Beyond Negative Affectivity: A Hierarchical Model of Global and Transdiagnostic Vulnerabilities for Emotional Disorders

Abstract

Background: Negative affectivity (NA) has been linked to anxiety and depression (DEP). Identifying the common factors between anxiety and DEP is important when explaining their overlap and comorbidity. However, general factors such as NA tend to have differential relationships with different disorders, suggesting the need to identify mediators in order to explicate these relationships. Methods: The current study tests a theoretically and empirically derived hierarchical model of emotional disorders including both a general factor (NA) and transdiagnostic risk factors [anxiety sensitivity (AS) and intolerance of uncertainty (IoU)] using structural equation modeling. AS was tested as a mid-level factor between NA and panic disorder/agoraphobia, while IoU was tested as a mid-level factor between NA and social phobia, generalized anxiety disorder, obsessive-compulsive disorder, and DEP. Data from 642 clinical outpatients with a heterogeneous presentation of emotional disorders were available for analysis. Results: The hierarchical model fits the data adequately. Moreover, while a simplified model removing AS and IoU fits the data well, it resulted in a significant loss of information for all latent disorder constructs. Limitations: Data were unavailable to estimate post-traumatic stress disorder or specific phobias. Future work will need to extend to other emotional disorders. Conclusions: This study demonstrates the importance of both general factors that link disorders together and semi-specific transdiagnostic factors partially explaining their heterogeneity. Including these mid-level factors in hierarchical models of psychopathology can help account for additional variance and help to clarify the relationship between disorder constructs and NA.

Keywords::

• anxiety
• depression
• negative affectivity
• anxiety sensitivity
• intolerance of uncertainty
• transdiagnostic

Acknowledgement

We thank Fanny Kuang for help with data entry.

Disclosure statement: The authors have declared that no conflict of interest exists.

Notes

^1. OCD was placed on the thought disorder factor, though the authors note that comparable results were obtained when OCD was placed on the internalizing factor with the anxiety disorders and DEP.

^2. A link from IoU to DEP was included in this study given the significant relationship in past clinical samples (e.g., Norton et al., 2005).

^3. Inter-rater reliability was established by having additional blinded student clinicians watch recordings of ADIS sessions and determine diagnoses and severity.