Distinguishing between depression and anxiety: A proposal for an extension of the tripartite model (original) (raw)

Testing a Tripartite Model: I. Evaluating the Convergent and Discriminant Validity of Anxiety and Depression Symptom Scales

Journal of Abnormal …, 1995

  1. proposed a tripartite model that groups symptoms of depression and anxiety into 3 subtypes: symptoms of general distress that are largely nonspecific, manifestations of somatic tension and arousal that are relatively unique to anxiety, and symptoms of anhedonia and low Positive Affect that are specific to depression. This model was tested in 5 samples (3 student, 1 adult, and 1 patient sample) using the Mood and Anxiety Symptom Questionnaire (MASQ; D. Watson & L. A. Clark, 1991), which was designed to assess the hypothesized symptom groups, together with other symptom and cognition measures. Consistent with the tripartite model, the MASQ Anxious Arousal and Anhedonic Depression scales both differentiated anxiety and depression well and also showed excellent convergent validity. Thus, differentiation of these constructs can be improved by focusing on symptoms that are relatively unique to each.

The tripartite model of anxiety and depression: A new look at theory and measurement

The relationship between anxiety and depression remains unclear, despite ongoing revision of diagnostic concepts over the last sixty years. Various proposals have been suggested which attempt to explain this relationship. Some have suggested that anxiety and depression are distinct disorders, with different etiologies, symptoms, natural courses, and response to treatment (the pluralist position). Others have suggested that anxiety and depression are a single disorder, or at least different manifestations of the same underlying pathology (the unitary position). Clark & Watson (1991) proposed an alternative model in which anxiety and depression symptoms are divided into three clusters-a specific set of symptoms for each, as well as a shared set of non-specific symptoms seen in both disorders. They suggested that such a tripartite model of anxiety and depression symptoms provided the best description of the manifestation of anxiety and depression symptoms. Clark & Watson (1991) further suggested that by focusing on the specific symptoms of anxiety and depression, the discriminant validity of psychometric assessments of the two could be improved. The current research reviews the literature in support of unitary, pluralist and tripartite models of anxiety and depression symptoms, and concludes that a tripartite model is the most consistently supported by the literature, including studies of symptoms, course, treatment, etiology, family patterns and genetics in both. It examines in detail the research into the tripartite structure of anxiety and depression symptoms, and concludes that previous research also supports a three-factor structure of anxiety and depression symptoms in existing self-report measures. The Mood and Anxiety Symptom Questionnaire (MASQ) is reviewed as the only existing clinical symptom measure based on the tripartite model. Although previous authors have reported broad support for the MASQ, the present research uniquely used a sample of anxious and depressed patients and confirmatory factor analytic methods, and failed to support the MASQ as a valid tripartite measure. Specifically, there was no support at the item or subscale level for any of the two-factor or three-factor models tested. Furthermore, the MASQ subscales did not show the expected differences when compared between anxious and depression patients, and the instrument was found to be inadequate in discriminating between those diagnosed with anxiety versus those diagnosed with depression. In response to the psychometric inadequacy of the MASQ, the Tripartite Clinical Symptom Inventory (TCSI) was proposed as a measure based on the tripartite model which would be clinically useful, as well as showing strong reliability and validity. It was also proposed that the TCSI would further validate several aspects of the tripartite theory of anxiety and depression symptoms. The original 45-item set was reduced over a series of exploratory factor analyses, designed to yield a core subset of symptoms that were reliably and stably associated with

Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications

Journal of Abnormal Psychology, 1991

We review psychometric and other evidence relevant to mixed anxiety-depression. Properties of anxiety and depression measures, including the convergent and discriminant validity of self-and clinical ratings, and interrater reliability, are examined in patient and normal samples. Results suggest that anxiety and depression can be reliably and validly assessed; moreover, although these disorders share a substantial component of general affective distress, they can be differentiated on the basis of factors specific to each syndrome. We also review evidence for these specific factors, examining the influence of context and scale content on ratings, factor analytic studies, and the role of low positive affect in depression. With these data, we argue for a tripartite structure consisting of general distress, physiological hyperarousal (specific anxiety), and anhedonia (specific depression), and we propose a diagnosis of mixed anxiety-depression.

Differentiating anxiety and depression: the State-Trait Anxiety-Depression Inventory

Cognition & Emotion, 2016

The differentiation of trait anxiety and depression in nonclinical and clinical populations is addressed. Following the tripartite model, it is assumed that anxiety and depression share a large portion of negative affectivity (NA), but differ with respect to bodily hyperarousal (specific to anxiety) and anhedonia (lack of positive affect; specific to depression). In contrast to the tripartite model, NA is subdivided into worry (characteristic for anxiety) and dysthymia (characteristic for depression), which leads to a four-variable model of anxiety and depression encompassing emotionality, worry, dysthymia, and anhedonia. Item-level confirmatory factor analyses and latent class cluster analysis based on a large nationwide representative German sample (N = 3150) substantiate the construct validity of the model. Further evidence concerning convergent and discriminant validity with respect to related constructs is obtained in two smaller nonclinical and clinical samples. Factors influencing the association between components of anxiety and depression are discussed.

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

Behaviour Research and Therapy, 2007

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

Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample

Psychological Assessment, 1998

The factor structure, reliability, and validity of the Depression Anxiety Stress Scales (DASS; S. H. Lovihond & P. F. Lovibond, 1995) and the 21-item short form of these measures (DASS-21) were examined in nonclinical volunteers (n = 49) and patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnoses of panic disorder (n = 67), obsessive-compulsive disorder (n = 54), social phobia (n = 74), specific phobia (n = 17), and major depressive disorder (n -46). This study replicates previous findings indicating that the DASS distinguishes well between features of depression, physical arousal, and psychological tension and agitation and extends these observations to the DASS-21. In addition, the internal consistency and concurrent validity of the DASS and DASS-21 were in the acceptable to excellent ranges. Mean scores for the various groups were similar to those in previous research, and in the expected direction. The implications of these findings are discussed.