Murray W. Enns

Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample.

The factor structure, reliability, and validity of the Depression Anxiety Stress Scales (DASS; S. H. Lovibond & P. F. Lovibond, 1995) and the 21-item short form of these measures (DASS-21) were examined in nonclinical volunteers (n = 49) and patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnoses of panic disorder (n = 67), obsessive-compulsive disorder (n = 54), social phobia (n = 74), specific phobia (n = 17), and major depressive disorder (n = 46). This study replicates previous findings indicating that the DASS distinguishes well between features of depression, physical arousal, and psychological tension and agitation and extends these observations to the DASS-21. In addition, the internal consistency and concurrent validity of the DASS and DASS-21 were in the acceptable to excellent ranges. Mean scores for the various groups were similar to those in previous research, and in the expected direction. The implications of these findings are discussed.

Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample

&NA; Chronic pain and psychiatric disorders frequently co‐occur. However, estimates of the magnitude of these associations have been biased by the use of select clinical samples. The present study utilized the National Comorbidity Survey [Arch. Gen. Psychiatry 51 (1994) 8–19] Part II data set to investigate the associations between a chronic pain condition (i.e. arthritis) and common mood and anxiety disorders in a sample representative of the general US civilian population. Participants (N=5877) completed the Composite International Diagnostic Interview [World Health Organization (1990)], a structured interview for trained non‐clinician interviewers based on the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association (1987)], and provided self‐reports of pain and disability associated with a variety of medical conditions. Significant positive associations were found between chronic pain and individual 12‐month mood and anxiety disorders [odds ratios (OR) ranged from 1.92 to 4.27]. The strongest associations were observed with panic disorder (OR=4.27) and post‐traumatic stress disorder (OR=3.69). The presence of one psychiatric disorder was not significantly associated with pain‐related disability, but the presence of multiple psychiatric disorders was significantly associated with increased disability. The findings of the present study raise the possibility that improved efforts regarding the detection and treatment of anxiety disorders may be required in pain treatment settings.

Population Attributable Fractions of Psychiatric Disorders and Suicide Ideation and Attempts Associated With Adverse Childhood Experiences

OBJECTIVES We sought to determine the fractions of psychiatric disorders and suicide ideation and attempts in a general population sample attributable to childhood physical abuse, sexual abuse, and witnessing domestic violence. METHODS Data were obtained from the US National Comorbidity Survey Replication. Population attributable fractions were calculated to determine the proportion of psychiatric disorders and suicide ideation and attempts attributable to adverse childhood experiences. The analysis was stratified by gender. RESULTS The estimated attributable fractions for psychiatric disorders attributable to having experienced any adverse childhood event ranged from 22% to 32% among women and 20% to 24% among men. Having experienced any adverse event accounted for a substantial proportion of suicide ideation and attempts among women (16% and 50%, respectively) and men (21% and 33%, respectively). Substantial proportions of poor mental health outcomes were also attributable to increasing number of adverse events. CONCLUSIONS The estimated proportions of poor mental health outcomes attributed to childhood adversity were medium to large for men and women. Prevention efforts that reduce exposure to adverse childhood events could substantially reduce the prevalence of psychopathology and suicidal behavior in the general population.

The multidimensional structure of perfectionism in clinically distressed and college student samples.

Confirmatory factor analysis was used to evaluate 2 multidimensional measures of perfectionism (R. O. Frost, P. Marten, C. Lahart, & R. Rosenblate, 1990; P. L. Hewitt & G. L. Flett, 1991). On a first-order level, support was found for Hewitt and Fletts (1991) original 3-factor conceptualization of perfectionism, although only for an empirically derived 15-item subset. Support was also obtained for 5 of the 6 dimensions proposed by R. O. Frost et al. (1990), but the model only displayed good fit when a refined scale containing 22 of the original 35 items was used. A second-order analysis found evidence for 2 higher-order factors of adaptive and maladaptive perfectionism. Perfectionism dimensions correlated in expected directions with personality domains, symptom distress, and academic achievement. The brief measures of perfectionism also retained the construct-related validity displayed by the full-item versions.

Confirmatory Factor Analysis of the Depression–Anxiety–Stress Scales in Depressed and Anxious Patients

The Depression–Anxiety–Stress Scales (DASS; P. F. Lovibond & S. H. Lovibond, 1995) have shown considerable promise in their ability to differentially assess depression and anxiety symptoms. Most of the work to date has relied on normal or predominantly anxious clinical samples. To extend this research to a predominantly depressed sample, a psychiatric sample from a mood disorders program (N = 439) was used to investigate the factor structure of the DASS. Confirmatory factor analyses indicated that a 3-factor model for the 21-item DASS was supported. A 3-factor model with crossloading items for the 42-item version showed no practical improvement. Further confirmatory analyses evaluated the ability of item subsets from the DASS to represent the constructs specified in the tripartite model (L. A. Clark & D. Watson, 1991). Strong support was obtained for the DASS to represent the construct of anhedonia and physiological hyperarousal, and their relative importance is consistent with predictions of the tripartite model in understanding the relationship between anxiety and depression.

Depression, Hopelessness, and Suicidal Ideation in the Terminally Ill

This study investigated the mediational hypothesis of hopelessness in predicting suicidal ideation in a group of 196 patients with advanced terminal cancer. Each patient underwent a semistructured interview to assess hopelessness and suicidal ideation, and also completed the Beck Depression Inventory (short form). Hopelessness was correlated more highly with suicidal ideation than was the level of depression. In multiple linear-regression analyses, hopelessness contributed uniquely to the prediction of suicidal ideation when the level of depression was controlled. For health care providers attending to the needs of dying patients, hopelessness appears to be an important clinical marker of suicidal ideation in this vulnerable patient population.

Personality dimensions and depression: review and commentary.

Objectives The relationship between dimensionally assessed personality and the onset, features, and course of depressive illness will be critically examined and considered in relation to 4 hypothesized models: predisposition or vulnerability; pathoplasty; complication or scar; and spectrum or continuity. Method Studies that have used clinically depressed adult patients to explore the relationship between personality dimensions and depression will be reviewed. Results Higher-order personality factors that have shown a significant and consistent association with major depressive illness include neuroticism, extraversion (negative relationship), and the factors of Cloningers Tridimensional Personality Model. Neuroticism appears to be the most powerful predictor of depression. Lower-order factors showing a significant and consistent relationship with depressive illness include dependency, self-criticism, obsessionality, and perfectionism. The links between depression and dependency and self-criticism have the strongest empirical support. Conclusions Several personality dimensions are significantly associated with depressive illness, but the evidence that unequivocally demonstrates a true personality predisposition for depression is modest. Measures of personality may prove to be clinically useful for treatment selection.

Parental bonding and adult psychopathology: results from the US National Comorbidity Survey

BACKGROUND Research using the parental bonding instrument (PBI) has suggested that lack of parental care and/or overprotection may be important risk factors for adult mental disorders. Much of this research, however, has relied on clinical populations with one or two disorders, or has used highly select community samples. METHOD The association between parenting experiences and the occurrence of 13 common mental disorders in adulthood was evaluated in the US National Comorbidity Survey (N = 5877). The effect of sociodemographic variables (age, education, income) was statistically controlled and the effects of six parenting variables (maternal and paternal care, overprotection and authoritarianism) were examined simultaneously. The effects in men and women were examined separately. RESULTS Lack of care was the parenting variable most consistently associated with adult psychopathology. Parenting experiences with ones mother were more consistently associated with adult mental disorders. In general the impact of parenting was diagnostically non-specific. However, there appeared to be some unique effects for externalizing disorders (substance use disorders and antisocial personality disorder) in males; paternal overprotection and authoritarianism conferred a reduced risk of externalizing disorders in adult males. The overall impact of parenting as assessed by the PBI was modest, accounting for about 1 to 5 % of the variance in the occurrence of adult mental disorders. CONCLUSION Parenting experiences, particularly lack of care, are potentially causally related in a non-specific manner to a wide variety of forms of adult psychopathology in both men and women. The overall magnitude of the effect is small but statistically significant in a nationally representative US sample.

Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective.

ObjectivesInvestigations of the association between chronic pain conditions and suicidal ideation (SI) and suicide attempts (SA) have rarely taken the effect of mental disorders into account and have been limited by nonrepresentative samples. The present study used a large population-based sample to investigate the association between chronic pain conditions and SI and SA. MethodsData were from the Canadian Community Health Survey Cycle 1.2 public use file conducted by Statistics Canada from 2001 to 2002 (N=36,984; response rate 77%). Respondents were asked if they had been diagnosed with the following painful conditions: migraine, back problems, arthritis, and fibromyalgia. Respondents were assessed for past 12-month SI and SA. The Composite International Diagnostic Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders-IV. ResultsAfter adjusting for sociodemographics, Axis I mental disorders and comorbidity (3 or more mental disorders), the presence of 1 or more chronic pain conditions was associated with both SI and SA. Among respondents with a mental disorder, comorbidity with 1 or more chronic pain conditions was also associated with SI and SA. In models adjusting for other painful conditions, migraine had the strongest link with SI and SA. DiscussionThis is the first study to demonstrate the association between several chronic pain conditions and SI and SA while adjusting for mental disorders in a nationally representative sample. Moreover, this study demonstrates that among individuals with a mental disorder, having a chronic pain condition significantly increased the association with SI and SA.

Confirmatory Factor Analysis of The Multidimensional Scale of Perceived Social Support in Clinically Distressed and Student Samples

Previous authors (e.g., B. R. Sarason, Shearin, Pierce, & Sarason, 1987) have found that perceived social support can affect the emotional well-being of an individual. Consequently, the effective assessment of social supports is a key issue in both research and clinical practice. The Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988) divides perceived social support into 3 distinct constructs-that derived from Family members, from Friends, and from Significant Others. This study is the first to assess the MSPSS using confirmatory factor analysis in both a college student (N = 549) and psychiatric outpatient (N = 156) sample. Based on several goodness-of-fit indicators, a 3-factor model for the MSPSS was supported in both samples, as was a single, higher order domain of Global social support. The perceived social support factors of Family and Friends consistently had the strongest associations with symptomatology. These results support the use of the MSPSS as a brief instrument for assessing the hierarchical structure of perceived social support in a variety of samples.