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                            Perceived stigma in persons with early stage dementia and its impact on anxiety levels
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University of Iowa University of Iowa

Iowa Research Online Iowa Research Online

Theses and Dissertations

Fall 2012

Perceived stigma in persons with early stage dementia and its Perceived stigma in persons with early stage dementia and its

impact on anxiety levels impact on anxiety levels

Rebecca Jane Riley
University of Iowa

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Part of the Educational Psychology Commons

Copyright 2012 Rebecca Jane Riley

This dissertation is available at Iowa Research Online:

Recommended Citation Recommended Citation
Riley, Rebecca Jane. "Perceived stigma in persons with early stage dementia and its impact on anxiety
levels." PhD (Doctor of Philosophy) thesis, University of Iowa, 2012.

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Part of the Educational Psychology Commons

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dementia (Shankar, Walker, Frost, & Orrell, 1999). The RAID was designed to be

over a two week period. In this study, the RAID questions were answered by PwD. The

RAID was utilized with PwD in a previous study by Dr. Kathleen Buckwalter (K.C.

Buckwalter, personal communication, August 5, 2009) and procedures used in this study

will be discussed further at the end of this section. The following psychometric

properties are based on the RAID when utilized with caregiver and clinician responses.

six sub-groups (e.g., worry, apprehension and vigilance, motor tension, autonomic

hyperactivity, phobias, and panic attacks, however, phobias and panic attacks were not

included in the total score (Shankar et al., 1999) . Each question was rated based on four

different grades: absent, mild or intermittent, moderate, and severe. The worry category

measured the level of worry about various things (e.g., physical health; cognitive

performance). Apprehension and vigilance measured things such as sleep disturbances,

autonomic arousal, and irritability. Motor tension (e.g., trembling, headaches) was

examined because the concepts of anxiety and motor tension seemed to be related

(Yesavage & Taylor, 1991). Autonomic hyperactivity symptoms (e.g., palpitations, dry

mouth) were often reported by PwD and were related to anxiety. Phobias were also

reported in people over the age of 65, and this section of the tool addressed specific fears.

The section on panic attacks discussed the severity of symptoms of panic and asked PwD

to describe their symptoms.

Reliability analysis for the RAID examined its internal consistency, inter-rater

reliability, and test-retest reliability. High internal consistency was found as indicated by

(Shankar et al., 1999). In addition, alpha was calculated for

each subgroup in order to determine whether individual subgroup items were equally

prehension and

vigilance: alpha = 0.67; motor tension: alpha = 0.51; autonomic hyperactivity: alpha =

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0.74; Shankar et al.). Inter-rater reliability kappa values ranged from 0.51-1.0 on

individual items and overall agreement ranged from 82% to 100% (Shankar et al.). In

terms of test-retest reliability, kappa values ranged from 0.53 to 1.0 and the overall

agreement ranged from 84% to 100% (Shankar et al.).

The validity analysis of the RAID included an examination of content, concurrent,

criterion validity, and construct validity. Content validity was examined by 24

individuals including five psychiatrists, one clinical psychologist, three community

psychiatric nurses, five caregivers, and nine staff nurses. Most (n=14) thought all of the

items on the RAID were important (Shankar et al., 1999). Others (n=4) thought sleep

disturbances, trembling, and restlessnessness, might overlap with other medical

conditions (Shankar et al.). There were various concerns with the phobias and panic

attack sections (Shankar et al.). Some (n=7) thought the explanation given for phobias

and panic attacks was inadequate, while others felt these categories should not be

included in the total score because they were in a different diagnostic category (n=3).

Finally, three individuals thought the reliability of assessing autonomic hypersensitivity

symptoms and panic attacks was questionable.

of anxiety (0.73)

to determine concurrent validity (Shankar et al., 1999)

coefficient was also calculated between the RAID and the Anxiety Status Inventory

(0.62), Clinical Anxiety Scale (0.54), and the Cornell Scale for Depression (0.69;

Shankar et al.).

In order to examine criterion validity, Mann-Whitney U was calculated for

independent samples based on modified DSM-IV criteria and clinical impression. This

demonstrated that the RAID distinguished between groups of low and high anxiety based

on the DSM-IV criteria (U=22.5; p<0.006) and a

(U=31.5; p=0.03; Shankar et al., 1999). PwD determined to have clinically significant

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