The facets of anxiety sensitivity represented in the childhood anxiety sensitivity index: confirmatory analyses of factor models from past studies

Dimensional, categorical, or dimensional-categories: testing the latent structure of anxiety sensitivity among adults using factor-mixture modeling

The present study tested multiple, competing latent structural models of anxiety sensitivity (AS), as measured by the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007). Data were collected from 3 sites in North America (N=634). Participants were predominantly university students (M=21.3 years, SD=5.4). ASI-3 data were evaluated using an integration of mixture modeling and confirmatory factor analysis-factor mixture modeling (FMM; Muthén, 2008). Results supported a 2-class 3-factor partially invariant model of AS. Specifically, the FMM analyses indicated that AS is a taxonic (two-class) variable, and that each categorical class has a unique multidimensional factor structure. Consistent with the specific point-prediction regarding the hypothesized parameters of the putative latent class variable, FMM indicated that the putatively "high-risk" subgroup of cases or latent form of AS composed approximately 12% of the studied sample whereas the putatively "normative" subgroup of cases or latent form of AS composed 88% of the sample. In addition, the AS Physical and Psychological Concerns subscales, but not the Social Concerns subscale, most strongly discriminated between the two latent classes. Finally, comparison of continuous levels of AS Physical and Psychological Concerns between FMM-derived AS latent classes and independent clinical samples of patients with anxiety disorders provided empirical support for the theorized taxonic-dimensional model of AS and anxiety psychopathology vulnerability. Findings are discussed in regard to the implications of this and related research into the nature of AS and anxiety psychopathology vulnerability.

An examination of the tripartite model of anxiety and depression in an outpatient sample of adolescents

Anxiety and depressive disorders are the most common mental health problems for adolescents; understanding their etiology and course is necessary for developing effective prevention and treatment programs. The tripartite model of anxiety and depression was evaluated in a random, clinical sample of 185 adolescents, with an average age of 15.09 years (SD = 1.9), with 58.4% males (n = 108). Survey packets were mailed to participants (61% response rate). Two models were evaluated: (a) Model one fit adequately, however, modification indices and prior research and theory suggested adding paths between anxiety and depression. (b) Model two tested paths between anxiety and depression; this revised model fit the data well, suggesting a relationship from anxiety to depression. Further, physiological hyperarousal may be a distinct component for anxiety and negative affectivity may be a general risk factor for anxiety and depression in adolescents. The findings that different factors contribute to the cause of anxiety and depression have implications for practice.

Anxiety sensitivity: prospective prediction of anxiety among early adolescents

Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks as well as clinical syndromes in adult samples. The primary aim of the present study was to determine whether AS similarly acts as a vulnerability factor in the pathogenesis of anxiety symptoms among youth in early adolescence (ages 9-13). A large nonclinical community sample of youth (n=277) was prospectively followed over 1 year. The Childhood Anxiety Sensitivity Index (CASI: Silverman, Fleisig, Rabian, & Peterson, 1991) served as the primary predictor. After controlling for baseline anxiety symptoms as well as depression, AS significantly predicted the future development of anxiety symptoms. Consistent with the adult literature and expectancy theory, AS appears to act as a risk factor for anxiety symptoms in youth.

Anxiety sensitivity and catastrophizing: associations with pain and somatization in non-clinical children

This study examined the relationships among anxiety sensitivity (AS), catastrophizing, somatization and pain in 240 non-clinical children (121 girls; mean age = 12.7 years). Children with pain problems (n = 81; 33.8%) reported greater AS and catastrophizing (ps < .01) relative to children without pain problems. AS but not catastrophizing was significantly associated with current pain. However, both AS and catastrophizing were significantly associated with somatization. AS and catastrophizing represent related but partially distinct cognitive constructs that may be targeted by interventions aimed at alleviating pain and somatization in children.

The facets of anxiety sensitivity in adolescents

This study examined the factor structure, reliability, and validity of the German translation of the Childhood Anxiety Sensitivity Index (CASI). A total of 1292 adolescents participated in the study. Analyses using the Schmid-Leiman solution showed the CASI to have one higher order factor and three orthogonal lower order factors. CASI scores correlated significantly with anxiety symptoms and with general difficulties. Hierarchical multiple regression showed CASI to make a significant contribution in predicting anxiety even after controlling for variance due to general difficulties, thus giving further support to the incremental validity of the CASI. The CASI is a potentially useful measure to include in longitudinal studies that examine the development of childhood and adolescent anxiety disorders.

Stressful life events, anxiety sensitivity, and internalizing symptoms in adolescents

Anxiety sensitivity represents a robust risk factor for the development of anxiety symptoms among both adolescents and adults. However, the development of anxiety sensitivity among adolescents remains inadequately understood. In this study, the authors examined the role of stressful life events as a risk factor for the development of elevated anxiety sensitivity. Anxiety sensitivity was then examined in a longitudinal design as a mechanism linking stressful life events to changes in anxiety symptoms. Stressful life events, anxiety sensitivity, and internalizing symptoms were assessed in a diverse community sample of adolescents (N = 1,065) at 3 time points spanning 7 months. The results indicated that stressful life events were longitudinally associated with increases in anxiety sensitivity and that certain types of stressful life events, specifically events related to health and events related to family discord, were differentially predictive of increases in anxiety sensitivity. Moreover, anxiety sensitivity mediated the longitudinal relation between stressful life events and anxiety symptoms. Evidence was also found for the predictive specificity of anxiety sensitivity to symptoms of anxiety but not depression.

Research review: the relation between child and parent anxiety and parental control: a meta-analytic review

BACKGROUND

There is growing research interest in the association between parental control and child anxiety. Parental control may enhance child anxiety and parents may exert control in anticipation of their child's anxiety-related distress. Moreover, high levels of anxiety in parents could influence the development of parental control. Whereas past reviews have solely examined the relation between child anxiety and parental control, this meta-analysis focuses on the associations between both child and parent anxiety and parental control.

METHODS

The associations of parent anxiety and child anxiety with observed parental control (k = 23 studies, N = 1,305 parent-child dyads) were investigated using a meta-analytic approach. Moreover, factors were identified that may function as moderators of these relations, such as parent and child gender, family socioeconomic status, child age, and design and measurement characteristics.

RESULTS

A substantial association between child anxiety and parental control (d = .58) was found. Moderator analyses yielded the strongest effect sizes for studies with an overrepresentation of girls, for school-aged children, for families from higher socioeconomic backgrounds, and for studies using a discussion task to assess parental control. Although a nonsignificant relation was found for the relation between parent anxiety and parental control (d = .08), small but significant effects were found for school-aged children, for studies using a discussion task to assess parental control, and for samples with an overrepresentation of boys.

CONCLUSIONS

As the direction of the association between child anxiety and parental control is unknown, future studies should use experimental designs to further explore the causal link between child anxiety and parental control.

The factor structure of the Childhood Anxiety Sensitivity Index in German children

The factor structure of the Childhood Anxiety Sensitivity Index (CASI) was investigated in four nonclinic German samples (N=1244, 225, 230, and 143) with participants aged 8-16-years-old. Factor solutions suggested for different CASI versions were tested using confirmatory factor analysis. The best goodness-of-fit indices were found for the 13-item CASI version with 4 factors (Disease Concerns, Unsteady Concerns, Mental Incapacitation Concerns, and Social Concerns). Testing for factorial invariance of this model with respect to age and gender revealed non-invariant factor loadings between children and adolescents as well as between boys and girls. The theoretical and clinical implications of these findings for anxiety sensitivity in children and adolescents are discussed.

Smoking and posttraumatic stress symptoms among adolescents: does anxiety sensitivity matter?

The present study examined the hypothesized moderating role of anxiety sensitivity (AS) in the relationship between lifetime smoking history and posttraumatic stress symptoms among 64 traumatic event-exposed adolescents. As predicted, the relationship between smoking status and posttraumatic stress symptom levels was moderated by AS. Specific facets of AS also were examined. Disease concerns, but not unsteady, mental illness, or social concerns, moderated the association between smoking and symptom level. These findings are generally consistent with findings from adult samples, but importantly extend this area of research to another phase of the lifespan.

Anxiety sensitivity and posttraumatic stress among traumatic event-exposed youth

Total and factor scores of the Childhood Anxiety Sensitivity Index (CASI) were examined in relation to posttraumatic stress symptom levels within a community-based sample of 68 (43 females) traumatic event-exposed youth between the ages of 10 and 17 years (M age=14.74 years). Findings were consistent with hypotheses; global anxiety sensitivity (AS) levels, as well as disease, unsteady, and mental incapacitation concerns, related positively to posttraumatic stress levels, whereas social concerns were unrelated to symptom levels. These results suggest that fears of the physical and mental consequences of anxiety are associated with relatively higher levels of posttraumatic stress subsequent to traumatic event exposure. Findings are discussed in terms of potential implications for the role of AS in developmentally sensitive etiological models of posttraumatic stress disorder (PTSD).

Catastrophic associations predict level of change in anxiety sensitivity in response to cognitive-behavioural treatment for panic

The aim of the present study was to elucidate one of the factors that might be responsible for the maintenance of panic patients' harmful beliefs about anxiety. Specifically, it was hypothesized that harmful beliefs about anxiety, i.e. anxiety sensitivity, is maintained in panic patients by automatic activation of idiographic catastrophic cognitions. To test this prediction, panic patients participated in a one-session cognitive-behavioural treatment of 4-8h to reduce anxiety sensitivity. The strength of automatic catastrophic cognitions in response to idiographic anxiety symptoms, measured with a modified semantic priming task, as well as the strength of the consciously accessible catastrophic meaning of these symptoms were assessed before treatment. In accordance with the hypothesis, stronger automatic catastrophic cognitions predicted a smaller reduction of anxiety sensitivity independently of the strength of conscious catastrophic cognitions. Moreover, in a first exploration, the strength of catastrophic associations was also shown to have an incremental predictive value for change in anxiety sensitivity beyond that of a number of demographic, clinical, treatment and assessment variables. The theoretical and clinical implications are discussed.

Korean Anxiety Sensitivity Index-Revised: its factor structure, reliability, and validity in clinical and nonclinical samples

The factor structure and convergent and discriminant validity of the Anxiety Sensitivity Index-Revised (ASI-R) were examined in a community sample, a student sample, and patients with panic disorder in Korea. Results from a confirmatory factor analysis (CFA) comparing our data to factor solutions commonly reported as representative of European American populations indicated a poor fit. A subsequent exploratory factor analysis (EFA) indicated that a four-factor solution provided the best fit. Correlations between the ASI-R and anxiety measures were moderately high, providing evidence of convergent validity. Implications for assessment with Koreans are discussed.

Taxometric and factor analytic models of anxiety sensitivity among youth: exploring the latent structure of anxiety psychopathology vulnerability

This study represents an effort to better understand the latent structure of anxiety sensitivity (AS), a well-established affect-sensitivity individual difference factor, among youth by employing taxometric and factor analytic approaches in an integrative manner. Taxometric analyses indicated that AS, as indexed by the Child Anxiety Sensitivity Index (CASI; Silverman, Flesig, Rabian, & Peterson, 1991), demonstrates taxonic latent class structure in a large sample of youth from North America (N=4,462; M(age)=15.6 years; SD=1.3). Subsequent confirmatory factor analyses indicated that the latent continuous, multidimensional, 4-factor model of AS among youth (Silverman, Goedhart, Barrett, & Turner, 2003) provided good fit for the CASI data among the complement class ("normative form" of AS), but not among the taxon class ("high-risk form" of AS). EFAs supported the prediction that the AS taxon demonstrates a unique, heretofore unexplored latent continuous, unidimensional factor structure among youth. Findings are discussed in relation to refining our understanding of the latent structure of AS and the clinical implications that arise from it.

Links Between Life Course Trajectories of Family Dysfunction and Anxiety During Middle Childhood

Using data from three waves of a large Canadian data set, we examine the relationship between two middle childhood trajectory variables, family dysfunction and anxiety. We draw upon family systems theory and developmental psychopathology, while attempting to expand their boundaries by capitalizing on the strengths within both approaches. Our data treatment strategy, guided by the life course analytical framework, included separate multivariate logits to examine this relationship, with and without the extent to, which selected explanatory risk variables predicted belonging to the highest family dysfunction trajectory. We also explored possible interactions between anxiety and explanatory risk variables. Supporting our hypothesis, a prolonged duration of high doses of family dysfunction was associated with the most extreme developmental trajectories of anxious behavior during middle childhood for both boys and girls. This relationship prevailed above and beyond the influence of other correlates of family dysfunction such as marital transition, socioeconomic status, family size, and depressive symptoms experienced by the informant (mostly mothers).

Relationships among anxious symptomatology, anxiety sensitivity and laboratory pain responsivity in children

Existing laboratory-based research in adult samples has suggested that anxiety sensitivity (AS) increases an individual's propensity to experience pain-related anxiety, which in turn enhances pain responsivity. Such relationships have not been examined in younger populations. Thus, the present study used structural equation modeling (SEM) to test a conceptual model in which AS would evidence an indirect relationship with pain intensity via its contribution to state-specific anticipatory anxiety in relation to a variety of laboratory pain tasks (cold pressor, thermal heat, and pressure pain) in 234 healthy children (116 girls; mean age = 12.6 years, range = 8-18 years). The model further hypothesized that existing anxious symptomatology would demonstrate a direct relationship with pain intensity. Results of the SEM supported the proposed conceptual model with the total indirect effect of AS accounting for 29% of the variance in laboratory pain intensity via its effects on pain-related anticipatory anxiety. AS did not however, evidence a direct relationship with pain intensity. Anxious symptomatology on the other hand, demonstrated a significant direct effect on pain intensity, accounting for 15% of variance. The combined effects of AS, anxiety symptoms, and anticipatory anxiety together explained 62% of the variance in pain intensity. These relationships did not differ for boys and girls, indicating no moderating effect of sex in the proposed model. The present results support the potential benefit of assessing both AS and anxiety symptoms in children prior to undergoing painful stimulation.

Anxiety sensitivity, conscious awareness and selective attentional biases in children

The current study investigated whether physical anxiety sensitivity (AS) is associated with selective attentional biases to affective stimuli in children. The dot-probe paradigm was used to examine the deployment of attention towards words pertaining to anxiety symptomatology, socially threatening words, and positive words, in samples of 8-10-year-old children. Word pairs were presented under both masked and unmasked conditions. Irrespective of masking, children high in physical AS displayed an attentional vigilance for emotional words relative to neutral words, whereas those low in physical AS displayed a relative avoidance of such material. The results of this study are interesting as they not only suggest the presence of automatic AS-related biases in childhood, but that this is a general emotionality bias rather than one related to specific anxiety-related stimuli.

Validation of the Quality of Life Inventory for patients with anxiety and depression

BACKGROUND

In 1992, Frisch et al (Psychol Assess. 1992;4:92-101) developed the Quality of Life Inventory (QOLI) to measure the concept of quality of life (QOL) because it has long been thought to be related to both physical and emotional well-being. However, the psychometric properties of the QOLI in clinical populations are still in debate. The present study examined the factor structure of QOLI and reported its validity and reliability in a clinical sample.

METHOD

Two hundred seventeen patients with anxiety and depressive disorders completed the QOLI, and additional questionnaires measuring symptoms (Zung Self-rating Depression Scale, Beck Anxiety Inventory, Fear Questionnaire, Depression Anxiety Stress Scale-Stress) and subjective well-being (Satisfaction With Life Scale) were also used.

RESULTS

Exploratory factor analysis via the principal components method, with oblique rotation, revealed a 2-factor structure that accounted for 42.73% of the total variance, and a subsequent confirmatory factor analysis suggested a moderate fit of the data to this model. The 2 factors appeared to describe self-oriented QOL and externally oriented QOL. The Cronbach alpha coefficients were 0.85 for the overall QOLI score, 0.81 for the first factor, and 0.75 for the second factor.

CONCLUSION

Consistent evidence was also found to support the concurrent, discriminant, predictive, and criterion-related validity of the QOLI.

Anxiety sensitivity taxonicity across gender among youth

The present investigation comparatively evaluated the latent class structure and parameters of anxiety sensitivity (AS) among female and male youth using the Childhood Anxiety Sensitivity Index. Participants were 4462 adolescents (2189 females) in grades 7-12 (M(age)=15.6 years). Consistent with prediction, taxometric analyses indicated the latent structure of AS was taxonic in both males and females, demonstrating the taxonic latent structure of AS is similarly observed across gender. Also consistent with prediction, the base rate of the AS taxon differed between genders -- higher for females (12%) compared to males (7%). These findings are discussed in terms of their implications for the study of AS and panic vulnerability among youth.

Anxiety sensitivity taxon and trauma: discriminant associations for posttraumatic stress and panic symptomatology among young adults

The present investigation examined whether the anxiety sensitivity (AS) taxon interacts with theoretically relevant traumatic types of aversive life events to show discriminant (concurrent) associations with posttraumatic stress symptoms, but not panic attacks or bodily vigilance among young adults. The interaction between the AS Taxon Scale and trauma exposure accounted for significant variance above and beyond negative affectivity and each of the main effects in terms of a posttraumatic stress disorder (PTSD) symptom-severity criterion variable, but not for posttraumatic-related thoughts and beliefs or either panic-relevant criterion variable. Thus, results suggest that although the AS taxon may function as a common cognitive diathesis for PTSD and panic outcomes, the AS taxon coupled with traumatic life events may confer emotional vulnerability that is specific to PTSD symptoms. These findings are discussed in terms of theoretical and clinical implications for PTSD and panic vulnerability.

An examination of worry in relation to anxious responding to voluntary hyperventilation among adolescents

This study examined the association between worry and fearful responding to a 3-min voluntary hyperventilation procedure. Participants were 160 adolescents (71 females) between the ages of 12 and 17 years (M=14.92 years). After accounting for the significant effects of state anxiety and anxiety sensitivity, results indicated that pre-challenge levels of worry indexed by the Penn State Worry Questionnaire-Child Version predicted post-challenge anxiety and intensity of panic symptoms. Results are discussed in terms of the role of worry in relation to panic-relevant emotional vulnerability among youth.

Taxonicity of anxiety sensitivity: an empirical test among youth

Taxometric coherent cut kinetic analyses were used to test the latent structure of anxiety sensitivity (AS) among 371 youth. Anxiety sensitivity was indexed by the 18-item Childhood Anxiety Sensitivity Index (CASI; Silverman et al., J. Clin. Child Psychol. (1991), 20, 162-168). Two sets of manifest indicators of AS were constructed using the CASI: (1) three item-parcel manifest indicators: disease concerns, unsteady concerns, and mental illness concerns; and (2) nine single-item indicators representing each of these three facets of AS. Results from standard and short-scale MAXCOV procedures, internal consistency tests, analyses of simulated Monte Carlo data, and MAMBAC external consistency tests indicated that the latent structure of anxiety sensitivity among youth was taxonic. Estimated base rate of the observed AS taxon ranged between 13.6 and 16.5%. The present findings are discussed in terms of theoretical implications for the study of AS and vulnerability for anxiety psychopathology.

Evidence-Based Assessment of Anxiety and Its Disorders in Children and Adolescents

We provide an overview of where the field currently stands when it comes to having evidence-based methods and instruments available for use in assessing anxiety and its disorders in children and adolescents. Methods covered include diagnostic interview schedules, rating scales, observations, and self-monitoring forms. We also discuss the main purposes or goals of assessment and indicate which methods and instruments have the most evidence for accomplishing these goals. We also focus on several specific issues that need continued research attention for the field to move forward toward an evidence-based assessment approach. Finally, tentative recommendations are made for conducting an evidence-based assessment for anxiety and its disorders in children and adolescents. Directions for future research also are discussed.

A cross-sectional evaluation of the factorial invariance of anxiety sensitivity in adolescents and young adults

This study examined the cross-sectional factorial invariance of anxiety sensitivity in an ethnically diverse sample of adolescents (n = 173; mean age 15.5 years) and young adults (n = 291; mean age 20.1 years). Research in adult and youth samples suggests that anxiety sensitivity is best understood as a hierarchical construct with several lower-order factors. Factor models based on previous research using both adult and youth samples were compared and a hierarchical model with three lower-order factors provided the best fit to the data. Results supported the hypothesis that the factor structure of the Anxiety Sensitivity Index was invariant across age and gender. The factor scores also demonstrated differential correlations with symptoms of anxiety and depression. Results are discussed with regard to construct validation and understanding the structure of anxiety sensitivity in youth.

Health Perception Is a Unique Predictor of Anxiety Symptoms in Non‐Clinical Participants

This study evaluated the role of perceived health in predicting anxiety symptoms, bodily vigilance and agoraphobic cognitions among 71 individuals (30 females; mean age 19.9 years, SD=3.1) without a psychiatric history, including non-clinical panic attacks. Results indicated that, relative to anxiety sensitivity, perceived health was a distinct construct that incrementally predicted bodily-oriented catastrophic thinking (8% of unique variance) and heart-focused anxiety (13% of unique variance). Moreover, perceived health significantly incrementally predicted anxious arousal symptoms (9% of unique variance). Results are discussed in relation to the role of perceived health as a cognitive vulnerability factor for anxiety-related problems.

Investigating Invariance in the Factorial Structure of the Anxiety Sensitivity Index Across Adult Men and Women

The Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992) is one of the most widely used measures of the fear of anxiety-related sensations. Important gender differences also seem to exist in that women report higher levels of anxiety sensitivity than men. The primary objective of this study was to determine whether an equivalent factorial structure exists for the ASI among nonclinical adult men and women. In Study 1 (568 women; 251 men), the 2-factor (Fear of Cardiopulmonary Sensations and Fear of Mental Catastrophe), 10-item version of the ASI reported by Schmidt and Joiner (2002) provided the best fit to the data for both men and women. Using this model, Study 2 (503 women, 255 men) examined whether the factorial structure of the 10-item ASI was invariant for men and women. Noninvariance was found for one item on the Fear of Mental Catastrophe subscale (Item 15="When I am nervous, I worry that I might be mentally ill"). The implications of this are that this item should be dropped if an equivalent factor structure is to be assumed between men and women.

Clinical phenomenology, somatic symptoms, and distress in Hispanic/Latino and European American youths with anxiety disorders

This study compared clinic-anxious Hispanic/Latino and European American youths (ages 6 to 17 years old) along sociodemographic and clinical variables. Groups were relatively similar, although significant differences emerged as a function of ethnocultural and language choice (English, Spanish) used during the assessment. Within the English language choice group, Cuban American (CA) youths reported somatic symptoms as less distressing than non-Cuban American Hispanic/Latino (non-CA/HL) youths. Conversely, within the Spanish language choice group, CA youths reported somatic symptoms as more distressing than non-CA/HL youths. Also, parents in the European American and CA groups reported their youths as having less somatic symptoms than parents in the non-CA/HL group. Implications of findings are discussed, particularly regarding possible cultural significance of somatic symptoms.

Assessing Anxiety Sensitivity in Inner-City African American Children: Psychometric Properties of the Childhood Anxiety Sensitivity Index

This study examined the psychometric properties of the Childhood Anxiety Sensitivity Index (CASI; Silverman et al., 1991) in a sample of urban African American elementary school children. One hundred forty-four 4th- and 5th-grade children completed the CASI as part of a larger project. In contrast to prior research with community samples, CASI total scores were higher and means did not differ by sex. Internal consistency (alpha =.82), 2-week test-retest reliability (r =.80), and convergent and divergent validity were good and consistent with prior research. The factor structure of the CASI differed from the structure found with White children. Results of exploratory factor analyses suggest two factors: physical concerns and mental incapacitation concerns. Implications for assessing anxiety and anxiety sensitivity among African American children are discussed.