mildly (i.e., "It did not bother me much"), 2 meaning moderately (i.e., "It was very unpleasant, but I could stand it"), and 3 meaning severely (i.e., "I could barely stand it"). Score interpretation guidelines for the BAI indicate that scores of 0-7 denote minimal anxiety, 8-15 mild anxiety, 16-25 moderate anxiety, and 26-63 severe anxiety. Beck, Epstein, Brown, and Steer (1988) explained that the final 21 BAI items were developed from a pool of 86 items from three preexisting anxiety rating scales developed by Beck. Beck and Steer (1993) reported use of clinical and nonclinical standardization samples. The clinical sample was composed of 393 outpatients (236 women, 157 men) with a mean age of 37 years. Beck and Steer (1993) reported an alpha of .93 for this outpatient sample. The suggested cutoff score in the manual for clinically significant anxiety is 16. No norm-referenced interpretive data are available, although Beck and Steer (1993) did report means and standard deviations for three small nonclinical samples composing the nonclinical standardization sample: 65 university students (75% women; mean age of 19 years; M= 11.08, SD = 9.10), 142 medical students (51% women; M= 8.89, SD = 7.30), and 36 adults who were not students (78% women; mean age of 29 years; M = 7.78, SD = 5.65). Beck and Steer's (1993) final validation sample was 160 participants with anxiety and depressive disorders. The coefficient alpha for the total scale for this sample was .92, and a 1-week test-retest study of scores from 83 of these participants resulted in an [r.sub.tt] of .75. Principal factor analysis with promax rotation on the 160 participant protocols specified two factors: Factor I--Somatic Symptoms, composed of physical symptoms such as numbness and difficulty breathing (i.e., Items 1, 2, 3, 6, 7, 8, 12, 13, 17, 19, 20, and 21), and Factor II-Subjective Affective and Panic Symptoms, composed of psychological symptoms such as feeling unable to relax and nervous (i.e., Items 4, 5, 9, 10, 11, 14, 15, 16, and 18). These two factors correlated at r = .56. The BAI displayed discrimination between participants with and without anxiety and correlated moderately with the Hamilton Anxiety Rating Scale (HAM-A; Hamilton, 1959; r = . …