Distinguishing symptom dimensions of depression and anxiety: an integrative approach.

BACKGROUND: Clark and Watson developed the tripartite model in which a symptom dimension of 'negative affect' covers common psychological distress that is typically seen in anxious and depressed patients. The 'positive affect' and 'somatic arousal' dimensions cover more specific symptoms. Although the model has met much support, it does not cover all relevant anxiety symptoms and its negative affect dimension is rather unspecific. Therefore, we aimed to extend the tripartite model in order to describe more specific symptom patterns with unidimensional measurement scales. METHOD: 1333 outpatients provided self report data. To develop an extended factor model, exploratory factor analysis (EFA) was conducted in one part of the data (n=578). Confirmatory factor analysis (CFA) was conducted in the second part (n=755), to assess model-fit and comparison with other models. Rasch analyses were done to investigate the unidimensionality of the factors. RESULTS: EFA resulted in a 6-factor model: feelings of worthlessness, fatigue, somatic arousal, anxious apprehension, phobic fear and tension. CFA in the second sample showed that a 6-factor model with a hierarchical common severity factor fits the data better than alternative 1- and 3-factor models. Rasch analyses showed that each of the factors and the total of factors can be regarded as unidimensional measurement scales. LIMITATIONS: The model is based on a restricted symptom-pool: more dimensions are likely to exist. CONCLUSION: The extended tripartite model describes the clinical state of patients more specifically. This is relevant for both clinical practice and research.

How work and family can facilitate each other: distinct types of work-family facilitation and outcomes for women and men.

This study was designed to gain more insight in the different ways in which work and family roles can benefit each other. Both qualitative (N=25) and quantitative (N=352) results obtained in a financial service organization supported the distinction between energy-based, time-based, behavioral, and psychological work-family facilitation, in addition to different types of work-family conflict that were identified in previous research. As expected, facilitation contributed substantially and differentially to the prediction of work and nonwork outcomes, over and above the effects of conflict. As predicted, women experienced higher levels of facilitation than men did. Furthermore, results indicate that examining facilitation, in addition to conflict, is especially important to predict the work and home life experiences of women.

Social development from infancy to adolescence: longitudinal and concurrent factors in an adoption sample.

In the present longitudinal study, early adopted children (N = 160) were followed from infancy to adolescence to assess the influence of previous and concurrent factors on the children's social development. This study allowed for more conclusive evidence of the influence of early and concurrent rearing experiences and temperament on adolescents' social development, independent of shared genetic factors between children and parents. Results showed that social development and temperament were stable over time and that both previous and current parental sensitivity were important in predicting social development in adolescence. Quality of the early parent-child relationship was indirectly associated with social development in adolescence through the influence on social development in middle childhood. Maternal sensitivity in middle childhood and in adolescence partly buffered the negative effects of difficult temperament on social development in adolescence. Adaptation emerged as the product of both developmental history and current circumstances.

Factors associated with mental health service need and utilization among unaccompanied refugee adolescents.

This study is the first to address the need for mental health Care (MHC) and the patterns of utilization of MHC services among Unaccompanied Refugee Minors (URM). Information concerning the well being, mental health need, and utilization of services of URM was collected from three informants, the minors themselves (n = 920), their legal guardians (n = 557), and their teachers (n = 496). The well-being, need and utilization of MHC services of URM was compared with those of a representative Dutch adolescent sample (n = 1059). The findings of this study indicated that URM that report a mental health care need (57.8%) also report higher levels of emotional distress than Dutch adolescents who report a similar need for MHC (8.2%). In addition, guardians and teachers detect emotional distress and mental health care needs in only a small percentage (30%) of URM. The referral of URM to mental health care services does not appear to be driven by the reported needs of the URM, but by the need and emotional distress as observed and perceived by guardians. This resulted in the fact that 48.7% of the URM total sample reported that their need for mental health care was unmet.

Type I errors and power of the parametric bootstrap goodness-of-fit test: full and limited information.

In sparse tables for categorical data well-known goodness-of-fit statistics are not chi-square distributed. A consequence is that model selection becomes a problem. It has been suggested that a way out of this problem is the use of the parametric bootstrap. In this paper, the parametric bootstrap goodness-of-fit test is studied by means of an extensive simulation study; the Type I error rates and power of this test are studied under several conditions of sparseness. In the presence of sparseness, models were used that were likely to violate the regularity conditions. Besides bootstrapping the goodness-of-fit usually used (full information statistics), corrected versions of these statistics and a limited information statistic are bootstrapped. These bootstrap tests were also compared to an asymptotic test using limited information. Results indicate that bootstrapping the usual statistics fails because these tests are too liberal, and that bootstrapping or asymptotically testing the limited information statistic works better with respect to Type I error and outperforms the other statistics by far in terms of statistical power. The properties of all tests are illustrated using categorical Markov models.