Validating the Traditional Chinese Version of the Epilepsy Anxiety Survey Instrument (EASI) in Hong Kong

Ka Wai Chan^*Mei Cheung Wong

• Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong, SAR China

Background: Anxiety disorders are prevalent and impactful in people with epilepsy (PWE) but under-recognized. Issues regarding epilepsy-specific anxiety have received emerging attention in the literature. To improve mental health coverage for PWE, we developed and validated the traditional Chinese version of the Epilepsy Anxiety Survey Instrument (EASI) and its brief screener (brEASI) among PWE in Hong Kong.We developed the TC-EASI through forward and backward translations; an expert panel and a focus group reviewed it. We tested it among PWE 18 years and older using theManual of Mental Disorders, 4th Edition, Text Revision (CB-SCID), which is the gold standard for diagnosing anxiety disorders. We examined the internal consistency and test-retest reliability of the TC-EASI and TC-brEASI. We performed confirmatory factor analysis (CFA) to assess the TC-EASI's factor structure. We also investigated convergent and divergent validity using the Generalized Anxiety Disorder 7-item scale (GAD-7), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Depression Anxiety Stress Scales 21 (DASS-21), and the Liverpool Adverse Events Profile (LAEP). Further, we analyzed the TC-brEASI's receiver operating characteristic (ROC).We included 203 Chinese PWE; 19.7% had current anxiety disorders, 7.4% had panic disorder, and 5.9% had agoraphobia without panic disorder. The internal consistency and testretest reliability were satisfactory. The TC-EASI had two latent constructs measuring epilepsyspecific and typical anxiety. We found convergent and divergent validity, and a cut-off score of ⩾9 for the TC-brEASI, with a sensitivity of 77.1% (95% CI=65.2-89%), a specificity of 83.9% (95% CI=78.1-89.7%), and an area under the curve (AUC) of 0.885 (95% CI=0.830-Key Messages:• The traditional Chinese brEASI is a valid and reliable epilepsy-specific screening tool for anxiety disorders in Hong Kong.• It has an optimal cut-off score of ⩾9 with good sensitivity, specificity, and area under the curve.• The traditional Chinese EASI has a two-factor model, measuring typical and epilepsy-specific anxiety.