Validation study of tripartite model of anxiety and depression in children and adolescents: clinical sample in Korea

The Tripartite Model of Depression in Schizophrenia and Bipolar Disorder: A Secondary Analysis

ABSTRACT

Models of affect, like the tripartite model, suggest that positive affect (PA) and negative affect (NA) are independent between subjects and negatively correlated within. Correlations may differ in bipolar disorder (BD) and schizophrenia. Using ecological momentary assessment (EMA) and clinical ratings, this secondary analysis evaluated the tripartite model by examining PA and NA. Two hundred eighty-one participants with BD or a psychotic disorder completed 30 days of EMA of PA and NA, and clinical raters assessed depression. PA and NA were more related between subjects and less related within subjects among participants with schizophrenia. In BD, lower momentary PA was positively associated with clinical ratings of depression, although greater momentary NA was not significantly associated with clinical ratings. In schizophrenia, the inverse was found. These results suggest that the tripartite model was not confirmed in people with schizophrenia or BD. However, PA and NA manifested associations in BD that were more congruent with population studies than in schizophrenia. These findings may have implications for clinical interventions targeting depression, PA, and NA in these populations.

The promotion of mental health and the prevention of mental health problems in child and adolescent

Improving mental health and reducing the burden of mental illness are complementary strategies which, along with the treatment and rehabilitation of people with mental disorders, significantly improve population health and well-being. A Institute of Medicine report describes a range of interventions for mental disorders that included treatment and maintenance, reserving the term "prevention" for efforts that occur before onset of a diagnosable disorder. Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability and their long lasting consequences, the mental health needs of children and adolescents are neglected. Early intervention can help reduce the significant impacts that children and adolescents with serious mental health problems may experience. Screening is the first step in early intervention, recognizing emotional and behavioral problems and providing help at an early stage. It is essential to implement early intervention in a sensitive and ethical manner to avoid any of the negative outcomes.

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.

Specificity of cognitive and behavioral variables to positive and negative affect

The Tripartite Model proposes that a combination of greater Negative Affect (NA) and reduced Positive Affect (PA) contributes to depressive symptoms. The purpose of this study was to test a model of affective experience in which cognitive variables (i.e., negative cognitions and appraisals) are uniquely related to NA but not PA, and in which behavioral variables (i.e., activity participation) are uniquely associated with PA but not NA. Participants included 88 spousal Alzheimer caregivers (mean age = 74 years). Multiple regression models, in which negative cognitions (i.e., helplessness, blames self, and negative appraisals) and activity participation (i.e., frequency of engaging in social and recreational activities) were used to predict depressive symptoms, PA and NA. Results indicated that while helplessness, blaming oneself, negative appraisals, and activity participation all significantly predicted depressive symptoms, only negative cognitive variables significantly predicted NA, and only activity participation significantly predicted PA. These data confirm that depressive experience consists of two relatively independent components - increased Negative Affect and reduced Positive Affect - which have unique correlates in negative cognitions and activity participation. If confirmed, the findings suggest the utility of focusing interventions on each of these components in the management of depressive symptoms.

Predictors of self-reported depression in Korean children 9 to 12 years of age

PURPOSE

The aim of this study was to evaluate the relationships among various psychosocial factors, behavior problems, and depressive symptoms reported by parents, and to investigate self-reported depression in Korean children using a community sample.

MATERIALS AND METHODS

The sample consisted of 1279 children between 9 and 12 years of age. The children were evaluated using the Korean version of the Child Behavior Checklist (K-CBCL) and the Child Depression Inventory (CDI).

RESULTS

The average self-reported depression score as measured by the CDI was 12.34 (SD: 6.79), and a cut-off point of 19 identified approximately 14% of the children as depressed. The group difference was identified by the age at which younger children were found to have higher CDI scores. Univariate logistic regression analysis showed that the high-CDI group and the low-CDI group differed in all behavioral domains identified in the parent-reported subscales of the K-CBCL. Age and father's education level were also independently associated with the risk for childhood depression. In addition, results from the logistic regression analyses indicated that parental reporting of problem internalization, total behavior problems, and social competence were independent predictors of child depression not identified by the anxious/depressed subscale.

CONCLUSION

It is believed that extensive behavioral problems reported by parents and several sociodemographic factors are related to childhood depression. However, parents tend to under-report depressive symptoms relative to what their own children report. Thus, clinicians must consider the self-reports of children related to depression in their diagnosis and intervention, because reports of depressive symptoms from children are more valid measures than those from parents.