Depression Anxiety Stress Scales: Factor structure and differential item functioning across women and men

This study examined the factor structure, and differential item functioning of the Depression Anxiety Stress Scales (DASS; Lovibond & Lovibond, 1995) across sex. The DASS was completed by 201 women and 165 men from the general community. Confirmatory factor analysis (CFA) indicated support for the original 3-factor oblique model (factors for depression, anxiety and stress). There was however more support for a bifactor model, with four orthogonal factors: a general factor on which all the depression, anxiety and stress items load, and specific independent factors for depression, anxiety and stress items. None of the DASS items showed DIF. The practical, theoretical, research and clinical implications of the findings are discussed.     

The Structure of Anxiety and Depression in a Normative Sample of Younger and Older Australian Adolescents

It has been reported that depression and anxiety have overlapping symptoms and are conceptually interrelated. One of the most prominent theoretical developments that explain this association is Clark and Watson’s tripartite model (Journal of Abnormal Psychology, 100:316–336, 1991) that posits these two disorders and negative emotions share a latent component of negative affect (NA). The current study had two aims, (a) to compare a tripartite factor structure against competing models by Confirmatory Factor Analysis (CFA) of the Depression Anxiety and Stress Scales (DASS-21) (Lovibond and Lovibond 1995), and (b) explore the psychometric properties of the DASS-21. The DASS-21 was completed by a representative sample of 4039 young Australians, aged 12–18 years, as part of the South Australian Youth Mental Health Survey (SAYMHS), South Australia, Australia. The best fitting model for the data consisted of anhedonic depression, physiological hyperarousal, and general NA. The psychometric properties of the DASS-21 were excellent with a stable and interpretable factor structure and good internal consistency. The results of the current study suggest that the theoretical tripartite structure of depression and anxiety is robust and applicable among Australian youth. The diagnostic, clinical and theoretical implications of these findings are discussed.     

Depression Anxiety Stress Scales-21: Factor Structure and Test-Retest Invariance,and Temporal Stability and Uniqueness of Latent Factors in Older Adults

This study examined the factor structure and test-retest invariance, and temporal stability and uniqueness of the latent factors (depression, anxiety, and stress) of the Depression Anxiety Stress Scales-21 (DASS-21; Lovibond & Lovibond, 1995) in group a of 269 older adults (age ranging from 60 to 85 years) from the general community. Participants completed the DASS-21 twice, 3 months apart. Confirmatory factor analysis (CFA) of their ratings at Time 1 indicated support for the original 3-factor oblique model (factors for depression, anxiety, and stress). Additional analyses showed support for test-retest invariance for both the measurement (configural, metric and thresholds) and structural (variances and covariances) components of this model. Results also indicated temporal stability and uniqueness of the latent factors. The practical, theoretical, research and clinical implications of the findings are discussed.     

Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale

The practical significance of assessing disorders of emotion in children is well documented, yet few scales exist that possess conceptual if not empirical relevance to dimensions of DSM anxiety or depressive disorders. The current study evaluated an adaptation of a recently developed anxiety measure (Spence Children's Anxiety Scale; [Spence, S. H. (1997). Structure of anxiety symptoms among children: a confirmatory factor-analytic study. Journal of Abnormal Psychology, 106, 280-297; Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545-566]), revised to correspond to dimensions of several DSM-IV anxiety disorders as well as major depression. This investigation involved initial evaluation of the factorial validity of the revised measure in a school sample of 1641 children and adolescents and reliability and validity in an independent sample of 246 children and adolescents. Results yielded an item set and factor definitions that demonstrated structure consistent with DSM-IV anxiety disorders and depression. The revised factor structure and definitions were further supported by the reliability and validity analyses. Some implications for assessment of childhood anxiety and depressive disorders are discussed.     

Confirmatory Factor Analysis of the Depression–Anxiety–Stress Scales in Depressed and Anxious Patients

The Depression–Anxiety–Stress Scales (DASS; P. F. Lovibond & S. H. Lovibond, 1995) have shown considerable promise in their ability to differentially assess depression and anxiety symptoms. Most of the work to date has relied on normal or predominantly anxious clinical samples. To extend this research to a predominantly depressed sample, a psychiatric sample from a mood disorders program (N = 439) was used to investigate the factor structure of the DASS. Confirmatory factor analyses indicated that a 3-factor model for the 21-item DASS was supported. A 3-factor model with crossloading items for the 42-item version showed no practical improvement. Further confirmatory analyses evaluated the ability of item subsets from the DASS to represent the constructs specified in the tripartite model (L. A. Clark & D. Watson, 1991). Strong support was obtained for the DASS to represent the construct of anhedonia and physiological hyperarousal, and their relative importance is consistent with predictions of the tripartite model in understanding the relationship between anxiety and depression.     

Social anxiety and perceptions of likeability by peers in children

The current study aimed to investigate the discrepancy between self-reported and peer-reported likeability among children, and the relation with social anxiety, depression, and social support. In total, 532 children between 7 and 12 years completed questionnaires about social anxiety symptoms, depressive symptoms, and social support, estimated their own likeability, and indicated how much they liked their classmates. Children with higher levels of social anxiety or depression overestimated their likeability less or even underestimated their likeability. Social anxiety symptoms, but not depressive symptoms, were significant predictors of the discrepancy. Social support was positively related to likeability and negatively related to social anxiety, but did not moderate the association between social anxiety symptoms and perception accuracy of likeability. These results are in line with cognitive theories of childhood social anxiety, and they stress the importance of using multi-informant measures when studying the relation between social anxiety and social functioning in children.     

Anxiety and bodily symptoms under the threat of missile attacks: The israeli scene

Abstract

The present research, conducted in Israel during the recent “Desert Storm” operation in the Gulf, sets out to assess the degree of anxiety and bodily symptoms of Israeli citizens, threatened by Scud missile attacks and undergoing a period of acute stress. Data were gathered via questionnaires distributed during the crisis period to over 500 respondents, most of them residing in Haifa, one of the high-risk areas for the missile attacks at the time. State anxiety was reported to be highly elevated during the crisis period, in comparison with norm group data collected during normal times. The most frequently reported bodily symptoms were changes in eating habits (loss of appetite or overeating), fatigue, and insomnia. Women reported more anxiety and bodily symptoms, on average, than men, as well as higher tension, fear and depression. The younger adults in the sample reported more anxiety and bodily symptoms, as well as tension, fear and depression, than their older counterparts. Lower levels of fear and depression were reported at the later stages of the crisis than at the earlier ones; most stress indicators evidenced lower levels with the passage of time. Finally, a strong positive relationship between anxiety and bodily symptoms was found, over and above the contribution of background variables and response tendencies. The possible explanations for the effects of background variables, as well as the strong relationship between anxiety and symptoms reported, are discussed.     

Parenting Behaviors and Childhood Anxiety: A Psychometric Investigation of the EMBU-C

Parent rearing behaviors, including both behavioral modeling and parent–child interactions, are associated with anxiety in children. Patterns of overprotection or rejecting behavior from parents may lead children to develop behavioral avoidance, lower self-confidence, and higher symptoms of anxiety. Additional research is needed to further elucidate the role that parenting behavior plays in the development of childhood anxiety. Unfortunately, few measures of parenting behavior exist. The EMBU-C is a 40-item child-report measure of these behaviors, but empirical data supporting the psychometric properties of the EMBU-C are limited. The current investigation examined the psychometric properties of the EMBU-C in the context of childhood anxiety. Participants were 213 children with an anxiety disorder and 150 recruited from the community (all aged 8–13 years). Overall, the EMBU-C demonstrated promising psychometrics. In terms of convergent validity, parent rearing behaviors described on the EMBU-C were significantly related to children’s anxiety symptoms, anxiety-related disability, parenting stress, family functioning and children’s externalizing behaviors. Further, the overprotection and anxious-rearing subscales discriminated between clinical and community participants. Finally, parental overprotection significantly predicted increases in child anxiety and anxiety-related disability 1 year later. Thus, the EMBU-C appears to have value as a clinical tool for assessing parental factors that may contribute to anxiety in children. Recommendations for further item development and measure improvement are offered.     

Methylphenidate in treatment of adults with Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) can persist into adulthood with a continuation of the pattern of childhood psychopathology, cognition and functioning. Adult comorbidities include substance use disorders, antisocial personality disorder, anxiety, and depression. Studies have shown that as in children, methylphenidate treatment for adults can lead to a robust, dose-dependent improvement in ADHD symptoms. Future research is needed to evaluate the safety and efficacy of long-term treatment with methylphenidate (MPH).     

Financial strain,social capital,and perceived health during economic recession: a longitudinal survey in rural Canada

Although the health consequences of financial strain are well documented, less is understood about the health-protective role of social capital. Social capital refers to a sense of community embeddedness, which is in part reflected by group membership, civic participation, and perceptions of trust, cohesion, and engagement. We investigated whether perceptions of social capital moderate the relation between financial strain and health, both mental and physical. This longitudinal study surveyed adults in two communities in rural Ontario where significant job losses recently occurred. Data were collected on financial strain, social capital, perceived stress, symptoms of anxiety and depression, and physical health on three occasions over 18 months (N's = 355, 317, and 300). As expected, financial strain positively related to perceived stress, poor physical health and symptoms of anxiety and depression, whereas social capital related to less stress, better physical health, and fewer symptoms of anxiety and depression. Effects of financial strain on perceived stress and depressive symptoms were moderated by social capital such that financial strain related more closely to perceived stress and depressive symptoms when social capital was lower. The findings underscore the health-protective role of community associations among adults during difficult economic times.     

Anxiety and Depression During Childhood and Adolescence: Testing Theoretical Models of Continuity and Discontinuity

The present study sought to clarify the trajectory (i.e., continuous vs. discontinuous) and expression (i.e., homotypic vs. heterotypic) of anxiety and depressive symptoms across childhood and adolescence. We utilized a state-of-the-science analytic approach to simultaneously test theoretical models that describe the development of internalizing symptoms in youth. In a sample of 636 children (53% female; M _age = 7.04; SD _age = 0.35) self-report measures of anxiety and depression were completed annually by youth through their freshman year of high school. For both anxiety and depression, a piecewise growth curve model provided the best fit for the data, with symptoms decreasing until age 12 (the “developmental knot”) and then increasing into early adolescence. The trajectory of anxiety symptoms was best described by a discontinuous homotypic pattern in which childhood anxiety predicted adolescent anxiety. For depression, two distinct pathways were discovered: A discontinuous homotypic pathway in which childhood depression predicted adolescent depression and a discontinuous heterotypic pathway in which childhood anxiety predicted adolescent depression. Analytical, methodological, and clinical implications of these findings are discussed.     

A Meta-Analysis of Universal School-Based Prevention Programs for Anxiety and Depression in Children

Anxiety and depression are among the most common mental health issues experienced in childhood. Implementing school-based prevention programs during childhood, rather than adolescence, is thought to provide better mental health outcomes. The present meta-analysis aimed to investigate the efficacy of universal school-based prevention programs that target both anxiety and depression in children (aged 13 years or below), and examine three moderators (i.e., program type, primary target of program, and number of sessions) on prevention effects. PsycINFO, PubMED, and Google Scholar were systematically searched for relevant articles published up to and including January 2018. Fourteen randomised controlled trials, consisting of 5970 children, met eligibility criteria. Prevention programs led to significantly fewer depressive symptoms at post-program (g?=?0.172) and at long-term follow-up periods (g?=?0.180), but not at short-term follow-up. Programs were not found to prevent anxiety symptoms across any time point. Considerable heterogeneity was observed for all effects. Program type and length were found to moderate the relationship between prevention program and outcomes. Prevention programs were effective in preventing depressive symptoms at post-program and long-term follow-up, while no significant preventative effect on anxiety symptoms was observed. The FRIENDS Program and programs which contained a greater number of sessions showed beneficial effects on anxiety and depressive symptoms. Universal programs aimed at preventing both anxiety and depression in children are limited. Future research should investigate the long-term evaluation of school-based prevention programs for anxiety and depression in children.     

Early Maladaptive Schemas as Moderators of the Impact of Stressful Events on Anxiety and Depression in University Students

The aim of this study was to test the effects of early maladaptive schemas (EMS) derived from the Schema Therapy model (Young 1999) according to the diathesis-stress paradigm. We expected that EMS would make students more vulnerable to symptoms of depression and anxiety in the presence of stressful events and that the effects of these schemas would be different for each symptom. In particular, it was hypothesised that abandonment, emotional deprivation, defectiveness, and failure schemas would interact with stressful events to predict depressive symptoms, whereas abandonment, vulnerability to harm, and dependence schemas were expected to moderate anxiety symptoms. Due to gender differences in EMS and depressive and anxiety symptoms, we also expected that sex would act as a moderator of the relationships between EMS and symptoms. A two-wave prospective study showed that the presence of EMS constitutes a vulnerability factor for both, depressive and anxiety symptoms, and this effect was also moderated by sex. Moreover, the EMS’s content specificity revealed which schemas were more relevant to each symptom, providing valuable information for prevention and intervention programmes.     

A Psychometric Analysis of the Revised Child Anxiety and Depression Scales—Parent Version in a School Sample

The Revised Child Anxiety and Depression Scale—Parent Version (RCADS-P) is a parent-report questionnaire of youth anxiety and depression with scales corresponding to the DSM diagnoses of separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and major depressive disorder. The RCADS-P was recently developed and has previously demonstrated strong psychometric properties in a clinic-referred sample (Ebesutani et al., Journal of Abnormal Child Psychology 38, 249–260, 2010b). The present study examined the psychometric properties of the RCADS-P in a school-based population. As completed by parents of 967 children and adolescents, the RCADS-P demonstrated high internal consistency, test-retest reliability, and good convergent/divergent validity, supporting the RCADS-P as a measure of internalizing problems specific to depression and five anxiety disorders in school samples. Normative data are also reported to allow for the derivation of T-scores to enhance clinicians’ ability to make classification decisions using RCADS-P subscale scores.     

Genetic and environmental influences on interpersonal cognitions and associations with depressive symptoms in 8-year-old twins

Less is known about depression in children than in adults. This study integrates fields by combining cognitive and interpersonal research investigating childhood depression symptoms through the use of a genetic framework. Three research questions are addressed. First, what are the associations among interpersonal cognitions, anxiety, and depression? Second, what are the relative magnitudes of genetic and environmental influences on interpersonal cognitions? Third, to what extent do genetic and environmental influences explain associations between interpersonal cognitions and depression? Three hundred pairs of 8-year-old twins reported on symptoms of depression and anxiety by completing the Children's Depression Inventory and the Screen for Childhood Anxiety-Related Emotional Disorders. The authors examined interpersonal cognitions with the Children's Expectation of Social Behaviors and the Perceptions of Peers and Self Questionnaires. Interpersonal cognitions were more strongly correlated with depression (mean r = .35) than with anxiety (mean r = .13). Genetic influence on interpersonal cognitions was small (M = 3%), and associations between interpersonal cognitions and depression were mainly explained by environmental influences. These latter findings may result from interpersonal cognitions in young children, reflecting life experiences as opposed to trait-like cognitive biases.     

A preliminary comparison of teacher ratings and child self-report of depression,anxiety, and aggression in inpatient and elementary school samples

Using equivalent scales, the differential utility of teachers' ratings of elementary school (n=142) and inpatient (n=83) 8 to 12yearold children was examined by comparing teachers' correspondence with the inpatient and elementary school children's selfreports of depression, anxiety, and aggression. Teacherchild correspondence was significant for all three traits in the elementary school sample, yet only significant for aggression in the inpatient sample. However, the level or severity of depression and anxiety symptoms that the teachers reported for the inpatient sample was similar to that reported by the children themselves. In contrast, elementary school children reported significantly more internalizing symptoms than their teachers. Inpatient children reported more depression, but not significantly more anxiety and aggression than elementary school children. For all traits, teachers reported significantly more symptoms for inpatient children, after controlling for child selfreport and socioeconomic status. The utility of teachers' ratings across samples, method variance and rater biases, and issues pertaining to selfreport are discussed.     

Social Anxiety and Content Specificity of Interpretation and Judgemental Bias in Children

Previous research with adult samples has demonstrated that social anxiety disorder is associated with content‐specific interpretation and judgemental biases. The present study extends our understanding of the specificity of cognitive biases in childhood social anxiety. A sample of non‐clinical children aged 11–12 years completed social anxiety and depression scales and was presented with scenarios depicting hypothetical events varying along two dimensions: relevance to self (event occurs to self or to other) and domain of activity (event is social or non‐social). Partial support for the content‐specificity hypothesis was found. Children's social anxiety symptoms were positively associated with negative interpretation ratings for ambiguous self‐referent and other‐referent events, but only when these events were in the social domain. Further, children's social anxiety symptoms were positively associated with emotional cost judgements for ambiguous social and non‐social events, but only when these events referred to the self. Both patterns of results remained significant even after controlling for concurrent depressive symptoms. Implications of the results for our understanding of maintaining factors in childhood social anxiety are discussed. Copyright © 2011 John Wiley & Sons, Ltd.     

Depression and Social Anxiety in Children: Differential Links with Coping Strategies

Strategies that children use for coping with stressors are known to be related to emotional adjustment, but not enough is understood about specific links with social anxiety and depression. The present investigation tested differentiated associations of social anxiety and depression with specific types of coping strategies, and evaluated the direction of these associations over time. In Study 1, 404 children aged 8–13 years completed a coping scale modified from Kochendefer-Ladd and Skinner (Developmental Psychology 38:267-278, 2002) in order to evaluate factor structure and subscale internal consistency. In Study 2, 270 8–11-year-old children completed depression and social anxiety scales, a sociometric survey, and the coping scale from Study 1, with a follow-up timepoint 9 months later. In Study 1, factor analysis revealed six internally consistent coping subscales. In Study 2, social anxiety and depression were found to have distinctive longitudinal associations with subsequent coping strategies. Decreased problem-solving, social support-seeking, and distraction were uniquely predicted by depression but not by social anxiety. Internalising coping was a stronger outcome of social anxiety, and increased externalising was uniquely predicted by depression. There was also some evidence for a moderating role of peer relations. However, none of the coping strategies predicted changes in depression or social anxiety over the two timepoints. These results highlight the impact that emotional adjustment may have on children’s coping strategies, and clarify important distinctions between social anxiety and depression in relation to coping.     

Life outcomes influenced by war-related experiences during the Gulf crisis

This study examined the life outcomes of children exposed to the Gulf crisis in 1990–1991. We expected war-trauma exposure and psychological distress symptoms to predict poorer educational and occupational outcomes. Participants were 151 Kuwaiti citizens who were assessed during childhood (in 1993; M age = 10.6 years), and who were reassessed 10 years later in young adulthood (in 2003; M age = 21.2 years). Participants completed measures of intelligence, war-trauma exposure, posttraumatic stress symptoms, anxiety symptoms, depressive symptoms, intervening life events, and life outcomes. Results indicated that war-trauma exposure negatively impacted children's educational and occupational outcomes as young adults. Boys with higher levels of war-trauma exposure were less likely to attend University. Posttraumatic stress and anxiety symptoms also predicted poorer educational and occupational outcomes. However, this relationship was not significant when we accounted for children's intelligence. Depressive symptoms were not predictive of children's educational or occupational outcomes. Results suggest that war-trauma exposure may have life-altering effects on children. Tailored, early interventions are needed for children exposed to war traumas.     

Childhood maltreatment and adult personality disorder symptoms in a non‐clinical sample

It can be argued that the well‐substantiated relationship between childhood maltreatment and adult personality disorder (PD) symptoms may be confounded by comorbid symptoms of depression, anxiety or dysfunctional childhood family environments. Therefore, the current study was designed to test the hypothesis that retrospective reports of childhood maltreatment would still be significantly related to reports of more PD symptoms when statistically controlling for these factors. One hundred and seventy‐eight non‐clinical participants were divided into groups reporting childhood maltreatment (n = 54) or not (n = 124) according to scores on the Childhood Trauma Questionnaire. Participants also completed questionnaires measuring current depression, anxiety, and PD symptoms as well as retrospective reports of their childhood environment. Results showed that individuals reporting childhood maltreatment reported more symptoms of PD than those not reporting childhood maltreatment, even when statistically controlling for depression, anxiety and retrospective reports of dysfunctional family environment. These findings underscore the relevance and independent contribution of childhood maltreatment to the development of PDs, with important implications for further research and clinical practice.