Exploring the factor structure of the Mood and Anxiety Symptom Questionnaire (MASQ)

L. A. Clark and Watson (1991) proposed a tripartite model of anxiety and depression defined in terms of common symptoms relating to general distress, anxiety-specific symptoms of hyperarousal, and depression-specific symptoms of low positive affect and loss of interest. To aid the measurement of and discrimination between anxiety and depression they developed the Mood and Anxiety Symptom Questionnaire (MASQ). Although potentially useful, the MASQ is still in an early stage of development, and there is an indication that a discrepancy exists between items and scales. Therefore, the aim of this study was to explore the items and factors of the MASQ and determine whether a pattern similar to that suggested by L. A. Clark and Watson would emerge. Factor analysis of the MASQ revealed 3 factors relating to general distress, positive affect, and anxious arousal. Inspection of the individual items indicated that some refinements are required.     

Can you feel the beat? Interoceptive awareness is an interactive function of anxiety- and depression-specific symptom dimensions

Delineating the differential effects of anxiety versus depression on patterns of information processing has proved challenging. The tripartite model of mood disorders (Clark & Watson, 1991) suggests that one way forward is to adopt a dimensional rather than categorical approach, making it possible to explore the main and interaction effects of depression- and anxiety-specific symptoms on a given cognitive-affective process. Here we examined how the interplay of anxiety-specific arousal and depression-specific anhedonia symptoms in the same individuals relate to interoceptive (bodily) awareness. 113 participants with varying levels of mood disorder symptoms completed a heartbeat perception task to assess interoceptive accuracy. Superior interoception was associated with anxiety-specific arousal symptoms, and this relationship held when controlling for depression-specific anhedonia symptoms and shared general distress symptoms. This main effect was qualified by an interaction between anhedonia and arousal. As anhedonia symptoms increased in severity, the relationship between arousal and interoceptive accuracy became less strong. These results further validate the tripartite framework, help clarify the mixed existing literature on interoception in mood disorders, and suggest that considering the unique and interactive effects of different symptom dimensions is a useful strategy to help identify the cognitive-affective profiles associated with anxiety and depression.     

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.     

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.     

The tripartite model of anxiety and depression: symptom structure in depressive and hypertensive patient groups

The structure of self-reported symptoms representative of the tripartite model was examined using data drawn from the Medical Outcomes Study (Tarlov et al., 1989). Participants were persons who had been diagnosed 48 months previously as suffering from either depression (N = 315) or hypertension (N = 403). Results of confirmatory factor analyses were broadly consistent with the tripartite model (L. A. Clark & Watson, 1991). Factors emerged corresponding to each of the 3 posited first-order dimensions of negative affect, positive affect, and physiologic arousal. Nonetheless, some discrepancies were found between the observed data and the hypothesized tripartite model. First, the obtained physiologic arousal factor was best viewed as reflecting nonspecific somatic distress rather than physiologic arousal. Finally, although differentiable in the strictest statistical sense, all three domains were significantly correlated (.36 to.86, absolute value). In particular, contrary to the tripartite model, positive and negative affect covaried markedly (-.81 to -.86). Findings raise issues concerning the utility of the tripartite model as a heuristic framework for enhancing understanding of individual differences in normal mood as well as mood disorders.     

A reduction in positive self-judgment bias is uniquely related to the anhedonic symptoms of depression

Identifying patterns of biased cognitive processing specific to depression has proved difficult. The tripartite model of mood disorders [Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316-336] suggests that a clearer processing ‘blueprint’ may emerge if depression is viewed dimensionally rather than categorically and by focusing on variations in the degree of positive, rather than negative, processing bias. To investigate this possibility, the present study examined the extent to which a reduced positive self-judgment bias previously found in depressed individuals relates to depression-specific anhedonic symptoms. Sixty participants with varying levels of anxiety and depression symptoms evaluated their own performance on a working memory task in the absence of external feedback. Overall, participants showed a positive self-judgment bias, overestimating the number of trials they had performed correctly relative to objective criteria. Consistent with the tripartite framework, the extent of this positive self-judgment bias was significantly and uniquely related to depression-specific symptoms, with the positive bias reducing as anhedonia severity increased across three different symptom measures.     

Hierarchical model of vulnerabilities for emotional disorders

Clark and Watson's (1991) tripartite model of anxiety and depression has had a dramatic impact on our understanding of the dispositional variables underlying emotional disorders. More recently, calls have been made to examine not simply the influence of negative affectivity (NA) but also mediating factors that might better explain how NA influences anxious and depressive syndromes (e.g. Taylor, 1998; Watson, 2005). Extending preliminary projects, this study evaluated two hierarchical models of NA, mediating factors of anxiety sensitivity and intolerance of uncertainty, and specific emotional manifestations. Data provided a very good fit to a model elaborated from preliminary studies, lending further support to hierarchical models of emotional vulnerabilities. Implications for classification and diagnosis are discussed.     

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.     

Development and preliminary validation of the physiological hyperarousal scale for children

Considerable empirical support exists for the positive affect and negative affect components of the tripartite model of anxiety and depression proposed by L. A. Clark and D. Watson (1991); however, less attention has been paid to the physiological hyperarousal component of the model. The development of the Physiological Hyperarousal Scale for Children (PH-C; J. Laurent, S. J. Catanzaro, & T. E. Joiner Jr., 1995) is described. The psychometric properties of items are examined using students in Grades 6-12 (N = 398). Initial scale validation includes a joint factor analysis with the Positive and Negative Affect Scale for Children (PANAS-C; J. Laurent et al., 1999; J. Laurent, K. Potter, & S. J. Catanzaro, 1994). The relationship between the PH-C and existing measures that tap related constructs is examined. Together, the PH-C and PANAS-C provide a means to assess tripartite model constructs useful in differentiating anxiety and depression.     

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.     

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.     

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.     

Anxiety sensitivity in adolescents: factor structure and relationships to trait anxiety and symptoms of anxiety disorders and depression

The current study examined the anxiety sensitivity construct in a large sample of normal Dutch adolescents aged 13-16 years (n=819). Children completed the Childhood Anxiety Sensitivity Index (CASI; Silverman, W. K., Fleisig, W., Rabian, B. & Peterson, R. A. (1991). Journal of Clinical Child Psychology, 20, 162-168) and measures of trait anxiety, anxiety disorder symptoms and depression. Results showed that (1) anxiety sensitivity as indexed by the CASI seems to be a hierarchically organized construct with one higher-order factor (i.e., anxiety sensitivity) and three or four lower-order factors, (2) anxiety sensitivity and trait anxiety were strongly correlated, (3) anxiety sensitivity was substantially connected to symptoms of anxiety disorders (in particular of panic disorder and agoraphobia) and depression, and (4) anxiety sensitivity and trait anxiety both accounted for unique proportions of the variance in anxiety disorder symptoms. Altogether these findings are in agreement with those of previous research in adult and child populations, and further support the notion that anxiety sensitivity should be viewed as an unique factor of anxiety vulnerability.     

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 tripartite model for assessing symptoms of anxiety and depression: psychometrics of the Dutch version of the mood and anxiety symptoms questionnaire

AIM: The tripartite model conceptualizes symptoms of depression and anxiety in three groups: low positive affect and anhedonia, which is specific to depression, somatic arousal, which is unique to anxiety, and nonspecific general distress. The Mood and Anxiety Symptoms Questionnaire (MASQ) was developed to measure these symptom domains. This study reports on the psychometric properties of the Dutch translation of the MASQ. METHOD: The questionnaire was completed by a population-based sample and by patients with anxiety and/or mood disorders. Scores of these respondent groups were compared to assess the discriminant validity of the MASQ and evaluate the appropriateness of the tripartite model. RESULTS: The psychometric properties of the translated MASQ were highly satisfactory. In accordance with the model, we found the MASQ to comprise three main scales, which discriminate well between subgroups of patients with mood and anxiety disorders. DISCUSSION: Overall, like the English version the Dutch translation of the instrument appears to be a reliable and valid measure of symptoms of depression and anxiety, conceptualized as comprising three groups of symptoms. The Dutch MASQ is better able to distinguish unique aspects of mood and anxiety disorders than other self-report instruments.     

Integrating Anxiety Sensitivity, Distress Tolerance, and Discomfort Intolerance: A Hierarchical Model of Affect Sensitivity and Tolerance

The purpose of the present investigation was to concurrently examine the latent dimensional and hierarchical structure of anxiety sensitivity (AS) and two key theoretically relevant and related affect (in)tolerance and sensitivity constructs: distress tolerance and discomfort intolerance. These constructs were measured using the Anxiety Sensitivity Index (Reiss, Peterson, Gursky, & McNally, 1986), the Distress Tolerance Scale (Simons & Gaher, 2005), and the Discomfort Intolerance Scale (Schmidt, Richey, & Fitzpatrick, 2006). A total of 229 individuals (124 females; M_age = 21.0 years, SD = 7.5) without current Axis I psychopathology participated by completing a battery of self-report questionnaires. A two-stage exploratory factor analysis was conducted to examine the lower- and higher-order latent structural relations among the variables. The factor solution was subsequently evaluated in relation to negative affectivity, anxious arousal, and anhedonic depression. AS and distress tolerance appeared to be related to one another as distinct lower-order facets of a common higher-order affect tolerance and sensitivity factor, whereas discomfort intolerance did not appear to demonstrate similar relations with either AS or distress tolerance at the lower-order or higher-order levels. A unique pattern of association with theoretically-relevant criterion variables was observed between the affect tolerance and sensitivity higher-order factor, the AS and distress tolerance lower-order factors, and the discomfort intolerance factor. Findings are discussed in the context of theoretical and clinical implications and future directions for the study of affect tolerance and sensitivity in relation to emotional vulnerability.     

Cross-cultural examination of the tripartite model in adults

Clark and Watson's (1991) tripartite model is commonly viewed as the preferred model for examining the relationship between anxiety and depression. The tripartite model proposes that the overlap and distinction between anxiety and depression can be best understood along three dimensions: positive affect, negative affect, and physiological hyperarousal. Although the tripartite model has received support in a wide variety of samples, little has been done to examine whether the tripartite model holds cross-culturally. Using a highly diverse sample of undergraduate students (n = 923), this study set out to determine the generalizability of the tripartite model among students who identified themselves as African American/Black (non-Hispanic), Caucasian/White (non-Hispanic), Hispanic/Latino(a), and Asian. The results of the present study suggest that the model fits generally for each group, but the study did not find cross-group equivalence in the relationships between constructs. Possible reasons for the lack of cross-group equivalence, as well as limitations of this study, are also discussed.     

Anxiety,depression, and the suicidal spectrum: a latent class analysis of overlapping and distinctive features

ABSTRACT

Anxiety and depression diagnoses are associated with suicidal thoughts and behaviours. However, a categorical understanding of these associations limits insight into identifying dimensional mechanisms of suicide risk. This study investigated anxious and depressive features through a lens of suicide risk, independent of diagnosis. Latent class analysis of 97 depression, anxiety, and suicidality-related items among 616 psychiatric outpatients indicated a 3-class solution, specifically: (1) a higher suicide-risk class uniquely differentiated from both other classes by high reported levels of depression and anxious arousal; (2) a lower suicide-risk class that reported levels of anxiety sensitivity and generalised worry comparable to Class 1, but lower levels of depression and anxious arousal; and (3) a low to non-suicidal class that reported relatively low levels across all depression and anxiety measures. Discriminants of the higher suicide-risk class included borderline personality disorder; report of worthlessness, crying, and sadness; higher levels of anxious arousal and negative affect; and lower levels of positive affect. Depression and anxiety diagnoses were not discriminant between higher and lower suicide risk classes. This transdiagnostic and dimensional approach to understanding the suicidal spectrum contrasts with treating it as a depressive symptom, and illustrates the advantages of a tripartite model for conceptualising suicide risk.     

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.