Distinguishing depression and anxiety in self-report: evidence from confirmatory factor analysis on nonclinical and clinical samples

Development of a Screening Tool for Common Mental Disorders Among General Hospital Inpatients in China

Background: Depression and anxiety disorders are common conditions among general hospital inpatients, but are believed to be under-recognized in China. Methods: A short, practical questionnaire termed the happiness index scale (HIS) was developed for screening co-morbid mental disorders in non-psychiatric clinical settings. The HIS was completed by 1,005 non-psychiatric inpatients in a general hospital in China. The reliability and validity of the HIS were then assessed. Results: The HIS comprised eight items which loaded onto four dimensions: (a) sleep quality; (b) suicidal tendency; (c) depression; and (d) anxiety. These dimensions explained 84.2% of the total variance. Confirmatory factor analysis showed reasonably good fit of the four-factor model (χ2/df = 1.27, p < 0.001, goodness-of-fit index = 0.95, comparative fit index = 0.99, root-mean-square error of approximation = 0.008). The correlation coefficients between each item and the corresponding factor were all > 0.5. Cronbach's α of the entire scale was 0.83, indicating good internal consistency. The area under the ROC curve was 0.95 compared with the original 31-item scale. Using the optimal cut-off score of HIS (mild happiness), the sensitivity and specificity were 0.933 and 0.882, respectively. Conclusions: The new HIS scale is a practical screening tool composed of eight items covering the four most common and important dimensions of mental disorder. The HIS exhibited good reliability and specificity. The HIS is potentially suitable for large-scale screening in busy non-psychiatric clinical settings in China. Further verification using larger samples is warranted.

Inspecting Vulnerability to Depression From Social Media Affect

Affect describes a person's feelings or emotions in reaction to stimuli, and affective expressions were found to be related to depression in social media. This study examined the longitudinal pattern of affect on a popular Chinese social media platform: Weibo. We collected 1,664 Chinese Weibo users' self-reported CES-D scores via surveys and 3 years' worth of Weibo posts preceding the surveys. First, we visualized participants' social media affect and found evidence of cognitive vulnerability indicated by affect patterns: Users with high depression symptoms tended to use not only more negative affective words but also more positive affective words long before they developed early depression symptoms. Second, to identify the type of language that is directly predictive of depression symptoms, we observed ruminations from users who experienced specific life events close to the time of survey completion, and we found that: increased use of negative affective words on social media posts, together with the presence of specific stressful life events, increased a person's risk of developing high depression symptoms; and meanwhile, though tending to focus on negative attributes, participants also incorporated problem-solving skills in their ruminations. These findings expand our understanding of social media affect and its relationship with individuals' risks of developing depression symptoms.

Exploratory Factor Analysis of the Beck Anxiety Inventory and the Beck Depression Inventory-II in a Psychiatric Outpatient Population

BACKGROUND

To further understand the relationship between anxiety and depression, this study examined the factor structure of the combined items from two validated measures for anxiety and depression.

METHODS

The participants were 406 patients with mixed psychiatric diagnoses including anxiety and depressive disorders from a psychiatric outpatient unit at a university-affiliated medical center. Responses of the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI)-II, and Symptom Checklist-90-Revised (SCL-90-R) were analyzed. We conducted an exploratory factor analysis of 42 items from the BAI and BDI-II. Correlational analyses were performed between subscale scores of the SCL-90-R and factors derived from the factor analysis. Scores of individual items of the BAI and BDI-II were also compared between groups of anxiety disorder (n = 185) and depressive disorder (n = 123).

RESULTS

Exploratory factor analysis revealed the following five factors explaining 56.2% of the total variance: somatic anxiety (factor 1), cognitive depression (factor 2), somatic depression (factor 3), subjective anxiety (factor 4), and autonomic anxiety (factor 5). The depression group had significantly higher scores for 12 items on the BDI while the anxiety group demonstrated higher scores for six items on the BAI.

CONCLUSION

Our results suggest that anxiety and depressive symptoms as measured by the BAI and BDI-II can be empirically differentiated and that particularly items of the cognitive domain in depression and those of physical domain in anxiety are noteworthy.

Assigning Clinical Significance and Symptom Severity Using the Zung Scales: Levels of Misclassification Arising from Confusion between Index and Raw Scores

BACKGROUND

The Zung Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) are two norm-referenced scales commonly used to identify the presence of depression and anxiety in clinical research. Unfortunately, several researchers have mistakenly applied index score criteria to raw scores when assigning clinical significance and symptom severity ratings. This study examined the extent of this problem.

METHOD

102 papers published over the six-year period from 2010 to 2015 were used to establish two convenience samples of 60 usages of each Zung scale.

RESULTS

In those papers where cut-off scores were used (i.e., 45/60 for SDS and 40/60 for SAS), up to 51% of SDS and 45% of SAS papers involved the incorrect application of index score criteria to raw scores. Inconsistencies were also noted in the severity ranges and cut-off scores used.

CONCLUSIONS

A large percentage of publications involving the Zung SDS and SAS scales are using incorrect criteria for the classification of clinically significant symptoms of depression and anxiety. The most common error-applying index score criteria to raw scores-produces a substantial elevation of the cut-off points for significance. Given the continuing usage of these scales, it is important that these inconsistencies be highlighted and resolved.

A Korean validation study of the Clinically Useful Anxiety Outcome Scale: Comorbidity and differentiation of anxiety and depressive disorders

Background

This study aimed to evaluate the psychometric properties of the Korean version of the Clinically Useful Anxiety Outcome Scale (CUXOS) and to examine the current diagnostic comorbidity and differential severity of anxiety symptoms between major depressive disorder (MDD) and anxiety disorders.

Methodology

In total, 838 psychiatric outpatients were analyzed at their intake appointment. Diagnostic characteristics were examined using the structured clinical interview from the DSM-IV because the DSM5 was not available at the start of the study. The CUXOS score was measured and compared with that of 3 clinician rating scales and 4 self-report scales.

Principal findings

The CUXOS showed excellent results for internal consistency (Cronbach’s α = 0.90), test–retest reliability (r = 0.74), and discriminant and convergent validity. The CUXOS significantly discriminated between different levels of anxiety severity, and the measure was sensitive to change after treatment. Approximately 45% of patients with MDD were additionally diagnosed with anxiety disorders while 55% of patients with anxiety disorders additionally reported an MDD. There was a significant difference in CUXOS scores between diagnostic categories (MDD only, anxiety only, both disorders, and no MDD or anxiety disorder). The CUXOS scores differed significantly between all categories of depression (major, minor, and non-depression) except for the comparison between minor depression and non-depression groups.

Conclusions

The Korean version of the CUXOS is a reliable and valid measure of the severity of anxiety symptoms. The use of the CUXOS could broaden the understanding of coexisting and differentiating characteristics of anxiety and depression.

Fluctuation in Relationship Quality Over Time and Individual Well-Being: Main, Mediated, and Moderated Effects

This study examined how the degree of within-person variation (or temporal fluctuation) in relationship quality over time was associated with well-being (psychological distress and life satisfaction). A national sample of 18- to 34-year-old men and women in unmarried, opposite-sex relationships completed six waves of surveys every 4 months (N = 748). Controlling for initial levels of and linear changes in relationship quality, greater temporal fluctuation in relationship quality over time was associated with increasing psychological distress and decreasing life satisfaction over time. Decreased confidence in one's relationship partially mediated these associations. Moderation analyses revealed that the association between fluctuations in relationship quality and change in life satisfaction was stronger for women, participants cohabiting with their partners, and those with greater anxious attachment, whereas the association between fluctuations in relationship quality and change in psychological distress was stronger for people with greater avoidant attachment.

Detecting and categorizing fleeting emotions in faces

Expressions of emotion are often brief, providing only fleeting images from which to base important social judgments. We sought to characterize the sensitivity and mechanisms of emotion detection and expression categorization when exposure to faces is very brief, and to determine whether these processes dissociate. Observers viewed 2 backward-masked facial expressions in quick succession, 1 neutral and the other emotional (happy, fearful, or angry), in a 2-interval forced-choice task. On each trial, observers attempted to detect the emotional expression (emotion detection) and to classify the expression (expression categorization). Above-chance emotion detection was possible with extremely brief exposures of 10 ms and was most accurate for happy expressions. We compared categorization among expressions using a d' analysis, and found that categorization was usually above chance for angry versus happy and fearful versus happy, but consistently poor for fearful versus angry expressions. Fearful versus angry categorization was poor even when only negative emotions (fearful, angry, or disgusted) were used, suggesting that this categorization is poor independent of decision context. Inverting faces impaired angry versus happy categorization, but not emotion detection, suggesting that information from facial features is used differently for emotion detection and expression categorizations. Emotion detection often occurred without expression categorization, and expression categorization sometimes occurred without emotion detection. These results are consistent with the notion that emotion detection and expression categorization involve separate mechanisms.

Associations Among Therapist Beliefs, Personal Resources and Burnout in Clinical Psychologists

There were two aims of the research with 190 Australian clinical psychologists: (1) to investigate the construct validity of the Therapist Belief Scale (TBS), and (2) to examine the relative contribution of demographics, workplace variables, and individual factors to burnout. Construct validity was examined using exploratory and confirmatory factor analyses and associations between the variables. Multivariate regressions were used to examine the relative contributions to burnout. The TBS showed three factors related to distress, inflexibility, and control, all of which were significantly associated with lower levels of personal accomplishment. Multivariate analyses showed emotional exhaustion to be associated being a woman, working for the government, having less personal resources, and endorsing more therapist beliefs related to control. Higher levels of personal accomplishment were significantly associated with a lower annual income, not having a mixed caseload, having more personal resources, and endorsing lower levels of therapist beliefs related to inflexibility and control.

Neural responses to negative feedback are related to negative emotionality in healthy adults

Prior neuroimaging and electrophysiological evidence suggests that potentiated responses in the anterior cingulate cortex (ACC), particularly the rostral ACC, may contribute to abnormal responses to negative feedback in individuals with elevated negative affect and depressive symptoms. The feedback-related negativity (FRN) represents an electrophysiological index of ACC-related activation in response to performance feedback. The purpose of the present study was to examine the FRN and underlying ACC activation using low resolution electromagnetic tomography source estimation techniques in relation to negative emotionality (a composite index including negative affect and subclinical depressive symptoms). To this end, 29 healthy adults performed a monetary incentive delay task while 128-channel event-related potentials were recorded. We found that enhanced FRNs and increased rostral ACC activation in response to negative--but not positive--feedback was related to greater negative emotionality. These results indicate that individual differences in negative emotionality--a putative risk factor for emotional disorders--modulate ACC-related processes critically implicated in assessing the motivational impact and/or salience of environmental feedback.

LEARNING TO WORK SAFELY WITH REFERENCE TO A SOCIAL-COGNITIVE MODEL

Issues concerning the effectiveness of promotional activities for working people's occupational safety and health are the focus of the present study. Data were collected from a random sample of 668 working people in Hong Kong by the telephone survey method. The study relies on a framework of social cognitive theory, which posits mediational roles of beliefs concerning one's self-efficacy, the collective efficacy of the promotional organization, and the efficacy of behavior for occupational safety and health. It involves a causal model incorporating exposure, learning, efficacy beliefs, actual and intended behavior, work accident, occupation and other background characteristics, and prior scores of self-efficacy, behavior, and accident. Analysis of the causal model reveals the significant contribution of promotional activities, through the social learning process of exposure, learning, and development of efficacy beliefs, to behavioral change. That is, the total effects of exposure and learning on behavioral outcomes and their mediators were significant. Moreover, working people in industries targeted for promotion demonstrated higher levels of behavior and efficacy beliefs than those in non-targeted industries.

REDEFINING THE VALUE STRUCTURE OF COLLEGE STUDENTS IN HONG KONG AND THE MAINLAND OF CHINA

Research and the theory of historical and dialectical materialism suggest that tradition and modes of production would shape the individual's value structure. Corresponding ideologies of modes of production, namely, socialism, capitalism, and feudalism would have their corresponding value factors on Chinese. A study of 1,221 China's and 1,174 Hong Kong's college students provided a test of the proposed 3-factor structure defining socialist/Confucian, capitalist, feudalist values. Confirmatory factor analysis verified its validity. The 3-factor structure was also more theoretically, methodologically, and empirically adequate than Bond's (1988) conceptualization of Chinese values. In addition, indifference in levels of the three values between students in Mainland China and Hong Kong reflected the students' common orientation to Chinese culture.

Development of a scale to measure symptoms of anxiety and depression in the general UK population: the psychiatric symptom frequency scale

OBJECTIVES

The psychiatric symptom frequency (PSF) scale was developed to assess symptoms of anxiety and depression (i.e. affective symptoms) experienced over the past year in the general population. This study aimed to examine the distribution of PSF scores, internal consistency, and factor structure and to investigate relationships between total scores for this scale and other indicators of poor mental health.

PARTICIPANTS

The Medical Research Council national survey of health and development, a class stratified cohort study of men and women followed up from birth in 1946, with the most recent interview at age 43 when the PSF scale was administered.

MAIN RESULTS

The PSF scale showed high internal consistency between the 18 items (Cronbach's alpha = 0.88). Ratings on items of the scale reflected one predominant factor, incorporating both depression and anxiety, and two additional factors of less statistical importance, one reflecting sleep problems and the other panic and situational anxiety. Total scores were calculated by adding 18 items of the scale, and high total scores were found to be strongly associated with reports of contact with a doctor or other health professional and use of prescribed medication for "nervous or emotional trouble or depression," and with suicidal ideas.

CONCLUSIONS

The PSF is a useful and valid scale for evaluating affective symptoms in the general population. It is appropriate for administration by lay interviewers with minimal training, is relatively brief, and generates few missing data. The total score is a flexible measure which can be used in continuous or binary form to suit the purposes of individual investigations, and provides discrimination at lower as well as upper levels of symptom severity.

TELEVISION VIEWING AND MEAN WORLD VALUE IN HONG KONG'S ADOLESCENTS

Past theory and research have held television responsible for cultivating the viewer's materialism and trivialization of crime, that is, mean world value. The cultivation effect occurs when the viewer watches television intensely and trustfully. It leads to hypotheses that one who watches television longer on a day and watches television serials repeatedly, and/or believes in the reality of television portrayals endorses mean world value to a greater extent. These effects reflect mechanisms of heuristic and peripheral processing. With data collected from 402 high school students in Hong Kong, this study supports the mediating hypotheses concerning perceived reality and its interaction with repeated exposure. These variables and the amount of television viewing on a weekday, exerted relatively strong cultivation effects on the adolescent viewer's mean world value, in terms of materialism and trivialization of moral value. The cultivation effect is attributable to the profusion of violence and consumerism on commercial television in Hong Kong.