Depression, anxiety, and stress as hierarchical factors of general ...
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Depression, anxiety, and stress as hierarchical factors of general ...

Depression, anxiety, and stress ashierarchical factors of generaldistress in Hispanic young adults.Thom Taylor, José Cabriales, Theodore V. Cooper,Yvette Güereca, Justin Kepple, & FranciscoSalgado-Garcia


Hispanic Psychological Distress• Hispanics experience frequent distress (10.5% )– May be partially mediated by socio-economic status (SES)– Low SES associated with 2 times the likelihood ofexperiencing psychological distress across all ethnicities– Potentially higher exposure to stressors in Hispanics• Psychological distress associated with other negativeoutcomes in Hispanics– Substance use in young adults– Lower school engagementCenters for Disease Control, 2004; Brown, Meadows, & Elder Jr., 2007; USDHHS, 2004; Swanson et al., 1992;Roberts, Roberts, & Chen, 1997; Herman-Stahl, Krebs, Kroutil, & Heller, 2007; Close & Solber, 2008; Brown et al.,2007

Conceptualizations of Distress• Often includes:– Anxiety– Depression– Comorbid anxiety and depression– Mixed anxiety-mood diagnosis urged in DSM-IViterations• Non-specific symptoms may also be present:– Negative affect symptoms– Stress symptoms (reactions to stressors)Widiger & Clark, 2000; Lustman, Sowa, & O’Hara, 1984; Cervantes, Salgado de Snyder, & Padilla, 1989; Roy-Byrne etal., 1994

Tripartite Model Framework• Depression: lesser positive affect• Anxiety (arousal symptoms): physiologicalarousal• Stress reaction anxiety (negative affect):“inferiority, rejection, self-consciousness,social distress, and anxious mood” (stressand negative affect)Clark & Watson, 1991, p.329 ; Mineka, Watson, & Clark, 1998; Chorpita, Albano, & Barlow, 1998; Zinbarg & Barlow,1996

Measurement of DistressDepression, Anxiety, and Stress Scale(DASS)– Supported by Tripartite model• Recently suggested to have an overarchinggeneral distress component– Clinical samples– General population (non-clinical)Lovibond & Lovibond, 1995; Brown, Chorpita, Korotitsch, & Barlow, 1997; Page, Hooke, & Morrison, 2007; Henry &Crawford, 2005; Crawford & Henry, 2003


Aims and HypothesesAIM: To better understand general psychologicaldistress within Hispanics– Depression– Anxiety– StressHypotheses1.Existence of a hierarchical structure of generalpsychological distress with sub-factors of depression,anxiety, and stress2.Sub-factors will load equally on general distress(after correlated errors among items are accountedfor)

Hypothesized Model: 3 Sub-factors toGeneral DistressGeneralDistress===DepressionAnxietyStress

The DASS in Detail• Common and in the open domain• 42 item measure (21 item measure also exists)• Range of each item is 0 – 3• Total scores for each subscale (DEP, ANX, STR) can rangebetween 0 – 42• Higher scores indicate higher levels of the distress constructs• Example items:– I couldn’t seem to experience any positive feeling at all (DEP)– I was aware of dryness of my mouth (ANX)– I found myself getting upset by quite trivial things (STR)Lovibond & Lovibond, 1995; Ng et al., 2007; Bados, Solanas, & Andrés, 2005

Sampling and Approach To Analysis• Cross-sectional survey of Hispanic young adults• Hierarchical Confirmatory Factor Analysis (CFA)– Theoretical approach– ANX, DEP, and STR loading on a broader General Distress(GD) factor– Correlated item disturbances– Equality constraints imposed for model difference testing• Eigenvalues estimated from entire data set– Empirical approach– Principal component eigenvalues >1.00 (Kaiser rule)– Minimum Average Partial Correlation (MAP)Kaiser, 1960; Velicer, 1976


Descriptive Statistics of Sample• n = 434• 59% Female• 87% Mexican American/Other Hispanic; 13%Mexican NationalContinuousVariables M SD Range Overall αAge 20.16 3.97 18 - 39 -DASS Depression 5.19 7.49 0 - 41 0.95DASS Anxiety 5.11 5.81 0 - 33 0.87DASS Stress 8.94 8.00 0 - 42 0.92

Unconstrained Stnd. Factor LoadingsGeneralDistress.90 .93.99DepressionAnxietyStressModel Fitχ² (763) = 1634.96, p < .001CFI = .92NNFI = .91RMSEA = .05SRMR = .05Note: Items loaded on putativefactors; Factor loadings of DASSitems, as well as errors andcorrelation among errors availableupon request

Equality of Factor LoadingsModel (λ Constraint) χ² (df) AIC BICD = A 1641.64 (764) 25945.94 26666.12D = S 1634.97 (764) 25939.27 26659.45A = S 1640.00 (764) 25944.30 26664.48Any 2 of 3 λs constr. 1642.06 (765) 25944.36 26660.56D = A, D = S, A = S Underidentified-no convergenceUnconstrained 1634.96 (763) 25857.26 26414.30Note: D = Depression; A = Anxiety; S = StressAIC = Akaike Information Criterion; BIC = Bayesian Information Criterion

Unequal Hierarchical LoadingsGeneralDistress.90≠.99≠.93≠DepressionAnxietyStress

DASS Performance: Blank SlateApproach• Kaiser Rule (eigenvalues >1.00) suggests 6 factors• MAP estimation suggests 4 factors• Eigenvalue sizes may indicate 1 factorNo. Guassian Normal Categorical MAP1 18.09 23.99 0.014892 2.26 1.99 0.010853 1.78 1.87 0.009724 1.31 1.22 0.009715 1.23 1.15 0.010056 1.09 1.04 0.01035MAP = Min. Average Partial Correlation of Components


Nuances of General Distress• Hierarchical GD factor largely supported forHispanics• Strong evidence for GD factor encompassingDEP, ANX, and STR– Associations among DASS DEP, ANX, and STR arestronger in Hispanics relative to other ethnicities– Anxiety symptomology (particularly autonomicarousal related symptomology) may be mostdistressing for healthy young adult HispanicsHenry & Crawford, 2005; Norton, 2007; Roy-Byrne et al., 1994; Zinbarg & Barlow, 1996;

Implications for Mental Health• DASS conceptualization of mental health fitsreasonably with Tripartite Model– 3 sub-factors supported in Hispanic population– Still, multiple sub-factors to GD, DEP, ANX, and STR mayexist (3 level structure)• Possibility that sub-clinical symptoms become morefocused over time (i.e., more perceptible and/ordetectable)– Higher scores on DASS among treatment seeking samplesrelative to non-clinical samples– ANX DEP significantly more thanDEP ANX at the population levelChorpita, Albano, & Barlow, 1998; Power & Tarsia, 2007; Hinden, Compas, Howell, & Achenbach, 1997; Clark &Watson, 1991; Brown et al., 1997; Mineka et al., 1998

Analogy: Hurricane DevelopmentWell developed eye:Clinical symptomologyStrengthening: Morespecific symptomclustersEarly stages: Diffuse,but focusing symptomspresent

Future Directions• Longitudinal tracking (e.g., National Latino andAsian American Study) of Hispanics across time– Specific symptom cluster development patterns– Brief measures that are sensitive to nuances oflanguage usage on U.S./México border• Representativeness (other ethnicities, ages)• Monitoring and effective treatment andprevention resources– Evidence based care– Hispanics and U.S./México border region generallyresource deprivedYoung, Klap, Sherbourne, & Wells, 2001; USDHHS, 2004; Riolo, Nguyen, Greden, & King; Mikolajczyk, Bredehorst,Khelaifat, Maier, & Maxwell, 2007; Kessler et al., 2002

Acknowledgements• This research project was supported by:– The Hispanic Health Disparities Research Center,Grant 1P20MD002287-03– A Smoke Free Paso del Norte: An Initiative of thePaso del Norte Health Foundation Grant # 26-8113-17• Members of the PATCH Lab past and presentPREVENTION AND TREATMENTIN CLINICAL HEALTH


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