The anxiety disorders and suicidal ideation: accounting for co-morbidity via underlying personality traits

2010 ◽  
Vol 41 (7) ◽  
pp. 1437-1447 ◽  
Author(s):  
K. Naragon-Gainey ◽  
D. Watson
Keyword(s):  
Suicidal Ideation ◽  
Social Anxiety ◽  
Anxiety Disorders ◽  
Personality Traits ◽  
Internalizing Disorders ◽  
Specific Phobia ◽  
Self Report ◽  
Equation Modeling ◽  
Co Morbidity ◽  
Shared Variance

BackgroundThe anxiety disorders are robust correlates/predictors of suicidal ideation, but it is unclear whether (a) the anxiety disorders are specifically associated with suicidal ideation or (b) the association is due to co-morbidity with depression and other disorders. One means of modeling co-morbidity is through the personality traits neuroticism/negative emotionality (N/NE) and extraversion/positive emotionality (E/PE), which account for substantial shared variance among the internalizing disorders. The current study examines the association between the internalizing disorders and suicidal ideation, after controlling for co-morbidity via N/NE and E/PE.MethodThe sample consisted of 327 psychiatric out-patients. Multiple self-report and interview measures were collected for internalizing disorders [depression, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), social anxiety, panic and specific phobia] and suicidal ideation, as well as self-report measures for N/NE and E/PE. A model was hypothesized in which each disorder and suicidal ideation was regressed on N/NE, and depression and social anxiety were regressed on E/PE. Structural equation modeling (SEM) was used to examine the unique association of suicidality with each disorder, beyond shared variance with N/NE and E/PE.ResultsThe hypothesized model was an acceptable fit to the data. Although zero-order analyses indicated that suicidal ideation was moderately to strongly correlated with all of the disorders, only depression and PTSD remained significantly associated with suicidal ideation in the SEM analyses.ConclusionsIn a latent variable model that accounts for measurement error and a broad source of co-morbidity, only depression and PTSD were uniquely associated with suicidal ideation; panic, GAD, social anxiety and specific phobia were not.

scholarly journals Transdiagnostic and disorder-specific models of intergenerational transmission of internalizing pathology

2013 ◽  
Vol 44 (1) ◽  
pp. 161-172 ◽  
Author(s):  
L. R. Starr ◽  
C. C. Conway ◽  
C. L. Hammen ◽  
P. A. Brennan
Keyword(s):  
Anxiety Disorders ◽  
Maternal Depression ◽  
Intergenerational Transmission ◽  
Latent Variable ◽  
Structural Equation ◽  
Depressive Disorders ◽  
Internalizing Disorders ◽  
Equation Modeling ◽  
Co Morbidity ◽  
Child Psychiatric

BackgroundNumerous studies have supported an association between maternal depression and child psychiatric outcomes, but few have controlled for the confounding effects of both maternal and offspring co-morbidity. Thus, it remains unclear whether the correspondence between maternal and offspring depressive and anxiety disorders is better explained by associations between shared features of maternal and offspring internalizing disorders or by specific effects exerted by unique aspects of individual disorders.MethodPairs of mothers and offspring overselected for maternal depression (n = 815) were assessed at offspring age 15 years for anxiety and depressive disorders; 705 completed a follow-up at offspring age 20 years. For both mothers and offspring, structural equation modeling was used to distinguish transdiagnostic internalizing pathology – representing the overlap among all depressive and anxiety disorders – from diagnosis-specific forms of pathology. To discriminate between general versus specific pathways of intergenerational transmission of psychopathology, we examined (a) the general association between the maternal and offspring internalizing factors and (b) the correlations between maternal and offspring diagnosis-specific pathology for each disorder.ResultsFor mothers and offspring, a unidimensional latent variable model provided the best fit to the correlations among depressive and anxiety disorders. The maternal transdiagnostic internalizing factor strongly predicted the corresponding factor among offspring. In addition, the unique component of post-traumatic stress disorder among offspring was significantly related to the analogous unique component among mothers, but specific components of other maternal disorders, including depression, did not predict corresponding offspring pathology.ConclusionsResults suggest that intergenerational transmission of internalizing disorders is largely non-specific.

Differences in Suicide Risk Severity Among Suicidal Youth With Anxiety Disorders

Crisis ◽  
2019 ◽  
Vol 40 (5) ◽  
pp. 333-339 ◽  
Author(s):  
Joanna Herres ◽  
Annie Shearer ◽  
Tamar Kodish ◽  
Barunie Kim ◽  
Shirley B. Wang ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Suicidal Ideation ◽  
Social Anxiety ◽  
Anxiety Disorders ◽  
Suicide Risk ◽  
Suicide Ideation ◽  
Self Report ◽  
Health Concern ◽  
Future Research ◽  
Major Depressive

Abstract. Background: Adolescent suicidality is a growing public health concern. Although evidence supports a link between anxiety and suicidality, little is known about risk associated with specific anxiety disorders. Aims: This study examined the prevalence of anxiety disorders in a sample of adolescents with depression and suicidal ideation and the associations between specific anxiety disorders and suicide ideation severity and attempt history. Method: The sample consisted of 115 adolescents ( Mage= 14.96 years; 55.8% African American) entering a clinical trial for suicidal ideation and depressive symptoms. Prior to treatment, adolescents completed self-report and interview measures. Results: In all, 48% of the sample met criteria for an anxiety disorder, 22% met criteria for social anxiety disorder (SAD), and 40% met criteria for major depressive disorder (MDD). SAD was uniquely associated with more severe suicidal ideation. Limitations: Findings may not generalize to all suicidal adolescents, and non-measured variables may account for the observed relationships. Conclusion: Future research should examine whether targeting social anxiety would improve treatment response for suicidal adolescents.

The Relations Between Identity Disturbances, Borderline Features, Internalizing Disorders, and Suicidality in Inpatient Adolescents

2021 ◽  
pp. 1-19
Author(s):  
Marcin Sekowski ◽  
Malgorzata Gambin ◽  
Carla Sharp
Keyword(s):  
Suicidal Ideation ◽  
Identity Development ◽  
Structural Equation ◽  
Rating Scale ◽  
Internalizing Disorders ◽  
Self Report ◽  
Equation Modeling ◽  
Multiple Mediation ◽  
Severity Rating ◽  
Identity Disruption

Previous studies have demonstrated positive associations between identity disturbances and suicidality in adolescents; however, mechanisms underlying these relationships are not well understood. The authors propose that borderline features and various internalizing disorders may mediate these relations. The aim of this study was to test a multiple mediation model of the associations between these constructs using structural equation modeling. Ninety-six inpatient adolescents aged 12–17 years completed the Assessment of Identity Development in Adolescents, the Childhood Interview for DSM-IV Borderline Personality Disorder, the Youth Self-Report, and the Columbia-Suicide Severity Rating Scale. Findings partly confirmed the theoretical model. Borderline features mediated the positive effect of identity disturbances on suicidal ideation severity. Mediations of withdrawn/depression and anxiety/depression on the effect of identity disruption on suicidal ideation intensity were demonstrated. Identity disruptions and borderline and depressive symptoms could be possible targets for interventions for youth experiencing suicidal ideation.

scholarly journals Neuroticism as a common dimension in the internalizing disorders

2009 ◽  
Vol 40 (7) ◽  
pp. 1125-1136 ◽  
Author(s):  
J. W. Griffith ◽  
R. E. Zinbarg ◽  
M. G. Craske ◽  
S. Mineka ◽  
R. D. Rose ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Structural Equation ◽  
Discriminant Validity ◽  
Self Report ◽  
Equation Modeling ◽  
Internalizing Psychopathology ◽  
Mood And Anxiety Disorders ◽  
Co Morbidity ◽  
Peer Report ◽  
The Relationship

BackgroundSeveral theories have posited a common internalizing factor to help account for the relationship between mood and anxiety disorders. These disorders are often co-morbid and strongly covary. Other theories and data suggest that personality traits may account, at least in part, for co-morbidity between depression and anxiety. The present study examined the relationship between neuroticism and an internalizing dimension common to mood and anxiety disorders.MethodA sample of ethnically diverse adolescents (n=621) completed self-report and peer-report measures of neuroticism. Participants also completed the Structured Clinical Interview for DSM-IV (SCID).ResultsStructural equation modeling showed that a single internalizing factor was common to lifetime diagnosis of mood and anxiety disorders, and this internalizing factor was strongly correlated with neuroticism. Neuroticism had a stronger correlation with an internalizing factor (r=0.98) than with a substance use factor (r=0.29). Therefore, neuroticism showed both convergent and discriminant validity.ConclusionsThese results provide further evidence that neuroticism is a necessary factor in structural theories of mood and anxiety disorders. In this study, the correlation between internalizing psychopathology and neuroticism approached 1.0, suggesting that neuroticism may be the core of internalizing psychopathology. Future studies are needed to examine this possibility in other populations, and to replicate our findings.

scholarly journals Personality traits and combat exposure as predictors of psychopathology over time

2015 ◽  
Vol 46 (1) ◽  
pp. 209-220 ◽  
Author(s):  
E. Koffel ◽  
M. D. Kramer ◽  
P. A. Arbisi ◽  
C. R. Erbes ◽  
M. Kaler ◽  
...  
Keyword(s):  
Personality Traits ◽  
Indirect Effects ◽  
Internalizing Symptoms ◽  
Externalizing Symptoms ◽  
Combat Exposure ◽  
Self Report ◽  
Equation Modeling ◽  
Direct And Indirect Effects ◽  
Internalizing And Externalizing ◽  
Internalizing And Externalizing Symptoms

Background.Research suggests that personality traits have both direct and indirect effects on the development of psychological symptoms, with indirect effects mediated by stressful or traumatic events. This study models the direct influence of personality traits on residualized changes in internalizing and externalizing symptoms following a stressful and potentially traumatic deployment, as well as the indirect influence of personality on symptom levels mediated by combat exposure.Method.We utilized structural equation modeling with a longitudinal prospective study of 522 US National Guard soldiers deployed to Iraq. Analyses were based on self-report measures of personality, combat exposure, and internalizing and externalizing symptoms.Results.Both pre-deployment Disconstraint and externalizing symptoms predicted combat exposure, which in turn predicted internalizing and externalizing symptoms. There was a significant indirect effect for pre-deployment externalizing symptoms on post-deployment externalizing via combat exposure (p< 0.01). Negative Emotionality and pre-deployment internalizing symptoms directly predicted post-deployment internalizing symptoms, but both were unrelated to combat exposure. No direct effects of personality on residualized changes in externalizing symptoms were found.Conclusions.Baseline symptom dimensions had significant direct and indirect effects on post-deployment symptoms. Controlling for both pre-exposure personality and symptoms, combat experiences remained positively related to both internalizing and externalizing symptoms. Implications for diagnostic classification are discussed.

scholarly journals Modeling and treating internalizing psychopathology in a clinical trial: a latent variable structural equation modeling approach

2013 ◽  
Vol 43 (8) ◽  
pp. 1611-1623 ◽  
Author(s):  
M. G. Kushner ◽  
R. F. Krueger ◽  
M. M. Wall ◽  
E. W. Maurer ◽  
J. S. Menk ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Structural Equation Modeling ◽  
Structural Equation ◽  
Treatment Condition ◽  
Specific Treatment ◽  
Internalizing Disorders ◽  
Equation Modeling ◽  
Internalizing Psychopathology ◽  
Co Morbidity

BackgroundClinical trials are typically designed to test the effect of a specific treatment on a single diagnostic entity. However, because common internalizing disorders are highly correlated (‘co-morbid’), we sought to establish a practical and parsimonious method to characterize and quantify changes in a broad spectrum of internalizing psychopathology targeted for treatment in a clinical trial contrasting two transdiagnostic psychosocial interventions.MethodAlcohol dependence treatment patients who had any of several common internalizing disorders were randomized to a six-session cognitive-behavioral therapy (CBT) experimental treatment condition or a progressive muscle relaxation training (PMRT) comparison treatment condition. Internalizing psychopathology was characterized at baseline and 4 months following treatment in terms of the latent structure of six distinct internalizing symptom domain surveys.ResultsExploratory structural equation modeling (ESEM) identified a two-factor solution at both baseline and the 4-month follow-up: Distress (measures of depression, trait anxiety and worry) and Fear (measures of panic anxiety, social anxiety and agoraphobia). Although confirmatory factor analysis (CFA) demonstrated measurement invariance between the time-points, structural models showed that the latent means of Fear and Distress decreased substantially from baseline to follow-up for both groups, with a small but statistically significant advantage for the CBT group in terms of Distress (but not Fear) reduction.ConclusionsThe approach demonstrated in this study provides a practical solution to modeling co-morbidity in a clinical trial and is consistent with converging evidence pointing to the dimensional structure of internalizing psychopathology.

scholarly journals Evaluation of the Clinical Global Impression Scale among individuals with social anxiety disorder

2003 ◽  
Vol 33 (4) ◽  
pp. 611-622 ◽  
Author(s):  
T. I. ZAIDER ◽  
R. G. HEIMBERG ◽  
D. M. FRESCO ◽  
F. R. SCHNEIER ◽  
M. R. LIEBOWITZ
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Anxiety Disorders ◽  
Social Anxiety Disorder ◽  
Clinical Global Impression ◽  
Severity Of Illness ◽  
Anxiety Symptoms ◽  
Self Report ◽  
Clinical Global Impression Scale ◽  
Additional Variance

Background. The clinical Global Impression Scale (CGI) is commonly used as a primary outcome measure in studies evaluating the efficacy of treatments for anxiety disorders. The current study evaluated the psychometric properties and predictors of clinicians' ratings on an adapted version of the CGI among individuals with social anxiety disorders.Method. An independent assessor administered the CGI Severity of Illness and Improvement ratings to 123 patients at baseline and the subset of treated patients again mid- and post-treatment.Results. Improvement ratings were strongly related to both concurrent Severity of Illness and changes in Severity of Illness ratings from baseline. Additionally, both CGI ratings were positively correlated with both self-report and clinician-administered measures of social anxiety, depression, impairment and quality of life. Measures of social anxiety symptoms accounted for a large portion of the variance in Severity of Illness ratings, with significant additional variance accounted for by measures of impairment and depression. Changes in social anxiety symptoms from baseline accounted for significant variance in Improvement ratings, but no significant additional variance was accounted for by changes in impairment and depressive symptoms.Conclusions. Our findings support the utility of the CGI as an index of global severity and symptom-specific improvement among individuals with social anxiety disorder.

Anxiety Symptoms

2017 ◽  
pp. 206-231
Author(s):  
David Watson ◽  
Michael W. O’Hara
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Panic Disorder ◽  
Social Phobia ◽  
Convergent Validity ◽  
Discriminant Validity ◽  
Specific Phobia ◽  
Incremental Validity ◽  
Self Report ◽  
Symptom Measures

This chapter reviews the convergent, discriminant, criterion, and incremental validity of symptoms of the DSM-5 anxiety disorders; these include panic disorder, agoraphobia, social anxiety disorder/social phobia, specific phobia, and generalized anxiety disorder (GAD). Symptom measures of social anxiety/social phobia, panic disorder, claustrophobia, and GAD generally displayed impressive construct validity in these data. Specifically, they tended to show strong convergent validity and significant discriminant validity across both self-report and interview-based measures; moreover, they displayed substantial criterion validity and impressive incremental validity in relation to conceptually linked DSM diagnoses. One problem, however, is that they generally showed poor diagnostic specificity; that is, although they correlated substantially with their target diagnoses, they often displayed equally strong relations with at least some other internalizing disorders. In contrast, self-report measures of agoraphobia and specific phobia (particularly the latter) generally exhibited unimpressive criterion and incremental validity in these analyses.

A longitudinal examination of psychosocial impairment across the anxiety disorders

2013 ◽  
Vol 44 (8) ◽  
pp. 1691-1700 ◽  
Author(s):  
K. Naragon-Gainey ◽  
M. W. Gallagher ◽  
T. A. Brown
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Anxiety Disorders ◽  
Behavioral Therapy ◽  
Clinical Sample ◽  
Anxiety Symptoms ◽  
Latent Growth ◽  
Psychosocial Impairment ◽  
Co Morbidity

BackgroundAnxiety disorders are highly prevalent disorders associated with substantial psychosocial impairment, but few studies have examined impairment within specific anxiety disorders. Furthermore, it is unclear how change in different types of anxiety has an impact on change in impairment, particularly given high rates of co-morbidity. The current study assessed the temporal associations of impairment and symptoms of three common anxiety disorders in a large, diagnostically heterogeneous clinical sample.MethodData were collected from 606 treatment-seeking individuals at an anxiety clinic, most of whom subsequently enrolled in cognitive-behavioral therapy. Symptoms of panic, social anxiety and generalized anxiety disorder (GAD), as well as levels of impairment, were assessed three times over 2 years. In addition to examining levels of impairment across diagnostic groups, latent growth modeling was used to evaluate the longitudinal associations of anxiety symptoms and impairment.ResultsThose with a principal diagnosis of GAD reported higher levels of impairment in some domains at baseline; however, at follow-up assessments individuals with social anxiety disorder reported greater impairment than those with panic disorder. Anxiety symptoms and impairment both declined over time. Change in all three anxiety symptoms was closely associated with change in impairment, but only GAD remained a significant (positive) predictor of change in impairment after accounting for co-morbidity.ConclusionsImpairment and all three anxiety disorders were closely associated, both cross-sectionally and longitudinally. Because change in GAD was most specifically related to change in impairment, treatment for those with multiple anxiety disorders could focus on treating GAD symptoms first or treating transdiagnostic processes.

scholarly journals Anxiety at age 15 predicts psychiatric diagnoses and suicidal ideation in late adolescence and young adulthood: results from two longitudinal studies

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sabrina Doering ◽  
◽  
Paul Lichtenstein ◽  
Christopher Gillberg ◽  
Christel M. Middeldorp ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Anxiety Disorders ◽  
Depressive Disorders ◽  
Self Report ◽  
Psychiatric Diagnoses ◽  
Adolescent Anxiety ◽  
National Patient Register ◽  
National Patient ◽  
Psychiatric Outcomes ◽  
Psychiatric Outcome

Abstract Background Anxiety disorders in adolescence have been associated with several psychiatric outcomes. We sought to describe the prospective relationship between various levels of adolescent anxiety and psychiatric diagnoses (anxiety-, bipolar/psychotic-, depressive-, and alcohol and drug misuse disorders) and suicidal ideation in early adulthood while adjusting for childhood attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and developmental coordination disorder (DCD). Furthermore, we aimed to estimate the proportion attributable to the various anxiety levels for the outcomes. Methods We used a nation-wide population-based Swedish twin study comprising 14,106 fifteen-year-old twins born in Sweden between 1994 and 2002 and a replication sample consisting of 9211 Dutch twins, born between 1985 and 1999. Adolescent anxiety was measured with parental and self-report. Psychiatric diagnoses and suicidal ideation were retrieved from the Swedish National Patient Register and via self-report. Results Adolescent anxiety, of various levels, predicted, in the Swedish National Patient Register, anxiety disorders: hazard ratio (HR) = 4.92 (CI 3.33–7.28); depressive disorders: HR = 4.79 (3.23–7.08), and any psychiatric outcome: HR = 3.40 (2.58–4.48), when adjusting for ADHD, ASD, and DCD. The results were replicated in the Dutch data. The proportion of psychiatric outcome attributable to adolescent anxiety over time (age 15–21) was 29% for any psychiatric outcome, 43–40% for anxiety disorders, and 39–38% for depressive disorders. Conclusion Anxiety in adolescence constitutes an important risk factor in the development of psychiatric outcomes, revealing unique predictions for the different levels of anxiety, and beyond the risk conferred by childhood ADHD, ASD, and DCD. Developmental trajectories leading into psychiatric outcomes should further empirically investigated.

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