General distress, hopelessness—suicidal ideation and worrying in adolescence: Concurrent and predictive validity of a symptom-level bifactor model for clinical diagnoses

Abstract

BackgroundClinical disorders often share common symptoms and aetiological factors. Bifactor models acknowledge the role of an underlying general distress component and more specific sub-domains of psychopathology which specify the unique components of disorders over and above a general factor.MethodsA bifactor model jointly calibrated data on subjective distress from The Mood and Feelings Questionnaire and the Revised Children's Manifest Anxiety Scale. The bifactor model encompassed a general distress factor, and specific factors for (a) hopelessness—suicidal ideation, (b) generalised worrying and (c) restlessness—fatigue at age 14 which were related to lifetime clinical diagnoses established by interviews at ages 14 (concurrent validity) and current diagnoses at 17 years (predictive validity) in a British population sample of 1159 adolescents.ResultsDiagnostic interviews confirmed the validity of a symptom-level bifactor model. The underlying general distress factor was a powerful but non-specific predictor of affective, anxiety and behaviour disorders. The specific factors for hopelessness—suicidal ideation and generalised worrying contributed to predictive specificity. Hopelessness—suicidal ideation predicted concurrent and future affective disorder; generalised worrying predicted concurrent and future anxiety, specifically concurrent generalised anxiety disorders. Generalised worrying was negatively associated with behaviour disorders.LimitationsThe analyses of gender differences and the prediction of specific disorders was limited due to a low frequency of disorders other than depression.ConclusionsThe bifactor model was able to differentiate concurrent and predict future clinical diagnoses. This can inform the development of targeted as well as non-specific interventions for prevention and treatment of different disorders.

Psychopathological Differences Between Suicide Ideators and Suicide Attempters in Patients with Mental Disorders

“…These discrepancies in the results could be explained by differences in the sample studied, in this case, depressive patients. Mean scores on hopelessness in this study were higher than in our study, perhaps indicating that hopelessness is a more common symptom in depressive patients (Brodbeck et al, 2014) than in eating disorder patients, who represented a large percentage of our sample. As no measure was used to detect the level of depression in this study, the influence of depression on hopelessness or on the lack of purpose in life should be explored in future studies.…”

Sporadic and recurrent non-suicidal self-injury before age 14 and incident onset of psychiatric disorders by 17 years: prospective cohort study

“…27 From these items a bifactor analysis revealed an underlying 'general distress factor' shown to predict onsets of depressive, anxiety and behavioural disorders between 14 and 17 years in this cohort. 20,21 Evaluation of the early family environment and exposure to adversities before the age of 5 years was measured by information obtained from one parent respondent (>90% biological mothers) using the Cambridge Early Experiences Interview. 18 Latent class analysis was used to assign all participants to one of four groups: optimal family environment (63%) and three suboptimal ones labelled atypical (7%), discordant (24%) and hazardous family environments (6%).…”

“…In this sample such a general latent distress trait has been reported 20 and is associated with the emergence of all mental illnesses and NSSI over the 14-to 17-year age range (available from authors on request). 21 Here, we report a prospective study that investigates the general hypothesis that NSSI by 14 years of age is a behavioural marker for incident onset mental illness by 17 years. More specifically we hypothesise that any such association is confined to those with recurrent episodes of NSSI.…”

Factor Structure of the Parent-Report Mood and Feelings Questionnaire (MFQ) in an Outpatient Mental Health Sample

“…As discussed above, establishing adequate construct validity includes identifying differential associations between items within and between symptom domains. As such, MFQ items assessing symptoms more unique to depression (e.g., cognitive vs. somatic symptoms) have helped to distinguish depressive disorders from general distress among youth with multiple psychiatric diagnoses (Brodbeck et al 2011;Brodbeck et al 2014;Diler et al 2007) and have also demonstrated predictive value for critical outcomes such as suicidality (Hammerton et al 2014;Nrugham et al 2008). For researchers and clinicians primarily interested in criterion validity, a shortened, unidimensional, 13-item version of the MFQ with adequate criterion validity is available Messer et al 1995).…”