A comparison and integration of structural models of depression and anxiety in a clinical sample: Support for and validation of the tri-level model.

Abstract

Prominent structural models of depression and anxiety arise from two traditions: (1) the tri-partite/integrative hierarchical model based on symptom dimensions, and (2) the fear/anxious-misery model based on diagnostic comorbidity data. The tri-level model of depression and anxiety was developed to synthesize these structural models, postulating that narrow (disorder-specific), intermediate (fear and anxious-misery), and broad (general distress) structural factors are needed to most fully account for covaration among these symptoms. Although this model has received preliminary support (Prenoveau et al., 2010), the current study compares it to the above established models and seeks to validate the best-fitting structure. We evaluated the tri-level model and alternative structural models in a large clinical sample (N = 1,000) using bi-factor analysis. In exploratory and confirmatory subsamples, the tri-level model provided a good fit to the data and each of the three levels (narrow, intermediate, and broad) accounted for substantial variance; this model provided a superior fit relative to more parsimonious competing structural models. Furthermore, impairment was independently associated with all three levels of the tri-level model, comorbidity was most closely linked to the broad tri-level dimensions, and the factors generally showed the expected convergent/discriminant associations with diagnoses. Results suggested several revisions to prior research: (1) worry may be best modeled at the broadest structural level, rather than as an indicator of anxious-misery or fear; (2) social interaction anxiety may belong with anxious-misery, rather than fear; and (3) obsessive-compulsive disorder is generally associated with fear disorders, but hoarding is associated with both fear and anxious-misery.

Depression diagnoses, but not individual differences in depression symptoms, are associated with reduced autobiographical memory specificity

“…Future studies could explore the possibility that individual differences in depression severity rated by a clinician are associated with rAMS even if self‐reported disorder severity is not, or whether different aspects of depression are differentially associated with rAMS. It could also be that, as rAMS is evident amongst people with a range of diagnoses rather than just MDD, that rAMS is instead associated with the severity of the general distress that underlies all emotional disorders (Naragon‐Gainey, Prenoveau, Brown, & Zinbarg, ; Prenoveau et al ., ) rather than the severity of the narrow depressive symptoms that are captured by the BDI‐II. Future research could explore this possibility by examining the extent to which the general distress factor that underlies each of the disorders correlates more strongly with specificity than narrow disorder‐specific factors.…”

Three-way interaction of neuroticism, extraversion, and conscientiousness in the internalizing disorders: Evidence of disorder specificity in a psychiatric sample

“…In addition, dysthymic disorder (the DSM-IV predecessor to PDD) consistently loads with the distress disorders (Krueger, 1999; Slade & Watson, 2006; Watson, 2005), and social anxiety has been linked to the distress disorders in some structural studies (Naragon-Gainey, Prenoveau, Brown, & Zinbarg, 2016). But neither of these disorders showed any interactive effects among traits in our data.…”

“…But neither of these disorders showed any interactive effects among traits in our data. With regard to social anxiety, there is evidence that generalized or interaction social anxiety (that is, social anxiety in most or all social interactions) is distinct in terms of personality and functioning from performance social anxiety (that is, social anxiety in specific situations in which one is observed), and that interaction social anxiety is more closely related to depression and to the distress disorders (Carter & Wu, 2010; Hughes et al, 2006; Naragon-Gainey et al, 2016). Thus, it is plausible that the three-way interaction may have emerged for interaction social anxiety, but combining these symptoms in the current study may have inhibited the detection of this effect.…”

Bifactor and Hierarchical Models: Specification, Inference, and Interpretation

“…Bifactor models are now ubiquitous in structural modeling of psychopathology. They have been central to general factor models of psychopathology (e.g., Caspi et al 2014, Laceulle et al 2015, Lahey et al 2012, Stochl et al 2015, and have become a prominent focus in modeling a range of phenomena, as diverse as internalizing psychopathology (Naragon-Gainey et al 2016), externaling psychopathology (Krueger et al 2007), psychosis (Shevlin et al 2017), somatic-related psychopathology (Witthöft et al 2016), cognitive functioning (Frisby & Beaujean 2015), and constructs central to prominent therapeutic paradigms (Aguado et al 2015). They have also become central to modeling method effects, such as informant (Bauer et al 2013), keying (Gu et al 2017;Tomas & Oliver 1999), and other effects (DeMars 2006), and have been used to explicate fundamental elements of measurement theory (Eid et al 2017).…”