Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-28T08:55:56.156Z Has data issue: false hasContentIssue false
  • English
  • Français

Identifying Individuals With Generalised Anxiety Disorder: A Receiver Operator Characteristic Analysis of Theoretically Relevant Measures

Published online by Cambridge University Press:  16 September 2015

Joshua Curtiss  and
David H. Klemanski
Joshua Curtiss*
Affiliation:
Yale University, New Haven, Connecticut, USA
David H. Klemanski
Affiliation:
Yale University, New Haven, Connecticut, USA
*
Address for correspondence: Joshua Curtiss, Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT 06520, USA. Email: [email protected]
Get access

Abstract

This article appraises the ability of several measures, assessing symptomatology theoretically relevant to generalised anxiety disorder (GAD), to accomplish successful classification of individuals with DSM-IV GAD and individuals with mood or other anxiety disorders. Participants were 197 individuals (average age = 36.43; 67.5% female) receiving treatment at a clinic, who completed pretreatment self-report measures. Receiver operator characteristic analyses and logistic regression analyses were employed to determine the classificatory abilities, including sensitivity and specificity, of several GAD relevant measures. The Penn State Worry Questionnaire (PSWQ) accomplished significant classification in both comparison group dyads: GAD-Anxiety and GAD-Mood. Whereas the general distress of depression subscale of the Mood and Anxiety Symptoms Questionnaire (MASQ) accomplished significant classification in the GAD-Anxiety group dyad, both the general distress of anxiety and anxious arousal subscales of the MASQ did so in the GAD-Mood group dyad. Only the PSWQ significantly predicted the presence of GAD, while controlling for other symptom variables. Though evidence supports the uniqueness of some symptoms of GAD, including worry, often considered pathognomonic to GAD, the modest areas under the curve, sensitivity, and specificity of the measures afford tenuous support for the utility of these measures. The lack of highly sensitive and specific symptomatology comport with critiques of GAD as a diagnostically delimited category.

Keywords

generalised anxiety disorderanxietydepressionreceiver operator characteristics
Type
Standard Papers
Information
Behaviour Change , Volume 32 , Issue 4 , December 2015 , pp. 255 - 272
Copyright
Copyright © The Author(s) 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andrews, G., Hobbs, M.J., Borkovec, T.D., Beesdo, K., Craske, M.G., Heimberg, R.G., . . . & Stanley, M.A. (2010). Generalized worry disorder: A review of DSM-IV generalized anxiety disorder and options for DSM-V. Depression and Anxiety, 27, 134–147. doi:10.1002/da.20658CrossRefGoogle ScholarPubMed
Behar, E., DiMarco, I.D., Hekler, E.B., Mohlman, J., & Staples, A.M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23, 1011–1023.CrossRefGoogle ScholarPubMed
Bond, F.W., Hayes, S.C., Baer, R.A., Carpenter, K.M., Guenole, N., Orcutt, H.K., . . . & Zettle, R.D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676–688. doi:10.1016/j.beth.2011.03.007CrossRefGoogle ScholarPubMed
Boschen, M.J., & Oei, T.P. (2007). Discriminant validity of the MASQ in a clinical sample. Psychiatry Research, 150, 163–171. doi:10.1016/j.psychres.2006.03.008CrossRefGoogle Scholar
Brawman-Mintzer, O., Emmanuel, N., Jarrell, M.P., & Ballenger, J.C. (1993). Psychiatric comorbidity in patients with generalized anxiety disorder. American Journal of Pyschiatry, 150, 1216–1218.Google ScholarPubMed
Brown, T.A., Barlow, D.H., & Liebowitz, M.R. (1994). The empirical basis of generalized anxiety disorder. The American Journal of Pyschiatry, 151, 1272–1280.Google ScholarPubMed
Brown, T.A., Campbell, L.A., Lehman, C.L., Grisham, J.R., & Mancill, R.B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585–599. doi:10.1037/0021-843X.110.4.585CrossRefGoogle Scholar
Brown, T.A., Chorpita, B.F., & Barlow, D.H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107, 179–192. doi:10.1037/0021-843X.107.2.179CrossRefGoogle ScholarPubMed
Brown, T.A., Marten, P.A., & Barlow, D.H. (1995). Discriminant validity of the symptoms constituting the DSM–III–R and DSM–IV associated symptom criterion of generalized anxiety disorder. Journal of Anxiety Disorders, 9, 317–328. doi:10.1016/0887-6185(95)00012-DCrossRefGoogle Scholar
Bruce, S.E., Machan, J.T., Dyck, I., & Keller, M.B. (2001). Infrequency of ‘pure’ GAD: Impact of psychiatric comorbidity on clinical course. Depression and Anxiety, 14, 219–225. doi:10.1002/da.1070CrossRefGoogle ScholarPubMed
Buhr, K., & Dugas, M.J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour Research and Therapy, 40, 931–945. doi:10.1016/S0005-7967(01)00092-4CrossRefGoogle ScholarPubMed
Buhr, K., & Dugas, M.J. (2006). Investigating the construct validity of intolerance of uncertainty and its unique relationship with worry. Journal of Anxiety Disorders, 20, 222–236. doi:10.1016/j.janxdis.2004.12.004CrossRefGoogle ScholarPubMed
Chelminski, I., & Zimmerman, M. (2003). Pathological worry in depressed and anxious patients. Journal of Anxiety Disorders, 17, 533–546. doi:10.1016/S0887-6185(02)00246-3CrossRefGoogle ScholarPubMed
Comer, J.S., Roy, A.K., Furr, J.M., Gotimer, K., Beidas, R.S., Dugas, M.J., & Kendall, P.C. (2009). The intolerance of uncertainty scale for children: a psychometric evaluation. Psychological Assessment, 21, 402–411. doi:10.1037/a0016719CrossRefGoogle ScholarPubMed
Dugas, M.J., Freeston, M.H., & Ladouceur, R. (1997). Intolerance of uncertainty and problem orientation in worry. Cognitive Therapy and Research, 21, 593–606. doi:10.1023/A:1021890322153CrossRefGoogle Scholar
Dugas, M.J., Gagnon, F., Ladouceur, R., & Freeston, M.H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215–226. doi:10.1016/S0005-7967(97)00070-3CrossRefGoogle ScholarPubMed
Dugas, M.J., Gosselin, P., & Ladouceur, R. (2001). Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognitive Therapy and Research, 25, 551–558. doi:10.1023/A:1005553414688CrossRefGoogle Scholar
Dugas, M.J., Marchand, A., & Ladouceur, R. (2005). Further validation of a cognitive-behavioral model of generalized anxiety disorder: Diagnostic and symptom specificity. Journal of Anxiety Disorders, 19, 329–343. doi:10.1016/j.janxdis.2004.02.002CrossRefGoogle ScholarPubMed
Dugas, M.J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. Boca Raton, FL: CRC Press.Google Scholar
Dugas, M.J., Schwartz, A., & Francis, K. (2004). Brief report: Intolerance of uncertainty, worry, and depression. Cognitive Therapy and Research, 28, 835–842. doi:10.1007/s10608–004-0669-0CrossRefGoogle Scholar
Dupuy, J.B., & Ladouceur, R. (2008). Cognitive processes of generalized anxiety disorder in comorbid generalized anxiety disorder and major depressive disorder. Journal of Anxiety Disorders, 22, 505–514. doi:10.1016/j.janxdis.2007.05.010CrossRefGoogle ScholarPubMed
Endler, N.S., Cox, B.J., Parker, J.D., & Bagby, R.M. (1992). Self-reports of depression and state-trait anxiety: Evidence for differential assessment. Journal of Personality and Social Psychology, 63, 832–838. doi:10.1037/0022-3514.63.5.832CrossRefGoogle ScholarPubMed
Fisher, P.L., & Durham, R.C. (1999). Recovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990. Psychological Medicine, 29, 1425–1434. doi: 10.1017/S0033291799001336CrossRefGoogle ScholarPubMed
Freeston, M.H., Rhéaume, J., Letarte, H., Dugas, M.J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791–802. doi:10.1016/0191-8869(94)90048-5CrossRefGoogle Scholar
Fresco, D.M., Heimberg, R.G., Mennin, D.S., & Turk, C.L. (2002). Confirmatory factor analysis of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 40, 313–323. doi:10.1016/S0005-7967(00)00113-3CrossRefGoogle ScholarPubMed
Fresco, D.M., Mennin, D.S., Heimberg, R.G., & Turk, C.L. (2003). Using the Penn State Worry Questionnaire to identify individuals with generalized anxiety disorder: A receiver operating characteristic analysis. Journal of behavior therapy and experimental psychiatry, 34, 283–291. doi:10.1016/j.jbtep.2003.09.001CrossRefGoogle ScholarPubMed
Hanley, J.A., & McNeil, B.J. (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology, 143, 29–36.CrossRefGoogle Scholar
Hanley, J.A., & McNeil, B.J. (1983). A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology, 148, 839–843.CrossRefGoogle ScholarPubMed
Hayes, S.C., Strosahl, K., Wilson, K.G., Bissett, R.T., Pistorello, J., Toarmino, D., . . . & McCurry, S.M. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553–578.CrossRefGoogle Scholar
Hayes, S.C., Wilson, K.G., Gifford, E.V., Follette, V.M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168. doi:10.1037/0022-006X.64.6.1152CrossRefGoogle ScholarPubMed
Heimberg, R.G., Turk, C.L., & Mennin, D.S. (Eds.). (2004). Generalized anxiety disorder: Advances in research and practice. Guilford Press.Google Scholar
Hong, R.Y. (2007). Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behaviour Research and Therapy, 45, 277–290. doi:10.1016/j.brat.2006.03.006CrossRefGoogle ScholarPubMed
Joiner, T.E. Jr, Steer, R.A., Beck, A.T., Schmidt, N.B., Rudd, M.D., & Catanzaro, S.J., (1999). Physiological hyperarousal: Construct validity of a central aspect of the tripartite model of depression and anxiety. Journal of Abnormal Psychology, 108, 290–298. doi:10.1037/0021-843X.108.2.290CrossRefGoogle ScholarPubMed
Kendler, K.S. (1996). Major depression and generalised anxiety disorder. Same genes, (partly) different environments — revisited. The British Journal of Psychiatry, 30 (Suppl.), 68–75.CrossRefGoogle Scholar
Kendler, K.S., Neale, M.C., Kessler, R.C., Heath, A.C., & Eaves, L.J. (1992). Major depression and generalized anxiety disorder: Same genes, (partly) different environments?. Archives of General Psychiatry, 49, 716–722. doi:10.1001/archpsyc.1992.01820090044008CrossRefGoogle ScholarPubMed
Kessler, R.C., Chiu, W.T., Demler, O., & Walters, E.E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Journal of the American Medical Association Psychiatry, 62, 617–627. doi:10.1001/archpsyc.62.6.617Google ScholarPubMed
Khawaja, N.G., & Chapman, D. (2007). Cognitive predictors of worry in a non-clinical population. Clinical Psychologist, 11, 24–32. doi:10.1080/13284200601151778CrossRefGoogle Scholar
Kraemer, H.C. (1992). Evaluating medical tests: Objective and quantitative guidelines. Newbury Park, CA: Sage.Google Scholar
Ladouceur, R., Blais, F., Freeston, M.H., & Dugas, M.J. (1998). Problem solving and problem orientation in generalized anxiety disorder. Journal of Anxiety Disorders, 12, 139–152. doi:10.1016/S0887-6185(98)00002-4CrossRefGoogle Scholar
Ladouceur, R., Dugas, M.J., Freeston, M.H., Rhéaume, J., Blais, F., Boisvert, J.M., . . . & Thibodeau, N. (1999). Specificity of generalized anxiety disorder symptoms and processes. Behavior Therapy, 30, 191–207. doi:10.1016/S0005-7894(99)80003-3CrossRefGoogle Scholar
Leentjens, A.F., Verhey, F.R., Luijckx, G.J., & Troost, J. (2000). The validity of the Beck Depression Inventory as a screening and diagnostic instrument for depression in patients with Parkinson's disease. Movement Disorders, 15, 1221–1224. doi:10.1002/1531-8257(200011)15:6<1221::AID-MDS1024>3.0.CO;2-H3.0.CO;2-H>CrossRefGoogle ScholarPubMed
Mahoney, A.E., & McEvoy, P.M. (2012). A transdiagnostic examination of intolerance of uncertainty across anxiety and depressive disorders. Cognitive Behaviour Therapy, 41, 212–222.CrossRefGoogle ScholarPubMed
Marcus, D.K., Sawaqdeh, A., & Kwon, P. (2014). The latent structure of generalized anxiety disorder in midlife adults. Psychiatry Research, 215, 366–371.CrossRefGoogle ScholarPubMed
Mennin, D.S., & Fresco, D.M. (2013). What, me worry and ruminate about DSM-5 and RDoC? The importance of targeting negative self-referential processing. Clinical Psychology: Science and Practice, 20, 258–267.Google ScholarPubMed
Mennin, D.S., Heimberg, R.G., Turk, C.L., & Fresco, D.M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43, 1281–1310. doi:10.1016/j.brat.2004.08.008CrossRefGoogle ScholarPubMed
Meyer, T.J., Miller, M.L., Metzger, R.L., & Borkovec, T.D. (1990). Development and validation of the Penn State worry questionnaire. Behaviour Research and Therapy, 28, 487–495. doi:10.1016/0005-7967(90)90135-6CrossRefGoogle ScholarPubMed
Moffitt, T.E., Harrington, H., Caspi, A., Kim-Cohen, J., Goldberg, D., Gregory, A.M., & Poulton, R. (2007). Depression and generalized anxiety disorder: Cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Archives of General Psychiatry, 64, 651–660. doi:10.1001/archpsyc.64.6.651CrossRefGoogle Scholar
Molina, S., & Borkovec, T.D. (1994). The Penn State Worry Questionnaire: Psychometric properties and associated characteristics. In Davey, G.C.L. & Tallis, F. (Eds.), Worrying: Perspectives on theory, assessment and treatment (pp. 265–283). Chichester, England: John Wiley & Sons.Google Scholar
Newman, M.G., & Llera, S.J. (2011). A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry. Clinical Psychology Review, 31, 371–382.CrossRefGoogle ScholarPubMed
Olatunji, B.O., Broman-Fulks, J.J., Bergman, S.M., Green, B.A., & Zlomke, K.R. (2010). A taxometric investigation of the latent structure of worry: Dimensionality and associations with depression, anxiety, and stress. Behavior Therapy, 41, 212–228.CrossRefGoogle ScholarPubMed
Ormel, J., VonKorff, M., Ustun, T.B., Pini, S., Korten, A., & Oldehinkel, T. (1994). Common mental disorders and disability across cultures. JAMA, 272, 1741–1748. doi:10.1001/jama.272.22.1741CrossRefGoogle ScholarPubMed
Peters, L. (2000). Discriminant validity of the Social Phobia and Anxiety Inventory (SPAI), the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS). Behaviour Research and Therapy, 38, 943–950. doi:10.1016/S0005-7967(99)00131-XCrossRefGoogle ScholarPubMed
Pini, S., Cassano, G.B., Simonini, E., Savino, M., Russo, A., & Montgomery, S.A. (1997). Prevalence of anxiety disorders comorbidity in bipolar depression, unipolar depression and dysthymia. Journal of Affective Disorders, 42, 145–153. doi:10.1016/S0165-0327(96)01405-XCrossRefGoogle ScholarPubMed
Rapee, R.M. (1991). Generalized anxiety disorder: A review of clinical features and theoretical concepts. Clinical Psychology Review, 11, 419–440. doi:10.1016/0272-7358(91)90116-CCrossRefGoogle Scholar
Rapee, R.M. (2001). The development of generalized anxiety. In Vasey, M.W. 8 Dadds, M.R. (Eds.), The developmental psychopathology of anxiety (pp. 481–503). New York: Oxford University Press.CrossRefGoogle Scholar
Roemer, L., & Orsillo, S.M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9, 54–68. doi:10.1093/clipsy/9.1.54Google Scholar
Ruscio, A.M. (2002). Delimiting the boundaries of generalized anxiety disorder: Differentiating high worriers with and without GAD. Journal of Anxiety Disorders, 16, 377–400. doi: 10.1016/S0887-6185(02)00130-5CrossRefGoogle ScholarPubMed
Ruscio, A.M., & Borkovec, T.D. (2004). Experience and appraisal of worry among high worriers with and without generalized anxiety disorder. Behaviour Research and Therapy, 42, 1469–1482. doi:10.1016/j.brat.2003.10.007CrossRefGoogle ScholarPubMed
Sadock, B.J., Sadock, V.A. (2007). Kaplan and Sadock's synopsis of psychiatry. Wolters Kluwer Health.Google Scholar
Sanderson, W.C., & Barlow, D.H. (1990). A description of patients diagnosed with DSM-III-R generalized anxiety disorder. The Journal of nervous and mental disease, 178, 588–591. doi:10.1097/00005053-199009000-00006CrossRefGoogle ScholarPubMed
Schonfeld, W.H., Verboncoeur, C.J., Fifer, S.K., Lipschutz, R.C., Lubeck, D.P., & Buesching, D.P. (1997). The functioning and well-being of patients with unrecognized anxiety disorders and major depressive disorder. Journal of Affective Disorders, 43, 105–119. doi:10.1016/S0165-0327(96)01416-4CrossRefGoogle ScholarPubMed
Slade, T.I.M., & Watson, D. (2006). The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychological Medicine, 36, 1593–1600. doi:10.1017/S0033291706008452CrossRefGoogle ScholarPubMed
Spielberger, C.D. (1983). Manual for the State-Trait Anxiety Inventory STAI (Form Y). Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Spielberger, C.D. (1985). Assessment of state and trait anxiety: Conceptual and methodological issues. Southern Psychologist, 2, 6–16.Google Scholar
Starcevic, V. (1995). Pathological worry in major depression: A preliminary report. Behaviour Research and Therapy, 33, 55–56. doi:10.1016/0005-7967(93)E0028-4CrossRefGoogle ScholarPubMed
Stark, D., Kiely, M., Smith, A., Velikova, G., House, A., & Selby, P. (2002). Anxiety disorders in cancer patients: Their nature, associations, and relation to quality of life. Journal of Clinical Oncology, 20, 3137–3148.CrossRefGoogle ScholarPubMed
Tull, M.T., & Gratz, K.L. (2008). Further examination of the relationship between anxiety sensitivity and depression: The mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. Journal of Anxiety Disorders, 22, 199–210. doi:10.1016/j.janxdis.2007.03.005CrossRefGoogle ScholarPubMed
Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology, 114, 522. doi:10.1037/0021-843X.114.4.522CrossRefGoogle ScholarPubMed
Watson, D., & Clark, L.A. (1991). The Mood and Anxiety Symptom Questionnaire (MASQ). Unpublished manuscript, University of Iowa City.Google Scholar
Watson, D., Weber, K., Smith Assenheimer, J., Clark, L.A., Strauss, M.E., & McCormick, R. (1995). Testing a tripartite model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptom scales. Journal of Abnormal Psychology, 104, 3–3. doi:10.1037/0021-843X.104.1.3CrossRefGoogle ScholarPubMed