Confirmatory factor structure of anxiety and depression: evidence of item variance across childhood.

The distinctiveness of anxiety and depressive symptoms in children has previously been questioned based on their high degree of comorbidity, shared risk factors, and treatment response. Developing children may show an unstable presentation of anxiety and depressive symptoms that would complicate interpretation of studies of comorbidity. The present study examined the measurement stability of anxiety and depressive symptoms across time and sex using a large epidemiologic sample of children. A nationally representative cohort of 1329 children (624 girls and 705 boys) aged four to seven in 1994 were drawn from the National Longitudinal Survey of Youth (NLSY). Using eight years of prospective data we examined whether a one or two factor structure of anxiety (five items) and depressive (four items) symptoms would be invariant across time and sex. Despite item variability within each factor across time, confirmatory factor analysis revealed distinct factors for anxiety and depression that were stable across time and sex. Results provide support that covariation between anxiety and depression is not likely the result of measurement overlap. However, items indicating factors of anxiety and depression in the NLSY may not be sufficient to permit developmentally-sensitive measurement of these factors.

Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar disorder.

BACKGROUND: High rates of comorbid anxiety disorders have been described in individuals with bipolar disorder. Although it is well recognized that anxiety disorders often co-occur with bipolar disorder, few studies have examined the impact of more than 1 anxiety disorder on long-term outcome in patients with bipolar disorder. METHOD: The rates of DSM-IV generalized anxiety disorder, panic disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder were determined using structured clinical interviews in 138 patients with bipolar disorder who presented consecutively between 1994 and 1999. Patients were then followed for up to 3 years with longitudinal clinical surveillance. The impact of 1 or more comorbid anxiety disorders on mood symptoms and general function was evaluated. RESULTS: In our sample, 55.8% of the patients had at least 1 comorbid anxiety disorder, and 31.8% had 2 or more anxiety disorder diagnoses. The most common anxiety disorder was generalized anxiety disorder, followed by panic disorder. The presence of an anxiety disorder led to significantly (p <.05) worse outcome on global as well as specific illness measures, including illness severity, proportion of patients characterized as euthymic, and proportion of the year spent ill. Number of anxiety disorders was less important than type, with generalized anxiety disorder and social phobia having the most negative impact on outcome. CONCLUSION: Our data suggested that multiple anxiety disorder comorbidities were not infrequent in bipolar disorder and that generalized anxiety disorder and social phobia were more likely to be associated with poor outcome. We discuss some potential mechanisms and implications in our findings.