Relationship between Symptoms of Anxiety and Depression in a Sample of Arab College Students Using the Hopkins Symptom Checklist 25

Abstract

Background: The controversy over the relationship between symptoms of anxiety and depression is an enduring issue. Various models have been proposed to explain this relationship. We explored the following research questions. First, using exploratory factor analysis (EFA), will the symptoms that define anxiety and depression (as in the Hopkins Symptom Checklist 25, HSCL-25) appear together in 1 factor, or are they separable into the hypothesized dimensions of the disorders? Second, using confirmatory factor analysis, how will the structural integrity of the resulting factors compare with those of the various models that have been proposed to explain the relationship between the symptoms of anxiety and depression? This issue has not been investigated in an Arab setting. Method: Participants (n = 624) were Kuwaiti national college students, who completed the HSCL-25 in class. EFA was done by principal axis factoring. Seven models were generated for comparison in confirmatory factor analysis, using 8 ‘fit’ indices in Analysis of Moment Structures, version 16. Results: The 5 factors from EFA were similar in construct to the subscales of the Mood and Anxiety Symptom Questionnaire, on which the tripartite model of anxiety and depression was validated (‘core anxiety’, ‘core depression’, ‘general distress mixed’, ‘general distress anxiety’, ‘general distress depression’). The hierarchical bifactor model and the dimensional model characterized by the correlation of these factors were best at meeting the fit indices, followed by the correlated 2-factor anxiety/depression model. In line with theory, the correlation between the specific anxiety/depression factors was lower than that between each of them and the general distress mixed factor; and there was no significant gender difference in the summed score for core depression. Conclusion: The findings support the impression that, although the core symptoms of anxiety are separable from the core symptoms of depression, there is an overlapping set of symptoms which contribute to the experience of comorbidity. The relationship between symptoms of anxiety and depression probably has dimensional and hierarchical elements. The findings broaden the evidence base of the cross-cultural validity of the tripartite model.

The assessment of psychopathology among traumatized refugees: measurement invariance of the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 across five linguistic groups

“…Although research showed that headaches are usually part of the anxiety scale (e.g. Al-Turkait et al, 2011; Glaesmer et al, 2013) or at least coincide with depression and anxiety (Juang, Wang, Fuh, Lu, & Su, 2000; Zwart et al, 2003), in our non-western refugee groups headache was part of neither the depression nor the anxiety scale. This indicates that among non-western refugee groups headache is not part of depression or anxiety.…”

“…According to Al-Turkait and colleagues (2011), most scholars found evidence for the 2-factor model and the 3-factor model of the HSCL-25. The 2-factor model comprises symptoms specific to anxiety and symptoms specific to depression, and the 3-factor model additionally distinguishes nonspecific symptoms of general distress which the two disorders share (Al-Turkait et al, 2011).…”

“…The 2-factor model comprises symptoms specific to anxiety and symptoms specific to depression, and the 3-factor model additionally distinguishes nonspecific symptoms of general distress which the two disorders share (Al-Turkait et al, 2011). Glaesmer and colleagues (2013) concluded that, because of the high inter-correlations of the factors of the tripartite model, the 2-factor model is the preferable factor solution.…”

Measurement invariance of the Hopkins Symptoms Checklist: a novel multigroup alignment analytic approach to a large epidemiological sample across eight conflict-affected districts from a nation-wide survey in Sri Lanka

“…The measure has been adapted and translated for use in conflict settings in Asia [11–13], the Middle East [14], Africa [15, 16], and the former Yugoslavia [17, 18]. The HSCL-25 is currently available in a wide range of languages including Arabic [19], Hmong [20], Kiswahili [16], Pashto [14], Farsi, Dari, Bosnian, Somali [9], Vietnamese [21], Swedish [22], Serbo-Croatian, Russian [23], Tibetan [13], Indochinese [24, 25], and Khmer.…”

Translation and validation of the Cardiac Depression Scale to Arabic

“…Although the difference in the correlations may not be clinically significant, it suggests that there was a comorbidity of depression and anxiety in our sample. This may have two not mutually exclusive explanations: a) The comorbidity of depression and anxiety is evident worldwide (Kessler et al, 2015) and in the Arabic population specifically (Al-Turkait et al, 2011;Belzer and Schneier, 2004;Ohaeri et al, 2010) and b) there is evidence that depression is correlated to anxiety in patients with heart disease (Frasure-Smith et al, 1995;Watkins et al, 2013) and this comorbidity can affect between 21% to 26% of the patients (Doering et al, 2010;Frasure-Smith and Lesperance, 2008). Both explanations support the validity of the A-CDS.…”