Monitoring ECT-related anxiety: the ECT-related Anxiety questionnaire (ERAQ)

Introduction:Although electroconvulsive therapy (ECT) is an effective and safe treatment, a significant proportion of patients are afraid of the treatment. Too often, this ECT-related anxiety makes patients refuse or discontinue ECT. A reliable questionnaire designed to measure ECT-related anxiety is currently not available. We report the development and psychometric evaluation of the ECT-related anxiety questionnaire (ERAQ), a questionnaire that measures anxiety with respect to ECT in clinical practice.

Methods: This study was conducted at two psychiatric hospitals in Belgium and The Netherlands. Patients who were about to start with or were having an ECT course were included. ECT-related anxiety was measured with a Dutch self-designed questionnaire. The questionnaire contains 17 items further subdivided into a five-point scale. We used an exploratory (EFA) and confirmatory factor analysis (EFA) to investigatepsychometric properties of the ERAQ. We also examined the ERAQ in the context of item response theory (IRT).

Results: 185 patients were included. From the EFA we concluded that the scale was unidimensional. The location parameters for the 17 parameters reflected a sizeable underlying anxiety for ECT (-1.06; 2.02).

Conclusion: ERAQ is a valid questionnaire to measure ECT-related anxiety. ERAQ offers a global score in the form of the sum of 17 items on a 4-category response scale as a measure of severity of ECT-related anxiety. Moreover, the ERAQ can differentiate between various topics of anxiety and can inform the clinician about the specific aspects of an ECT-course that trigger less or more anxiety. The differentiation of the ERAQ between various topics and intensities of anxiety can have an important role in the future development of psychoeducational programs and in guiding clinicians to talk with their patients and relatives about ECT-related anxieties.