Development of a short version of the Spielberger state and trait anxiety inventory (STAI) for pregnant women

Abstract

Background: The Spielberger state-trait anxiety inventory (STAI) is a widely recognized tool for assessing state and trait anxiety components in the general population. While reliable and valid, each scale in the STAI has 20 items, which limits its usability in certain real-world clinical settings. Additionally, certain items can inaccurately increase anxiety scores among expectant women. This study aimed to develop a concise yet dependable and valid version of these scales tailored for pregnant individuals. Methods: We engaged 1,158 expectant women who completed the STAI and other assessments to determine criterion validity. Our methodology incorporated item response theory, confirmatory factor analysis, and k-fold cross-validation. Additionally, Bland-Altman regressions and plots assisted in gauging score accuracy, and receiver operating characteristic analyses determined discriminative validity. We also set clinical change benchmarks. Results: Confirmatory factor analysis yielded the following fit indices: X2(5) = 32.08, CFI = .99, TLI = .97, RMSEA = .07 (90% CI [.05, .09]), and SRMR = .02 for the state anxiety scale (omega total = .85), and X2(5) = 23.58, CFI = .99, TLI = .97, RMSEA = .06 (90% CI [.04, .08]), and SRMR = .02 for the trait anxiety scale (omega total = .79). Furthermore, both scales showed meaningful correlations with measures depression. Conclusion: The resulting five-item STAI short forms manifested robust psychometric attributes and reliability, providing a theoretically grounded and reliable anxiety assessment during pregnancy. This can be effectively applied in obstetric and gynecological settings, offering a streamlined response experience for expectant women.

Keywords

• perinatal anxiety
• pregnancy
• psychometric properties
• scale development
• self-report.