Anxiety sensitivity cognitive concerns drive the relation between anxiety sensitivity and symptoms of depression

Depression is typically treated as a homogeneous construct despite evidence for distinct cognitive, affective, and somatic symptom dimensions. Anxiety sensitivity (AS; the fear of consequences of anxiety symptoms) is a cognitive risk factor implicated in the development of depressive symptoms. However, it is unclear how lower order AS dimensions (i.e. physical, cognitive, and social concerns) relate to depressive symptom factors. Confirmatory factor analysis, followed by structural equation modeling, were conducted to examine the factor structure of depression and to then examine the relations between these factors and the lower order factors of AS. This study was conducted in a sample of 374 adults (M age = 35.5, 54.3% female) with elevated levels of psychopathology (89.2% meeting criteria for at least one DSM-5 diagnosis, 25.6% primary depressive disorder). In this study a two-factor model of depression, composed of Cognitive and Affective/Somatic factors, was superior to one- and three-factor solutions. AS cognitive concerns were related to both cognitive and affective/somatic symptoms of depression. Neither of the other AS dimensions was related to depression symptom dimensions. These findings provide a better understanding of the relations between AS and depression symptoms.     

Competitive anxiety in young athletes: differentiating somatic anxiety, worry, and concentration disruption

The age-appropriate Sport Anxiety Scale-2 (SAS-2; Smith, Smoll, Cumming, & Grossbard, 2006) was used to assess levels of cognitive and somatic anxiety among male and female youth sport participants. Confirmatory factor analyses with a sample of 9-14 year old athletes (N=1038) supported the viability of a three-factor model of anxiety involving somatic anxiety, worry, and concentration disruption previously demonstrated in high school and college samples. Tests for factorial invariance revealed that the three-factor model was an equally good fit for 9-11 year olds and 12-14 year olds, and for both males and females. Gender and age were modestly related to anxiety scores. Worry about performing poorly was highest in girls and in older athletes, whereas boys reported higher levels of concentration disruption in competitive sport situations. Implications for emotional perception and for the study of competitive anxiety in young athletes are discussed.     

Psychometric properties of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA): comparison to the State-Trait Anxiety Inventory (STAI)

The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA; M. J. Ree, C. MacLeod, D. French, & V. Locke, 2000) was designed to assess cognitive and somatic symptoms of anxiety as they pertain to one's mood in the moment (state) and in general (trait). This study extended the previous psychometric findings to a clinical sample and validated the STICSA against a well-published measure of anxiety, the State-Trait Anxiety Inventory (STAI; C. D. Spielberger, 1983). Patients (N=567) at an anxiety disorders clinic were administered a battery of questionnaires. The results of confirmatory factor analyses (Bentler-Bonnett nonnormed fit index, comparative fit index, and Bollen fit index>.90; root-mean-square error of approximation<.05); convergent and discriminant validity analyses; and group comparisons supported the reliability and validity of the STICSA as a measure of state and trait cognitive and somatic anxiety. In addition, compared with the STAI (anxiety: rs/=.64), the STICSA was more strongly correlated with another measure of anxiety (rs>/=.67) and was less strongly correlated with a measure of depression (rs相似文献   

The Yale-Brown Obsessive-Compulsive Scale: Confirmatory Factor Analytic Findings

The psychometric properties of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have recently been heavily examined. Specifically, a number of researchers have been interested in determining the factor structure of this scale to find whether it best forms a one, two, or three factor model. The present study continued this examination by considering different scaling models using confirmatory factor analysis with a sample of individuals diagnosed with Obsessive-Compulsive Disorder (OCD). One hundred and forty-six individuals diagnosed with OCD participated and were administered the Y-BOCS and scales measuring depression (Hamilton Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale). It was found that the Y-BOCS forms two different two-factor models. One model consisted of an obsessions and compulsions factor; the other composed of disturbance and symptom severity factors. It was likewise found that depression and anxiety were related to both factors in one model (disturbance and symptom severity). The finding that depression was related to obsessions and anxiety to compulsions was found, as in a previous factor analysis of the Y-BOCS. These findings suggest that OCD may be best characterized as a multidimensional syndrome that may not be adequately examined by a single unitary factor as described in the Y-BOCS.     

Psychometric Properties of the Generalized Anxiety Disorder Scale-7 (GAD-7) in Outpatients with Anxiety and Mood Disorders

This study examined the psychometric properties of the Generalized Anxiety Disorder Scale-7 (GAD-7) in a sample of 536 outpatients presenting at a specialty clinic for anxiety and mood disorders. A confirmatory factor analysis (CFA) was used to test the unidimensionality of the GAD-7. This model did not fit the data well. The CFA solution was respecified correlating residuals among items assessing somatic symptoms. This respecified model fit the data well. A series of multiple-groups CFAs determined that the measurement properties of the GAD-7 were invariant between sexes. Scale reliability estimates of the GAD-7 were favorable for the full sample, and for males and females. Sensitivity and specificity could not be balanced at any cut-point. Findings attest to the value of this instrument as a dimensional indicator of GAD severity rather than a screening tool for the presence or absence of the disorder in outpatients with anxiety and mood disorders.     

Psychological and Somatic Factors in Patients Undergoing Coronary Artery Bypass Graft Surgery: Towards Building a Psychological Framework

The present study explored the relationships between psychological and somatic factors in patients undergoing Coronary Artery Bypass Graft surgery (CABG). The data-analysis of previous work was extended by adding somatic factors, including feelings of disability, somatic complaints and fatigue. The focus was on their relationships with psychological factors, including anxiety, depression and neuroticism. Prior to surgery and six months postoperatively, 217 patients completed self-report questionnaires. Using the method of structural equation modeling (SEM), the structure of relationships between the somatic, psychological and background factors (i.e., gender, age and medical factors) was explored. A model was developed providing a good fit and accounting for a substantial amount of variance. The structure of relationships revealed that somatic factors lead to anxiety and depression in the preoperative period, whereas anxiety and depression lead to somatic factors in the postoperative period. The structure further strengthened the key position of neuroticism and its overall negative prognostic implications.     

Relationships among Dispositional Attributional Style,Trauma-Specific Attributions,and PTSD Symptoms

The learned helplessness model and its various revisions suggest that causal attributions influence responses to events. This study examined relationships among the 3-factor symptom clusters of posttraumatic stress disorder (PTSD) represented in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV; American Psychiatric Association, 1994) and the individual dimensions of dispositional attributional style and trauma-specific attributions (i.e., internal–external, stable–unstable, global–specific). Relationships among attributions and clusters of PTSD symptoms represented by the 4-factor dysphoria model were also examined. Trauma-specific attributions were most predictive of PTSD symptoms, with higher associations for avoidance and numbing symptoms compared to arousal symptoms in the three-factor model and higher associations for dysphoria symptoms compared to arousal and avoidance symptoms in the four-factor dysphoria model. Results suggest that cognitive vulnerabilities could underlie the comorbidity between PTSD and depression and might represent a high-impact target for treatment.     

Empathy in informal dementia caregivers and its relationship with depression,anxiety, and burden

Background/Objective: Recent interventions aim to heighten informal caregivers’ empathy levels assuming that this will lead to better well-being. However, previous studies have explored linear associations between empathy and aspects of well-being and yielded mixed results. We hypothesized that quadratic models may be more fitting to describe these relationships. Method: A cross-sectional study, with two groups (201 informal caregivers, and 187 non-caregivers) was conducted. Participants completed questionnaires on cognitive and affective empathy, and depression, anxiety, and caregiver burden. AN(C)OVA's and multiple hierarchical regression analyses including linear and quadratic terms were used to analyze the data. Results: For caregivers, there was a negative quadratic relationship between depression and cognitive empathy, and a positive linear relationship between anxiety and affective empathy, irrespective of sociodemographic characteristics. For non-caregivers, there were positive quadratic relationships between depression and cognitive and affective empathy, and between anxiety and affective empathy. The empathy levels did not differ between the groups. Conclusions: While caregivers and non-caregivers had the same amount of empathy, the relationships between empathy and depression and anxiety differed between the groups. Interventions for informal caregivers could aim to heighten cognitive empathy and to lower affective empathy to diminish depression and anxiety symptoms.     

Cognitive specificity and positive-negative affectivity: complementary or contradictory views on anxiety and depression?

A principal factor analysis, conducted on a mixed psychiatric outpatient sample (N = 470), identified both common and specific dimensions underlying anxiety and depression. Although an initial single-factor extraction accounted for a significant proportion of variance in cognitive and symptom measures of anxiety and depression, a two-factor solution, in which anxiety and depression formed separate dimensions, proved to be the better solution. MANOVAS performed on pure depressed, pure anxious, and mixed anxious/depressed subgroups provided evidence of a specific cognitive profile for anxiety and depression. The mixed subsample evidenced greater severity, a mixed cognitive and symptom profile, and character traits that may indicate increased vulnerability to psychological disturbance. Results are discussed in terms of Beck's (1976) cognitive content-specificity hypothesis and the positive-negative affect model (Watson & Tellegen, 1985).     

Common Etiological Sources of Anxiety,Depression, and Somatic Complaints in Adolescents: A Multiple Rater twin Study

Somatic complaints in children and adolescents may be considered part of a broader spectrum of internalizing disorders that include anxiety and depression. Previous research on the topic has focused mainly on the relationship between anxiety and depression without investigating how common somatic symptoms relate to an underlying factor and its etiology. Based on the classical twin design with monozygotic and dizygotic twins reared together, our study aimed to explore the extent to which the covariation between three phenotypes in adolescent girls and boys can be represented by a latent internalizing factor, with a focus on both common and specific etiological sources. A population-based sample of twins aged 12–18 years and their mothers and fathers (N?=?1394 families) responded to questionnaire items measuring the three phenotypes. Informants’ ratings were collapsed using full information maximum likelihood estimated factor scores. Multivariate genetic analyses were conducted to examine the etiological structure of concurrent symptoms. The best fitting model was an ACE common pathway model without sex limitation and with one substantially heritable (44 %) latent factor shared by the phenotypes. Concurrent symptoms also resulted from shared (25 %) and non-shared (31 %) environments. The factor loaded most on depression symptoms and least on somatic complaints. Trait-specific influences explained 44 % of depression variance, 59 % of anxiety variance, and 65 % of somatic variance. Our results suggest the presence of a general internalizing factor along which somatic complaints and mental distress can be modeled. However, specific influences make the symptom types distinguishable.     

Anxiety as a context for understanding associations between hypochondriasis, obsessive-compulsive, and panic attack symptoms

In the context of the integrative model of anxiety and depression, we examined whether the essential problem of hypochondriasis is one of anxiety. When analyzed, data from a large nonclinical sample corresponded to the integrative model's characterization of anxiety as composed of both broad, shared and specific, unique symptom factors. The unique hypochondriasis, obsessive-compulsive, and panic attack symptom factors all had correlational patterns expected of anxiety with the shared, broad factors of negative emotionality and positive emotionality. A confirmatory factor analysis showed a higher-order, bifactor model was the best fit to our data; the shared and the unique hypochondriasis and anxiety symptom factors both contributed substantial variance. This study provides refinements to an empirically based taxonomy and clarifies what hypochondriasis is and, importantly, what it is not.     

Factor structure and psychometric characteristics of the beck depression inventory-II

The present study evaluated the factor structure and psychometric properties of the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) in the nonclinical sample of 230 young adults. The BDI-II is a revised version of the BDI-IA. We evaluated the fit of three alternative models to the sample data, using confirmatory factor analysis. Results provided support for the fit of the oblique three-factor model. The BDI-II and factor scales had satisfactory coefficient alpha indices. We obtained gender differences on the BDI-II item, total, and factor scale scores. We examined the relations of the BDI-II with demographic variables and with other self-report measures of social desirability, anxiety, depression, stress, and self-esteem. We also examined the issue of whether specific self-report measures of anxiety and depression assess separate or different constructs. We discuss the limitations of the present study.     

Is Therapist Support Needed? Comparing Therapist- and Self-Guided Internet-Based CBT for Somatic Symptom Distress (iSOMA) in Emerging Adults

Persistent somatic symptoms of varying etiology are very common in emerging adults and can lead to distress and impairment. Internet-delivered interventions could help to prevent the burden and chronicity of persistent somatic symptoms. This study investigated the impact of therapist guidance on the effectiveness of a cognitive-behavioral Internet intervention for somatic symptom distress (iSOMA) in emerging adults, as a secondary analysis of a two-armed randomized controlled trial. We included 149 university students (83.2% female, 24.60 yrs) with varying degrees of somatic symptom distress who were either allocated to the 8-week intervention with regular, written therapeutic guidance (iSOMA guided) or to the control group (waitlist), which was afterwards crossed over to receive iSOMA with guidance-on-demand (iSOMA-GoD). Primary outcomes were somatic symptom distress (assessed by the PHQ-15) and psychobehavioral symptoms of the somatic symptom disorder (assessed by the SSD-12) at pre- and post-treatment. Secondary outcomes included depression, anxiety, and disability. Both treatments showed statistically significant pre-post improvements in primary (iSOMA-guided: d = 0.86–0.92, iSOMA-GoD: d = 0.55–0.63) and secondary outcomes. However, intention-to-treat analysis revealed non-significant between-group effects for all outcomes (ps ≥ .335), after controlling for confounding variables, and effect sizes were marginal (d = −0.06 to 0.12). Overall, our findings indicate that Internet-delivered cognitive behavioral therapy with regular guidance is not unequivocally superior to guidance-on-demand in alleviating somatic symptom distress and associated psychopathology in emerging adults. As a next step, non-inferiority studies are needed to test the robustness of these findings and their impact on clinical populations.     

A longitudinal analysis of anxiety and depressive symptoms

The authors modeled depressive and anxiety symptom data from 1,391 participants in a longitudinal study of middle-aged and older Swedish twins (M age = 60.9 years, SD = 13.3). Although anxiety and depression were highly correlated, a model with distinct Anxiety and Depression factors fit the data better than models with Positive and Negative Affect factors or a single Mental Health factor. Lack of well-being was associated with anxiety rather than depression. Over two 3-year intervals, anxiety symptoms led to depressive symptoms, but the relationship was not reciprocal. Anxiety symptoms were more stable than depression. These findings provide additional support for the idea that anxiety symptoms may reflect a personality trait such as neuroticism more than do depressive symptoms and suggest that low positive affect may not be as specific to depression among older adults as in younger people.     

An investigation into the psychometric properties of the Hospital Anxiety and Depression Scale in individuals with chronic fatigue syndrome

The study sought to determine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in individuals with chronic fatigue syndrome (CFS) assessed using a web-based data collection tool. Exploratory and confirmatory factor analyses were conducted on the HADS to determine its psychometric properties in 117 individuals with CFS. Seven models were tested to determine model fit to the data. Internal reliability estimations of the anxiety and depression sub-scales were found to be acceptable, however, a three-factor model was found to provide a significantly better fit to the data when compared to the bi-dimensional two-factor structure previously assumed to underpin the HADS' construct validity. The clinical utility of the HADS in the assessment of anxiety and depression in CFS appears to be fundamentally compromised by the presence of a three-dimensional underlying factor structure. Future revision of the HADS is recommended if the instrument is to be used reliably to screen CFS patients.     

Familiarity and free recall

Using stimulus material drawn from a single category, it is shown that formal recognition tests yield superior performance to recall when the category cannot be completely enumerated by the subjects, but not otherwise. Furthermore, within these categories recognition is superior only if unfamiliar items are selected as stimuli. These findings fit the theory that when recalling subjects attempt to scan the relevant category and “recognize” those items employed as stimuli.     

Identification and explanation of racial differences on contamination measures

Compared with published norms, African Americans endorse significantly more items intended to assess pathological anxiety about contamination on self-report instruments for obsessive–compulsive disorder. The current study suggests that this is not due to greater psychopathology in African Americans, but rather to differences in normal attitudes about cleanliness that also influence responses to items intended to assess anxiety pathology. Contamination items from obsessive–compulsive disorder (OCD) scales including the Padua Inventory [Sanavio E. (1988). Obsessions and compulsions: The Padua Inventory. Behaviour Research and Therapy, 26(2), 169–177] were supplemented with cleanliness attitude items and administered to Black and White participants (N=1483). An exploratory factor analysis suggested a three-factor solution: one factor that encompassed pathological anxiety, and two that expressed attitudes about cleanliness, grooming, and domestic animals. African Americans scored significantly higher on all three factors. A confirmatory factor analysis demonstrated that the difference between Black and White participants on the pathological anxiety factor was eliminated when differences on the attitude factors were controlled statistically.     

Criterion and construct validity of the Beck Depression Inventory (BDI-II) to measure depression in patients with cancer: The contribution of somatic items

Background/ObjectiveScreening for depression in patients with cancer can be difficult due to overlap between symptoms of depression and cancer. We assessed validity of the Beck Depression Inventory (BDI-II) in this population.MethodData was obtained in an outpatient neuropsychiatry unit treating patients with and without cancer. Psychometric properties of the BDI-II Portuguese version were assessed separately in 202 patients with cancer, and 376 outpatients with mental health complaints but without cancer.ResultsConfirmatory factor analysis suggested a three-factor structure model (cognitive, affective and somatic) provided best fit to data in both samples. Criterion validity was good for detecting depression in oncological patients, with an area under the ROC curve (AUC) of 0.85 (95% confidence interval [CI], 0.76–0.91). A cut-off score of 14 had sensitivity of 87% and specificity of 73%. Excluding somatic items did not significantly change the ROC curve for BDI-II (difference AUCs = 0.002, p=0.9). A good criterion validity for BDI-II was also obtained in the non-oncological population (AUC = 0.87; 95% CI 0.81–0.91), with a cut-off of 18 (sensitivity=84%; specificity=73%).ConclusionsThe BDI-II demonstrated good psychometric properties in patients with cancer, comparable to a population without cancer. Exclusion of somatic items did not affect screening accuracy.     

Attributional Style, Self-Esteem, and Human Immunodeficiency Virus: A Test of the Hopelessness and Self-Esteem Theories of Depression

Research on the hopelessness and self-esteem theories of depression (Abramson, Metalsky, & Alloy, 1989; Metalsky, Joiner, Hardin, & Abramson, 1993) suggests that HIV-infected persons with depressotypic attributional style (AS) and low self-esteem (SE) may be at risk for onset of a syndrome referred to as hopelessness depression (HD). In a prospective study conducted to test these theories, measures of anxiety and depression, AS, and SE were administered to 85 HIV+ and 43 HIV– men; symptoms were reassessed 6 months later. Results indicated that: (1) The interaction of AS, SE, and HIV status predicted change in HD symptoms, but not overall depression or anxiety symptoms; (2) HIV+ men with depressotypic AS and high SE had increased HD symptom levels while other men with high SE had decreased HD symptom levels; (3) HD symptoms remained stable over the 6-month interval among men with low SE; and (4) High SE predicted decreases in anxiety symptoms among HIV– men, but not among HIV+ men. Contrary to the study hypothesis, these findings suggest that among individuals with life-threatening illnesses such as HIV infection, those with depressotypic AS and high SE may be at highest risk for onset of HD.     

Facets of Emotion Regulation and Emotional Disorder Symptom Dimensions: Differential Associations and Incremental Validity in a Large Clinical Sample

A growing literature suggests robust associations between dimensions of emotion regulation and emotional disorder psychopathology. However, limited research has investigated associations of emotion regulation dimensions across several emotional disorders (transdiagnostic associations), or the incremental validity of emotion regulation versus the higher-order construct of neuroticism. The current study used exploratory structural equation modeling and a large clinical sample (N = 1,138) to: (a) develop a multidimensional emotion regulation measurement model, (b) evaluate the differential associations between latent emotion regulation dimensions and five latent emotional disorder symptom dimensions (social anxiety, depression, agoraphobia/panic, obsessions/compulsions, generalized worry), and (c) determine the incremental contribution of emotion regulation in predicting symptom dimensions beyond neuroticism. The best-fitting measurement model of emotion regulation included four dimensions: Problematic Responses, Poor Recognition/Clarity, Negative Thinking, and Emotional Inhibition/Suppression. Although many zero-order associations between the four latent emotion regulation dimensions and five latent symptom dimensions were significant, few associations remained significant in a structural regression model that included neuroticism. Specifically, Negative Thinking and Problematic Responses incrementally predicted depression symptoms, while Emotional Inhibition/Suppression predicted both social anxiety and depression symptoms. Associations between neuroticism and the emotional disorder dimensions were similar regardless of whether the emotion regulation dimensions were held constant. These results suggest that self-reported emotion regulation dimensions are associated with the severity and expression of a range of emotional disorder symptoms, but that some emotion regulation dimensions have limited incremental validity after accounting for general emotional reactivity. Studies of emotion regulation should assess neuroticism as a key covariate.