Tripartite model of depression and anxiety in youth psychiatric inpatients: relations with diagnostic status and future symptoms

Examined the relation of the depression aspect of the tripartite model of depression and anxiety to the diagnostic status and future symptoms of two samples that included 74 child and adolescent psychiatric inpatients, ages 7 to 17 years (M = 13.57, SD = 2.39), some with either internalizing or externalizing diagnoses. The tripartite model suggests that anhedonia (low positive affect, or PA) differentiates depression from other conditions, whereas generalized negative affect (NA) also characterizes depression but is not specific to it. In this study, differences among children in PA and NA were associated with depressive versus externalizing diagnostic status and with future symptoms of depression. Depressive disorder diagnoses were associated with the combination of low levels of PA and high levels of NA. Changes over time in depression, but not in anxiety, also were associated with the combination of low PA and high NA. Results provide support for the applicability, clinical utility, and extension of the tripartite model with children.     

A Test of the Tripartite Model of Anxiety and Depression in Elementary and High School Boys and Girls

The applicability of the tripartite model of emotion, which distinguishes the shared aspect of depression and anxiety, negative affect (NA), from their respective specific components of low positive affect (PA) and physiological hyperarousal (PH), was examined in 472 elementary and high school students. The relations among depression, anxiety, and the three tripartite dimensions were examined for the total sample and across four subgroups based on age and gender. High school girls reported more depression, anxiety, NA, and PH than the other groups, and lower PA as assessed by the PANAS-C, but not the AFARS. Using structural equation modeling, the tripartite model proved to be a reasonably good fit for the total sample. Among the subgroups, the best fit was found for high school girls. However, several findings for the total sample and for individual subgroups were not consistent with the tripartite model, raising issues related to the independence and specificity of the tripartite constructs and their measurement. Alternative age- and gender-specific models to better account for the shared and unique aspects of depression and anxiety in children need to be explored.     

A psychometric analysis of the Positive and Negative Affect Schedule for Children-Parent Version in a school sample

The current study was the 1st to examine the psychometric properties of the Positive and Negative Affect Schedule for Children-Parent Version (PANAS-C-P) using a large school-based sample of children and adolescents ages 8 to 18 (N = 606). Confirmatory factor analysis supported a 2-factor (correlated) model of positive affect (PA) and negative affect (NA). The PANAS-C-P scale scores also demonstrated acceptable internal consistency and convergent and divergent validity. The PANAS-C-P PA and NA scale scores also related to measures of anxiety and depression in a manner consistent with the tripartite model. Scale means and standard deviations were reported by grade and sex to provide normative data for the PANAS-C-P scales. Results from the present study provide initial support for the PANAS-C-P as a parent-reported perspective of youth PA and NA among school-based youths.     

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.     

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.     

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.     

Examining Youth Anxiety Symptoms and Suicidal Ideation in the Context of the Tripartite Model of Emotion

This study sought to clarify the relation of anxiety symptoms and suicidal ideation in children and adolescents by examining these variables in the context of depression and negative affect. As outlined in the tripartite model of anxiety and depression, negative affectivity is common to both emotional constructs; therefore negative affectivity may best explain the relation of each to suicidal ideation. Self report measures of generalized anxiety, depression, negative affectivity, and suicidal ideation were assessed in a primarily externalizing sample of children ages 7–18. Results suggested that the relation between anxiety and suicidal ideation was best accounted for by depression, not negative affectivity. Results also suggested that negative affectivity was associated with suicidal ideation but did not account for the relations among anxiety, depression, and suicidal ideation. Further, depression, negative affect, and anxiety all significantly contributed to the prediction of suicidal ideation scores (r ²  = .307, p < .01).     

The 10-Item Positive and Negative Affect Schedule for Children, Child and Parent Shortened Versions: Application of Item Response Theory for More Efficient Assessment

The Positive and Negative Affect Schedule for Children (PANAS-C/P; child and parent versions) yield positive affect (PA) and negative affect (NA) scales that are clinically useful for identifying youth with anxiety and mood problems. Despite the advantages that item response theory (IRT) offers relative to classical test theory with respect to shortening test instruments, no studies to date have applied IRT methodology to the PANAS-C/P scales. In the present study, we thus applied IRT methodology using a school-based development sample (child sample: N = 799; parent sample: N = 553) and developed a shortened 5-item PA scale (joyful, cheerful, happy, lively, proud) and a 5-item NA scale (miserable, mad, afraid, scared, sad) for the sake of simultaneously increasing the assessment efficiency of the PANAS-C/P scales while improving the psychometric properties of the scales. The reduced PA and NA child scales classified relevant diagnostic groups in a separate clinic-referred validation sample (N = 662) just as well as the original PANAS-C child scales and may be used to help identify youth with internalizing disorders in need of mental health services.     

Changes in affect during treatment for depression and anxiety

We tested the hypothesis that the tripartite model [Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and psychometric implications. Journal of Abnormal Psychology, 100, 316-336] can be extended to account for change during treatment for anxiety and depression. Forty-one patients treated naturalistically in private practice with cognitive behavior therapy completed weekly measures of depression, anxiety, negative affect (NA), positive affect (PA), and anxious arousal (AA). Consistent with the model, NA was associated with anxiety and depression during treatment, PA was more strongly related to depression than to anxiety, and AA was more strongly related to anxiety than to depression. As predicted, symptoms of depression and anxiety and NA all decreased during treatment. As predicted, AA also decreased, particularly for patients with panic disorder. PA increased during treatment, but only for patients who showed a significant decline in depression and only over an extended period of treatment. Nearly two-thirds of the variance in anxiety change was accounted for by changes in depression and NA, and just over three-fourths of the variance in depression change was accounted for by changes in anxiety and NA, indicating that much of the change in anxiety and depression across the course of treatment is shared in common.     

Brief Book,Software, and Test Announcements

This study extended previous cross-cultural work regarding the tripartite model of anxiety and depression by developing Serbian translations of the Positive and Negative Affect Scale for Children (PANAS–C), the Physiological Hyperarousal Scale for Children (PH–C), and the Affect and Arousal Scale (AFARS). Characteristics of the scales were examined using 449 students (M age = 12.61 years). Applying item retention criteria established in other studies, PH–C, PANAS–C, and AFARS translations with psychometric properties similar to English-language versions were identified. Preliminary validation of the scales was conducted using a subset of 194 students (M age = 12.37 years) who also completed measures of anxiety and depression. Estimates of reliability, patterns of correlations among scales, and age and gender differences were consistent with previous studies with English-speaking samples. Findings regarding scale validity were mixed, although consistent with existing literature. Serbian translations of the PH–C, PANAS–C, and AFARS mirror the original English-language scales in terms of both strengths and weaknesses.     

Comparison of the PAD and PANAS as models for describing emotions and for differentiating anxiety from depression

Positive (PA) and Negative (NA) Affect scales were analyzed using the Pleasure-Arousal-Dominance (PAD) Emotion Model. PA was weighted by high arousal, pleasure, and dominance (listed in order of beta weights), thus approximating exuberance in PAD space. NA and markers of somatic anxiety were weighted by displeasure, high arousal, and submissiveness, approximating anxiety in PAD space. PA (or exuberance) represented only one of four basic variants of positive affect (exuberant, relaxed, dependent, docile) and NA (or anxiety) represented only one of four basic categories of negative affect (hostile, anxious, disdainful, bored). Thus, PA and NA lacked validity as general and balanced measures of positive and negative affect, respectively. Indeed, the counterintuitive mutual independence of PA and NA was possible only because PA (and NA) dealt narrowly with selective aspects of positive (negative) affect. The PAD alternative to the tripartite model showed anxiety and depression shared unpleasant and submissive temperament characteristics but differed because anxiety involved more arousability than depression.     

Modeling trait and state variation using multilevel factor analysis with PANAS daily diary data

This study used daily diary data to model trait and state Positive Affect (PA) and Negative Affect (NA) using the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988). Data were collected from 364 college students over five days. Intraclass correlation coefficients suggested approximately equal amounts of variability at the trait and state levels. Multilevel factor analysis revealed that the model specifying two correlated factors (PA, NA) and correlated uniqueness terms among redundant items provided the best fit. Trait and state PA and NA were generally associated with stress, anxiety, depression, and three types of self-esteem (performance, academic, social). The coefficients describing these relationships differed somewhat, suggesting that trait and state measurement may have different predictive utility.     

Maternal Psychopathology and Early Child Temperament Predict Young Children’s Salivary Cortisol 3 Years Later

Neuroendocrine dysfunction is hypothesized to be an early emerging vulnerability marker for depression. We tested whether the main and interactive effects of maternal psychopathology and early child temperamental vulnerability for depression assessed at age three predicted offspring’s basal cortisol function at age 6 years. 228 (122 males) children participated in the baseline and follow-up assessments. At age three, maternal lifetime psychopathology was assessed with a diagnostic clinical interview, and child temperamental positive affectivity (PA) and negative affectivity (NA) were assessed using laboratory observations. At age six, children’s waking and evening cortisol were assessed on 2 days. Maternal lifetime anxiety predicted offspring’s higher morning cortisol at age six. Child temperamental NA at age three predicted higher evening cortisol at age six. There was a significant interaction between maternal lifetime depression and child temperamental PA at age three in predicting offspring’s morning cortisol at age six. For the offspring of mothers with lifetime depression, higher PA at age 3 predicted lower morning cortisol at age 6. These findings highlight the importance of examining the main and interactive effects of maternal psychopathology and early child temperamental vulnerability in predicting the development of offspring’s stress physiology. Findings hold significance in identifying etiological mechanisms of risk and delineating the complex developmental pathways to psychopathology.     

Reactive and self-regulatory dimensions of temperament: Interactive relations with symptoms of general distress and anhedonia

Converging evidence indicates that shared temperamental diatheses partly underlie the covariance between anxiety and depression. Although developmental psychopathology research suggests that self-regulatory temperament (e.g., effortful control or EC) mitigates reactive risks associated with negative affectivity (NA) and positive affectivity (PA), and their respective counterparts, behavioral inhibition- and activation sensitivity (BIS and BAS), no studies have established EC’s protective effects in adulthood. This study examined concurrent relations between temperament and distress symptoms shared by anxiety and depression, and anhedonic symptoms unique to depression, in young adults. Anticipated two- and three-way interactions emerged supporting EC’s moderating effect between reactive temperament (i.e., high BIS and low BAS) and both symptom dimensions. However, no interactive relations emerged between symptoms and NA, PA, and EC.     

Cross-Cultural Examination of the Tripartite Model With Children: Data From the Barretstown Studies

The Positive and Negative Affect Scale for Children (PANAS-C; Laurent et al., 1999) and the Physiological Hyperarousal Scale for Children (PH-C; Laurent, Catanzaro, & Joiner, 1998) were administered to a group of 240 children from European countries to determine their utility in examining the tripartite model of anxiety and depression (L. A. Clark & Watson, 1991) in a cross-cultural sample. Most of the children (n = 196) had been diagnosed with a medical illness; the remainder were siblings of these youngsters (n = 44). Only slight variations were noted in items between this sample and samples from the United States. Despite these minor differences, 3 distinct scales measuring the positive affect, negative affect, and physiological hyperarousal constructs of the tripartite model were identified. These findings illustrate that the PH-PANAS-C provides a useful measure of the tripartite model in a cross-cultural sample of youth. The findings also demonstrate that the tripartite model is generalizable to a cross-cultural milieu.     

Stress Generation and Adolescent Depression: Contribution of Interpersonal Stress Responses

This research examined the proposal that ineffective responses to common interpersonal problems disrupt youths’ relationships, which, in turn, contributes to depression during adolescence. Youth (86 girls, 81 boys; M age = 12.41, SD = 1.19) and their primary female caregivers participated in a three-wave longitudinal study. Youth completed a measure assessing interpersonal stress responses; youth and caregivers completed semi-structured interviews assessing youths’ life stress and psychopathology. Consistent with the hypothesized model, ineffective stress responses (low levels of effortful engagement, high levels of involuntary engagement and disengagement) predicted the generation of subsequent interpersonal stress, which partially accounted for the association between stress responses and depression over time. Moreover, results revealed that self-generated interpersonal, but not noninterpersonal stress, predicted depression, and that this explanatory model was specific to the prediction of depression but not anxiety. This research builds on interpersonal stress generation models of depression, and highlights the importance of implementing depression-focused intervention programs that promote effective stress responses and adaptive interpersonal relationships during adolescence.     

Differentiating anxious and depressive self-statements in youth: factor structure of the Negative Affect Self-Statement Questionnaire among youth referred to an anxiety disorders clinic

Conducted a factor analysis on the items from the Negative Affect Self-Statement Questionnaire (NASSQ; Ronan, Kendall, & Rowe, 1994). This analysis yielded 4 factors (Depressive Self-Statements, Anxiety/Somatic Self-Statements, Negative Affect Self-Statements, and Positive Affect Self-Statements) broadly consistent with both the content-specificity hypothesis (Beck & Clark, 1988) and L. A. Clark and Watson's (1991b) tripartite model of anxiety and depression. The association between children's self-talk and measures of trait anxiety and depression was also examined. Self-statements with content theoretically specific to depression were the best predictors of self-reported depressive symptoms, but the results were less clear for trait anxiety. Overall, these results provide evidence for the discriminability of anxious and depressive self-talk in youth and for the utility of the NASSQ as a cognitive assessment instrument.     

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.     

Diagnostic differences in social anhedonia: a longitudinal study of schizophrenia and major depressive disorder

This study examined the hypothesis that, in schizophrenia, elevated trait social anhedonia (SA) is a stable individual difference, whereas in depression, increased SA is a reflection of a current clinical state that will diminish with recovery. Differences in trait Negative Affect (NA) and Positive Affect (PA) were also examined. Individuals with schizophrenia (n = 55) and depression (n = 34) were evaluated at baseline during hospitalization and compared with nonpsychiatric control participants (n = 41). Participants were assessed again at a 1-year follow-up. At baseline, compared with control participants, individuals with schizophrenia and depression were both characterized by elevated SA, greater NA, and lower PA. In schizophrenic individuals, elevated SA remained stable over the follow-up. However, in recovered depressed patients, SA declined over the follow-up period. Group differences remained in NA and PA over the 1-year follow-up. These results support the view that elevated SA is enduring in schizophrenia but that elevated SA is transiently related to clinical status in depression.     

Aging and symptoms of anxiety and depression: structural invariance of the tripartite model

Negative affect measures were evaluated in a cross-sectional community sample of adults aged 18-93 (N = 335) to examine the structure of neuroticism, anxiety, and depressive symptoms in young, middle, and older adult cohorts. Structural equation modeling was used to contrast 3 nested models: a 1-factor general distress model; a 2-factor high negative-low positive affect model; and a 3-factor "tripartite model" reflecting a higher order Negative Affect factor that is common to depression and anxiety problems and 2 lower order factors, Low Positive Affect (mostly specific to depression) and Arousal (specific to anxiety/panic). As expected, the tripartite model fit best for all age groups. Further, multigroup analyses indicated age invariance for the tripartite model, suggesting the model can be effectively applied with older populations.