A test of the tripartite model of anxiety and depression in elementary and high school boys and girls

A Complex Relationship between Quality of Life, Anxiety, and Depression among General Population during Second Year of COVID-19 Pandemic: A Population-Based Study

Background: The COVID-19 pandemic has had a significant impact on the global economy and public health, disrupting various aspects of daily life. Apart from its direct effects on physical health, it has also significantly affected the overall quality of life and mental health. This study employed a path analysis to explore the complex association among multiple factors associated with quality of life, anxiety, and depression in the general population of the Republic of Srpska during the pandemic's second year. Method: A cross-sectional study was conducted on a nationally representative sample (n = 1382) of the general population (adults aged 20+) during the second year of the COVID-19 pandemic in the Republic of Srpska, Bosnia, and Herzegovina. Assessment tools included the DASS-21 scale for depression, anxiety, and stress, along with the Brief COPE scale, Quality of Life Scale (QOLS), and Oslo Social Support Scale (OSSS-3). Sociodemographic factors and comorbidities were also assessed. Structural equation modeling was used to identify the direct and indirect links of various characteristics to quality of life, anxiety, and depression. Results: This study revealed a considerable prevalence of anxiety and depression symptoms (27.5% and 20.9%, respectively), with quality of life playing a significant mediating role. The constructed path model accounted for 33.1% of moderate to severe depression and 79.5% of anxiety. Negative coping was directly linked to anxiety and indirectly to depression via anxiety, while the absence of positive coping had both direct and indirect paths (through quality of life) on depression. Among variables that directly affected depression, anxiety had the highest effect. However, the bidirectional paths between anxiety and depression were also suggested by the model. Conclusions: Pandemic response strategies should be modified to effectively reduce the adverse effects on public mental health. Further research is necessary to assess the long-term effects of the pandemic on mental health and to analyze the contributing factors of anxiety and depression in the post-COVID period.

Heightened Anxiety and Depression Among Autistic Adolescents with ADHD: Findings From the National Survey of Children's Health 2016-2019

Data from the National Survey of Children's Health 2016-2019 was used to examine the co-occurrence of autism and ADHD and the impact on anxiety and depression among adolescents age 12-17. Rates of anxiety and depression were up to ten-fold the prevalence of adolescents not diagnosed with autism or ADHD. Over half of autistic females (57%) and nearly half of autistic males (49%) are also diagnosed with ADHD. Autistic females with ADHD had the highest co-occurrence of anxiety at 72% followed by autistic males with ADHD at 69%. The prevalence of depression was highest among autistic adolescents with ADHD yet was consistent across genders (male/female) at 38-39%. Adolescents diagnosed with autism and/or ADHD are at heightened risk for anxiety and depression.

Are fearful boys at higher risk for anxiety? Person-centered profiles of toddler fearful behavior predict anxious behaviors at age 6

Dysregulated fear (DF), the presence of fearful behaviors in both low-threat and high-threat contexts, is associated with child anxiety symptoms during early childhood (e.g., Buss et al., 2013). However, not all children with DF go on to develop an anxiety disorder (Buss and McDoniel, 2016). This study leveraged the data from two longitudinal cohorts (N = 261) to (1) use person-centered methods to identify profiles of fearful temperament, (2) replicate the findings linking DF to anxiety behaviors in kindergarten, (3) test if child sex moderates associations between DF and anxiety behaviors, and (4) examine the consistency of findings across multiple informants of child anxiety behaviors. We identified a normative fear profile (low fear in low-threat contexts; high fear in high-threat contexts), a low fear profile (low fear across both low- and high-threat contexts) and a DF profile (high fear across both low- and high-threat contexts). Results showed that probability of DF profile membership was significantly associated with child self-reported overanxiousness, but not with parent-reported overanxiousness. Associations between DF profile membership and overanxiousness was moderated by child sex such that these associations were significant for boys only. Additionally, results showed that probability of DF profile membership was associated with both parent-reported social withdrawal and observations of social reticence, but there were no significant associations with child self-report of social withdrawal. Results highlight the importance of considering person-centered profiles of fearful temperament across different emotion-eliciting contexts, and the importance of using multiple informants to understand associations with temperamental risk for child anxiety.

Positive valence systems in youth anxiety development: A scoping review

Research on pathophysiological mechanisms supporting anxiety development in youth has traditionally focused on the role of threat systems. However, emerging research suggests that the positive valence system (PVS) may also play a strong and unique role in the development and maintenance of anxiety during childhood and adolescence. To better understand the connection between the PVS and anxiety, this scoping review describes current research spanning multiple units of analysis (i.e., self-report, behavior, neural circuits) linking child and adolescent anxiety and risk for anxiety to various PVS constructs (i.e., positive affect, reward responsiveness, reward learning and decision-making). After screening, 78 peer-reviewed articles and dissertations published between 1998 and May 2021 were included in a qualitative review. Though some consistencies in the literature were found, such as high neural reactivity to incentive anticipation in youth at temperamental risk for social anxiety and blunted positive affect in youth with social anxiety disorder, the literature is largely inconsistent. Inconsistencies could be related to the small number of similar studies, small and homogenous study samples, and variability in methodologies employed in this research. It cannot be confirmed whether findings linking PVS constructs to anxiety are unique to anxiety symptoms or better accounted for by co-occurring depressive symptoms. This review concludes with recommendations for robust future research in this area.

Professional quality of life as potential mediators of the association between anxiety and depression among Chinese health-care clinicians

OBJECTIVE

Building upon the tripartite model of anxiety and depression, the current study aims to examine mechanisms of comorbidity between anxiety and depression using the ProQOL (Professional Quality of Life; including the constructs of burnout, secondary traumatic stress, and compassion satisfaction) in a sample of Chinese health-care clinicians.

METHOD

A randomized cross-sectional survey was distributed to 1620 participants who were recruited from eight state-owned hospitals in a city in southern China between January and May 2017. A total of 1562 questionnaires were returned (a response rate of 96.4%). After the cases with more than 10% missing variables and multivariate outliers being removed, 1423 valid cases remained. Multiple mediator models were used for mediation analysis that was conducted using the PROCESS v3.1 macro for SPSS.

RESULTS

The indirect effects of anxiety upon depression through burnout (a1 = . 601 (95% confidence interval (CI): .552, .650), p < .001; b1 = .137 (95% CI: .101, .174), p < .001) and compassion satisfaction (a3= -.297 (95% CI: -.352, -.241), p < .001; b3 = -.069 (95% CI: -.100, -.039), p < .001) were significant, while there was no evidence that anxiety influenced depression by changing secondary traumatic stress. The indirect effects of depression upon anxiety through secondary traumatic stress (a2 = . 535 (95% CI: .483, .588), p < .001); b2 = .154 (95% CI: .120, .188), p < .001) were both positive and significant, while there was no evidence that depression influenced anxiety by changing burnout and compassion satisfaction.

CONCLUSIONS

In the current sample, burnout and compassion satisfaction mediated the effect of anxiety upon depression and secondary traumatic stress mediated the effect of depression upon anxiety. The findings of the current study offer support to the tripartite model.

The Predictive Role of Affectivity, Self-Esteem and Social Support in Depression and Anxiety in Children and Adolescents

Background: This study analyzes the relationship between depression and anxiety levels and positive and negative affect, self-esteem, and perceived social support from family and friends in an early and middle adolescent sample. These are psychological variables that are often associated with the prediction of emotional disorders, especially depression. Methods: Participants (N = 467) were a representative sample of this group of adolescents and were recruited from schools in the city of Concepción, Chile. Part of the sample (N = 177) was assessed three additional times—at one-, two-, and four-month intervals. Results: Results showed a practical stability of all measures across the four intervals, with no significant differences between sexes. Anxiety and depression displayed a similar pattern of significant relationships with affectivity, self-esteem, and social support. Depression had a higher correlation coefficient (−0.47) with positive affect, and so did anxiety with negative affect (0.58). Conclusions: Taking into account 23 initial scores on affectivity, self-esteem, and social support in predicting both depression and anxiety scores at one-month, two-month, and four-month intervals, positive affect was present in three regression analyses, predicting depression scores; negative affect was present in anxiety scores. Results are discussed according to previous findings, as well as the tripartite model.

Emotion Regulation Style and Daily Rumination: Potential Mediators between Affect and Both Depression and Anxiety during Adolescence

Adolescence is a vulnerable period for depressive and anxious symptom development, and emotion regulation (ER) may be one mechanism linking temperament—i.e., positive affect (PA) and negative affect (NA)—with such symptomatology. Rumination is a common ER strategy that is traditionally assessed using self-reported questionnaires, but it would also be interesting to examine it with an Ecological Momentary Assessment (EMA) approach. Sixty-five adolescents (M_age = 14.69; SD_age = 0.82; range = 14–17 years old; 53.80% girls) completed self-report measures of temperament, ER style, depression and anxiety, and underwent an EMA to investigate rumination use. Results revealed that negative ER style and rumination use mediated the relationship between NA and depression, while only rumination use mediated the relationship between PA and depression. Moreover, NA contributed to increase anxiety, but negative ER style did not significantly mediate this relationship. Rumination use also had no effect on anxiety. This study provides further support for the relationship between temperament, ER, and internalizing problems. It seems that both a negative ER style and rumination use mediate the relationship between NA and depression whereas only NA had a significant direct effect on anxiety. Furthermore, PA buffered the effect of rumination use on depression in this study.

PANAS Models of Positive and Negative Affectivity for Adolescent Boys

The measurement of affect is often of central interest in adolescent research. Very few studies have investigated the factor structure underlying adolescent responses to the Positive and Negative Affect Schedule, with mixed results. Only two studies reported on the trait version: one in Florida, the other in Chile. This study compared a range of prominent models to capture responses from adolescent boys from grades 7 to 12 in Australia (N = 1431) employing confirmatory factor analyses. Models included two, three, and a recently proposed bifactor model. While most models showed reasonable fit compared to a one-factor solution, cross-loading of the item feeling "strong" enhanced fit to the data. In the end, interpretation and parsimony advocate for the adoption of the uncorrelated two-factor Positive and Negative Affect Schedule (PANAS) model for representing general positive and negative affectivity in boys.

Childhood Motor Coordination and Adult Affective Experience Among Extremely Low Birth Weight Survivors

Poor motor coordination in childhood has been associated in adulthood with more negative affect, less positive affect, and an increased risk of psychopathology. While survivors of extremely low birth weight (ELBW; < 1,000 grams) are more likely to manifest poor motor coordination than people born at normal birth weight (NBW; > 2,500 g), they have had better mental health outcomes than those with NBW who have motor difficulties. How emotion is experienced is an important risk factor for mental illness; yet, little is known about the affective experience of survivors of ELBW who also have poor motor coordination. In this longitudinal study, we examined interactions between birth weight status and childhood motor coordination on affective experience among 88 ELBW and 89 NBW participants. We first assessed childhood motor coordination at eight years of age, using the Bruininks-Oseretsky Test of Motor Proficiency, and we later gathered self-report data regarding affective style, using the Positive and Negative Affect Scedule and the Affective Styles Questionnaire, when these participants were 30-35 years of age. We found a statistically significant interaction between motor coordination and birth weight status. As motor coordination worsened among ELBW survivors, positive affect increased, while we observed the opposite trend in NBW participants (p < 0.05). There was no interaction for negative affect. Positive affect may contribute to previous findings of better relative adult mental health among ELBW survivors with poor childhood motor coordination. Strategies aimed at optimizing positive affect may be fruitful for optimizing mental health outcomes among preterm survivors and others with reduced motor proficiency.

Relationships between affective states and childhood internalizing disorders

Internalizing disorders are mainly defined as psychosomatic, anxiety and depression problems. The aim of this study was to analyze the relationships between dairy affective states and internalizing disorders in early adolescence (10-12 years old), considering the influence of sex. The participants of the study were 367 children aged between 10 and 12 (190 girls and 177 boys). The results showed that fear was the best predictor for all internalizing disorders, and the only common predictor for all of them. The prediction of boys' internalizing disorders was based only in fear, whereas the prediction for girls involved more variables besides fear. An early detection/regulation of these affective states (particularly fear) may be useful for the prevention and treatment of child internalizing disorders.

Development and Evaluation of the PROMIS® Pediatric Positive Affect Item Bank, Child-Report and Parent-Proxy Editions

OBJECTIVE

The purpose of this study is to describe the psychometric evaluation and item response theory calibration of the PROMIS Pediatric Positive Affect item bank, child-report and parent-proxy editions.

METHODS

The initial item pool comprising 53 items, previously developed using qualitative methods, was administered to 1,874 children 8-17 years old and 909 parents of children 5-17 years old. Analyses included descriptive statistics, reliability, factor analysis, differential item functioning, and construct validity. A total of 14 items were deleted, because of poor psychometric performance, and an 8-item short form constructed from the remaining 39 items was administered to a national sample of 1,004 children 8-17 years old, and 1,306 parents of children 5-17 years old. The combined sample was used in item response theory (IRT) calibration analyses.

RESULTS

The final item bank appeared unidimensional, the items appeared locally independent, and the items were free from differential item functioning. The scales showed excellent reliability and convergent and discriminant validity. Positive affect decreased with children's age and was lower for those with a special health care need. After IRT calibration, we found that 4 and 8 item short forms had a high degree of precision (reliability) across a wide range of the latent trait (>4 SD units).

CONCLUSION

The PROMIS Pediatric Positive Affect item bank and its short forms provide an efficient, precise, and valid assessment of positive affect in children and youth.

The effect of positive and negative memory bias on anxiety and depression symptoms among adolescents

OBJECTIVE

To examine the interaction effect of anxiety and depression on the intentional forgetting of positive and negative valence words.

METHODS

One hundred fifty-five grade 7 to grade 10 students participated in the study. The item-method directed forgetting paradigm was used to examine the intentional forgetting of positive-valence, negative-valence, and neutral-valence words.

RESULTS

Negative-valence words were recognized better than either positive-valence or neutral-valence words. The results revealed an anxiety main effect (p = .01, LLCI = -.09, and ULCI = -.01) and a depression main effect (p = .04, LLCI = .00, and ULCI = .24). The anxiety score was negative, whereas the depression score was positively related to the directed forgetting of negative-valence words. Regression-based moderation analysis revealed a significant anxiety × depression interaction effect on the directed forgetting of positive-valence words (p = .02, LLCI = .00, and ULCI = .01). Greater anxiety was associated with more directed forgetting of positive-valance words only among participants with high depression scores. With negative-valence words, the anxiety × depression interaction effect was not significant (p = .15, LLCI = - .00, and ULCI = .01).

CONCLUSION

Therapeutic strategies to increase positive memory bias may reduce anxiety symptoms only among those with high depression scores. Interventions to reduce negative memory bias may reduce anxiety symptoms irrespective of levels of depression.

Irritability and internalizing symptoms: Modeling the mediating role of emotion regulation

BACKGROUND

Irritability and emotion regulation are both important transdiagnostic factors that contribute to the development of internalizing symptoms during adolescence. The current study examined whether emotion regulation mediates the relationship between irritability and internalizing symptoms.

METHODS

To examine this relationship we analysed the indirect effect of irritability (measured using a single item from the Goldberg Mania Questionnaire) on internalizing symptoms (anxiety and depression) via the mediator, emotion regulation (Difficulties in Emotion Regulation Scale) in 112 adolescent females.

RESULTS

Mediation analysis, using bootstrapping, showed a significant indirect effect and suggests that the relationship between irritability and internalizing symptoms is mediated by emotion dysregulation.

LIMITATIONS

These include measuring irritability using a single item and employing a cross sectional design.

CONCLUSIONS

These novel findings add to our understanding of the processes and mechanisms by which irritability contributes to the development of internalizing symptoms.

Letting Oneself Go Isn't Enough: Cognitively Oriented Expressive Writing Reduces Preadolescent Peer Problems

Peer problems are a stressor for many early adolescents, and simple cost-effective tools for managing peer stress are needed. Expressive writing (EW) may be one such tool. With a sample of middle school children aged 12-14 years (n = 119; 53% males), this research evaluates whether cognitively oriented expressive writing (CEW), which focuses more on psychological self-distancing, improves personal well-being better than traditional EW, which focuses more on emotional disclosure. CEW-compared with EW-slightly enhanced long-term social adjustment for the entire sample, and increased positive affect for those early adolescents that reported more peer problems at baseline. These findings suggest that structured writing instructions with early adolescents may be key to improvements.

Is low positive emotionality a specific risk factor for depression? A meta-analysis of longitudinal studies

Depression is well known to share a negative cross-sectional relationship with personality constructs defined by positive emotion (positive affect, extraversion, behavioral activation). These Positive Emotionality (PE) constructs have been proposed to represent stable temperamental risk factors for depression, not merely current mood state. These constructs have also been proposed to increase risk specifically for depression, relative to anxiety. We performed a meta-analysis of longitudinal studies to examine the relationship of PE to depression (59 effect sizes) and anxiety (26 effect sizes). In cross-sectional analyses, PE constructs were negatively associated with depression (r = -.34) and anxiety (r = -.24). PE constructs also prospectively predicted depression (r = -.26) and anxiety (r = -.19). These relationships remained statistically significant, but were markedly attenuated, when baseline levels of depression (β = -.08) and anxiety (β = -.06) were controlled. Moreover, depression and anxiety were equally strong predictors of subsequent changes in PE (β = -.07 and -.09, respectively). These findings are consistent with theoretical accounts of low PE as a temperamental vulnerability for depression, but suggest that the prospective relationship of PE to depression may be weaker and less specific than previously assumed. (PsycINFO Database Record

Preschoolers' psychophysiological responses to mood induction tasks moderate the intergenerational transmission of internalizing problems

To identify factors that can both exacerbate risk for, and protect against, internalizing problems during early childhood, the present study examined whether children's respiratory sinus arrhythmia (RSA) suppression in response to emotionally-laden film clips would moderate the association between maternal and child anxious/depressive symptoms in a cross-sectional sample of 108 mothers (M age=30.68years, SD=6.06) and their preschool-age children (M age=3.50years, SD=0.52, 61.30% male). Results indicated that RSA suppression in response to the fear clip moderated the positive association between maternal and child anxious/depressive symptoms, such that higher suppression served a protective-stabilizing function while lower suppression exacerbated children's risk for internalizing symptoms in the context of higher maternal symptoms. Moderation findings involving RSA suppression in response to a happiness-inducing clip were consistent with biological sensitivity to context; the association between maternal and child symptoms was strongest for children higher in suppression.

Positive and Negative Affect in Clinic-Referred Youth With ADHD

OBJECTIVE

To examine self-reported positive affect (PA) and negative affect (NA) among youth with ADHD (only and comorbid) and other non-ADHD-referred youth in an ethnically diverse clinical sample.

METHOD

Semi-structured interviews identified 80 pure ADHD, 284 ADHD plus one or more comorbidities, and 730 non-ADHD youth (e.g., other diagnoses or no diagnosis). The Positive and Negative Affect Scale-Children (PANAS-C) was used to assess affective states.

RESULTS

Even after controlling for the influence of potential confounds, youth with only ADHD reported higher PA and lower NA than other clinic-referred youth. The ADHD-comorbid group reported higher PA than the "non-ADHD" group, but these groups did not differ on level of NA. ADHD subtype did not influence results.

CONCLUSION

Among clinic-referred youth, ADHD is associated with higher levels of PA and when there are no comorbid disorders, lower levels of NA.

Focusing on the positive: a review of the role of child positive affect in developmental psychopathology

This review proposes a transactional model of child positive affect (PA) to reflect the ways that PA, in various contexts, may confer both risk and protection for psychosocial adjustment. Though research has largely explored the ways that low PA relates to maladjustment in youth, much less research has focused on the ways that PA can facilitate adjustment, particularly under conditions of risk. Yet, theory suggests that a greater emphasis on PA as a protective factor is an important endeavor in developmental psychopathology research; such conceptual issues are explored in this review. This review also seeks to spur a more nuanced approach to the study of child PA through the use of increased multi-method, longitudinal assessments as well as the consideration of contextual factors. Building upon this research base is important for aiding in the development of intervention and prevention efforts that attempt to promote positive psychosocial development and mitigate the course of psychopathology in youth at risk for PA difficulties.

Development and initial validation of the Child Disgust Scale

Although disgust sensitivity (DS) has been implicated in the development of anxiety disorders in children, the absence of a measure of DS specifically for children has not allowed for an adequate test of this claim. To fill this important gap in the literature, this investigation presents a series of studies on the development and examination of the psychometric properties (including reliability, validity, and factor structure) of scores on a newly developed Child Disgust Scale (CDS). Exploratory factor analysis in Study 1 (N = 1,500) found that a bifactor model, which allows for a "g" DS factor in addition to 2 distinct factors of Disgust Avoidance and Disgust Affect, was the best fit for the data. Study 2 (N = 573) confirmed a two-factor bifactor model above and beyond a 1-factor model that controlled for method effects due to reverse-worded items. Results from Study 3 (N = 50) provided support for convergent and discriminant validity such that scores on the CDS were significantly correlated with measures of anxiety and fear, but not depression. Finally, Study 4 (N = 86) found that the CDS differentiated children with a diagnosis of specific phobia (n = 43) from a matched nonclinical community sample of children (n = 43), such that those with a specific phobia reported greater DS compared with controls. Results from these studies suggest that the CDS is a developmentally appropriate measure with good psychometric properties that can aid research on the role of disgust sensitivity in anxiety-related disorders in children.

Maternal positive affect mediates the link between family risk and preschoolers' positive affect

The present study sought to further specify conceptual models of youth positive affect (PA) by examining mothers' observed PA as a mediator of the relation between family risk (based on maternal reports of demographic factors) and children's PA in a sample of 82 mothers (M = 31.25 years, SD = 6.16) and their preschool-aged children (M = 3.51 years, SD = .49, 63.00% boys). Results yielded a significant, negative correlation between family risk and child PA. Mediation analyses indicated that family risk was related to child PA through its effects on maternal PA, even after controlling for maternal depression symptoms. Findings suggest that family risk and maternal PA are important factors to consider in understanding preschoolers' PA development. Identifying children at risk for developing PA difficulties can aid in the implementation of prevention and intervention strategies for promoting young children's PA specifically, and their psychosocial functioning more broadly.

Mood and its association with metabolic health in adolescents: a longitudinal study, EarlyBird 65

BACKGROUND

Mood comprises two main traits - positive and negative affect, both associated with depression and anxiety. Studies in children have linked depression with obesity, but the association with metabolic health is unclear.

OBJECTIVE

To explore the relationship between mood and metabolic health in adolescents.

METHODS

We studied 208 healthy children (115 boys) enrolled in the longitudinal EarlyBird Diabetes Study, and reviewed at 7 and 16 yr. Participants completed the Positive Affect and Negative Affect Schedule - Child Form (PANAS-C) at 16yr to assess positive and negative affect, together representing mood. Measures at 7 and 16 yr: body mass index (BMI), fat (%; dual energy X-ray absorptiometry), physical activity (accelerometer), metabolic risk z-score comprising homeostasis model assessment-insulin resistance (HOMA-IR), triglycerides, total cholesterol/high density lipoprotein (HDL) ratio and blood pressure. Pubertal development was determined by age at peak height velocity.

RESULTS

Positive affect was higher in boys than girls, (50 vs. 46, p = 0.001), negative affect higher in girls than boys (26 vs. 22, p < 0.001). Those with lower mood were fatter (r = -0.24, p < 0.001), had higher HOMA-IR (r = -0.12, p = 0.05), higher cholesterol:HDL ratio (r = -0.14, p = 0.02), were less active (r = 0.20, p = 0.003) and had earlier pubertal development (r = 0.19, p = 0.004). Inverse associations between mood and metabolic risk z-score and change in metabolic risk z-score 7-16yr (β = -0.26, p = 0.006, and -0.40, p = 0.004, respectively) were independent of adiposity, physical activity and puberty and sex.

CONCLUSIONS

Low mood in healthy children is associated with poorer metabolic health independently of adiposity. These findings may have implications for the physical and mental health of contemporary youngsters, given their increasing obesity and cardiometabolic risk.

Symptom differentiation of anxiety and depression across youth development and clinic-referred/nonreferred samples: An examination of competing factor structures of the Child Behavior Checklist DSM-oriented scales

This study examined the psychometric properties of the DSM-oriented scales of the Child Behavior Checklist (Achenbach, Dumenci, & Rescorla, 2003) using confirmatory factor analysis to compare the six-factor structure of the DSM-oriented scales to competing models consistent with developmental theories of symptom differentiation. We tested these models on both clinic-referred (N = 757) and school-based, nonreferred (N = 713) samples of youths in order to assess the generalizability of the factorial structures. Although previous research has supported the fit of the six-factor DSM-oriented structure in a normative sample of youths ages 7 to 18 (Achenbach & Rescorla, 2001), tripartite model research indicates that anxiety and depressive symptomology are less differentiated among children compared to adolescents (Jacques & Mash, 2004). We thus examined the relative fit of a six- and a five-factor model (collapsing anxiety and depression) with younger (ages 7-10) and older (ages 11-18) youth subsamples. The results revealed that the six-factor model fit the best in all samples except among younger nonclinical children. The results extended the generalizability of the rationally derived six-factor structure of the DSM-oriented scales to clinic-referred youths and provided further support to the notion that younger children in nonclinical samples exhibit less differentiated symptoms of anxiety and depression.

Comorbidity of anxiety and depression in children and adolescents: 20 years after

Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.

The relationship of religious and general coping to psychological adjustment and distress in urban adolescents

The present study explored the relationships among stress, general and religious coping, and mental health in a sample of urban adolescents. The participants included 587 9th- through 12th-grade students attending two Catholic high schools in the New York City area. They completed a set of self-report measures assessing perceived stress, religious coping, general coping, clinical symptomology, positive and negative affect, and life satisfaction. Correlation and regression analyses were used to describe relationships among variables. Perceived stress, negative religious coping, and avoidant coping were significantly associated with indicators of psychological distress. Conversely, positive religious coping and active/engagement coping were significantly associated with indicators of psychological adjustment. Negative religious coping also was found to moderate the relationship between perceived stress and positive affect. Finally, partial correlational analyses revealed significant relationships between religious coping and mental health indicators, even after controlling for the contributions of general coping. Implications of the findings for research and clinical practice with adolescent populations are considered.

Die gemeinsamen und spezifischen Komponenten von Depression und Angst

Theoretischer Hintergrund: Mit Fragebögen erfasste Depressions- und Angstwerte sind häufig hoch korreliert. Nach dem Tripartite Modell von Clark und Watson (1991) ist diese Kovariation auf die gemeinsame Komponente negativer Affekt zurückzuführen. Eine bessere Differenzierung depressiver und ängstlicher Symptome sei über den depressionsspezifischen geringen positiven Affekt und das angstspezifische physiologische Hyperarousal möglich. Fragestellung: Ziel dieser Studie ist die Überprüfung dieses Modells und die Bestimmung übergeordneter angst- und depressionsspezifischer Faktoren. Methode: Die Evaluation des Modells erfolgte anhand von Fragebögen zu Depression, Angst und Affekt an einer Stichprobe von 1 110 gesunden Erwachsenen (48 % weiblich; Alter: M = 25.43; SD = 6.07). Ergebnisse: Eine Hauptachsenanalyse erbrachte eine zweifaktorielle Lösung, welche sich ebenfalls in den Strukturgleichungsmodellen abbildete und die Konstrukte Depression und Angst repräsentiert. Beide Faktoren waren mit negativem Affekt assoziiert, nur die Komponente Depression war durch das Fehlen von positivem Affekt gekennzeichnet. Die angstspezifische Komponente Hyperarousal konnte nicht nachgewiesen werden. Schlussfolgerungen: Implikationen für weiterführende Studien, insbesondere hinsichtlich der Weiterentwicklung des Modells, werden diskutiert.

Anxiety, affect, self-esteem, and stress: mediation and moderation effects on depression

Background

Mediation analysis investigates whether a variable (i.e., mediator) changes in regard to an independent variable, in turn, affecting a dependent variable. Moderation analysis, on the other hand, investigates whether the statistical interaction between independent variables predict a dependent variable. Although this difference between these two types of analysis is explicit in current literature, there is still confusion with regard to the mediating and moderating effects of different variables on depression. The purpose of this study was to assess the mediating and moderating effects of anxiety, stress, positive affect, and negative affect on depression.

Methods

Two hundred and two university students (males  = 93, females  = 113) completed questionnaires assessing anxiety, stress, self-esteem, positive and negative affect, and depression. Mediation and moderation analyses were conducted using techniques based on standard multiple regression and hierarchical regression analyses.

Main Findings

The results indicated that (i) anxiety partially mediated the effects of both stress and self-esteem upon depression, (ii) that stress partially mediated the effects of anxiety and positive affect upon depression, (iii) that stress completely mediated the effects of self-esteem on depression, and (iv) that there was a significant interaction between stress and negative affect, and between positive affect and negative affect upon depression.

Conclusion

The study highlights different research questions that can be investigated depending on whether researchers decide to use the same variables as mediators and/or moderators.

Why do anxious children become depressed teenagers? The role of social evaluative threat and reward processing

BACKGROUND

Depression is a leading cause of worldwide disability. Adolescence represents a key developmental window in which rates of this disorder increase markedly. Children with an anxiety disorder show a particular risk of developing depression during adolescence.

METHOD

We present and review evidence for a developmental model that considers the intersection of two vulnerabilities relevant to the trajectory from anxiety to depression: difficulties in response to potential social evaluation and changes in reward processing at puberty.

RESULTS

Evidence suggests that these vulnerabilities (a) have been associated with depression, (b) are likely to be problematic in many, but not all, anxious youth, and (c) may be exacerbated by maturational processes that occur around pubertal development in ways that can create a negative spiral into a depressive disorder.

CONCLUSIONS

We discuss the possibility that early intervention strategies targeting key aspects of these vulnerabilities could alter the trajectory away from depression for many anxious youth.

Responding to Anxiety with Rumination and Hopelessness: Mechanism of Anxiety-Depression Symptom Co-Occurrence?

The current research proposes that certain anxiety response styles (specifically, responding to anxiety symptoms with rumination or hopeless cognitions) may increase risk of depressive symptoms, contributing to anxiety-depression comorbidity. We delineate preliminary evidence for this model in three studies. In Study 1, controlling for anxiety response styles significantly reduced the association between anxiety and depressive symptoms in an undergraduate sample. In Study 2, these findings were replicated controlling for conceptually related variables, and anxiety interacted with anxiety response styles to predict greater depressive symptoms. In Study 3, anxiety response styles moderated the prospective association between anxiety and later depression in a generalized anxiety disorder sample. Results support a role for anxiety response styles in anxiety-depression co-occurrence, and show that hopeless/ruminative anxiety response styles can be measured with high reliability and convergent and divergent validity.

Understanding the latent structure of the emotional disorders in children and adolescents

Investigators are persistently aiming to clarify structural relationships among the emotional disorders in efforts to improve diagnostic classification. The high co-occurrence of anxiety and mood disorders, however, has led investigators to portray the current structure of anxiety and depression in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, APA 2000) as more descriptive than empirical. This study assesses various structural models in a clinical sample of youths with emotional disorders. Three a priori factor models were tested, and the model that provided the best fit to the data showed the dimensions of anxiety and mood disorders to be hierarchically organized within a single, higher-order factor. This supports the prevailing view that the co-occurrence of anxiety and mood disorders in children is in part due to a common vulnerability (e.g., negative affectivity). Depression and generalized anxiety loaded more highly onto the higher-order factor than the other disorders, a possible explanation for the particularly high rates of comorbidity between the two. Implications for the taxonomy and treatment of mood and anxiety disorders for children and adolescents are discussed.

Measuring school-related subjective well-being in adolescents

The tripartite model of subjective well-being (SWB) incorporates 3 components: frequent positive emotions, infrequent negative emotions, and an overall positive evaluation of life circumstances (Diener, Suh, Lucas, & Smith, 1999). In light of the large amount of time that youth spend in school, this study investigated a tripartite model of school-related SWB among adolescents, based on 3 measures of SWB appropriate for adolescents. The measures included a measure of school satisfaction (SS) and measures of positive and negative emotions experienced specifically during school hours. Confirmatory factor analysis was conducted to analyze the factorial validity of 3- and 4-factor models of school-related SWB in a sample of 921 adolescents. Results indicated that a 4-factor model comprised of positive emotions, negative emotions, fear-related negative emotions, and SS best described the structure of school-related SWB in the current sample. Results also revealed a comparable factor structure for male and female students. The study points to the possible benefits of a contextualized approach to SWB that takes into account the specific environments in which adolescents live.

Affective determinants of anxiety and depression development in children and adolescents: an individual growth curve analysis

The tripartite model (in Clark and Watson, J Abnorm Psychol 100:316-336, 1991) comprises Negative Affect (NA), Positive Affect (PA), and Physiological Hyperarousal (PH), three temperamental-based dimensions. The current study examined the tripartite model's assumptions that (a) NA interacts with PA to predict subsequent depressive (but not anxiety) symptom developments and (b) NA interacts with PH to predict subsequent anxiety (but not depressive) symptom developments in a sample of 243 community and referred children and adolescents (42.8% boys; M age = 10.87 years, SD = 1.83). Results confirmed that individuals with a combined high NA/low PA profile display the least favorable course of depressive -but not anxiety- symptoms. In contrast with the model, the combination of NA and PH influenced the development of depression, but not anxiety. Relations were not moderated by sex or sample. Results revealed that the assessment of the tripartite components is warranted as it can help to identify children at risk for an unfavorable depressive symptom course.

An examination of the tripartite model of depressive and anxiety symptoms in African American youth: stressors and coping strategies as common and specific correlates

The purpose of the current study was to examine the tripartite model of depression and anxiety in a community-based sample of 278 African American adolescents (M age = 12.89) from low-income communities and to identify stressors and coping strategies that were associated with the specific features of each disorder. Participants reported on depression, anxiety, stressors, and coping strategies. As predicted, the three-factor structure of the tripartite model was a valid representation of anxiety and depression in African American youth. Further, stressors and coping strategies showed specific associations to features of depression and anxiety. The findings provide evidence of factors that may help to distinguish between internalizing symptoms in African American youth.

Do positive and negative temperament traits interact in predicting risk for depression? A resting EEG study of 329 preschoolers

Researchers have long been interested in whether particular temperamental traits in childhood connote risk for depressive disorders. For example, children characterized as having high negative emotionality (NE; sadness, fear, anger) and low positive emotionality (PE; anhedonia, listlessness, and lack of enthusiasm) are hypothesized to be at risk for depression. Few studies, however, have examined whether (and how) these two temperamental dimensions interact to confer risk. In a sample of 329 preschoolers, the present study addressed this question by examining the relation between PE and NE and asymmetry in resting EEG activity in frontal and posterior regions, which are putative biomarkers for depression. Using a laboratory battery to define temperament, we found an interaction of PE and NE on posterior asymmetry. Specifically, when PE was high, NE was associated with greater relative right activity. When PE was low, NE was not related to posterior asymmetry. These results were driven by differences in EEG activity in right posterior regions, an area associated with emotional processing and arousal, and were specific to girls. We found no relation between temperament and frontal asymmetry. These findings suggest that, at least for girls, PE and NE may have an interactive effect on risk for depression.