Anxiety and Depression in Children and Adolescents: A Factor-Analytic Examination of the Tripartite Model

The tripartite model of Clark and Watson (1981) suggests that the oft-observed covariation between anxiety and depression can best be understood by examining three related yet distinct constructs: negative affectivity, positive affectivity, and elevated physiological arousal. In the present study, 510 boys and girls in the 4th, 7th, and 10th grades completed the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. Confirmatory factor analyses were conducted to determine the goodness of fit of single-factor (i.e., negative affectivity), two-factor (i.e., anxiety and depression), and three-factor models (i.e., negative affectivity, positive affectivity, and physiological arousal). Analyses were conducted by examining each of the models in the whole sample first and then separately for boys and girls and for fourth, seventh, and tenth grade youths. Results failed to support the tripartite theory; rather, the findings supported a two-factor model in all cases. These factors represented the general constructs of anxiety and depression, and these factors remained significantly interrelated. Consistent with previous findings, the strength of these relations was stronger for boys than girls and for children than adolescents.     

An Examination of the Tripartite Model of Anxiety and Depression and Its Application to Youth

The ability to differentiate anxiety and depression has been a topic of discussion in the adult and youth literatures for several decades. The tripartite model of anxiety and depression proposed by L. A. Clark and D. Watson (1991) has helped focus the discussion. In the tripartite model, anxiety is characterized by elevated levels of physiological hyperarousal (PH), depression is characterized by low levels of positive affect (PA), and negative affect (NA) or generalized emotional distress is common to both. The advent of the model led to the development of measures of tripartite constructs and subsequent validity studies. The tripartite model and resultant activity concerning the model was largely devoted to adult samples. However, those interested in anxiety and depression among youth are now incorporating the tripartite model in their work. This paper examines the current influence of the tripartite model in the youth literature, especially with regard to measuring anxiety and depression.     

Depression and Anxiety: Integrating the Tripartite and Cognitive Content-Specificity Assessment Models

The cognitive content-specificity hypothesis proposes that depression and anxiety can be discriminated on the basis of unique cognitive profiles. Alternatively, the Tripartite model suggests that, although depression and anxiety share a general distress factor, anhedonia is a characteristic of depression with anxious arousal a characteristic of anxiety. Past research devoted to integrating these two models has been limited in a number of ways. To remedy these limitations, this study attempted to assess the complete Tripartite model and used a multidimensional cognitive assessment tool to handle the heterogeneity of anxious cognitive content. Results on data collected from 411 clients seeking services at a university counseling center suggested that a one-to-one mapping between Tripartite dimensions and cognitive content was possible. Further, variables from each model simultaneously explained unique variance in depression and anxiety ratings.     

Anxiety and Depression in Children: A Preliminary Examination of the Utility of the PANAS-C

Recent research has questioned the validity of identifying depression and anxiety as separate constructs in children. The current investigation examined the usefulness of the Positive and Negative Affect Schedule for Children (PANAS-C) in differentiating between anxiety and depression in children while also providing needed reliability and validity data on the PANAS-C. In addition, the relationship between positive and negative affect and coping was examined. Subjects included 110 third through fifth graders from a semirural public school setting. Children completed the PANAS-C, as well as self-report measures of depression, anxiety, and coping strategies. Moderate item–total correlations and high internal consistency indicated that the PANAS-C has good reliability. Validity results were mixed: a two-factor solution resembled previous studies, and negative affect was associated with avoidance coping strategies whereas positive affect was associated with approach coping strategies, as expected. However, correlations of positive and negative affect, anxiety, and depression scales suggest that positive and negative affectivity are negatively related in children as opposed to separate and independent constructs. Results of the present investigation question the validity of the use of the PANAS-C for differentiating anxiety and depression with this age group and lend support to the possibility that high overlap between anxiety and depression in this age group may be specific for childhood depression.     

Relations of Tripartite Dimensions of Emotion to Childhood Anxiety and Mood Disorders

This study examined preliminary higher-order models relating tripartite dimensions of emotion to severity of anxiety and depressive disorders in 100 clinically referred children and adolescents. In light of the accumulating support for multifactor models of vulnerability and negative emotion in children, the present investigation was designed to establish preliminary estimates of the structure and magnitude of the relations of three emotion factors with dimensions of social anxiety, depression, panic, generalized anxiety, obsessions/compulsions, and separation anxiety. Results were consistent with structures that minimally specified two higher-order emotion factors, yet only some parameter estimates were consistent with theory regarding the tripartite model. Problems with the measurement of tripartite factors and possibilities for further research are outlined.     

Assessment of Tripartite Factors of Emotion in Children and Adolescents II: Concurrent Validity of the Affect and Arousal Scales for Children

The authors assessed the reliability and validity of the Affect and Arousal Scale for Children (AFARS; Chorpita, Daleiden, Moffitt, Yim, & Umemoto, 2000). The AFARS is a new measure of children's positive affect (PA), negative affect (NA), and physiological hyperarousal (PH). In the first study, 176 school children, 7 to 17 years of age, were administered measures of childhood worry, anxiety sensitivity, and autonomic arousal and their parents completed a child behavior problem checklist. In a second study, two groups of 100 and 114 school children, 8 to 18 years of age, were administered measures of childhood depression and anxiety, respectively, Also, 120 of these children took part in a 1-week retest administration of the AFARS. These studies provided preliminary evidence of acceptable 1-week test–retest reliability, convergent validity, and discriminant validity for the AFARS PA, NA, and PH scales. However, the predicted pattern of convergent and discriminant relations with parent-reported criterion only emerged for children over 11 years of age. Further, a consistent positive relation emerged between NA and PH, yet each of these scales accounted for unique variance in the prediction of criterion measures.     

Assessment of Tripartite Factors of Emotion in Children and Adolescents I: Structural Validity and Normative Data of an Affect and Arousal Scale

The authors developed and evaluated a self-report measure for children designed to assess factors of the tripartite model of emotion (Clark & Watson, 1991). Factor analytic results from a large, multi-ethnic sample (n = 1,289) supported the structural validity of the scale, with the additional suggestion that negative affect appeared to contain two lower order dimensions in the item pool. Confirmatory factor analysis in an independent sample of 300 children and adolescents suggested favorable structure. Consistent with prediction, positive and negative affect emerged as relatively orthogonal dimensions. Physiological hyperarousal was found to be positively correlated with negative affect. Normative data are presented, and tests for differences by sex, grade level, and ethnicity demonstrated nonsignificant or minimal differences between groups. The implications for the assessment of tripartite factors and their relation to psychopathology in youth are discussed.     

Altered Emotional Processing in Pediatric Anxiety,Depression, and Comorbid Anxiety-Depression

The goal of this study was to examine some of the mechanisms underlying emotion regulation in childhood affective disorders by examining the impact of distracting emotional information during performance on a working memory task (Emotional n-back or E-n-back). The sample included 75 children (38 girls and 37 boys) between 8 and 16 years of age meeting criteria for: Anxiety disorder (ANX, n = 17), Major depressive disorder (MDD, n = 16), Comorbid anxiety and depression (CAD, n = 24), or Low-risk normal control (LRNC, n = 18). Results showed that the MDD and CAD groups had significantly longer reaction times on negative emotional backgrounds compared to neutral backgrounds, whereas the LRNC group had significantly longer reaction times on positive backgrounds. These results suggest altered processing of emotional information particularly associated with depression. Because the E-n-back task engages higher-order cognitive processes, these results suggest that these alterations in processing emotional information also interfere with the cognitive processes that govern how attentional resources are allocated. Further, research is needed to replicate this study and delineate underlying neural mechanisms.     

The tripartite model and dimensions of anxiety and depression: an examination of structure in a large school sample

This study was designed to build on recent findings that (a) factors of the tripartite model in adults are not uniformly related to all anxiety disorder dimensions as recent research has suggested (T. A. Brown, B. F. Chorpita, & D. H. Barlow, 1998; S. Mineka, D. W. Watson, & L. A. Clark, 1998), and (b) the tripartite model of emotion appears to have increasing support and utility in child samples (e.g., C. J. Lonigan, E. S. Hooe, C. F. David, & J. A. Kistner, 1999). The structural relations were evaluated among tripartite factors and dimensions representing selected anxiety disorders and depression in a large multiethnic school sample of children and adolescents. General aspects of the tripartite model were supported. For example, Negative Affect was positively related with all anxiety and depression scales, and Positive Affect was negatively correlated with the depression scale. Consistent with previous observations in adult samples, Physiological Hyperarousal was positively related with Panic only, and was not significantly positively correlated with other anxiety syndromes. The structure of the best fitting model appeared robust across different grade levels and gender. In follow-up analyses, several interactions of grade level with structural parameters emerged, such that the relation of some of the tripartite factors with anxiety and depression were noted to increase or decrease across grade level.     

A Self-Modeling Intervention for High School Students with Public Speaking Anxiety

ABSTRACT

The study investigated the effectiveness of self-modeling as an intervention for public speaking anxiety. The participants were six high school students with elevated levels of self-reported public speaking anxiety. Students presented public speeches to randomly selected peer audiences. Direct observations measured the behavioral manifestations of public speaking anxiety. In the intervention phase, students viewed self-modeling videotapes that were edited to remove speech dysfluencies and behavioral symptoms of speech anxiety. The self-modeling tapes depicted only adaptive, exemplary behavior with an edited-in audience feature making it appear that the students were producing a fluent speech to an audience of their peers. All of the participants evidenced substantial decreases in behavioral symptoms of speech anxiety and these changes were maintained throughout follow-up. The range of the participants' effect sizes was 2.7 to 4.9. Self-report measures of state anxiety and confidence as a speaker were used to assess additional effects of treatment. For all participants, there were also substantial decreases in self-reported public speaking anxiety and state anxiety from baseline to follow-up. A post-treatment interview revealed high social validity and self-reported generalization of treatment.     

Negative Thoughts in Children with Symptoms of Anxiety and Depression

This study examined whether negative thoughts are different in anxious, depressed, and chronically ill children. Screening of 1,316 children on anxiety, depression, and asthma resulted in the selection of 118 children. Four groups were formed: (1) a high anxiety group, (2) a high anxiety/depression group, (3) an asthma group, and (4) a low anxiety, low depression, and no chronic disease (control) group. The data yielded no pure depression group. Subsequently, the Negative Affectivity Self-Statement Questionnaire (NASSQ) and a Worry scale were administered. Results showed that cognitive scores were different in all groups. Highest scores were obtained from the high anxiety/depression group, and lowest from the control group. Children with asthma scored high on anxiety, not on depression. High correlations between scores on negative thoughts and conventional measures of negative emotions suggested that negative thoughts provided no unique information about the problems underlying emotional states in different groups of children. Implications for cognitive assessment in emotionally disturbed children are discussed.     

初中生的抑郁与焦虑:结构与发展特点

本研究采用问卷法,对南充市3所普通中学的500名初中生进行了调查,考察其抑郁、焦虑的结构和发展特点。研究发现:(1)初中生的抑郁、焦虑都具有一定的内在结构,抑郁包括无助与孤独感、绝望与无价值感、能力减退感、不良心境和生理症状五个维度,焦虑则包括担忧与过敏倾向、对人不安、恐惧倾向、生理症状四个因素;(2)初中生的抑郁与焦虑的总体水平表现出明显的年龄特征,即随年龄的增长,其抑郁与焦虑的水平不断提高,初中二年级是重要的转折期。(3)初中生的抑郁和焦虑情绪有显著的性别差异。     

Allergies and Anxiety in Children and Adolescents: A Review of the Literature

  There is an increasing prevalence of anxiety disorders and allergic conditions in children and adolescents, with previous research showing that these illnesses are often comorbid. Knowledge of the association between anxiety and allergies in children and adolescents is important because these comorbid disorders may negatively impact functioning and development. This research is necessary for identification of at risk children and to develop intervention and prevention programs. A review of studies examining comorbid anxiety and allergies in children and adolescents demonstrated a consistent association between these disorders despite differences in methodology. Several methodological limitations are presented, followed by a discussion of theories which may explain the association between these conditions. Implications of this work and suggestions for future research are provided.     

青少年罪犯焦虑抑郁特征研究

青少年罪犯存在抑郁症状的比例达74.5%以上,患焦虑症的比例为30.5%.引起青少年罪犯抑郁的因素有自罪、精神性焦虑、胃肠道症状、体重下降、迟滞与疑病;引起焦虑的因素有躯体性障碍、焦虑的心理障碍.     

Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya

Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14–17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week “Shamiri” (“thrive”) group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17–21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9–12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.     

焦虑和抑郁动物模型的研究方法和策略

焦虑和抑郁障碍是严重威胁人们健康的精神疾病。焦虑和抑郁动物模型是通过一定的心理社会应激使动物产生明显的焦虑和抑郁情绪,模拟人类焦虑和抑郁障碍,以探讨其细胞、分子和基因水平机制。情绪障碍动物模型通常通过表面效度、结构效度和预测效度进行评价。目前的动物模型虽然存在一定的缺点,但已经为临床和科研提供了巨大帮助。     

Depression and Anxiety in Roman Catholic Secular Clergy

A nationally selected random sample of Roman Catholic secular priests was investigated using the Center for Epidemiological Studies-Depression scale and the State-Trait Anxiety Inventory Form Y. Additionally, a Self-Report Inventory requested information regarding participants' demographics as well as four categories of predictor variables (i.e., Vocational Satisfaction, Social Support, Spiritual Activities, Physical Environment) potentially associated with depression and anxiety. The study yielded a return rate of 64%. Secular clergy reported significantly greater depression and anxiety (both state and trait) than are reported in the general population. Low Vocational Satisfaction was found to be predictive of depression as well as both state and trait anxiety. Additionally, low Social Support was found to be predictive of state and trait anxiety. When the significant predictor variables were conceptually collapsed, it appeared that both people and place were significantly related to Roman Catholic secular priests' experience of depression and anxiety.     

Long-Term Outcome of a Cluster-Randomized Universal Prevention Trial Targeting Anxiety and Depression in School Children

The present study concerns a 3-year follow-up of a universal prevention trial targeting anxiety and depressive symptoms in school children. In addition to evaluating the long-term effect of the prevention program, we also examined attrition and its effect on the outcome. High rates of attrition have commonly been observed in studies in the field. However, the role of attrition is not sufficiently understood regarding internal and external validity biases. The current study comprised 695 children (aged 8–11 at baseline) from 17 schools in Sweden. Schools were cluster-randomized to either the intervention or control condition. Children completed measures of anxiety and depressive symptoms and parents completed measures of their child’s anxiety and general mental health. We found no evidence of long-term effects of the prevention program, except for a small effect regarding parent reports of child anxiety. However, that effect was not found to be of clinical significance. Regarding attrition, children with missing data at the 3-year follow-up displayed higher levels of psychiatric symptoms at baseline and increasing symptoms across time. Furthermore, children in the control condition with missing follow-up data were found to be significantly deteriorated across time compared to the corresponding children in the intervention condition regarding depressive symptoms and total difficulties. In other words, attrition served as a moderator of the effect, which suggests that the overall result was biased toward a null-result. Our study highlights that large and nonrandom attrition severely limits the validity of the results. Further, given the common problem of retaining participants in long-term evaluations of school-based prevention trials, previous studies may suffer from the same limitations as the current study.     

Behavioral Genetics as a Tool for Developmental Psychology: Anxiety and Depression in Children and Adolescents

Over the past decade there has been a huge increase in the number of behavioral genetic studies looking into anxiety and depression in children and adolescents. There are now enough data in this area to make a review of the results useful. This paper begins with an outline of the methods used in such research and moves on to review the results in extant studies. Overall, these studies indicate modest to moderate genetic influence on both anxiety and depression. However, behavioral genetic methods are also paramount for exploring environmental influences in addition to genetic influences. Shared environment (that which makes family members resemble one another) is rarely identified in adult studies of personality or psychopathology and does not appear to be a significant influence for depression but it is for anxiety. Nonshared environment, which makes family members differ from one another, is found to be a significant influence for both anxiety and depression. Patterns within these results due to rater effects, age effects, sex effects, the precise phenotype measured, and the study design are explored.     

Anxiety and Depression in Medically Ill Older Adults

Anxiety and depression are extremely common in the elderly with medical problems. They can manifest not only as symptoms of a primary psychiatric illness, but also as physiologic sequelae of medical illnesses and medical treatments. Recognition and treatment of depression and anxiety in the medically ill is especially difficult. If these states go untreated, they result in higher morbidity and mortality, higher health care costs and utilization, and poorer functional status and outcomes. Three of the most common medical illnesses that afflict geriatric patients, cardiovascular disease, pulmonary disease, and rheumatoid arthritis, will be presented to illustrate the difficulty in recognizing depression and anxiety and the impact of treating these symptoms in the medically ill elderly. Multidisciplinary approaches combining optimal medication regimens and psychosocial interventions can be effective for treatment of anxiety and depression in the medically ill elderly.