A Brief Measure of Worry Severity (BMWS)

A Brief Measure of Worry Severity (BMWS):

personality and clinical correlates

of severe worriers

Gemma L. Gladstone*, Gordon B. Parker, Philip B. Mitchell,Gin S. Malhi, Kay A. Wilhelm, Marie-Paule Austin

School of Psychiatry, University of New South Wales and Mood Disorders Unit, Black Dog Institute,

Prince of Wales Hospital, Randwick, NSW 2031, Australia

Received 31 August 2004; received in revised form 26 October 2004; accepted 15 November 2004

Abstract

This report describes the development of a brief and valid self-report measure to assess

severe and dysfunctional worry (the Brief Measure of Worry Severity or BMWS). Using

three independent subject groups (clinical and non-clinical), the measure was used to

examine the differential severity of worry in depression and anxiety and to examine the

clinical and personality correlates of severe worriers. Preliminary psychometric evaluation

revealed that the BMWS possesses good construct and clinical discriminant validity.

Subjects reporting greater worry severity tended to be more ‘‘introverted’’ and ‘‘obses-

sional,’’ but less ‘‘agreeable’’ and ‘‘conscientious.’’ Subjects with depression only, reported

less problems with worrying compared to those with co-morbid anxiety disorders.

However, among the anxiety disorders, severe and dysfunctional worry was not exclusively

experienced by subjects with generalized anxiety disorder (GAD). This study suggests that

pathological worry is not only relevant for patients with GAD, but may be an equally

detrimental cognitive activity for patients with panic disorder and obsessive–compulsive

disorder.

# 2004 Elsevier Inc. All rights reserved.

Keywords: Worry; Anxiety disorders; Depression; Questionnaire

Anxiety Disorders

19 (2005) 877–892

* Corresponding author. Fax: +61 2 9382 3712.

E-mail address: [email protected] (G.L. Gladstone).

0887-6185/$ – see front matter # 2004 Elsevier Inc. All rights reserved.

doi:10.1016/j.janxdis.2004.11.003

1. Introduction

Worry is both a common cognitive activity as well as a symptom correlated

with psychological disturbance capable of reaching marked intensity. Depending

on severity, worry may either be a general marker for anxiety proneness or a

significant component of more clinically meaningful anxiety, such as generalized

anxiety disorder (GAD) where it is recognized as the cardinal diagnostic feature

(APA, 1994). Worry activity can also be conceptualized as a ‘‘spectrum,’’ from

commonplace potentially useful ‘‘worrying,’’ which may possess a motiva-

tional quality, to problematic worry characterized by repetitive catastrophic

speculation. which is detrimental to performance and debilitating. The perceived

uncontrollability of worry, its pervasiveness and disruption to daily functioning,

and the presence of ‘‘meta-worry’’ (or worrying about worry), are all features

considered to characterize more severe or ‘‘pathological’’ worry (Gladstone &

Parker, 2003).

Interest in the phenomenology and function of worry has led the way to

developments in its measurement. Thus, various self-report instruments have

been designed to measure one or more components of worry or related cognitive

phenomena (e.g., Cartwright-Hatton & Wells, 1997; Wells, 1994). Some

instruments have focused on the assessment of what people actually worry

about (content), like the Worry Domains Questionnaire (WDQ; Tallis, Eysenck,

& Mathews, 1992), including those for specific populations, such as the Worry

Scale (Wisocki, Haden, & Morse, 1986) for elderly respondents, and the Student

Worry Scale (SWS; Davey, Hamptom, Farrell, & Davidson, 1992). Other

instruments have focused on worry as a trait, such as the well-known Penn

State Worry Questionnaire or PSWQ (Meyer, Miller, Metzger, & Borkovec,

1990), designed to assess the frequency and intensity of worrying in general.

There is currently no single brief measure of worry, which includes items

defining differential key markers for dysfunctional and severe worry (e.g.,

uncontrollability, thwarted problem solving, associated mood disturbance,

meta-worry).

The extent to which pathological worrying constitutes an important component

of different psychological disorders has gained recent attention in the literature,

with particular interest in the degree to which severe and uncontrollable worrying

is experienced by patients with differing anxiety disorders. Although pathological

worry is regarded as the hallmark feature of GAD (APA, 1994), ‘‘anxious

apprehension’’ (Barlow, 1988), described as a negative, future-orientated

emotional state, whereby feared outcomes are anticipated, is taken to be

characteristic of all anxiety disorders (Brown, O’Leary, & Barlow, 1993). Thus,

worry has gained preferential status in GAD, with studies suggesting that the

worry in GAD is both more severe (i.e., frequent and uncontrollable) (Brown,

Antony, & Barlow, 1992) and more pervasive in focus (Gross & Eifert, 1990) than

in other anxiety disorders. Chelkminski and Zimmerman (2003), for example,

compared worrying (using PSWQ scores) in patients with different anxiety

G.L. Gladstone et al. / Anxiety Disorders 19 (2005) 877–892878

disorders and found that patients with GAD scored significantly higher on the

PSWQ than those with social phobia, specific phobia, panic disorder and post-

traumatic stress disorder, but not obsessive–compulsive disorder (OCD).

Excessive and ‘‘unprovoked’’ worrying about minor matters, along with greater

concern about lack of control over the worry, are usually taken to be factors which

distinguish the worrying in GAD from similar cognitive processes in other anxiety

disorders (Craske, Rapee, Jackel, & Barlow, 1989).

Repetitive cognitive processes, like worry, are also commonly experienced by

patients with major depression (Starcevic, 1994). Also described in terms of

depressive rumination (Morrow & Nolen-Hoeksema, 1990), such repetitive

thought processes usually involve preseverative and static cognitions (rather than

elaborative worry) geared toward the depressive illness itself (e.g., ‘‘Why did this

happen to me?’’). One study (Diefenbach et al., 2001), however, identified that the

worrisome thoughts of depressed patients were particularly related to ‘‘aimless

future’’ themes—cognitions clearly linked to depressed mood. Studies have

demonstrated that ruminations work to maintain and exacerbate depressed affect,

both for those with experimentally induced low mood (Morrow & Nolen-

Hoeksema, 1990) and those with clinical depression (Nolen-Hoeksema &

Morrow, 1993).

However, the degree to which worrisome and other repetitive cognitions differ

in severity for those with depressed and anxious mood states has received limited

empirical attention, with the few existing studies showing contrasting results. One

study by Starcevic (1994) using the PSWQ, found no differences in worry scores

between patients with GAD compared to patients with major depression,

concluding that not only was pathological worrying not restricted to GAD

sufferers, but it was also a feature of depression, and was equally severe in both

disorders. However, the study by Chelkminski and Zimmerman (2003), which

also included a comparison between patients with GAD only and major

depression only, found that worry posed a significantly greater problem for those

with GAD compared to those with depression.

A small amount of research has examined the personality correlates of

people who worry excessively. Severe worriers also tend to be more self-

evaluative, more socially anxious and more perfectionistic. They also tend to

feel more time-pressured, and report more obsessional symptoms (Meyer et al.,

1990; Pruzinsky & Borkovec, 1990). One study (Pruzinsky & Borkovec, 1990)

found a greater tendency for negative daydreaming, along with poorer

attentional control among chronic worriers. This finding might be accounted

for by the view that worrying requires considerable attentional resources and

results in poorer problem solving efforts and interrupted task completion

(Dugas, Letarte, Rheaume, Freeston, & Ladouceur, 1995). Further research is

needed to better understand the relationship between worry and related

constructs such as conscientiousness, perfectionism and obsessionality,

particularly in relation to differentiating between so called ‘‘functional’’ and

‘‘dysfunctional’’ worrying.

G.L. Gladstone et al. / Anxiety Disorders 19 (2005) 877–892 879

The present study reports the development of a short (8-item) self-report

questionnaire of worry severity and dysfunction, with items designed to

measure the central components of pathological worry identified in the research

literature as being particularly relevant in the demarcation between ‘‘normal,’’

volitional worrying and dysfunctional worry which is detrimental to

performance and linked to emotional disturbance (see Gladstone & Parker,

2003). Using clinical and non-clinical samples, the aim of this study is to

provide an initial assessment of the psychometric properties of the new measure

(the Brief Measure of Worry Severity; BMWS); to further examine the

differential severity of worry in major depression and differing anxiety

disorders, and finally, to provide further insight into the clinical and personality

correlates of severe worriers.

2. Method

2.1. Participants and procedures

One-hundred and seventeen subjects including 28 medical students and 89

patients receiving psychiatric treatment, were used to develop a Brief Measure of

Worry Severity. The mean age for the student group was 22.4 years (S.D. = 0.68)

with 18 males and 10 females. The 89 patients included those attending our Mood

Disorders Unit (MDU) for outpatient assessment (n = 35); MDU inpatients

(n = 4) and those visiting MDU psychiatrists privately (n = 50), of whom most

had anxious or depressive disorders, with a minority reporting adjustment

disorders, ‘‘stress,’’ ‘‘grief reactions,’’ and disordered eating habits. Patients with

a psychotic illness, dementia or language difficulties were not included in the

study. The mean age for the total patient group was 41.2 years (S.D. = 15.0) and

58 (65%) were female.

In addition to that study group, two other samples (outlined below), were used

to assess the validity of the Brief Measure of Worry Severity and examine its

clinical utility.

2.1.1. Depression sample

This was a separate clinical sample comprising 184 patients referred to the

MDU for assessment of depression. All patients met DSM-IV criteria for major

depression, 79 (43%) of whom met DSM-IV criteria for melancholia. Patients

ranged in age from 17 to 68 with a mean age of 39.6 (S.D. = 12.7) years and 110

(60%) were female.

2.1.2. Antenatal sample

This comprised a general community sample of 748 women attending a public

antenatal clinic at the Royal Hospital for Women in Sydney, recruited from

approximately 26 weeks gestation onwards, for a separate longitudinal study into


risk factors for post-natal depression. Women ranged in age from 14 to 47 with a

mean age of 30.5 years (S.D. = 5.23).

2.2. Measures and assessments

2.2.1. Depression sample

Patients completed the final worry measure (BMWS; described shortly) as part

of their routine assessment together with other self-reports including the 60-item

NEO-PI (Costa & McCrae, 1985); the PSWQ (Meyer et al., 1990) and the seven-

factor Temperament and Character Inventory or TCI (Cloninger, Svrakic, &

Przybeck, 1993), as well as a 142-item personality questionnaire which measures

15 personality styles underlying formalized personality disorders (see Parker,

Hadzi-Pavlovic, & Wilhelm, 2000 for a full description of the measure).

Questionnaires were completed by patients at their home prior to their clinic

appointment. Patients were instructed to complete the measures based on how

they felt or behaved ‘‘usually’’ and not simply for how they felt when depressed.

Patients also underwent separate clinical research interviews with a

psychiatrist and a research psychologist. The psychologist administered the

Composite International Diagnostic Interview or CIDI (WHO, 1997) to assess

lifetime prevalence of anxiety disorders. The psychiatrist assigned patients an

MDU clinical diagnosis for their current depression (i.e., ‘‘psychotic depression,’’

‘‘melancholic depression,’’ or ‘‘non-melancholic depression’’), and completed

the 17-item Hamilton Rating Scale for Depression or HRSD (Hamilton, 1967).

The HRSD measures various depressive features and also includes (psychic and

somatic) anxiety items, and is widely used as a valid clinician-rated assessment

instrument for depression. The psychiatrist also rated the ‘‘severity’’ of patients’

current depression, using a global severity judgment (options being: 0: ‘‘not

depressed’’; 1: ‘‘mild’’; 2: ‘‘moderate’’; or 3: ‘‘severe’’). Based on behavioral

signs exhibited by the patient during interview, the psychiatrist was required to

rate (using clinical judgment) the degree to which patients’ displayed ‘‘observable

anxiety’’ and ‘‘observable irritability and/or hostility.’’ Both assessments were

rated on a 4-point scale (options being: 0: nil; 1: slight; 2: moderate; and 3:

marked). Finally, the psychiatrist also asked patients to provide a subjective

judgment of how much of a ‘‘worrier they were generally’’ (‘‘that is, when you are

not depressed’’) using a scale of: 0: ‘‘not at all’’; 1: ‘‘mild’’; 2: ‘‘moderate’’; or 3:

‘‘severe.’’

2.2.2. Antenatal sample

As well as the BMWS, these women also completed the trait subscale of the

State-trait Anxiety Inventory for Adults (Spielberger, 1983) as a measure of trait

anxiety and a general questionnaire including questions relating to depression,

anxiety, premenstrual stress and a tendency to worry question (i.e., ‘‘would you

consider yourself a worrier?’’) rated on a 5-point scale (1–5) from ‘‘not at all’’ to

‘‘very much.’’


2.3. Construction of the Brief Measure of Worry Severity

(Original sample n = 117)

A set of 26 questions about worry activity and process was constructed. Questions

were derived by review of the existing literature on worry (see Gladstone & Parker,

2003) and were designed to capture indicators of problematic worry, such as worry

marked by intensity, high frequency and uncontrollability, as well as the perceived

negative consequences of worry. Four of the questions required subjects to make

broad judgments about their experience of worrying and were later compared to the

remaining specific worry questions. The first of these ‘‘global’’ questions required

subjects to choose one of three options (scales 0–3) in response to the prompt:

‘‘generally I am a person who,’’ with options being: (i) ‘‘does not really worry to any

significant degree, under any circumstances’’; (ii) ‘‘worries only when there is

something stressful going on in my life and only when life is particularly difficult’’;

or (iii) ‘‘worries on a fairly constant basis, and not just when faced with very stressful

situations.’’ The second global question required subjects to judge the ‘‘truest’’

statement from six options (scales 0–5): (i) ‘‘I never worry’’; (ii) ‘‘my worrying is

only minor and doesn’t concern me’’; (iii) ‘‘my worrying is sometimes difficult to

manage’’; (iv) ‘‘my worrying is often difficult to stop once I start’’; (v) ‘‘my worrying

is mostly uncontrollable no matter what I try’’ or (vi) ‘‘my worrying is completely

uncontrollable.’’ The third global question required subjects to judge the personal

acceptability of their general worrying with options (scales 0–3) being: (i)

‘‘completely acceptable’’; (ii) ‘‘somewhat unacceptable’’; (iii) ‘‘moderately

unacceptable’’; or (iv) ‘‘definitely unacceptable.’’ The final global question required

subjects to judge the ‘‘intensity’’ (or strength) of their worrying with option ranging

from ‘‘insignificant/or absent’’ to ‘‘severe’’ (scales 0–3). The remaining 22 items

were all rated on a 4-point scale and included questions about the rebounding,

frequency and interferenceofworry throughout the day; the behavioral concomitants

associated with worry (e.g., nail biting); the perceived effectiveness of worry (e.g.,

worrying as prevention of negative things happening); catastrophizing as part of

worry; negative cognitive (e.g., problem solving) and affective (e.g., mood

disturbance) consequencesofworrying and meta-worry (i.e.,worrying about worry).

3. Results

Based on subjects’ responses to each of the four global worry questions, all

subjects endorsed worrying in general at least to some degree. Interestingly, no

subject reported they never worried.

3.1. Reduction of item set

Different methods were used to reduce the 22-item development set. Firstly, all

26 questions (i.e., the 4 global items and 22 specific worry questions) were


correlated with each other and with the total score in order to assess the degree of

commonality between items and total. Pearson correlation coefficients ranged

from 0.39 to 0.83 for item-total correlations. Items that consistently correlated

poorly with other items were considered for exclusion. Next, we examined for

items which failed to discriminate between the two options in the first global

worry question [i.e., those who worried only when stressed (n = 61) compared to

those who worried fairly constantly (n = 56)]. Of the 22 items, those that failed to

discriminate these groups, after applying a Bonferroni correction for multiple

comparisons (P < .002), were eliminated. The same procedure was conducted

using ‘‘worry acceptability’’ as the dependent variable. Response options on this

question were collapsed into two groups: ‘‘mostly acceptable’’ (i.e., ‘‘completely

acceptable’’ and ‘‘somewhat unacceptable’’) and ‘‘mostly unacceptable’’ (i.e.,

‘‘moderately unacceptable’’ and ‘‘definitely unacceptable’’). Again, those items

with mean scores significantly higher for the ‘‘mostly unacceptable’’ group were

retained.

These procedures yielded a residual set of 16 items, which were then entered

into a principal components analysis (PCA) with eigenvalues over 1 extracted and

with a varimax rotation. This analysis produced a single factor accounting for

61% of the variance. Eight items were selected from this single factor for the final

measure based on a number of decisions. Items with higher factor loadings and

commonality coefficients, those with more face validity for ‘‘severe’’ worry and

items that successfully predicted important variables were retained. Separate

regression analyses were used to determine this final decision. First, the 16 worry

items were entered into a general linear model regression analysis as covariates

(predictor variables) with subject status (patient vs. student) entered as the

dependent variable. Items which significantly predicted patient status were

retained. Similar analyzes were conducted separately using ‘‘uncontrollability’’

of worry (scales 0–5), ‘‘intensity’’ of worry (scales 0–3) and perceived

‘‘unacceptability’’ of worry (scales 0–3) as dependent variables, with significantly

predictive items retained. The remaining 8 items were entered into a final

principal components analysis with items and component coefficients (cc) given

in Table 1. The final eight items were also factor analyzed in both the depression

and antenatal samples in order to test the integrity of the single factor. In both

samples a single worry factor was retained, constituting 67.6% of the variance for

the depression sample, and 56.7% of the variance for the antenatal (non-clinical)

sample.

3.2. Descriptives statistics and internal consistency

The depression group (n = 184) was used to assess the measure’s internal

consistency with Cronbach’s (1951) coefficient a as the internal consistency

estimate. The BMWS demonstrated strong internal consistency with a coefficient

a of 0.92, and with item—total correlations ranging from 0.79 to 0.87. For the

total group, scores ranged form 0 to 24 with a mean score of 15.5 (S.D. = 6.9) and


median of 16.0 and with no differences in mean scores for males (M = 15.2,

S.D. = 6.7) and females (M = 14.1, S.D. = 7.1). Total worry scores were also

unrelated to patient age (r = .09).

3.3. Construct validity and personality correlates

Construct validity and personality correlate data from both the depression and

antenatal groups are presented in Table 2 in the form of Pearson correlations. In

order to gain comparison data, correlations were also obtained for the PSWQ. As

PSWQ data were available for only 113 subjects, correlations were carried out

listwise in order to ensure that identical subjects were used in both sets of

correlations. As anticipated, there was a strong correlation between the PSWQ

and the BMWS. Both the BMWS and the PSWQ were only moderately correlated

with the single worry question asked during interview, suggesting a reasonable

degree of independence between worry severity assessed by a global question

compared to a more elaborate measure. For the antenatal group, there was also a

moderate correlation between the single worry item and the BMWS. For this

sample, the BMWS was significantly correlated with the trait subscale of the

State-trait Anxiety Inventory.

Personality correlates are also reported. As expected, both worry measures

were significantly correlated with the neuroticism subscale, however, the strength

of the relationship was considerably weakened when the ‘‘worry’’ item was

partialed out and then became negligible when all three of the ‘‘anxiety’’ items


Table 1

Final 8-item Brief Measure of Worry Severity and component coefficients (cc) of single worry factor

Worry item cc Component of

dysfunctional worry

1. When I worry, it interferes with my

day-to-day functioning (e.g., stops me

getting my work done, or organizing my day)

0.85 Impairment and interference

2. When I think I should be finished worrying

about something, I find myself worrying

about the same thing over and over

0.79 Uncontrollability

3. My worrying leads me to feel down and depressed 0.80 Associated mood disturbance

4. When I worry, it interferes with my ability

to make decisions or solve problems

0.80 Associated indecision;

thwarted problem solving

5. I feel tense and anxious when I worry 0.82 Associated anxiety

6. I worry that bad things or events are certain to happen 0.77 Catastrophic cognitions

7. I often worry about not be able to stop

myself from worrying

0.78 Meta cognitions: concern

about excessive worrying

8. As a consequence of my worrying, I tend to

feel emotional unease or discomfort

0.83 Negative emotional

consequences

Instructions ‘‘Below is a list of statements about worrying. Please read each statement and indicate how

true each one is in describing your general or usual experience of worrying.’’ Item rating scale: 0: ‘‘not

true at all’’; 1: ‘‘somewhat true’’; 2: ‘‘moderately true’’; and 3: ‘‘definitely true.’’

from the neuroticism subscale were partialed. Both worry measures were

moderately inversely correlated with ‘‘extroversion’’ and unrelated to the

construct of ‘‘openness to experience.’’ Both measures were also negatively

associated with ‘‘agreeableness’’ (see Table 2). The BMWS was also negatively

correlated with ‘‘conscientiousness,’’ while the PSWQ was not significantly

related to this trait. Two of the TCI subscales were most significantly related to

worry severity. ‘‘Harm avoidance’’ was moderately correlated with worry severity

as measured by both the BMWS and the PSWQ, while ‘‘self-directedness’’ was

moderately inversely correlated with worrying. Also, a weak but significant

relationship between worry (as measured by the BMWS) and the ‘‘persistence’’

subscale of the TCI was also observed. Remaining TCI subscale scores were

unrelated to worry scores.

We also conducted correlations between the personality styles measured by the

DSM-derived 142 item self-report questionnaire described earlier and both of the


Table 2

Correlations between BMWS total scores and measures of worry and personality

Worry or personality measure BMWS PSWQ

Depression sample (n = 184)

Single worry question 0.39** 0.39**

PSWQ 0.75** –

NEO subscales

Neuroticism 0.62** 0.57**

N—worrya 0.54** 0.46**

N—anxietyb 0.12 0.01

Extroversion �0.34** �0.33**

Openness to experience 0.04 �0.09

Agreeableness �0.26** �0.20*

Conscientiousness �0.25** �0.13

TCI subscales

Novelty seeking �0.04 �0.15

Harm avoidance 0.42** 0.49**

Reward dependence �0.04 0.02

Persistence �0.20** �0.17

Self-directedness �0.48** �0.43**

Cooperative �0.13 �0.13

Self-transcendence 0.06 0.04

Antenatal sample (n = 748)

Single worry question 0.52**

Trait anxiety 0.68**

a Partial correlation controlling for neuroticism worry item.b Partial correlation controlling for neuroticism worry/anxiety items.* P < .05.** P < .01 (two-tailed); listwise n = 113.

worry measures. The pattern of correlations between worry and personality styles

was mostly equivalent across both the BMWS and the PSWQ. All of the

personality styles except for ‘‘narcissistic,’’ ‘‘sadistic,’’ and ‘‘schizoid’’ were

significantly positively correlated with worry severity as measured by the BMWS,

with correlation coefficients ranging from 0.24 (P < .01) for ‘‘histrionic’’ to 0.59

(P < .001) for ‘‘anxious.’’ The ‘‘obsessional’’ subscale was moderately correlated

with worry severity (r = .40, P < .001).


Table 3

Means and standard deviations (S.D.) of BMWS scores for different study groups, with and without

specified clinical criteria.

Sample/clinical variable BMWS total scores Statistic (df)

Original sample (n = 117) Student

(n = 28)

Clinical

(n = 89)

t(115)

Mean S.D. Mean S.D.

6.3 4.1 13.8 5.5 6.59***

Clinical sub-sample (n = 89) Depression

only (n = 56)

Anxiety only

(n = 16)

t(70)

Mean S.D. Mean S.D.

13.9 5.2 17.4 5.7 2.35*

Depression sample (n = 184) Absent Present F(6,177)

Mean S.D. Mean S.D.

Panic disorder (n = 61)a 13.1 6.7 17.4 6.1 16.4***

GAD (n = 30)a 13.9 6.9 18.1 4.8 10.7**

Social phobia (n = 44)a 14.6 6.9 14.3 6.7 0.1

OCD (n = 31)a 14.6 7.1 19.3 3.9 5.1*

Agoraphobia (n = 24)a 13.6 6.8 14.7 7.6 0.5

Specific phobia (n = 36)a 16.3 6.9 15.6 6.7 0.1

t(182)

Any anxiety disorder (n = 110) 11.8 6.8 16.4 6.3 4.8***

DSM-IV melancholia (n = 79) 14.4 6.7 14.7 7.1 0.3

Clinical diagnosis melancholia (n = 72)b 15.5 6.3 13.0 7.6 2.4

Antenatal sample (n = 748) Absent Present t(745)

Mean S.D. Mean S.D.

Lifetime depressive episode (n = 285) 5.3 4.1 8.5 5.4 9.4***

Significant PMS (n = 72)c 5.7 4.4 11.4 5.6 10.0***

Significant current anxiety or

depression (n = 107)d

5.9 4.3 10.1 6.1 8.7***

a Analysis of variance controlling for other anxiety disorders.b MDU clinical diagnosis ‘‘melancholia’’: melancholic and/or psychotic.c History of significant self-reported premenstrual sadness or anxiety.d Significant self-reported anxiety or depression during current pregnancy.* P < .05.** P < .01.*** P < .001.

3.4. Discriminant clinical validity

Clinical validity data for the three study groups are presented in Tables 3 and 4.

Firstly, means and standard deviations are given for the original sample, showing

significantly higher BMWS scores for the ‘‘clinical’’ compared to the ‘‘non-

clinical’’ (student) group. Group comparisons for a subset of clinical subjects

(those with depression only compared to those with anxiety only) revealed that

patients with anxiety disorders had significantly greater worry scores than patients

with depression.

A large proportion of the depression sample (60%) also had co-morbid

anxiety disorders (see Table 3), and these patients had significantly higher

BMWS scores than patients without co-morbid anxiety disorders. Differences in

mean scores between patients with and without anxiety co-morbidity were

examined for each separate anxiety disorder (controlling for the influence of

overlapping co-morbid disorders). Depressed subjects with co-morbid panic

disorder had significantly greater BMWS scores than depressed subjects

without co-morbid panic disorder. Similarly, patients with co-morbid GAD had

greater worry scores compared to those without co-morbid GAD. Also, patients

with co-morbid OCD had higher worry scores compared to those without co-

morbid OCD. There were no differences in worry scores between depressed

patients with and without co-morbid social phobia, agoraphobia or specific

phobias. There were no significant differences in worry scores between patients

with and without melancholia, defined both by DSM-IV and MDU clinical

diagnosis criteria.

Key clinical variables were then examined for the antenatal sample. As part of

a questionnaire assessing risk factors for post-natal depression, women were

asked three separate questions related to depression and anxiety. Women who

reported a past episode of major depression had significantly higher BMWS

scores than those who did not. Similarly, women who reported problems with

previous pre-menstrual stress as well as those who reported present (during

current pregnancy) difficulties with anxiety or depression had significantly higher

worry scores than those women who did not report such disturbances (see

Table 3).


Table 4

BMWS and PSWQ correlated with different clinician-rated anxiety and depression measures

Clinical measure BMWS PSWQ

Observable anxiety 0.25** 0.17

Observable irritability 0.08 0.08

Depression severity score �0.02 �0.05

Total HRSD 0.16 0.13

HRSD—depression 0.10 �0.03

HRSD—anxiety 0.24** 0.15

** P < .01 (two-tailed); listwise n = 113.

In the depression sample, correlations were conducted between the BMWS

and the PSWQ on various clinician-rated measures of depression and observable

behavioral anxiety and irritability. The PSWQ was not significantly correlated

with any of the clinician-judged estimates of anxiety or depression. Self-reported

worry severity as measured by the BMWS was significantly positively correlated

with observable (clinician-judged) anxiety and with the anxiety subscale of the

HRSD (see Table 4), while measures of irritability and depression were unrelated

to worry severity scores.

4. Discussion

This study reports the development and initial validation of a new Brief Measure

of Worry Severity. Application of factor analytic techniques to a set of worry items

produced a single worry factor accounting for most of the variance, with this factor

structure retained when examined in two independent samples. The measure

includes 8 items each measuring a key characteristic of pathological or dysfunctional

worry, and each predictive of three ‘‘global’’ subjective judgments about worrying

(i.e., ‘‘uncontrollability,’’ ‘‘intensity,’’ and ‘‘unacceptability’’ of worry).

The BMWS was found to possess good construct validity. The measure was

moderately independent of worry assessed by a single question and was

significantly associated with high trait anxiety in a normal sample. As expected,

BMWS scores were significantly associated with neuroticism scores, with the

relationship between excessive worry and neuroticism mediated entirely by the

influence of worry and anxiety items.

Correlations with other personality measures revealed some interesting

associations. We found that subjects who reported excessive worrying also tended

to have an introverted personality style. This relationship is consistent with the act

of worrying itself, and the considerable degree of ‘‘inward’’ energy expended by

an individual when engaged in worrying (Dugas et al., 1995). An interesting

inverse relationship between BMWS and both ‘‘agreeableness’’ and ‘‘con-

scientiousness’’ was observed, providing validation for the measure’s ability to

assess worry which has become an impediment to both general functioning and

self-efficacy. The negative relationship between ‘‘conscientiousness’’ and worry

(as measured by the BMWS), suggests that excessive worrying interferes with an

individual’s sense of self-competence, and organization, and one’s sense of

effective planning or problem solving. Only the BMWS was sensitive to this

aspect of dysfunctional worry. Conversely, a moderate (positive) relationship

between worry and (DSM-derived) ‘‘obsessionality’’ was observed. Thus, it is

worth noting that severe worry is positively related to obsessional cognitions and

behaviors—which are dysfunctional, yet negatively related to ‘‘conscientious-

ness’’—which is a functional trait. While previous research has linked worry to

‘‘perfectionism’’ (e.g., Pruzinsky & Borkovec, 1990), the current study

contributes further by differentiating the associations excessive worrying has


with related personality constructs, and underscores the distinction between

conscientiousness and obsessionality.

A modest but significant relationship was also found between worrying and

personality qualities such as cynicism and suspiciousness—as evidenced by its

inverse relationship with NEO ‘‘agreeableness.’’ This finding fits well with the

idea that people who worry excessively (including GAD sufferers) are particularly

concerned about potential dangers and threats to personal safety (Mathews, 1990),

have a general heightened awareness of potential threat cues and are often

preoccupied with catastrophic thinking. Similarly, based on TCI scores, worriers

were more likely to identify with ‘‘harm avoidance’’ behaviors. Worry was also

significantly inversely related to ‘‘self-directedness,’’ a finding which also fits

with research suggesting worriers have poor attentional control (Pruzinsky &

Borkovic, 1990). Although worry (as measured by the BMWS only) was

negatively related to the tendency to be ‘‘persistent,’’ suggesting that the thwarted

problem solving effects of excessive worrying may lead to a felt sense of failure,

the relationship was only weak.

In a subset of clinical subjects, worry scores were significantly higher for those

with anxiety only, compared with depression only. This result contrasts the study by

Starcevic (1994), who reported equivalent levels of worrying in anxious and

depressed patients, but is consistent with findings by Chelkminski and Zimmerman

(2003) who reported higher worry scores in anxious, compared with depressed

patients. Depressed patients with co-morbid anxiety disorders reported more severe

worry compared to thosewithout anxious disorders, which is further evidence for the

greater relevance of worry in anxiety, compared with depression. Analyzes of

individual co-morbid disorders revealed that worry was particularly relevant for not

only patients with GAD, but also for those with panic disorder and OCD. As

cognitive appraisal in these disorders primarily focus upon threats to personal safety

(e.g., panic, worry about personal harm, contamination fears), it is not surprising that

worry is highly salient for these patients. Patients with co-morbid social phobia did

not report worrying more than those without this co-morbidity, despite previous

research suggesting that worriers tend to be more socially anxious (Pruzinsky &

Borkovec, 1990). The present results suggest that while severe worry appears more

relevant for anxiety than depression, among the anxiety disorders it is not exclusively

relevant for GAD. In the depressed sample, worry was also unrelated to depression

severity (based on clinician judgments), and also unrelated to depression subtype

(i.e., melancholic vs. non-melancholic depression).

Further validity of the BMWS was demonstrated in two significant correlations

with clinician-rated anxiety measures, including the HRSD anxiety sub-scale

score and clinician judgment of ‘‘observable’’ anxiety (both rated by psychiatrists

independently of patient reported BMWS scores). This relationship between

worry and behavioral signs of anxiety (found only with the BMWS) provides

further evidence for the instrument’s clinical utility and is consistent with research

linking worry with somatic anxiety symptoms, particularly muscle tension

(Joormann & Stober, 1999). The PSWQ, however, was not significantly correlated


with these clinical assessments of anxiety. The most likely explanation for this

may be found in key differences between the BMWS and PSWQ. The PSWQ is a

valid unifactorial instrument, with items predominately measuring the frequency

and uncontrollability of worry. Although the BMWS was also found to be

unifactorial, its 8 items are distinctly more varied, perhaps providing a broader

assessment of worry severity, including features of associated emotional

disturbance (e.g., felt anxiety and depression) and functional impairment (e.g.,

interference with daily tasks and decision making). The BMWS may, therefore,

have greater potential to detect pathological worry and clinical anxiety, but this

issue requires further investigation.

The present study also found evidence for the role of worry as a potentially key

vulnerability marker for depressed and anxious symptoms within a non-clinical

sample. In a large community group of antenatal clinic attendees, higher worry

scores discriminated between women with and without a self-reported history of

depression. Furthermore, women who reported having had previous difficulties

with premenstrual stress (PMS) reported significantly greater worry than those

who did not report PMS problems. Significantly higher worry scores were also

returned by women reporting difficulties with contemporaneous depression or

anxiety. Thus, the tendency to worry, for this sample may constitute a general

vulnerability marker, or alternatively might reflect the women’s current emotional

state. Issues of vulnerability for this sample are, however, difficult to decipher due

to the cross-sectional nature of the data.

The present study supports the validity of a newly devised Brief Measure of

Worry Severity and provides evidence of its clinical utility for future worry-

related research. The BMWS requires further psychometric examination, but

shows promise as a succinct, easy to complete and valid self-report assessment of

pathological or dysfunctional worrying. Finally, our findings broaden the current

empirical knowledge base on the personality characteristics of worriers while

raising questions about the exclusive relevance of worry for GAD among the

anxiety disorders.

Acknowledgments

We thank the National Health and Medical Research Council (Program grant

2223208), the NSW Centre for Mental Health for infrastructure funding, Chris

Boyd for data management and Karen Saint for collection of data for the antenatal

clinic sample.

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A Brief Measure of Worry Severity (BMWS)