Psychometric properties of the Spence Children's Anxiety Scale (SCAS) in Mainland Chinese children and adolescents

Abstract

This study examined the psychometric properties of the Spence Children's Anxiety Scale (SCAS) in a Mainland Chinese community sample. The 38-item Chinese version of SCAS was administered to 1878 children and adolescents. Multiple group confirmatory factor analyses supported a common 6-factor model of SCAS for children and adolescents, and for boys and girls. The internal consistency and test–retest reliability of SCAS were satisfactory. Convergent and divergent validity of SCAS were supported by significant correlations with a measure of anxiety to a greater extent than with a measure of depression. Adolescents reported higher anxiety levels than children, and girls reported higher anxiety levels than boys. Compared to other studies, anxiety symptoms of Chinese children were found at a moderate level, but anxiety symptoms of Chinese adolescents were found at a high level. Our findings suggest that the SCAS is suitable for assessing anxiety symptoms in Mainland Chinese children and adolescents.

Introduction

Anxiety disorders represent one of the most common psychiatric disorders in children and adolescents, with a cumulative prevalence of 9.9% by 16 years of age (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003) and a lifetime prevalence of 28.8% (Kessler et al., 2005). Childhood anxiety disorders are associated with impairment in various life domains and may act as a risk factor for the development of other psychiatric disorders in adulthood (Essau et al., 2008, Essau et al., 2002). Moreover, the societal costs of families with clinically anxious youth aged 8–18 years were almost 21 times as high compared with families from the general population (Bodden, Dirksen, & Bögels, 2008). However, despite the prevalence and severity of anxiety disorders, only few children who suffer from these problems receive appropriate care and treatment due to the covert nature of the symptoms (Muris et al., 2006). Therefore, an economic and easily administered instrument for screening anxiety disorders in children and adolescents can serve as an important first step toward the identification and treatment of anxiety pathology.

Many aspects of anxiety represent subjective cognitive and emotional experiences that are not easily observed by others (Spence, Barrett, & Turner, 2003). Thus, self-report measures have been widely used to assess the “hidden” anxiety problems in children and adolescents. The most extensively used measures include the Revised Children's Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978), State-Trait Anxiety Inventory for Children (STAIC; Spielberger, 1973) and Fear Survey Schedule for Children-Revised (FSSC-R; Ollendick, 1983). Although these measures possess adequate psychometric properties and provide valuable information on psychopathological symptoms of children and adolescents (Silverman & Ollendick, 2005), they are all indices of general anxiety and not keyed to the specific anxiety symptoms listed in the DSM-IV (American Psychiatric Association, 1994).

The Spence Children's Anxiety Scale (SCAS; Spence, 1997) is a self-report measure that specifically assesses multiple symptoms of childhood anxiety disorders based on the criteria in the DSM-IV. It was developed with community samples of children and designed to measure six anxiety dimensions, including separation anxiety disorder, physical injury fears, social phobia, panic attack and agoraphobia, obsessive-compulsive disorder, and generalized anxiety disorder. Since the initial publication of the SCAS, the psychometric properties of this instrument have been examined in diverse settings and cultures, including in Australia (Spence, 1998, Spence et al., 2003), Netherlands (Muris, Schmidt, & Merckelbach, 2000), Germany (Essau, Sakano, Ishikawa, & Sasagawa, 2004), Japan (Ishikawa, Sato, & Sasagawa, 2009), Greece (Mellon & Moutavelis, 2007), South Africa (Muris, Schmidt, Engelbrecht, & Perold, 2002), Spain (Tortella-Feliu, Balle, Servera, & de la Banda, 2005) and in the United States (Whiteside & Brown, 2008). The SCAS was found reliable in terms of internal consistency and test–retest stability (Ishikawa et al., 2009, Spence et al., 2003, Spence, 1998, Tortella-Feliu et al., 2005). The convergent and divergent validity of the SCAS were also supported because of its significant correlations with other measures of children's anxiety disorders (e.g. RCMAS, SCARED) to a greater extent than with the measure of children's depression (e.g. CDI; Muris et al., 2002a, Spence, 1998, Spence et al., 2003). In general, these studies support the usefulness of the SCAS as a reliable and valid instrument for assessing anxiety symptoms in community children and adolescents.

Although the SCAS has been studied in multiple cultures, it has not been evaluated empirically in a Mainland Chinese sample. A series of evidence seems to indicate that the psychometrics of SCAS vary to some extent across cultures. For example, the structure of SCAS differed between Australian (Spence, 1998) and German samples (Essau et al., 2004), and between South African (Muris, Schmidt, et al., 2002) and Dutch samples (Muris et al., 2000). A recent study investigated the psychometrics of the SCAS in Hong Kong Chinese children aged 6–11 years (Li, Lau, & Au, 2011). This study examined the factor structure, internal consistency reliability and convergent validity of the SCAS, but did not investigate the test–retest reliability and divergent validity. In addition, only primary school children were included in this study and hence the applicability of SCAS in Chinese adolescents still remains to be tested. More importantly, although Hong Kong and Mainland China come from the same cultural root (Lin & Ho, 2009), Hong Kong Chinese have been influenced by Western cultures owing to their colonized authority of Britain for a long time. The development of Hong Kong may provide a Chinese subculture that may be different from that of Mainland China (Cheung, Conger, Hau, Lew, & Lau, 1992). Therefore, the question of whether the SCAS can validly assess anxiety symptoms in Mainland Chinese community samples need to be tested, even though there is evidence supporting the applicability of this instrument in Hong Kong community children (Li et al., 2011). For the aforementioned reasons, the current study intends to test the applicability of the SCAS in Mainland Chinese children and adolescents. Meanwhile, this study also evaluates the applicability of the SCAS in boys and girls, since a wide range of evidence seems to indicate that children's anxiety symptoms vary significantly between boys and girls (Crocetti et al., 2009, Hale et al., 2011).

Additionally, the manifestations of anxiety are at least to some extent determined by cultural factors associated with socialization practices (Li, Ang, & Lee, 2008). Western socialization practices encourage individualism and independence (Essau et al., 2008), which may contribute to the lowing of anxiety problems in children and adolescents. By contrast, Chinese socialization practices are generally characterized by being restrictive, encouragement of self-control, as well as high emphasis on other peoples’ opinions and academic excellence in school (Chen et al., 1997, Dong et al., 1994, Li et al., 2008), which may contribute to a high level of anxiety symptoms among Chinese children and adolescents. Therefore, the other aim of the present study is to investigate the levels of specific anxiety symptoms among Chinese children and adolescents, and then to compare symptom levels of the current Mainland Chinese samples with those found in previous studies of the SCAS in other cultures.

In summary, the purpose of this study was to expand the literature on the applicability of the SCAS in China (Li et al., 2011) in several ways: (1) to examine the factor structure of the Chinese SCAS in Mainland Chinese community samples; (2) to evaluate the internal consistency, test–retest reliability, and convergent and divergent validity of the Chinese SCAS; (3) to investigate age and gender differences of anxiety symptoms; (4) to compare anxiety levels of the current Mainland Chinese samples with those found in previous studies of SCAS.