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

The role of temperament and character in the anxiety-depression spectrum among Korean adults

BACKGROUND

Temperament and character are useful in risk assessment and therapy of individuals in the anxiety-depression spectrum but understudied in South Korea.

OBJECTIVE

The study aimed to identify the temperament and character features associated with anxiety and/or depression in individuals with clinical disorders and in the general population.

METHODS

A representative sample of 1384 Korean adults over 18 years old (58 % female) were assessed with the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Temperament and Character Inventory (TCI). Multivariate analyses, including structural equation modeling and complex systems analysis, evaluated how personality influenced risk and resilience for anxiety and/or depression.

RESULTS

The three groups with anxiety and/or depression were strongly distinguished by temperament and character: (i) In AD (n = 58), Harm Avoidance and Reward Dependence were higher than in DD, and Self-directedness was higher than in AD+DD; (ii) In DD (n = 90), Persistence, Self-Directedness and Cooperativeness were higher than in AD+DD; and (iii) In AD+DD (n = 101), Harm Avoidance was highest and Persistence and Self-directedness were lowest (i.e., they were lowest in Resilience). Structural equation models confirmed these risk relations with strong character development reducing the adverse effects of emotional hyperreactivity from extreme temperaments.

LIMITATIONS

Self-reports were measured only at one point in time, requiring collateral experimental data to support causal interpretation.

CONCLUSIONS

Interactions of temperament and character are strongly predictive of risk and resilience to anxiety and/or depression by regulating both positive and negative affect. Character mediates the adverse effects of extreme temperaments on affect.

Examination of Construct Validity of ANX and DEP Scales of the PAI-A

Anxiety and depression are the two most common psychiatric problems of adolescence. The Personality Assessment Inventory, Adolescent Version (PAI-A) is a broadband instrument designed to assist in the detection and differential diagnosis of common psychiatric disorders in adolescents, and it includes a Depression scale (DEP) to detect the presence of major depressive episodes and an Anxiety scale (ANX) designed to detect clinically significant anxiety. However, there is limited research on this measure. The current study examined both the convergent and discriminant validities of the PAI-A Anxiety and Depression scales by observing their relationships to other self-report measures (e.g., PAI-A scales, MMPI-A), observer ratings (e.g., HPRS), and performance-based measures (e.g., Rorschach CS). The sample consisted of 352 records of the psychological assessments of adolescent inpatients between the ages of 13 to 17; the sample was about equally male (51.6%) and female with a mean age of 15.5 years. The sample was ethnically diverse with 48.7% of individuals identifying as Caucasian, 12.9% Black, 16% Hispanic, 2.6% Asian, 3.2% Other, and 16.6% unknown. There is strong evidence for convergent validity for the PAI-A ANX and DEP scales with r's ranging from .11 to .78. There is moderate evidence for discriminant validity for these scales. Results demonstrated that PAI-A scales correlated strongest with self-report, followed by therapist rating scale, and then performance-based measures. Various strengths of the PAI-A for the assessment of anxiety and depression are discussed.

Exploratory factor analysis of shared and specific genetic associations in depression and anxiety

BACKGROUND

Previous genetic studies of anxiety and depression were mostly based on independent phenotypes. This study aims to investigate the shared and specific genetic structure between anxiety and depression.

METHOD

To identify the underlying factors of Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and their combined scale (joint scale), we employed exploratory factor analysis (EFA) using the eigenvalue of parallel analysis. Subsequently, we conducted a genome-wide association study (GWAS) for these factors. In addition, we utilized LD Score Regression (LDSC) to determine the genetic correlations between the identified factors and four common mental disorders, three sleep phenotypes, and other traits that have been previously linked to anxiety and depression.

RESULTS

The EFA uncovered two factors for the GAD-7 scale, namely nervousness and disturbance, two factors for the PHQ-9 scale, namely negative affect and sleep/appetite disturbance, and four factors for the joint scale, specifically nervousness, anhedonia, sleep/appetite disturbance, and fidget. We identified two genome-wide significant genomic loci, with overlap across GAD-7 factor 1 and joint scale factor 1: rs148579586 (P_GAD-7 = 1.365 × 10^-09, P_{Joint scale} = 1.434 × 1^0-09) and rs201074060 (P_GAD-7 = 3.672 × 10^-09, P_{Joint scale} = 3.824 × 10^-09). Genetic correlations in factors ranged from 0.722 to 1.000 (all p < 1.786 × 10^-3) with 27 of 28 correlations being significantly smaller than one. The genetic correlations with external phenotypes showed small variation across the eight factors.

CONCLUSION

Unidimensional structures can provide more precise scores, which can aid in identifying the shared and specific genetic associations between anxiety and depression. This is a crucial step in characterizing the genetic structure of these conditions and their co-occurrence.

Predictors of depressive symptoms among hospitalized COVID-19 patients with respiratory problems

COVID-19 patients and survivors quite often experience depressive symptoms, which can increase risk for lower immune system response and poorer recovery. Vulnerability to depressive symptoms may be elevated in those patients who have the most severe COVID-19 course of illness, that is, patients who require supplementary oxygen therapy or even intubation. The current study involved a unique sample of patients who were hospitalized due to COVID-19 and who required respiratory support (N = 34, 10 women) in which we investigated depressive symptoms as well as psychopathological personality traits (PID5) as predictors. The majority of patients (76.5%) presented some degree of depressive symptoms. Although we expected severe levels of depressive symptoms to be most prevalent, more patients showed rather moderate levels. At the same time, Negative Affectivity was most predictive of depressive symptoms. We suggest that medical care for patients with greater emotional sensitivity and vulnerability to stress be supplemented with psychological support in order to address depressive symptoms and foster recovery.

Predictive utility of symptom measures in classifying anxiety and depression: A machine-learning approach

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly prevalent, co-occurring disorders with significant symptom overlap, posing challenges in accurately distinguishing and diagnosing these disorders. The tripartite model proposes that anxious arousal is specific to anxiety and anhedonia is specific to depression, though anxious apprehension may play a greater role in GAD than anxious arousal. The present study tested the efficacy of the Mood and Anxiety Symptom Questionnaire anhedonic depression (MASQ-AD) and anxious arousal (MASQ-AA) scales and the Penn State Worry Questionnaire (PSWQ) in identifying lifetime or current MDD, current major depressive episode (MDE), and GAD using binary support vector machine learning algorithms in an adult sample (n = 150). The PSWQ and MASQ-AD demonstrated predictive utility in screening for and identification of GAD and current MDE respectively, with the MASQ-AD eight-item subscale outperforming the MASQ-AD 14-item subscale. The MASQ-AA did not predict MDD, current MDE, or GAD, and the MASQ-AD did not predict current or lifetime MDD. The PSWQ and MASQ-AD are efficient and accurate screening tools for GAD and current MDE. Results support the tripartite model in that anhedonia is unique to depression, but inclusion of anxious apprehension as a separate dimension of anxiety is warranted.

Towards an affect intensity regulation hypothesis: Systematic review and meta-analyses of the relationship between affective states and alcohol consumption

While self-medication and positive and negative reinforcement models of alcohol use suggest that there is an association between daily affect and alcohol consumption, findings within the academic literature have been inconsistent. This pre-registered systematic review meta-analytically interrogated the results from studies amongst non-clinical populations that examine the relationship between daily affective states and alcohol consumption volume. PRISMA guided searches of PsychINFO, PsycARTICLES, Science Direct, PubMed, SCOPUS, and JSTOR databases were conducted. When both laboratory and field studies were included, meta-analyses with robust variance estimation yielded 53 eligible studies on negative affect (8355 participants, 127 effect sizes) and 35 studies for positive affect (6384 participants, 50 effect sizes). The significant pooled associations between intra-day affect and alcohol consumption were r = .09, [.03, .14] for negative affect, and r = .17, [.04, .30] for positive affect. A small-to-medium sized effect (d = .275, [.11, .44]) of negative affect on daily alcohol consumption volume was found in laboratory studies (14 studies, 1100 participants). While publication bias was suspected, P-curve analyses suggested that the results were unlikely to be the product of publication bias and p-hacking alone, and selection model analysis revealed no significant differences in results when publication bias was accounted for. For negative affect, using number of drinks as the measure of alcohol consumption was associated with lower effect sizes. For positive affect, the results demonstrated a decline of this observed effect over time. Overall, findings point towards the possibility of developing an affect intensity regulation theory of alcohol use. Conceptualizing the mood-alcohol nexus in terms of affect intensity regulation may afford a more parsimonious explanation of alcohol consumption rather than viewing the behavior as being shaped by either positive or negative affective states.

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.

Emotional adaptation during a crisis: decline in anxiety and depression after the initial weeks of COVID-19 in the United States

Crises such as the COVID-19 pandemic are known to exacerbate depression and anxiety, though their temporal trajectories remain under-investigated. The present study aims to investigate fluctuations in depression and anxiety using the COVID-19 pandemic as a model crisis. A total of 1512 adults living in the United States enrolled in this online study beginning April 2, 2020 and were assessed weekly for 10 weeks (until June 4, 2020). We measured depression and anxiety using the Zung Self-Rating Depression scale and State-Trait Anxiety Inventory (state subscale), respectively, along with demographic and COVID-related surveys. Linear mixed-effects models were used to examine factors contributing to longitudinal changes in depression and anxiety. We found that depression and anxiety levels were high in early April, but declined over time. Being female, younger age, lower-income, and previous psychiatric diagnosis correlated with higher overall levels of anxiety and depression; being married additionally correlated with lower overall levels of depression, but not anxiety. Importantly, worsening of COVID-related economic impact and increase in projected pandemic duration exacerbated both depression and anxiety over time. Finally, increasing levels of informedness correlated with decreasing levels of depression, while increased COVID-19 severity (i.e., 7-day change in cases) and social media use were positively associated with anxiety over time. These findings not only provide evidence for overall emotional adaptation during the initial weeks of the pandemic, but also provide insight into overlapping, yet distinct, factors contributing to depression and anxiety throughout the first wave of the pandemic.

Specificity of trait anxiety in anxiety and depression: Meta-analysis of the State-Trait Anxiety Inventory

The State-Trait Anxiety Inventory - Trait version (STAI-T) was developed to measure an individual's tendency to experience anxiety, but it may lack discriminant evidence of validity based on strong observed relationships with measures of depression. The present series of meta-analyses compares STAI-T scores among individuals with depressive disorders, anxiety disorders, and nonclinical comparison groups, as well as correlations with measures of anxiety and depressive symptom severity, in order to further examine discriminant and convergent validity. A total of 388 published studies (N = 31,021) were included in the analyses. Individuals with an anxiety disorder and those with a depressive disorder displayed significantly elevated scores on the STAI-T compared to nonclinical comparison groups. Furthermore, anxiety and depressive symptom severity were similarly strongly correlated with the STAI-T (mean r = .59 - .61). However, individuals with a depressive disorder had significantly higher STAI-T scores than individuals with an anxiety disorder (Hedges's g = 0.27). Given these findings, along with previous factor analyses that have observed a depression factor on the STAI-T, describing the scale as a measure of 'trait anxiety' may be a misnomer. It is proposed that the STAI-T be considered a non-specific measure of negative affectivity rather than trait anxiety per se.

Attentional Control in Subclinical Anxiety and Depression: Depression Symptoms Are Associated With Deficits in Target Facilitation, Not Distractor Inhibition

Mood and anxiety disorders are associated with deficits in attentional control involving emotive and non-emotive stimuli. Current theories focus on impaired attentional inhibition of distracting stimuli in producing these deficits. However, standard attention tasks struggle to separate distractor inhibition from target facilitation. Here, we investigate whether distractor inhibition underlies these deficits using neutral stimuli in a behavioral task specifically designed to tease apart these two attentional processes. Healthy participants performed a four-location Posner cueing paradigm and completed self-report questionnaires measuring depressive symptoms and trait anxiety. Using regression analyses, we found no relationship between distractor inhibition and mood symptoms or trait anxiety. However, we find a relationship between target facilitation and depression. Specifically, higher depressive symptoms were associated with reduced target facilitation in a task-version in which the target location repeated over a block of trials. We suggest this may relate to findings previously linking depression with deficits in predictive coding in clinical populations.

Norms for Zung's Self-rating Anxiety Scale

BACKGROUND

Zung's Self-rating Anxiety Scale (SAS) is a norm-referenced scale which enjoys widespread use a screener for anxiety disorders. However, recent research (Dunstan DA and Scott N, Depress Res Treat 2018:9250972, 2018) has questioned whether the existing cut-off for identifying the presence of a disorder might be lower than ideal.

METHOD

The current study explored this issue by examining sensitivity and specificity figures against diagnoses made on the basis of the Patient Health Questionnaire (PHQ) in clinical and community samples. The community sample consisted of 210 participants recruited to be representative of the Australian adult population. The clinical sample consisted of a further 141 adults receiving treatment from a mental health professional for some form of anxiety disorder.

RESULTS

Mathematical formulas, including Youden's Index and the Receiver Operating Characteristics Curve, applied to positive PHQ diagnoses (presence of a disorder) from the clinical sample and negative PHQ diagnoses (absence of a disorder) from the community sample suggested that the ideal cut-off point lies between the current and original points recommended by Zung.

CONCLUSIONS

Consideration of prevalence rates and of the potential costs of false negative and false positive diagnoses, suggests that, while the current cut-off of 36 might be appropriate in the context of clinical screening, the original raw score cut-off of 40 would be most appropriate when the SAS is used in research.

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.

Graphic and Arousing? Emotional and Cognitive Reactions to Tobacco Graphic Health Warnings and Associated Quit-Related Outcomes Among Low SEP Population Groups

Research on graphic health warnings (GHWs) indicates that beyond changing cognitions about the health effects of smoking, GHWs evoke emotional reactions that can influence quit-related outcomes. Emotions can be classified based on valence (positive or negative) and arousal (calm or excited). However, although considerable research has examined the differential effectiveness of positive versus negative GHW-evoked emotions, research investigating the role of arousal activation in quit-related behaviors is scarce. This study examined associations between quit-related outcomes (intention and attempt to quit) and GHWs-evoked negative emotions classified as high and low in arousal activation as well as cognitive reactions among smokers of low socioeconomic position (SEP). It also examined whether perceived health risks of smoking moderate the relationship between emotional and cognitive reactions to GHWs and quit-related outcomes. Data were collected from low SEP smokers in three Massachusetts communities. Participants were screened and randomized to view one of the nine GHWs initially proposed for use by the U.S. Food and Drug Administration (FDA) and answered pre- and post-exposure questions. Results showed that GHW-evoked negative emotions high in arousal activation and cognitive reactions were both significantly associated with intention to quit during immediate post-test, controlling for age, warning label difference, and prior quit intention. However, these associations did not hold for quit attempts at follow-up. Perceived health risks of smoking moderated the association between cognitive reactions to GHWs and quit attempts at follow-up. The findings suggest that not all negative emotions evoked by GHWs are effective. Negative emotions high in arousal activation may be more effective in influencing quit-related behavioral intentions in low SEP groups. Additionally, unlike emotional reactions, cognitive reactions to GHWs may have effects that last relatively longer, but only among smokers who had low levels of perceived health risks of smoking at baseline.

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.

Clinical Utility of Beck Anxiety Inventory in Clinical and Nonclinical Korean Samples

Despite the prominent use of the Beck Anxiety Inventory (BAI) in primary healthcare systems, few studies have confirmed its diagnostic utility and psychometric properties in non-Western countries. This study aims to clarify the clinical utility of the BAI as a screening tool for anxiety disorders according to DSM-IV criteria, based on blind recruitment and diagnostic interviews of both clinical and non-clinical participants in the Korean population. A total of 1,157 participants were involved in the final psychometric analysis, which included correlational analysis with other anxiety and depression self-report measures and mean score comparison with the Beck Depression Inventory (BDI). ROC analysis and calculation of positive and negative predictive values were conducted to examine diagnostic utility. The BAI was found to have high correlations with depression-related self-report measures (0.747-0.796) and moderate to high correlations with anxiety-related self-report measures (0.518-0.776). The ROC analysis failed to provide cutoff scores with adequate sensitivity and specificity for identifying participants with anxiety disorders (85.0% sensitivity, 88.1% specificity, and 92.8% AUC). The comparison of BAI and BDI mean scores for different diagnostic groups revealed that BAI and BDI scores were higher in the depressive or anxiety disorders group than in the non-clinical group. However, BAI mean score was not higher for the anxiety-only group than the depression-only group. Our data supports the BAI reliability and validity as a tool to measure the severity of general anxiety in clinical and non-clinical populations; however, it fails to capture the unique characteristics of anxiety disorders that distinguish them from depressive disorders. Further clinical implications of the BAI based on these results and some limitations of the study are discussed.

Screening for anxiety and depression: reassessing the utility of the Zung scales

BACKGROUND

While the gold standard for the diagnosis of mental disorders remains the structured clinical interview, self-report measures continue to play an important role in screening and measuring progress, as well as being frequently employed in research studies. Two widely-used self-report measures in the area of depression and anxiety are Zung's Self-Rating Depression Scale (SDS) and Self Rating Anxiety Scale (SAS). However, considerable confusion exists in their application, with clinical cut-offs often applied incorrectly. This study re-examines the credentials of the Zung scales by comparing them with the Depression Anxiety Stress Scale (DASS) in terms of their ability to predict clinical diagnoses of anxiety and depression made using the Patient Health Questionnaire (PHQ).

METHOD

A total sample of 376 adults, of whom 87 reported being in receipt of psychological treatment, completed the two-page version of the PHQ relating to depression and anxiety, together with the SDS, the SAS and the DASS.

RESULTS

Overall, although the respective DASS scales emerged as marginally stronger predictors of PHQ diagnoses of anxiety and depression, the Zung indices performed more than acceptably in comparison. The DASS also had an advantage in discriminative ability. Using the current recommended cut-offs for all scales, the DASS has the edge on specificity, while the Zung scales are superior in terms of sensitivity. There are grounds to consider making the Zung cut-offs more conservative, and doing this would produce comparable numbers of 'Misses' and 'False Positives' to those obtained with the DASS.

CONCLUSIONS

Given these promising results, further research is justified to assess the Zung scales ability against full clinical diagnoses and to further explore optimum cut-off levels.

Economic Stressors and Psychological Distress: Exploring Age Cohort Variation in the Wake of the Great Recession

This study examined processes linking age cohort, economic stressors, coping strategies and two indicators of psychological distress (i.e. depressive symptoms and anxiety symptoms). Structural equation models were conducted utilizing data from a national survey that was undertaken in order to understand life change consequences of the period of economic downturn from 2007 to 2009 known as the Great Recession. Findings revealed that the associations between economic stressors and symptoms of both depression and anxiety were significantly greater for members of the millennial cohort compared with baby boomers. These effects are partly explained by the greater tendency of members of the baby boomer cohort to use active coping strategies. These findings clarify the circumstances in which age matters most for the associations among economy-related stressors, coping strategies and psychological well-being. They highlight how difficult economic circumstances influence the availability of coping strategies and, in turn, psychological well-being-and differently for younger and older age cohorts. Copyright © 2016 John Wiley & Sons, Ltd.

Psychometrics of the screen for adult anxiety related disorders (SCAARED)- A new scale for the assessment of DSM-5 anxiety disorders

OBJECTIVE

To examine the psychometrics of the Screen for Adult Anxiety Related Disorders (SCAARED).

METHODS

The SCAARED was adapted from the Screen for Child Anxiety Related Emotional Disorders. Participants (N=336) ages 18-27 years old were evaluated using the Structured Clinical Interview for DSM-IV Disorders (SCID). The SCAARED was completed at or within two-weeks before the SCID. The psychometrics of the SCAARED were analyzed using standard statistical analyses including principal components, and Receiver Operant Curve analyses. A replication was performed in an age/sex matched independent sample (N=158).

RESULTS

The SCAARED showed four factors: somatic/panic/agoraphobia, generalized anxiety, separation anxiety, and social anxiety. The total and each factor scores demonstrated good internal consistency (α=0.86-0.97) and good discriminant validity between anxiety and other disorders and within anxiety disorders for generalized and social anxiety. Area Under the Curve for the total and each of the factor scores ranged between 0.72 and 0.84 (p<0.0001). These results were replicated in the independent sample.

CONCLUSIONS

The SCAARED showed excellent psychometric properties supporting its use to screen adults for anxiety disorders, longitudinal studies following youth into adulthood and studies comparing child and adult populations. Further replication studies in larger community and clinical samples are indicated.

The development and validation of Huaxi emotional-distress index (HEI): A Chinese questionnaire for screening depression and anxiety in non-psychiatric clinical settings

BACKGROUND

Depression and anxiety among general hospital patients are common and under-recognized in China. This study aimed toward developing a short questionnaire for screening depression and anxiety in non-psychiatric clinical settings, and to test its reliability and validity.

METHODS

The item pool which included 35 questions about emotional distress was drafted through a comprehensive literature review. An expert panel review and the first clinical test with 288 general hospital patients were conducted for the primary item selection. The second clinical test was performed to select the final item in 637 non-psychiatric patients. The reliability and validity of the final questionnaire were tested in 763 non-psychiatric patients, in which 211 subjects were interviewed by psychiatrists using Mini International Neuropsychiatric Interview (MINI). Multiple data analysis methods including principal components analysis (PCA), item response theory (IRT), and receiver operating characteristic (ROC) curve were used to select items and validate the final questionnaire.

RESULTS

The series selection of items resulted in a 9-item questionnaire, namely Huaxi Emotional-distress Index (HEI). The Cronbach's α coefficient of HEI was 0.90. The PCA results showed a unidimensional construct. The area under the ROC curve (AUC) was 0.88 when compared with MINI interview. Using the optimal cut-off score of HEI (≥11), the sensitivity and specificity were 0.880 and 0.766, respectively.

CONCLUSIONS

The HEI is considered as a reliable and valid instrument for screening depression and anxiety, which may have substantial clinical value to detect patients' emotional disturbances especially in the busy non-psychiatric clinical settings in China.

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.

Depression as a Moderator of Relationships between Positive Daily Events and Day-to-Day Psychological Adjustment

For 21 days, 123 participants provided measures of their daily depressogenic adjustment, including Beck’s cognitive triad, causal uncertainty, control over the environment, self-esteem, and anxiety, and they described the positive and negative events that occurred. Daily adjustment negatively covaried with the number of negative events occurring each day and, except as measured by anxiety, positively covaried with positive events. The covariance between negative events and adjustment was stronger than the covariance between positive events and adjustment. Participants also provided measures of depressive symptoms. For the self-esteem and cognitive triad measures, adjustment covaried more strongly with negative and positive events for the depressed than they did for the nondepressed.

Variations in the Circumplex Structure of Mood

Typically, researchers have emphasized the similarity of the semantic and self-report mood circumplexes. The purpose of the present study was to investigate systematic differences in these structures. The semantic circumplex is defined by two dimensions: valence and level of arousal. The present study demonstrated that when making judgments of their mood, people weigh the arousal dimension less than the valence dimension, whereas in the semantic structure the two mood dimensions are weighed equally. This reduction in the size of the arousal dimension was directly associated with increases in the correlation between self-reported anxiety and depression. The results are discussed with reference to the meaning of subjective mood ratings.

Affect- and Self-Based Models of Relationships between Daily Events and Daily Well-Being

The present study examined affect- and self-based explanatory models of relationships between daily events and daily well-being. Twice a week for up to 10 weeks, participants described the events that occurred each day and provided measures of their daily affect, self-esteem, and depressogenic thinking. Participants also provided trait-level measures of affect, depression, and self-esteem. Measures of daily well-being representing each model covaried jointly and independently with daily negative and positive events. Positive events buffered the effects of negative events on daily self-esteem and daily depressogenic thinking, whereas there was no buffering effect for daily affect. More depressed people were more reactive to positive events, and those higher in trait PA were less reactive to negative events. Buffering effects for self-esteem were more pronounced for those with lower trait self-esteem, and buffering effects for daily depressogenic adjustment were more pronounced for those with higher trait negative affect. The results suggest that affect- and self-based models provide complementary perspectives on relationships between psychological well-being and daily events.

Are Emotions Natural Kinds?

Laypeople and scientists alike believe that they know anger, or sadness, or fear, when they see it. These emotions and a few others are presumed to have specific causal mechanisms in the brain and properties that are observable (on the face, in the voice, in the body, or in experience)—that is, they are assumed to be natural kinds. If a given emotion is a natural kind and can be identified objectively, then it is possible to make discoveries about that emotion. Indeed, the scientific study of emotion is founded on this assumption. In this article, I review the accumulating empirical evidence that is inconsistent with the view that there are kinds of emotion with boundaries that are carved in nature. I then consider what moving beyond a natural-kind view might mean for the scientific understanding of emotion.

A Prospective Study Of Somatic And Emotional Symptoms Of Pregnancy

Using a prospective design, this study examined somatic and emotional symptoms of planned pregnancy in a sample of 162 healthy women. All women participated in a baseline (prepregnancy) interview. Seventy women became pregnant and were assessed at each trimester; the 92 nonpregnant controls were interviewed 3, 6, and 9 months after their baseline interview. All participants also completed the Anxiety and Depression subscales of the Symptom Checklist-Revised (SCL 90-R). No significant group differences were found at baseline. As expected, however, pregnant women reported significantly more instances of digestive symptoms (nausea, vomiting, heartburn), fatigue, and moodiness than nonpregnant controls. Discriminant-function analyses found that in the context of all symptom variables, nausea and fatigue were the primary distinguishing features of the first trimester. In the second and third trimester, fatigue and heartburn contributed to the distinction of pregnant and nonpregnant women. Although pregnancy precipitates many physical and psychological changes in this sample of women who had planned pregnancies, our results did not support the notion that pregnancy is either a time of significant emotional turmoil or of heightened emotional well-being.

Maternity Leave And Women's Mental Health

The Wisconsin Maternity Leave and Health Study addresses an important policy issue, parental leave, by investigating the work status, maternity leave, and mental health of 570 women. In the longitudinal design, the women, all of whom were living with a husband or partner, were interviewed during the fifth month of pregnancy, 1 month postpartum, and 4 months postpartum. At 4 months postpartum, full-time workers, part-time workers, and homemakers did not differ in depression or anger, but full-time workers showed elevated anxiety compared with the other two groups. In multiple regression analyses, length of leave interacted significantly with marital concerns when predicting depression; women who took a short leave (6 weeks or less) and were high on marital concerns had the highest depression scores. Short maternity leave can be conceptualized as a risk factor that, when combined with other risk factors such as marital concerns, places women at greater risk for depression.

Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample

The Patient Health Questionnaire - 9 (PHQ-9) and Generalized Anxiety Disorder - 7 (GAD-7) are short screening measures used in medical and community settings to assess depression and anxiety severity. The aim of this study is to translate the screening tools into Arabic and evaluate their psychometric properties in an Arabic-speaking Lebanese psychiatric outpatient sample. The patients completed the questionnaires, among others, prior to being evaluated by a clinical psychiatrist or psychologist. The scales' internal consistency and factor structure were measured and convergent and discriminant validity were established by comparing the scores with clinical diagnoses and the Psychiatric Diagnostic Screening Questionnaire - MDD subset (PDSQ - MDD). Results showed that the PHQ-9 and GAD-7 are reliable screening tools for depression and anxiety and their factor structures replicated those reported in the literature. Sensitivity and specificity analyses showed that the PHQ-9 is sensitive but not specific at capturing depressive symptoms when compared to clinician diagnoses whereas the GAD-7 was neither sensitive nor specific at capturing anxiety symptoms. The implications of these findings are discussed in reference to the scales themselves and the cultural specificity of the Lebanese population.

Cultural differences in emotion: differences in emotional arousal level between the East and the West

Whether emotion is universal or social is a recurrent issue in the history of emotion study among psychologists. Some researchers view emotion as a universal construct, and that a large part of emotional experience is biologically based. However, emotion is not only biologically determined, but is also influenced by the environment. Therefore, cultural differences exist in some aspects of emotions, one such important aspect of emotion being emotional arousal level. All affective states are systematically represented as two bipolar dimensions, valence and arousal. Arousal level of actual and ideal emotions has consistently been found to have cross-cultural differences. In Western or individualist culture, high arousal emotions are valued and promoted more than low arousal emotions. Moreover, Westerners experience high arousal emotions more than low arousal emotions. By contrast, in Eastern or collectivist culture, low arousal emotions are valued more than high arousal emotions. Moreover, people in the East actually experience and prefer to experience low arousal emotions more than high arousal emotions. Mechanism of these cross-cultural differences and implications are also discussed.

Psychometric properties of the Geriatric Anxiety Inventory (GAI) and its short-form (GAI-SF) in a clinical and non-clinical sample of older adults

BACKGROUND

The Geriatric Anxiety Inventory is a 20-item geriatric-specific measure of anxiety severity. While studies suggest good internal consistency and convergent validity, divergent validity from measures of depression are weak. Clinical cutoffs have been developed that vary across studies due to the small clinical samples used. A six-item short form (GAI-SF) has been developed, and while this scale is promising, the research assessing the psychometrics of this scale is limited.

METHODS

This study examined the psychometric properties of GAI and GAI-SF in a large sample of 197 clinical geriatric participants with a comorbid anxiety and unipolar mood disorder, and a non-clinical control sample (N = 59).

RESULTS

The internal consistency and convergent validity with other measures of anxiety was adequate for GAI and GAI-SF. Divergent validity from depressive symptoms was good in the clinical sample but weak in the total and non-clinical samples. Divergent validity from cognitive functioning was good in all samples. The one-factor structure was replicated for both measures. Receiver Operating Characteristic analyses indicated that the GAI is more accurate at identifying clinical status than the GAI-SF, although the sensitivity and specificity for the recommended cutoffs was adequate for both measures.

CONCLUSIONS

Both GAI and GAI-SF show good psychometric properties for identifying geriatric anxiety. The GAI-SF may be a useful alternative screening measure for identifying anxiety in older adults.

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.

A Psychometric Evaluation of the STAI-Y, BDI-II, and PAI Using Single and Multifactorial Models in Young Adults Seeking Psychoeducational Evaluation

A psychometric evaluation on the measurement of self-report anxiety and depression using the Beck Depression Inventory (BDI-II), State Trait Anxiety Inventory, Form-Y (STAI-Y), and the Personality Assessment Inventory (PAI) was performed using a sample of 534 generally young adults seeking psychoeducational evaluation at a university-based clinic. Confirmatory factor analysis was used to evaluate single-factor and multifactorial models (including hierarchical and higher-order models). Fit indices indicated superiority of the hierarchical model where the BDI-II and PAI depression subscales loaded onto a depression factor, the PAI anxiety subscales loaded onto an anxiety factor, and the STAI-Y State and Trait scale scores loaded onto a separate factor that indexed variance associated with both depression and anxiety. Findings are discussed in regards to the construct validity of the BDI-II, STAI-Y, and PAI in young adults seeking psychoeducational evaluation and relations among these measures.

The PTSD Checklist-Civilian Version: reliability, validity, and factor structure in a nonclinical sample

OBJECTIVES

We examined the reliability, validity, and factor structure of the posttraumatic stress diorder (PTSD) Checklist-Civilian Version (PCL-C; Blanchard, Jones-Alexander, Buckley, & Forneris, 1996) among unselected undergraduate students.

PARTICIPANTS

Participants were 471 undergraduate students at a large university in the Eastern United States and were not preselected based on trauma history or symptom severity.

RESULTS

The PCL-C demonstrated good internal consistency and retest reliability. Compared with alternative measures of PTSD, the PCL-C showed favorable patterns of convergent and discriminant validity. In contrast to previous research using samples with known trauma exposure, we found support for both 1-factor and 2-factor models of PTSD symptoms.

CONCLUSIONS

Overall, the PCL-C appears to be a valid and reliable measure of PTSD symptoms, even among nonclinical samples, and is superior to some alternative measures of PTSD. The factor structure among nonclinical samples may not reflect each of the PTSD symptom "clusters" (i.e., reexperiencing, avoidance/numbing, and hyperarousal).

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.

Relationship between symptoms of anxiety and depression in a sample of Arab college students using the Hopkins Symptom Checklist 25

BACKGROUND

The controversy over the relationship between symptoms of anxiety and depression is an enduring issue. Various models have been proposed to explain this relationship. We explored the following research questions. First, using exploratory factor analysis (EFA), will the symptoms that define anxiety and depression (as in the Hopkins Symptom Checklist 25, HSCL-25) appear together in 1 factor, or are they separable into the hypothesized dimensions of the disorders? Second, using confirmatory factor analysis, how will the structural integrity of the resulting factors compare with those of the various models that have been proposed to explain the relationship between the symptoms of anxiety and depression? This issue has not been investigated in an Arab setting.

METHOD

Participants (n = 624) were Kuwaiti national college students, who completed the HSCL-25 in class. EFA was done by principal axis factoring. Seven models were generated for comparison in confirmatory factor analysis, using 8 'fit' indices in Analysis of Moment Structures, version 16.

RESULTS

The 5 factors from EFA were similar in construct to the subscales of the Mood and Anxiety Symptom Questionnaire, on which the tripartite model of anxiety and depression was validated ('core anxiety', 'core depression', 'general distress mixed', 'general distress anxiety', 'general distress depression'). The hierarchical bifactor model and the dimensional model characterized by the correlation of these factors were best at meeting the fit indices, followed by the correlated 2-factor anxiety/depression model. In line with theory, the correlation between the specific anxiety/depression factors was lower than that between each of them and the general distress mixed factor; and there was no significant gender difference in the summed score for core depression.

CONCLUSION

The findings support the impression that, although the core symptoms of anxiety are separable from the core symptoms of depression, there is an overlapping set of symptoms which contribute to the experience of comorbidity. The relationship between symptoms of anxiety and depression probably has dimensional and hierarchical elements. The findings broaden the evidence base of the cross-cultural validity of the tripartite model.

Subscales measuring symptoms of non-specific depression, anhedonia, and anxiety in the Edinburgh Postnatal Depression Scale

OBJECTIVES

There has been considerable research and clinical interest in the comorbidity of anxiety and depression in the post-partum period, and specifically in the possibility that the commonly used Edinburgh Postnatal Depression Scale (EPDS) incorporates an anxiety component. We hypothesized that the recommended version of factor analysis (Fabrigar, Wegener, MacCallum, & Strahan, 1999) would identify such covert dimensions more reliably than the commonly used principal components analysis with varimax rotation and eigenvalues greater than 1.

DESIGN

Principal axis factor extraction with parallel analysis and oblique (direct quartimin) factor rotation was applied to the 10 EPDS items.

METHOD

The study used a sample of recent mothers recruited and assessed via e-mail and the Internet (N=440). In addition to the EPDS, the Hospital Anxiety and Depression Scale (HADS) and the Positive and Negative Affect Scales (PANAS) were also administered.

RESULTS

Three factors were found, which were identified as 'non-specific depressive symptoms', 'anhedonia', and 'anxietal symptoms' subscales, respectively. These subscales were regressed on the HADS anxiety and depression and the PANAS positive and negative affectivity scales, with results substantially consistent with current structural models of the taxonomy of the emotional disorders.

LIMITATIONS

The data were obtained from a self-selected non-clinical sample. In addition, it is known that the use of computer-based assessment may tend to inflate self-report scores.

CONCLUSIONS

It was concluded that there is now sufficient evidence that clinicians should not assume the EPDS to be unidimensional, but should assess all three subscales when screening for susceptibility to post-partum depression and/or post-partum anxiety.

Development and validation of a child version of the obsessive compulsive inventory

Surprisingly, only 3 self-report measures that directly assess pediatric obsessive-compulsive disorder (OCD) have been developed. In addition, these scales have typically been developed in small samples and fail to provide a quick assessment of symptoms across multiple domains. Therefore, the current paper presents initial psychometric data for a quick assessment of pediatric OCD across multiple symptom domains, a child version of the Obsessive Compulsive Inventory (the OCI-CV). Data from a sample of over 100 youth ages 7 to 17 with a primary DSM-IV diagnosis of OCD support the use of the 21-item OCI-CV. Results support the use of the OCI-CV as a general index of OCD symptom severity and in 6 symptom domains parallel to those assessed by the revised adult version of the scale (OCI-R). The OCI-CV showed strong retest reliability after approximately 1.5 weeks in a subsample of 64 participants and was significantly correlated with clinician-rated OCD symptom severity and parent and child reports of dysfunction related to OCD. Significantly stronger correlations with self-reported anxiety than with depressive symptoms provide initial support for the divergent validity of the measure. Finally, preliminary data with 88 treatment completers suggest that the OCI-CV is sensitive to change.

Personal mastery predicts pain, stress, fatigue, and blood pressure in adults with rheumatoid arthritis

Among individuals with rheumatoid arthritis (RA), stress-associated disease flare can severely impact well-being. Psychological factors such as personal mastery may buffer an individual from the negative effects of those flares. We tested the hypothesis that a high sense of personal mastery would prospectively predict stress reactivity. Measures of pain,perceived stress, fatigue, and mean arterial pressure (MAP) were collected before, during, and after two interpersonal stressors conducted on 73 individuals with RA. Factor analysis of the personal mastery scale yielded two independent factors: a 5-item "fatalism" component and a 2-item "control" component. Individuals with high fatalism scores reported overall greater joint pain at baseline and those scoring high on control exhibited lower MAP, and reported less stress and fatigue at baseline. After controlling for baseline differences, those high in control exhibited greater MAP increase during stress, and less drop in pain when compared to those low in control. These results suggest that individuals high in control may be more susceptible to the effects of acute stress; however, the overall beneficial aspects of high control outweigh the acute negative effects. Personal mastery may play a role in the experience of pain, stress, and fatigue for people with RA.

The experience of emotion

Experiences of emotion are content-rich events that emerge at the level of psychological description, but must be causally constituted by neurobiological processes. This chapter outlines an emerging scientific agenda for understanding what these experiences feel like and how they arise. We review the available answers to what is felt (i.e., the content that makes up an experience of emotion) and how neurobiological processes instantiate these properties of experience. These answers are then integrated into a broad framework that describes, in psychological terms, how the experience of emotion emerges from more basic processes. We then discuss the role of such experiences in the economy of the mind and behavior.

The mediating effects of misinterpretation of intrusive thoughts on obsessive-compulsive symptoms

Perfectionism and inflated responsibility have both been identified as risk factors for the development and maintenance of obsessive-compulsive (OC) symptoms. The aim of the present study was to test whether the relationships between these two variables and OC symptoms are mediated by the misinterpretation of intrusive thoughts (MIT). Three hundred and three university students completed the Frost Multidimensional Perfectionism Scale, the Maudsley Obsessional Compulsive Inventory, the Responsibility Attitude Scale, and the Responsibility Interpretations Questionnaire. MIT was found to partially mediate the relationship between responsibility attitudes and OC symptoms. MIT also partially mediated the relationship between concern over mistakes and OC symptoms, even after controlling for responsibility attitudes. Both concern over mistakes and responsibility attitudes were significant predictors of MIT and OC symptoms, but responsibility was the stronger predictor when all of the variables were included in the model. Clinical implications for the treatment of OCD are discussed.

Generalized expectancies for negative mood regulation predict change in anxiety and depression among college students

Negative mood regulation (NMR) expectancies, or the beliefs held by individuals that, when faced with various manifestations of stress and negative affect, they can successfully cope with such mood states, have proven to be a most useful construct in the context of better understanding self-regulatory processes. In the present prospective study, we examined the predictive utility of NMR expectancies with respect to its ability to predict residual change in both depressive and anxiety symptoms over an 8-week timeframe in a sample of 322 college students. Initial correlational analyses revealed that, as anticipated, NMR expectancies were negatively correlated with depressive and anxiety symptomatology, as well as with maladaptive coping style. Conversely, NMR expectancies were positively associated with self-reported adaptive coping. A series of hierarchical regression analyses revealed that, even when controlling for age, sex, baseline levels of affective distress (depression or anxiety), and coping styles, NMR expectancies predicted change in both depressive and anxiety symptomatology. Implications of the findings pertinent to theory building and testing are discussed.