Development and Validation of the Schedule for the Assessment of Insight in Anxiety Disorders (SAI-A)

Abstract

There is a growing interest in understanding insight or illness awareness in anxiety; however, most assessment instruments were designed for psychosis. The unique features of anxiety highlight the need for tailored measures to accurately evaluate insight. The aim of this study was to develop and validate the Schedule for the Assessment of Insight in Anxiety (SAI-A), a clinician-rated scale for assessing insight in anxiety disorders. We interviewed 46 participants diagnosed with anxiety disorders, conducted SAI-A interviews, and administered self-report measures. Using correlation and principal component analysis (PCA), we identified and assessed scale components, ensuring their reliability and consistency. The SAI-A demonstrated acceptable psychometric properties, including convergent validity with an established self-report measure (r = -0.39, p=0.008) and internal consistency (Cronbach's α = 0.70). It showed moderate to strong agreement, interrater reliability (weighted kappa = 0.53, intraclass correlation coefficient [ICC] = 0.67), and test-retest reliability (ICC = 0.65). Two distinct insight components emerged: awareness of disorder and need for treatment. Higher overall SAI-A scores correlated with symptom severity and impairment (r = 0.56, r = 0.51, p < 0.001, respectively) and medication usage. The SAI-A is a valid and reliable assessment tool, providing a comprehensive framework for understanding and addressing insight in the context of anxiety disorders.

Keywords: anxiety disorders; denial of mental disorder; illness awareness; insight into illness; need for treatment.

Figure 1

Screen plot of factors extracted from the principal component analysis of the SAI-A.

Figure 2

Plot from multidimensional scaling analysis of the items of the Schedule for the Assessment of Insight in Anxiety (SAI-A).