Self-Report Differentiation of Anxiety and Depression in a Mood Disorders Sample

Several lines of research suggest there is considerable overlap between anxiety and depression and that it is difficult to distinguish between these two constructs. However, a few studies utilizing factor analytic procedures have provided evidence that anxiety and depression can be differentiated when measures of these constructs are considered at the item level. In addition, there is some evidence that differentiation can be accomplished in samples experiencing high levels of anxiety (i.e., a clinically anxious sample; B. J. Cox, R. P. Swinson, L. Kuch, & J. Reichman, 1993). In the present study, this research strategy was extended to a sample of patients with high levels of depressed mood (i.e., a mood disorders sample; N = 378). Their responses to widely used measures of depression (i.e., Beck Depression Inventory; A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) and anxiety (i.e., Spielberger State-Trait Anxiety Inventory—State subscale; C. D. Spielberger, R. L. Gorsuch, & R. E. Lushene, 1970) were entered into a principal-components analysis with oblique rotation. A 4-factor solution was retained. This solution was comprised of factors representing anxiety, anxiety absent (a reverse scored factor), cognitive symptoms of depression, and somatic/vegetative symptoms of depression. These findings indicated that anxiety and depression, as emotional states, can be differentiated within a mood disorders sample, using existing popular self-report measures. The clinical and research implications of these findings are briefly discussed.     

The Depression Anxiety Stress Scale-21: Spanish Translation and Validation with a Hispanic Sample

The English-language version of the Depression Anxiety Stress Scale-21 (DASS-21) was professionally translated into Spanish and field-tested among 98 bilingual Hispanic adults. Participants who were diagnosed with an anxiety disorder on the Anxiety Disorders Interview Schedule-IV completed the DASS-21, the Beck Depression Inventory-II, and the Beck Anxiety Inventory. Results indicated strong indices of internal consistency and expected patterns of discriminant, convergent, and structural validity. A confirmatory factor analysis compared a model fit of a first order 1-factor model, a first order 3-factor model, and a second order factor model. The latter 2 models were significantly better than the 1-factor model. Psychometric data were comparable to those of an English version. Clinicians and researchers in need of a brief, Spanish-language, screening measure of general psychopathology may want to consider this newly translated DASS-21.     

Shame,Early Abuse,and Course of Depression in a Clinical Sample: A Preliminary Study

This study of 35 depressed patients was designed to replicate findings from a community sample of a relationship between childhood abuse and bodily shame, and bodily shame and chronic or recurrent depression. In addition, we investigated whether characterological and behavioural shame would also be related to early abuse and depression course. The relation between bodily shame and childhood abuse was replicated. When the other types of shame were considered, bodily shame was the most powerful correlate of early abuse, with behavioural shame showing no relationship. However, all three types of shame appeared to be related to chronic or recurrent course of depression.     

A Pilot Study of Emotion Regulation Therapy for Generalized Anxiety and Depression: Findings From a Diverse Sample of Young Adults

Emotion regulation therapy (ERT) for generalized anxiety disorder (GAD) and accompanying major depressive disorder (MDD) is a theoretically derived, evidence-based treatment that integrates principles from traditional and contemporary cognitive-behavioral and experiential approaches with basic and translational findings from affect science to offer a blueprint for improving intervention by focusing on the motivational responses and corresponding self-referential regulatory characteristics. Preliminary evidence supports the efficacy of a 20-session version of ERT. However, previous trials of ERT and other traditional and contemporary cognitive-behavioral therapies have often utilized relatively homogeneous samples. Various contextual and demographic factors may be associated with challenges that increase risk for negative mental and social outcomes for young adults ages 18–29, particularly for individuals from diverse backgrounds. The aim of this pilot study was to examine the effectiveness of a briefer 16-session version of ERT in a racially and ethnically diverse sample of young adults. Participants (N = 31) were enrolled at an urban-based, commuter college who consented to treatment for anxiety, worry, or depression at an on-campus counseling center. Open-trial results demonstrate strong ameliorative changes in worry, rumination, self-reported and clinician-rated GAD and MDD severity, social disability, quality of life, attentional flexibility, decentering/distancing, reappraisal, trait mindfulness, and negative emotionality from pre- to posttreatment. These gains were maintained throughout a 3- and 9-month follow-up. These findings provide preliminary evidence for the efficacy of ERT in treating a racially and ethnically heterogeneous population. Further, this study highlights comparable effectiveness of a briefer 16-session version of ERT.     

Hierarchical Model of Vulnerabilities for Anxiety: Replication and Extension with a Clinical Sample

This study served to replicate and extend our previously obtained hierarchical model of the relationships among general anxiety vulnerabilities, specific anxiety vulnerabilities and specific anxiety manifestations including panic symptoms, health anxiety, obsessive‐compulsive symptoms and worry. Questionnaires assessing these variables, as well as positive affectivity and depressiveness, were administered to 125 outpatients seeking treatment for panic disorder, social anxiety disorder, obsessive‐compulsive disorder, generalized anxiety disorder or major depressive disorder. The results, using a clinical sample, were highly consistent with the hierarchical model obtained in the previous study using a student sample. A more elaborate model, based on published theoretical and empirical evidence, was identified and tested, and similar results were obtained. Negative affectivity had expected direct positive effects on all of the specific anxiety and depression manifestations, with the exception of health anxiety, which showed a negative relationship, and OCD symptoms, which showed no relationship. Positive affectivity was found to be a specific risk factor for depression, while intolerance of uncertainty was found to be a specific risk factor for worry and depression. Finally, anxiety sensitivity appears to be a significant risk factor for panic and health anxiety.     

Cognitive Specificity in Trait Anger in Relation to Depression and Anxiety in a Community Sample

The current research explored 16 of Young's schemas in relation to trait anger and to anxiety and depression symptoms among 262 non‐clinical Australian adults with low‐level symptomatology and average anger levels. The study partially replicated previous work with a sample of Spanish students that investigated the relationship between anger, depression, and anxiety and Young's schemas. Predictions derived from Beck's notion of cognitive specificity were examined using structural equation modelling and showed that of the sixteen schemas, Vulnerability was linked to anxiety, Social Isolation and Enmeshment were linked to depression, and Entitlement, Insufficient Self‐Control, Mistrust and Abuse, Subjugation (negatively), and Abandonment were linked to anger. The discrepancies between these and the Spanish findings and the difficulties of other researchers in establishing higher order aggregations of Young's schemas prompted further consideration of the range of such schemas with respect to anger, depression, and anxiety, and the possibility that sample characteristics may play a critical role in determining the varying affect—schema relationships.     

Calibrating for Comorbidity: Clinical Decision-Making in Youth Depression and Anxiety

Comorbidity in clinical youth populations is more the rule than the exception, yet few established guidelines exist to help practicing clinicians manage complex diagnostic profiles. The current paper reviews efforts within the treatment development literature to handle comorbidity in depressed and anxious children and adolescents, including single-target, modular-based, and transdiagnostic interventions. Two case studies are presented to describe how comorbid anxiety and depression are managed within two different evidence-based single-target interventions. A third case is presented to introduce a novel individual behavioral activation therapy (IBAT) designed to address co-occurring depression and anxiety by targeting a single maintaining mechanism (avoidance) that underlies both disorders. Implications for clinical decision-making (assessing complex clinical profiles in practice, prioritizing treatment goals, selecting interventions from a broad evidence base) are discussed.     

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

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

Trajectories of Depression and Anxiety Symptoms in Adolescent Girls: A Comparison of Parallel Trajectory Approaches

Longitudinal mixture models have become popular in the literature. However, modest attention has been paid to whether these models provide a better fit to the data than growth models. Here, we compared longitudinal mixture models to growth models in the context of changes in depression and anxiety symptoms in a community sample of girls from age 10 to 17. Model comparisons found that the preferred solution was a 5-class parallel process growth mixture model that differed in the course of depression and anxiety symptoms reflecting both ordering of symptoms and qualitative group differences. Comparisons between classes revealed substantive differences on a number of outcomes using this solution. Findings are discussed in the context of clinical assessment and implementation of growth mixture models.     

Gender Differences in the Relationship of Anger and Depression in a Clinical Sample

This study examined the relationship of anger dimensions with depression in a clinical sample. Results suggest that the differences between women and men in nonclinical samples typically used in this research may not generalize completely to clinical samples. Further evidence is presented to support the contention that the relationship between anger and depression is important for both men and women.     

The Interplay Between Post-Critical Beliefs and Anxiety: An Exploratory Study in a Polish Sample

The present research investigates the relationship between anxiety and the religiosity dimensions that Wulff (Psychology of religion: classic and contemporary views, Wiley, New York, 1991; Psychology of religion. Classic and contemporary views, Wiley, New York, 1997; Psychologia religii. Klasyczna i współczesna, Wydawnictwo Szkolne i Pedagogiczne, Warszawa, 1999) described as Exclusion vs. Inclusion of Transcendence and Literal vs. Symbolic. The researchers used the Post-Critical Belief scale (Hutsebaut in J Empir Theol 9(2):48–66, 1996; J Empir Theol 10(1):39–54, 1997) to measure Wulff’s religiosity dimensions and the IPAT scale (Krug et al. 1967) to measure anxiety. Results from an adult sample (N = 83) suggest that three dimensions show significant relations with anxiety. Orthodoxy correlated negatively with suspiciousness (L) and positively with guilt proneness (O) factor—in the whole sample. Among women, Historical Relativism negatively correlated with suspiciousness (L), lack of integration (Q3), general anxiety and covert anxiety. Among men, Historical Relativism positively correlated with tension (Q4) and emotional instability (C), general anxiety, covert anxiety and overt anxiety. External Critique was correlated with suspiciousness (L) by men.     

Parent and Child Anxiety Sensitivity: Relationship in a Nonclinical Sample

Little is known about the relationship between parent and child anxiety sensitivity (AS), particularly in nonclinical samples. The present study examined this association in 207 healthy parent-child pairs including 244 children (mean age = 12.3 years, 103 girls) and 226 parent figures (175 mothers). Sequential multiple linear regression revealed that parent AS was significantly associated with child AS in girls, but not in boys. Parent AS accounted for 9% of incremental variance in child AS, after controlling for child age, parent depression, and parent anxiety. Analyses of parent AS dimensions indicated that the social concerns dimension accounted for 14% of incremental variance in child AS in girls only. Parent anxiety and depression showed no association with child AS, once parent AS was taken into account. The findings indicate that parent AS, especially AS social concerns, demonstrates a significant relationship with child AS in this nonclinical sample of girls.     

Perception of Organizational Ethical Climate by University Staff and Students in Medicine and Humanities: A Cross Sectional Study

Science and Engineering Ethics - We assessed students’ and employees’ perception of ethical climate at a university school of medicine compared to that of social sciences and...     

Emotion Appraisal and Anxiety Symptomatology in a University Sample

Current conceptualizations for anxiety disorders focus heavily on cognitive and behavioral aspects of anxiety and address other emotions to a far lesser extent. Studies have demonstrated that negative appraisals of anxiety and fear (e.g., anxiety sensitivity) are elevated in each of the anxiety disorders and depressive disorders. Much less is known about how the appraisal of other emotions is related to anxiety disorder symptom presentation. The current study examines the appraisal of specific aversive emotions in relation to anxiety symptomatology. Undergraduate university students (N = 530) completed measures of specific anxiety and depressive symptoms, as well as a measure of emotional appraisal. A maximum likelihood estimated multivariate regression model was used to examine the unique relationships between emotional appraisal and anxiety and depressive symptoms. Results indicated that anxiety symptoms varied in their relationships with emotional appraisal. Each symptom group was highly related to fear of appraisals of anxiety; however, some anxiety symptoms were also related to fear of other emotional states, including guilt, sadness, disgust, lust, and embarrassment. Understanding the full range of appraisals of emotional experiences in anxiety conditions may help inform conceptualizations, and potentially treatments, by guiding the focus to the feared emotional states of the individual. The present study helps to clarify some of the relationships between emotion appraisal and anxiety symptoms.     

Health Anxiety: Latent Structure and Associations with Anxiety-related Psychological Processes in a Student Sample

Although currently classified as a somatoform disorder, cognitive-behavioral models conceptualize hypochondriasis (HC) as a severe form of health anxiety. The Short Health Anxiety Inventory (SHAI) is a measure derived from this conceptualization that measures health anxiety symptoms across the range of severity. Previous studies have reported inconsistent findings regarding this measure’s factor structure, but these studies employed factor analytic tools that did not account for the categorical nature of SHAI items. The present psychometric study was designed to address these inconsistencies using categorical factor analysis. Using data from a large student sample we found that the SHAI had two factors: Illness Likelihood and Illness Severity. We also examined the relationship between these domains and cognitive variables associated with other anxiety disorders. Results suggested that the psychological processes present in obsessive-compulsive disorder and panic disorder are also associated with health anxiety. Implications for the conceptualization and classification of severe health anxiety are discussed.     

Quality of Life (QoL) in a Brazilian Sample of Older Adults: The Role of Sociodemographic Variables and Depression Symptoms

The aim of the present study was to identify relevant variables associated with Quality of Life (QoL) in older adults. Older adults, up to 60 years old, were interviewed. Subjects were recruited through convenience sampling. 339 paticipants, who were stratified by gender, age, and subjective perception of health and illness, answered questions on sociodemographic issues, QoL (WHOQOL-100) and depressive symptomathology (Beck Depression Inventory—BDI). The multiple linear regression analysis showed associations of overall perception of QoL with depression levels, subjective perception of health status and gender. The individual analysis of each domain concluded that depression levels are correlated to all QoL domains, while health status was associated with physical, psychological, independence level and social relationship domains. Other variables were also assessed. The assessment of older adults concerning their QoL perceptions is associated with gender, age, marital status, social class, literacy rate, perception of health, and more substantially associated with depressive symptoms levels. Nevertheless, some limitations of this study and further ones are suggested.     

Modeling Interactions Between Latent Variables in Research on Type D Personality: A Monte Carlo Simulation and Clinical Study of Depression and Anxiety

Several approaches exist to model interactions between latent variables. However, it is unclear how these perform when item scores are skewed and ordinal. Research on Type D personality serves as a good case study for that matter. In Study 1, we fitted a multivariate interaction model to predict depression and anxiety with Type D personality, operationalized as an interaction between its two subcomponents negative affectivity (NA) and social inhibition (SI). We constructed this interaction according to four approaches: (1) sum score product; (2) single product indicator; (3) matched product indicators; and (4) latent moderated structural equations (LMS). In Study 2, we compared these interaction models in a simulation study by assessing for each method the bias and precision of the estimated interaction effect under varying conditions. In Study 1, all methods showed a significant Type D effect on both depression and anxiety, although this effect diminished after including the NA and SI quadratic effects. Study 2 showed that the LMS approach performed best with respect to minimizing bias and maximizing power, even when item scores were ordinal and skewed. However, when latent traits were skewed LMS resulted in more false-positive conclusions, while the Matched PI approach adequately controlled the false-positive rate.     

自我调节失败与抑郁和焦虑症状的关系：纵向追踪研究

对200名不同调节定向的大学生进行为期6个月的追踪调查以探索长期自我调节失败与抑郁和焦虑症状及两者共存的关系。结果发现：(1)促进定向组在抑郁、焦虑以及自我调节失败得分上低于预防定向组;(2)控制基线期抑郁和焦虑症状,促进和预防定向系统的自我调节失败均可正向预测3个月后抑郁–焦虑症状共存;(3)抑郁症状的维持和发展与促进目标失败有关,焦虑症状的维持和发展与预防目标失败有关;(4)基线期抑郁不仅通过促进目标失败程度来维持和发展,还通过促进和预防目标失败程度来正向预测继发的焦虑;基线期焦虑不仅通过预防目标失败程度来维持和发展,还能正向预测继发的抑郁。     

Cognitive and Behavioral Treatments for Anxiety and Depression in a Patient with an Implantable Cardioverter Defibrillator (ICD): A Case Report and Clinical Discussion

Implantable cardioverter-defibrillators (ICDs) are the treatment of choice for patients at risk for potentially life threatening arrhythmias. The associated stress of living with an implanted device and receiving ICD shock therapy has been noted to exert a psychological toll on the individual patient and family. Anxious and depressive symptomatology is frequently reported by these patients, thus creating a demand for tailored psychological interventions for this population. The current case report describes the components, delivery, and effectiveness of a targeted treatment approach for anxiety and depression in an individual with an ICD. Test results and interview data revealed significant improvements in multiple domains of cognitive, emotional, and behavioral functioning. Improvements in marital relations were also achieved. These treatment effects were maintained at follow-up and in the context of acute, medical stressors. Future clinical and research directions are also discussed.     

Treating Inpatients With Comorbid Depression and Alcohol Use Disorders: A Comparison of Acceptance and Commitment Therapy Versus Treatment as Usual

The Psychological Record - Inpatients involuntarily committed to a chemical dependency unit and exhibiting a co-occurring depressive disorder received either individual sessions of acceptance and...