Skip to main content Accessibility help

Measuring anxiety in the elderly: psychometric properties of the state trait inventory of cognitive and somatic anxiety (STICSA) in an elderly Italian sample

  • Michela Balsamo (a1), Marco Innamorati (a1), Nicholas T. Van Dam (a2), Leonardo Carlucci (a1) and Aristide Saggino (a1)...



Despite its increasing personal and societal impact, assessment of late-life anxiety has received relatively little attention in psychiatric research. Differential symptom presentation and physical comorbidities among the elderly, relative to younger cohorts creates a need for anxiety measures that are psychometrically validated in the elderly.


The present study examined the factor structure and discriminant validity of the state-trait inventory for cognitive and somatic anxiety (STICSA) in a sample of Italian middle-aged and older adults. Participants were 396 community-dwelling middle-aged (50–64 years) and older (≥65 years) adults. In addition to the STICSA, participants completed two depression measures and a general well-being survey with physical and mental health subscales.


Factor analysis supported the validity of both state–trait and cognitive–somatic distinctions underlying the STICSA, all dimensions exhibited excellent internal consistency (Cronbach's α coefficients ≥ 0.86), and correlations with depression measures provided limited evidence for differentiation of anxious and depressive symptoms. The STICSA also showed evidence of discriminating anxious symptoms from physical health symptoms, a particularly relevant feature of a valid anxiety measure in elderly samples.


The STICSA appears to be a valid measure of cognitive and somatic anxiety in the elderly.


Corresponding author

Correspondence should be addressed to: Michela Balsamo, Psychometric Laboratory, Department of Psychological Sciences, Humanities and Territory, “G. d’Annunzio” University, Via dei Vestini 30, 66100 Chieti, Italy. Phone/Fax: +39-0871 3555309. Email:


Hide All
Alwahhabi, F. (2003). Anxiety symptoms and generalized anxiety disorder in the elderly: a review. Harvard Review of Psychiatry, 11, 180193.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision ed. Washington, DC: American Psychiatric Association.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn, Arlington, VA: American Psychiatric Association.
Andrew, D. H. and Dulin, P. L. (2007). The relationship between self-reported health and mental health problems among older adults in New Zealand: experiential avoidance as a moderator. Aging & Mental Health, 11, 596603.
Andrich, D. (1995). Models for measurement, precision, and the nondichotomization of graded responses. Psychometrika, 60, 726.
Ayers, C. R., Sorrell, J. T., Thorp, S. R. and Wetherell, J. L. (2007). Evidence-based psychological treatments for late-life anxiety. Psychology and Aging, 22, 817.
Balsamo, M., Giampaglia, G. and Saggino, A. (2014). Building a new Rasch-based self-report inventory of depression. Neuropsychiatric Disease and Treatment, 13, 153165.
Balsamo, M., Romanelli, R., Innamorati, M., Ciccarese, G., carlucci, L. and Saggino, A. (2013). The state-trait anxiety inventory: shadows and lights on its construct validity. Journal of Psychopathology and Behavioral Assessment, 35, 475486.
Balsamo, M. and Saggino, A. (2007). Test per l’assessment della depressione nel contesto italiano: un’analisi critica [Tests for depression assessment in Italian context: a critical review]. Psicoterapia Cognitiva e Comportamentale, 13, 167199.
Balsamo, M. and Saggino, A. (2013). Il Teate Depression Inventory- Manuale di standardizzazione [Teate Depression Inventory, Manual]ed. Firenze: Hoegrefe.
Balsamo, M. and Saggino, A. (2014). Determining a diagnostic cut-off on the teate depression inventory. Neuropsychiatric Disease and Treatment, 10, 987995.
Beekman, A. T., de Beurs, E., van Balkom, A. J., Deeg, D. J., van Dyck, R. and van Tilburg, W. (2000). Anxiety and depression in later life: co-occurrence and communality of risk factors. The American Journal of Psychiatry, 157, 8995.
Bergua, V. et al. (2012). The STAI-Y trait scale: psychometric properties and normative data from a large population-based study of elderly people. International Psychogeriatrics, 24, 11631171.
Brown, T. A. (2006). Confirmatory Factor Analysis for Applied Researched. New York: Guilford Press.
Browne, M. W. and Cudek, R. (1993). Alternative ways of assessing model fit. In Long, J. S. (ed.), Testing Structural Equation Models (pp. 136162) Newbury Park, CA: Sage.
Byrne, G. J. and Pachana, N. A. (2011). Development and validation of a short form of the geriatric anxiety inventory–the GAI-SF. International Psychogeriatrics, 23, 125131.
Byrne, G. J., Pachana, N. A., Arnold, L., Chalk, J. B. and Appadurai, K. (2008). P2-239: performance characteristics of the geriatric anxiety inventory in memory clinic attendees. Alzheimer's and Dementia, 4, T441T442.
Copeland, J., Kelleher, M., Duckworth, G. and Smith, A. (1976). Reliability of psychiatric assessment in older patients. International Journal of Aging & Human Development, 7, 313322.
Crawford, J. R. and Henry, J. D. (2003). The depression anxiety stress scales (DASS): normative data and latent structure in a large non-clinical sample. The British Journal of Clinical Psychology, 42, 111131.
Crittendon, J. and Hopko, D. R. (2006). Assessing worry in older and younger adults: Psychometric properties of an abbreviated penn state worry questionnaire (PSWQ-A). Journal of Anxiety Disorders, 20, 10361054.
Cully, J. A. et al. (2006). Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. Psychosomatics, 47, 312319.
Dawson, P., Kline, K., Wiancko, D. C. and Wells, D. (1986). Preventing excess disability in patients with Alzheimer's disease. Geriatric Nursing, 7, 298301.
Dennis, R. E., Boddington, S. J. and Funnell, N. J. (2007). Self-report measures of anxiety: are they suitable for older adults? Aging & Mental Health, 11, 668677.
Diefenbach, G. J., Tolin, D. F., Meunier, S. A. and Gilliam, C. M. (2009). Assessment of anxiety in older home care recipients. The Gerontologist, 49, 141153.
Edelstein, B. A. et al. (2008). Older adult psychological assessment: current instrument status and related considerations. Clinical Gerontologist, 31, 135.
Federal Interagency Forum on Aging-Related Statistics (2012). Older Americans 2012: Key Indicators of Well-Beinged. Washington, DC: U.S. Government Printing Office.
Foley, D., Ancoli-Israel, S., Britz, P. and Walsh, J. (2004). Sleep disturbances and chronic disease in older adults: results of the 2003 national sleep foundation sleep in America survey. Journal of Psychosomatic Research, 56, 497502.
Gould, C. E., Segal, D. L., Yochim, B. P., Pachana, N. A., Byrne, G. J. and Beaudreau, S. A. (2014). Measuring anxiety in late life: a psychometric examination of the geriatric anxiety inventory and geriatric anxiety scale. Journal of Anxiety Disorders, 28, 804811.
Gros, D. F., Antony, M. M., Simms, L. J. and McCabe, R. E. (2007). Psychometric properties of the state-trait inventory for cognitive and somatic anxiety (STICSA): comparison to the state-trait anxiety inventory (STAI). Psychological Assessment, 19, 369381.
Gros, D. F., Simms, L. J. and Antony, M. M. (2010). Psychometric properties of the state-trait inventory for cognitive and somatic anxiety (STICSA) in friendship dyads. Behavior Therapy, 41, 277284.
Hopko, D. R. et al. (2003). Assessing worry in older adults: confirmatory factor analysis of the penn state worry questionnaire and psychometric properties of an abbreviated model. Psychological Assessment, 15, 173183.
Hu, L. and Bentler, P. M. (1998). Fit indices in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424453.
Hu, L. and Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: a Multidisciplinary Journal, 6, 155.
Innamorati, M. et al. (2013). Psychometric properties of the Attitudes toward Self-Revised in Italian young adults. Depression Research and Treatment. Available at:; last accessed 5 January 2015.
Johnco, C., Knight, A., Tadic, D. and Wuthrich, V. M. (2014). Psychometric properties of the Geriatric Anxiety Inventory (GAI) and its short-form (GAI-SF) in a clinical and non-clinical sample of older adults. International Psychogeriatrics, CJO2014. doi:10.1017/S1041610214001586.
Jöreskog, K. G. and Sörbom, D. (2006). LISREL for Windows [Computer software]. Lincolnwood, IL: Scientific Software International, Inc.
Kahn, J. H. (2006). Factor analysis in counseling psychology research, training, and practice: principles, advances, and applications. The Counseling Psychologist, 34, 684718.
Kennedy, B. L., Schwab, J. J., Morris, R. L. and Beldia, G. (2001). Assessment of state and trait anxiety in subjects with anxiety and depressive disorders. The Psychiatric Quarterly, 72, 263276.
Kline, R. B. (2011). Principles and Practice of Structural Equation Modeling, 3rd ed. New York: Guilford Press.
Kogan, J. N., Edelstein, B. A. and McKee, D. R. (2000). Assessment of anxiety in older adults: current status. Journal of Anxiety Disorders, 14, 109132.
Lovibond, P. F. and Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behaviour Research and Therapy, 33, 335343.
Magni, G. and DeLeo, D. (1984). Anxiety and depression in geriatric and adult medical patients. Psychological Reports, 55, 607612.
Meng, X. L., Rosenthal, R. and Rubin, D. B. (1992). Comparing correlated correlation coefficients. Psychological Bulletin, 111, 172175.
Mineka, S., Watson, D. and Clark, L. A. (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology, 49, 377412.
Mueller, A. E. (2014). Psychometric Properties of the Geriatric Anxiety Scale in Community-Dwelling, Clinical, and Medical Samples of Older Adults. Department of Psychology Colorado Springs: University of Colorado.
Naughton, C., Feely, J. and Bennett, K. (2007). A clustered randomized trial of the effects of feedback using academic detailing compared to postal bulletin on prescribing of preventative cardiovascular therapy. Family Practice, 24, 475480.
Nuevo, R., Mackintosh, M. A., Gatz, M., Montorio, I. and Wetherell, J. L. (2007). A test of the measurement invariance of a brief version of the penn state worry questionnaire between American and Spanish older adults. International Psychogeriatrics, 19, 89101.
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E. and Arnold, E. (2007). Development and validation of the geriatric anxiety inventory. International Psychogeriatrics, 19, 103114.
Rasch, G. (1980). Probabilistic Models for some Intelligence and Attainment Tests, Expanded ed. Chicago: University of Chicago Press.
Ree, M. J., French, D. J., Macleod, C. and Locke, V. M. (2008). Distinguishing cognitive and somatic dimensions of state and trait anxiety: Development and validation of the state-trait inventory for cognitive and somatic anxiety (STICSA). Behavioural and Cognitive Psychoterapy, 36, 313332.
Reynolds, C. R., Richmond, B. O. and Lowe, P. A. (2003). The Adult Manifest Anxiety Scale-Elderly Version (AMAS-E) ed. Los Angeles: Western Psychological Services.
Satorra, A. and Bentler, E. M. (1994). Corrections to test statistics and standard enors in covariance structure analysis. In von Eye, A. and Clogg, C. C. (eds.), Latent Variables Analysis: Applications for Developmental Research (pp. 399419) Thousand Oaks, CA: Sage.
Schermelleh-Engel, K., Moosbrugger, H. and Müller, H. (2003). Evaluating the fit of structural equation models: test of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8, 2374.
Segal, D. L., June, A., Payne, M., Coolidge, F. L. and Yochim, B. (2010). Development and initial validation of a self-report assessment tool for anxiety among older adults: The geriatric anxiety scale. journal of anxiety disorders, 24, 709714.
Seignourel, P. J., Kunik, M. E., Snow, L., Wilson, N. and Stanley, M. (2008). Anxiety in dementia: a critical review. Clinical Psychology Review, 28, 10711082.
Smarr, K. L. and Keefer, A. L. (2011). Measures of depression and depressive symptoms: beck depression inventory-II (BDI-II), center for epidemiologic studies depression scale (CES-D), geriatric depression scale (GDS), hospital anxiety and depression scale (HADS), and patient health questionnaire-9 (PHQ-9). Arthritis Care & Research, 63 (Suppl. 11), S454S466.
Spielberger, C. D., Gorsuch, R. L., Lushene, R. E., Vagg, P. R. and Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory STAI (Form Y) ed. Palo Alto, CA: Consulting Psychologists Press.
Stewart, A. and Ware, J. (eds.) (1992). Measuring Functioning and Well-being: the Medical Outcomes Study Approach. Durham, NC: Duke University Press.
Therrien, Z. and Hunsley, J. (2012). Assessment of anxiety in older adults: a systematic review of commonly used measures. Aging & mental Health, 16, 116.
Van Dam, N. T., Gros, D. F., Earleywine, M. and Antony, M. M. (2013). Establishing a trait anxiety threshold that signals likelihood of anxiety disorders. Anxiety, Stress, and Coping, 26, 7086.
van de Vijver, F. J. R. and Tanzer, N. K. (1997). Bias and equivalence in cross-cultural assessment: an overview. European Review of Applied Psychology, 47, 263280.
Ware, J. E. Jr., Kosinski, M. and Keller, S. D. (1996). A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220233.
Ware, J. E. Jr. and Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473483.
Wolitzky-Taylor, K. B., Castriotta, N., Lenze, E. J., Stanley, M. A. and Craske, M. G. (2010). Anxiety disorders in older adults: a comprehensive review. Depression and Anxiety, 27, 190211.
World Health Organisation (2014). Definition of An Older or Elderly Person. Geneva: WHO.
Wuthrich, V. M., Johnco, C. and Knight, A. (2014). Comparison of the penn state worry questionnaire (PSWQ) and abbreviated version (PSWQ-A) in a clinical and non-clinical population of older adults. Journal of Anxiety Disorders, 28, 657663.
Yesavage, J. A. et al. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 3749.
Yochim, B. P., Mueller, A. E., June, A. and Segal, D. L. (2011). Psychometric properties of the geriatric anxiety scale: comparison to the beck anxiety inventory and geriatric anxiety inventory. Clinical Gerontologist, 34, 2133.


Related content

Powered by UNSILO

Measuring anxiety in the elderly: psychometric properties of the state trait inventory of cognitive and somatic anxiety (STICSA) in an elderly Italian sample

  • Michela Balsamo (a1), Marco Innamorati (a1), Nicholas T. Van Dam (a2), Leonardo Carlucci (a1) and Aristide Saggino (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.