Validation of the Tripartite Model of Anxiety and Depression (TRAD) in Australian Children and Adults Using the PANAS (Adult) and PH-PANAS-C (Child) Self-report Measures

8/10/2019 Validation of the Tripartite Model of Anxiety and Depression (TRAD) in Australian Children and Adults Using the PANAS (Adult) and PH-PANAS-C (Child) Self-r

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Validation of the Tripartite Model of Anxiety and Depression (TRAD) in Australian

Children and Adults using the PANAS (adult) and PH-PANAS-C (child) Self-report

Measures

Michael Scott

Literature Review and Research Paper submitted in partial fulfilment of the

requirements for the Degree of Bachelor of Psychology with Honours at James Cook

University, Cairns, Australia. October 2012


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v

Summary: PH-PANAS-C ........................................................................................... 29

Conclusion ...................................................................................................................... 29

Aims and Hypotheses of the Research ........................................................................... 30

References ....................................................................................................................... 31

Part 2: Research Report .................................................................................................. 43

Validating Psychometric Properties of the Tripartite Model of Anxiety and Depression

(TRAD) in Australian Children and Adults .................................................................... 43

Abstract ........................................................................................................................... 44

Introduction ..................................................................................................................... 45

Method ............................................................................................................................ 49

Participants .................................................................................................................. 49

Design and Procedure ................................................................................................. 50

Measures ..................................................................................................................... 51

PANAS.................................................................................................................... 51

PH-PANAS-C.......................................................................................................... 52

Statistical Analysis ...................................................................................................... 53

Ethical Considerations ................................................................................................ 53

Results ............................................................................................................................. 54

Hypothesis One ........................................................................................................... 54

Hypothesis Two .......................................................................................................... 58

Hypothesis Three ........................................................................................................ 59

Discussion ....................................................................................................................... 60

Hypothesis One: Dimensional and Structural Integrity of the TRAD model and the

PH-PANAS-C and PANAS ........................................................................................ 61

PCA: PH-PANAS-C................................................................................................ 61

PCA: PANAS........................................................................................................... 62Hypothesis Two: Sex Differences between Adolescents would be defined by

Increased levels of NA in Female Adolescents Compared to Male Adolescents ....... 63

Hypothesis Three: Child and Adult PA and NA scores on the PANAS will differ

from their PA and NA scores on the PH-PANAS-C but would be correlated ........... 64

Limitations .................................................................................................................. 66

Conclusion .................................................................................................................. 66

References ....................................................................................................................... 67

Appendices...................................................................................................................... 74


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List of Tables

Table Title Page

1 Mean Age, Sex and Socioeconomic Status of Participants in Each

Participant Group 50

2 Cronbachs Alpha Reliability Results for all Participants on both

the PANAS and PH-PANAS-C 54

3 Oblimin Rotation Pattern Matrix Results for Child Participant

Scores on the PH-PANAS-C 56

4 Oblimin Rotation Structure Matrix Results for Child Participant

Scores on the PH-PANAS-C 57

5 Varimax Rotated Component Matrix Results for Adult Participant

Scores on the PANAS 58

6 Results of Spearmans rho Correlational Analysis andIndependent

Samples t-Tests Showing Significant Positive Relationships

between Corresponding Dimensions and Significant Variations

between Dimensional Means on the PANAS Compared to the PH-

PANAS-C for Both Adult and Child Participants 60


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vii

List of Figures

Figure Title Page

1 Mean NA scores with standard error bars (females= 1.86, males=

1.66) for adolescent male and female participants 59


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Psychometric Properties of TRAD 1

Part 1: Literature Review

A Review of the Psychometric Properties of the Tripartite Model of Anxiety and

Depression (TRAD) in Child and Adult Populations

Michael Scott

James Cook University, Department of Psychology, School of Arts and Social Sciences,

Cairns, Australia


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Abstract

Research suggests that depression and anxiety disorders may coexist or overlap yet can

be differentiated. The tripartite model of anxiety and depression (TRAD model)

differentiates disordered affect through three independent dimensions - positive affect

(PA), negative affect (NA), and physiological hyperarousal (PH). Although the TRAD

model has received extensive empirical support in both research and diagnostic settings,

recent evidence in the literature has documented results that are inconsistent with

TRAD model predictions. Issues raised in the literature relate to the independence of the

TRAD dimensions, cross loading of items, poor model fit across varied samples, and

sex differences in adolescent samples. Two contemporary self-report measures that

feature prominently in the literature include the Positive and Negative Affect Schedule

(PANAS; used for adult populations), and the Physiological Hyperarousal and Positive

and Negative Affect Schedule for Children (PH-PANAS-C; used in child and

adolescent populations). The present paper reviewed the literature on the TRAD

models psychometric properties in adults and children. The conclusion reached is that,

while TRAD-based instruments may require some further refinement; the TRAD

models theoretical framework appears sound, and current TRAD-based self-report

instruments provide an effective method of screening and assessment in both clinical

and community populations.


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Statement of Research Topic/Question

The TRAD model proposes to differentiate anxiety and depression through the

three dimensions of positive affect (PA), negative affect (NA), and physiological

hyperarousal (PH). Two TRAD-based measures (the PANAS and PH-PANAS-C) are

frequently used to assess levels of anxiety and depression in adults and children

respectively. Issues of interest relate to TRAD model theory, and the psychometric

properties of the PANAS and PH-PANAS-C. In regards to both instruments, areas of

exploration include the dimensional and structural independence of factors, sex

differences in adolescent populations, and the applicability of age-specific instruments

for use with adult and child populations. The principal research question being

addressed is Are the TRAD model-based PANAS and PH-PANAS-C psychometrically

sound in Australian populations and are the two instruments necessary or do the

measures duplicate the same outcomes in child and adult samples?

Tripartite Model of Depression and Anxiety Differentiation

Introduction

Clark, Watson and Tellegen (1988) proposed the Tripartite Model of Anxiety

and Depression (TRAD Model) as a theoretical structure to help explain the overlap

between anxiety and depression. The theory asserts that the differentiation of depression

and anxiety is determined by the expression of symptoms in three primary domains -

positive affect (PA), negative affect (NA), and autonomic arousal (physiological

hyperarousal or PH).

Two of the most widely used contemporary self-report instruments that

differentiate anxiety and depression in adults and children using the TRAD model

framework are the 20 item Positive and Negative Affect schedule (PANAS: Watson,


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Clark, & Tellegen, 1988)and the 48 item Physiological Hyperarousal and Positive and

Negative Affect Schedule for Children (PH-PANAS-C: Laurent, Catanzaro, & Joiner,

2004)respectively. The PANAS comprises 10 PA items and 10 NA items. The PH-

PANAS-C comprises 15 PA, 15 NA, and 18 PH items. Both instruments have been

validated in clinical and community populations, and are widely used in clinical and

research settings as screening and diagnostic tools.

Although the TRAD model and both the PANAS and PH-PANAS-C have

received extensive empirical support over the years, several psychometric anomalies

have been documented in the literature which range from TRAD theoretical

perspectives through to diagnostic application. Issues of concern relate to- inconsistent

model fit across varied samples (Crawford & Henry, 2004;Jacques & Mash, 2004),

inconsistent findings related to factorial independence (the model requires that factors

exhibit relative independence) (De Bolle & De Fruyt, 2010;Jacques & Mash, 2004), the

capability of the model to accurately account for the diversity of anxiety disorders (E.

R. Anderson & Hope, 2008;T. A. Brown, Chorpita, & Barlow, 1998;Chorpita, 2002;

De Bolle, De Fruyt, & Decuyper, 2010), cross-loading of items (Jacques & Mash, 2004;

Laurent & Ettelson, 2001), irregular correlations between dimensions associated with

varied samples (Crawford & Henry, 2004;Tuccitto, Giacobbi, & Leite, 2010), and sex

differences in adolescent school samples (Jacques & Mash, 2004). Additional debate in

the literature has raised issues related to the applicability of the TRAD model and

associated TRAD-based instruments in child samples, and has prompted some

discussion as to whether age-specific TRAD-based measures are necessary for adult and

child populations.


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Theoretical Framework of Model

The underlying principle of the TRAD model is that disordered affect can be

differentiated using three core dimensions. These are positive affect (PA), negative

affect (NA), and physiological hyperarousal (PH). These dimensions are proposed to be

unique, yet somewhat related (Watson, Gamez, & Simms, 2005). According to the

TRAD model, all disorders of affect share the common characteristic of elevated NA

(Novovic, Mihic, Tovilovic, & Jovanovic, 2008;Watson, Clark, & Carey, 1988).

Depression then differentiates through the presence of the added dimension of low PA,

and anxiety through the additional presence of increased PH (Watson, Clark, &

Tellegen, 1988).

The first two unique, though closely related dimensions are NA and PA. NA, a

core characteristic of all affective disorders, refers to negative emotional experiences

such as fear, sadness, and anger. Individuals with high NA may display increased

pessimism and experience emotional distress even in the absence of overt stressors,

while individuals with low NA are more likely to be secure and self-satisfied (Watson

& Pennebaker, 1989). PA refers to positive emotional experiences such as joy,

happiness, and excitement (Cohen & Pressman, 2006). Individuals with low PA are

characterised by emotions reflecting a lack of interest, joy, and motivation (Voelz &

Joiner, 2002)and experience symptoms such as anhedonia, lassitude, fatigue, and an

inability to feel joy (Mineka, Watson, & Lee, 1998). Individuals with high PA are

generally- active, energetic, motivated and perceive experience positively (Watson &

Clark, 1992). Paradoxically, because NA and PA are largely unique constructs, an

individual may experience both positive and negative affect in concert (Watson &

Clark, 1984).


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It is important to note that researchers have experienced difficulty differentiating

anxiety and depression with only the two dimensions of PA and NA (Pandey &

Srivastava, 2008). Notwithstanding the concept that the TRAD model proposes three

dimensions to differentiate anxiety and depression, PA and NA have been used to

differentiate the two clinical states (Pandey & Srivastava, 2008). According to Watson,

Clark and Carey (1988), Anxiety is essentially a state of high NA, and has no

significant relation with PA, but depression is a mixed state of high NA and low PA (p.

347). Hence, in affect only terms, it is the presence of low PA that differentiates

depression from anxiety (Chorpita, Daleiden, Moffitt, Yim, & Umemoto, 2000).

The third dimension of the TRAD Model is PH (Watson & Clark, 1991). In the

three-dimensional structure, the presence of elevated PH is a defining characteristic of

anxiety disorder and differentiates it from depression (Joiner, Catanzaro, & Laurent,

1996;Joiner et al., 1999;Watson & Clark, 1991). Physiological hyperarousal is defined

as elevated autonomic arousal and is characterised by a racing heart, shortness of breath,

light-headedness, trembling and dizziness (Cox, 2011). In addition to anxiety and

depression, the TRAD model also defines mixed-type anxiety-depression (AD). Mixed

AD is characterised by the presence of the combined symptoms of both anxiety and

depression (Voelz & Joiner, 2002). That is, mixed-type AD is differentiated from either

anxiety or depression alone by the presence of high NA, low PA, and high PH (Voelz &

Joiner, 2002).

Current research indicates that in youth, those with a primary symptomology of

depression are likely to also display anxiety symptoms, whereas those who are primarily

anxious are less likely to also be depressed (E R Anderson, 2007). From this

observation comes the notion that there may be a temporal relationship between anxiety

and depression with evidence from both adult and child samples suggesting that anxiety


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disorders may occur earlier than depression developmentally(E. R. Anderson & Hope,

2008). The current consensus is that younger children lack the cognitive ability to

adequately define their symptoms in a way that allows for a clear identification of

depression but rather attribute generalised fear and worry to factors characteristic of

negative affect. It is suggested that only later comes the ability to separate one's fear

from sadness. As such, Mineka et al. (1998)argue that it is crucial that any diagnostic

models dimensions adequately separate the mixed symptoms of depression and anxiety

into the appropriate dimensions and thereby reflect a comorbid classification as opposed

to one of either disorder. In this way there has been some concern that measures

developed to differentially diagnose affective disorders using the TRAD model may

lack this discriminant capacity in younger populations (Jacques & Mash, 2004). To

address such concerns, alternate age and gender models and accompanying instruments

that specifically examine the relationship between anxiety and depression within the

context of child and adolescent development could be explored.

PA and NA, have been associated with both state (brief/transitory) and trait

(stable and sustained) measures of emotion (Watson & Pennebaker, 1989)with global

and specific measures of affect in clinical and community samples showing reliably

high levels of positive correlation (Watson, Clark, & Tellegen, 1988). The trait nature of

both PA and NA is further supported by research showing that each relate to specific

factors on the five-factor model of personality (Watson, Clark, & Tellegen, 1988)with

PA being associated with extraversion and NA with neuroticism (Meyer & Shack, 1989;

Uziel, 2006;Watson & Clark, 1984; Watson, Clark, & Tellegen, 1988).

Extensive psychometric testing supports the theoretical framework of the TRAD

model, showing the three dimensions of the model to be independent (Joiner, et al.,

1996;Laurent, Catanzaro, Rudolph, Joiner, & et al., 1999). While factorial analysis


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of one (very slightly or not at all) to five (extremely). As the TRAD model and the

PANAS gained acceptance, it was increasingly used in younger populations. The use of

the measure in younger populations prompted renewed research interest in the tool and

whether the validity and reliability of the TRAD model translated to child and

adolescent populations (Yang, et al., 2006).

A number of measures using the TRAD model were developed specific to

younger populations however; two primary measures emerged as the most valid and

reliable. These were the Affect and Arousal Scale for Children(AFARS: Chorpita, et al.,

2000)and the Positive and Negative Affect Schedule for Children (PANAS-C) which

eventually became the Physiological Hyperarousal and Positive and Negative Affect

Schedule for Children (PH-PANAS-C:Laurent, et al., 2004;Laurent, et al., 1999).

These instruments utilised new theoretical, conceptual, and empirical construction

processes that had been lacking in previous scales. The AFARS uses a range of

interpretive phrases such as I cant calm down once I get upset which respondents

then rate on a Likert-Type scale of one to five, with one being a low indicator and five

indicating an often or always response to the phrase content. In contrast, the PH-

PANAS-C intentionally utilises the same format as the adult PANAS in order to offer a

diagnostic continuity from childhood through adolescence and into adulthood. The

literature acknowledges the good psychometric properties of both scales (Chorpita, et

al., 2000;Laurent, et al., 2004), and both instruments are commonly used to

differentiate anxiety and depression in school, clinical, and cross-cultural samples of

adolescents and children (Chorpita, et al., 2000;Ebesutani et al., 2011;Laurent, et al.,

2004).


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Validation

The orthogonal exclusivity of the three dimensions of the TRAD model (PA,

NA, PH), has been validated and replicated in many studies supporting the convergent

and divergent validity of the model (Laurent, Joiner, & Catanzaro, 2011; Lim, Yu, Kim,

& Kim, 2010;Pandey & Srivastava, 2008;Thompson, 2007;Watson & Clark, 1999; D

Watson et al., 1995). Initial validation of the PA and NA dimensions was undertaken by

Watson using self-report data obtained from twin and co-twin clinical samples with

depression or anxiety. As predicted by the TRAD model, NA positively correlated with

both depression and anxiety items and PA negatively correlated with depression and not

anxiety (Pandey & Srivastava, 2008). Furthermore, results suggested that PA and NA

were potential risk factors for anxiety and mood disorders and that the dimensions could

also predict major depression and dysthymia (Watson, Clark, & Carey, 1988).

Further validation has been undertaken using large and diverse samples (Watson

& Clark, 1999). The model was supported by results showing that psychiatric patients

reported significantly higher rates of NA than non-clinical samples, that the results of

TRAD model based self-report assessments were able to predict clinical samples, that

the correlations between PA and NA were low (between -.35 and -.05) and internal

consistency of the dimensions was high (Cronbachs Alpha between .83 .90 for PA

and .85.90 for NA).

To further establish construct validity, Watson and colleagues (2005)utilised the

dimensions of PA and NA from the PANAS to assess the relationships between positive

affect and negative affect with extraversion, and neuroticism respectively. Utilising the

Neo Personality Inventory (Costa & McCrae, 1985), Watson established that PA is

strongly correlated with extraversion and NA with neuroticism (Bourgeois, LeUnes, &

Meyers, 2010;Watson, et al., 2005). Further, the TRAD model has been validated in


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young populations with results showing that the model can predict and differentiate

affective disorders in adolescent populations (E R Anderson, 2007; E. R. Anderson &

Hope, 2008; E R Anderson, Veed, Inderbitzen-Nolan, & Hansen, 2010;Austin &

Chorpita, 2004;Jacques & Mash, 2004;Kiernan, Laurent, Joiner, Catanzaro, &

MacLachlan, 2001;Laurent, et al., 2011).

Criticisms and ControversiesThe TRAD Model

The literature details some concerns over the TRAD model that relate to the

theoretical stability of the model across populations. Several studies have failed to

replicate the factor loading characteristics initially described by Watson, Clark, and

Tellegen (1988)prompting questions about the models reliability and predictive

capacity across various populations. For example, Jacques and Mash (2004)attempted

to replicate Watsons (1988)original validation study and found that, while the results

were in accordance with the TRAD models predications, items did not uniquely load as

described by Watson et al. (1988). When Jacques and Mash (2004)examined the fit of

structural equation modelling conducted separately on the subsamples of adolescent

boys (n= 87) and girls (n= 131), modifications were required to improve model fit. In

the new model, suggested paths for the adolescent male subgroup were from PA to NA

and from PH to PA, bringing into question the uniqueness of the three factors of the

model. In further contravention with TRAD model predictions, paths indicated for the

female adolescent subgroup were from PA to anxiety and PH to depression (Jacques &

Mash, 2004).

A number of additional problems have been identified with the TRAD model.

Several studies have found discriminant validity concerns in clinical anxiety

populations where the anxiety-differentiating dimension of PH has been shown to lack

the discriminant capacity to accurately account for the diversity of anxiety disorders


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position that PH may only define panic disorder and agoraphobia in exclusion of other

anxiety disorders. This is consistent with Watsons (1988)initial findings from the

original measure developed to test the TRAD model - the Mood and Anxiety Symptom

Questionnaire (MASQ). The anxious arousal (PH) scale of the MASQ was determined

to be overly specific on somatic items which further characterised it as a scale

specifically related to panic disorder rather than anxiety. Subsequent studies have

suggested that the panic-related specificity of the PH scale means that it does not

adequately distinguish between those with or without an anxiety disorder

(denHollander-Gijsman, deBeurs, vanderWee, vanRood, & Zitman, 2010;Keogh &

Reidy, 2000).

These results suggest that the TRAD model fails to accurately explain the

heterogeneity of anxiety disorders and that the tripartite dimensions may discriminate

disparately across anxiety disorders in contradiction to its own predictions (E R

Anderson, et al., 2010). According to Zinbarg and Barlow (1996)

Our studies suggest that the emergence of one specific factor for anxiety

disorders in models such as the tripartite model may be an artefact of lumping

all the anxiety disorders together into a single group without recognising

important differences between the anxiety disorders (p. 190).

Finally, concerns have been raised about the lack of fit of the model to pre-

adolescent children and adolescent female populations (E. R. Anderson & Hope, 2008;

T. A. Brown, et al., 1998;Jacques & Mash, 2004). While the modelsbasic assumptions

are supported in younger populations, results from a number of studies show

considerable overlap between dimensions with items cross-loading in contradiction to

the proposed uniqueness of the dimensions (Jacques & Mash, 2004). This was further

supported by research showing significant correlations between PA and NA in pre-

adolescents (De Bolle & De Fruyt, 2010;Laurent & Ettelson, 2001). Further, questions


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about the differentiation capacity of the model in younger populations have been raised

after it was shown that in pre-adolescent populations PA and anxiety were shown to be

correlated as were PH and depression (E. R. Anderson & Hope, 2008;Jacques & Mash,

2004). Sex and age have been found to be significant variables in younger populations.

Jacques and Mash (2004)found that adolescent girls reported more symptoms of

anxiety and depression and scored lower on PA and higher on NA and PH than

adolescent boys. This sex difference has not been found in other age samples. The

literature indicates that the age and sex discrepancies may be a result of neurobiological,

cognitive, and psychosocial developmental influences during childhood and

adolescence (Ordaz & Luna, 2012;Stickle, Marini, & Thomas, 2012).

Summary: Tripartite Model

Constructed by Watson, Clark, and Tellegen, the TRAD model posits that

anxiety and depression share the common component of general distress (NA), and

hypothesises that depression is characterised by high NA and low PA and that high PH

and high NA are specific to anxiety, with high NA, low PA, and high PH characterising

comorbid depression/anxiety. Two factor (PA and NA) TRAD-based models have also

demonstrated the capability to differentiate anxiety and depression. Constructs such as

PA and NA have been associated with Extraversion and Neuroticism respectively. The

TRAD model has received extensive empirical support, and has been applied to adult,

adolescent, and child samples over the past decades. However, some research has

questioned the models proposed orthogonal dimensions and structural integrity of its

factors. There have been some inconsistencies in the findings in younger populations.


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The PANAS: Using the TRAD Model in Adults

Rationale for Development

In studies investigating the structure of affect, NA and PA emerged as the two

dominant dimensions (Watson, Clark, & Tellegen, 1988). However, a number of the

instruments designed to measure mood and anxiety were found to be unreliable and to

exhibit poor convergent and discriminant validity (Watson, Clark, & Tellegen, 1988).

At least some of the questionable reliability and validity arose because several scales

were created on a purely ad hoc basis without statistical procedures such as factor

analysis (Watson, Clark, & Tellegen, 1988). Hence, a need was identified for a valid

and reliable PA and NA scale that was brief and easy to administer in research and

diagnostic settings (Watson & Clark, 1999;Watson, Clark, & Carey, 1988).

Initial Development and Construction of the PANAS

A large pool of positive and negative affect items were produced and placed into

a five-point Likert-type response format for preliminary testing (1 = very slightly, to 5 =

very much). An initial community group from Southern Methodist University and a

small clinical group rated the frequency with which they had experienced each

emotionally descriptive item over seven different time periods (the present moment,

today, the past few days, the past week, the past few weeks, the past year, and on

average). Factor analysis reduced this large pool of items to 20 items (10 each for PA

and NA (Watson, Clark, & Tellegen, 1988). The subsequent state and trait inter-scale

correlations were high ranging between .86 to .90 for PA and .84 and .87 for NA, with

acceptable internal reliabilities reported for all the varied time-response formats

(Watson & Clark, 1999;Watson, Clark, & Tellegen, 1988). The PANAS gained

widespread empirical support and was quickly incorporated into clinical and research

settings across a number of cultural and linguistic groups (Voelz & Joiner, 2002).


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TRAD model is predicated on the well conceptualised characteristics of anxiety and

depression, the relationship between them, and the capacity of the tripartite dimensions

to predict them (Watson & Clark, 1999). The PANAS capacity to be utilised in this

manner to support the TRAD models theoretical underpinnings has provided evidence

of its construct validity.

Further, the construct validity of the PANAS has been supported by studies

showing that, in accordance with TRAD model predictions, extraversion was strongly

related to PA and not related to NA, while neuroticism was related to NA and not

related to PA (Watson & Clark, 1992). Specifically, factorial analysis of the PANAS

items using data obtained from both clinical and community samples, has shown that

items correctly load on their respective factors (NA or PA) and supports good construct

validity (Pandey & Srivastava, 2008;Terracciano, et al., 2003;Watson, Clark, & Carey,

1988).

While the majority of validation research has been conducted in the United

States of America (Thompson, 2007), cross cultural studies have helped establish the

instruments validity across such diverse cultures as Asia and the Middle East (Lim, et

al., 2010;Novovic, et al., 2008). These cross-cultural studies have shown that the

PANAS retains its validity when translated into different languages (Pandey &

Srivastava, 2008;Yang, et al., 2006).

The content validity of PANAS items has gained support through comparative

correlational findings drawn from a number of similar affect scales (D. Watson et al.,

1995). Correlational analyses identified that the items of the PANAS scales correlated

well with a number of recognised mood scale items, and correctly demonstrated weak

relationships with the items that were not related (Watson & Clark, 1999). Similarly the


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convergent and divergent qualities of the PANAS have been supported. A number of

studies have shown that the dimension-specific items cluster appropriately to their target

factor and account for the relative symptoms (i.e. NA or PA), and accurately display the

characteristics that define that dimension (Crawford & Henry, 2004). The divergent

properties of the items have been illustrated and show the uniqueness of the PA and NA

dimensions (Watson, Clark, & Tellegen, 1988).

Reliability

Good to excellent reliability of the 20-item PANAS measure has been

established in both clinical and community populations, with Cronbachs Alpha (CA)

coefficients ranging from .86 to .90 for PA and .84 to .87 for NA (Watson, Clark, &

Tellegen, 1988). The reliability of the scales (PA and NA) remained strong in all time-

response report formats (present moment, today, past week, past month, etc.) (Watson,

Clark, & Tellegen, 1988). Initial test-retest reliability was not as strong with correlations

ranging from .47 to .68 for PA and .39 to .71 for NAgenerally below the .70 value

considered a good CA level of reliability (Watson, Clark, & Carey, 1988).

More contemporary studies have shown good to excellent internal and test-retest

reliability, including cross cultural studies (Lim, et al., 2010;Watson, Clark, &

Tellegen, 1984). For example, the PANAS was tested with a clinical Korean sample and

yielded internal consistency coefficients of .87 for PA and .91 for NA. Test-retest

reliabilities over a one week period were .79 for PA and .89 for NA (Lim, et al., 2010).

Moreover, in an Italian community sample of students the three-month test-retest

reliability coefficients were good to excellent with CA values between .84 and .90 for

both PA and NA (Terracciano, et al., 2003).


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The reliability of the PANAS was also supported in older populations with one

study of patients receiving inpatient medical rehabilitation (Mean age= 75 years)

showing weak dimensional correlations, and strong item-dimension correlations

(Cronbachs Alpha= .85 for PA and .90 for NA) that remained moderately strong at re-

test after 10 days (Ostir, Smith, Smith, & Ottenbacher, 2005).

Intended Population Use

The adult PANAS has been validated for use as a screening and diagnostic

instrument in adult inpatient and outpatient clinical populations as well as in a diverse

range of community populations across varied cultural and linguistic settings (E R

Anderson, 2007; Archer, Adrianson, Plancak, & Karlsson, 2007;De Bolle & De Fruyt,

2010;Harmon-Jones, Harmon-Jones, Abramson, & Peterson, 2009;Laurent, et al.,

2011;Watson & Clark, 1984; Watson, Clark, & Tellegen, 1988). This use of a large and

diverse variety of participants in the development and validation of the measure and in

subsequent research has enabled investigators to establish parameters in regards to the

normative and clinical levels of anxiety and depression and compare general/clinical

participant groups (Crawford & Henry, 2004;Laurent, et al., 2011).

The ease of use of the PANAS and the simplicity of interpretation of results has

meant that the PANAS can be used in a wide variety of screening, clinical and research

settings (Black, Blum, Pfohl, & St. John, 2004;Lonigan, Phillips, & Hooe, 2003;

Novovic, et al., 2008; Pandey & Srivastava, 2008;Voelz & Joiner, 2002).

Criticisms and ControversiesThe PANAS

Although the developers of the PANAS presented strong psychometric

validation, some issues have been identified in regards the models fit in various

populations. Crawford and Henry (2004)found a problematic model fit associated with


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a small number of items that either cross-loaded (e.g. strong), or loaded poorly (e.g.

distressed). CFA modelling conducted on the PANAS by Crawford and Henry (2004)

using a large general sample also found a poorer than expected fitting model. According

to Crawford and Henry (2004)results of CFA showed that the two dimensions of PA

and NA were unique, however, they also showed a moderate negative correlation. These

two results are characteristic of the independent literature reporting on the

psychometrics of the PANAS. The prevailing perspective in the literature is best

described by Thomson (2007)who states the PANAS has generally been shown to be

reliable and consistently reflective of the lowly, albeit significantly, correlating

dimensions of PA and NA (p. 230).

The original development and validation of the PANAS occurred in North

America using samples that were predominantly comprised of Caucasian

undergraduates and university employees. Attempts to explore the cross-cultural

validity of the measure was undertaken in a largely Hispanic and Asian American

sample of undergraduates. In this sample, CFA showed that the data obtained using the

original 20-item PANAS did not adequately fit the TRAD model (Villodas, Villodas, &

Roesch, 2011). In order for the model to fit the data, four items required removal. These

were proud, alert, jittery, and distressed. Subsequent CFA on the revised 16-item

PANAS in this sample showed a strong fit with the model. Researchers assert that the

initial poor fit of the 20-item PANAS was due to the cultural variations in the concept

of happiness between Western and Eastern cultures. The Western concept of happiness

(PA) being associated with self-esteem was posited to be different to the Eastern

conceptualization that is related more strongly to notions of social harmony (Villodas, et

al., 2011).


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Finally, there has been suggestion in the literature that the PANAS scales only

measure high-activation affective states (Barrett & Russell, 1999). This argument had

been previously addressed by the developers with Watson and Tellegen (1985)stating

that this was the price the PANAS authors had to pay in order to gain dimensional

independence. Put simply, high activation descriptors demonstrate excellent convergent/

divergent validity through their ability to uniquely load on either PA or NA. More

subtle descriptors might measure affect more broadly, however, be more likely to cross-

load and thus reduce validity (Watson & Tellegen, 1985).

Summary: PANAS

The PANAS is a brief, 20-item, self-report, positive and negative affect scale

developed by Watson, et al. (1988). The measure was initially validated with

undergraduate students and university employed adults primarily from a Caucasian

North American background. Based on the TRAD Model, the PANAS uses

respondents levels of positive and negative affect to determine the presence of

depression and anxiety. The PANAS has gained strong support for both research and

clinical use. Its wide use in adults and older youth from both community and clinical

populations has provided further evidence of its reliability, validity, and utility.

However, some criticisms have been directed at the PANAS in relation to its fit to the

TRAD model, the dimensional independence of the PA and NA factors, item

redundancy, and model fit within cross-cultural samples.

The PH-PANAS-C: Using the TRAD Model in Children and Adolescents

The Positive Affect and Negative Affect Schedule for Children (PANAS-C) was

initially developed as a 27 item self-report instrument designed to replicate the original

adult PANAS in child and adolescent populations (Laurent, et al., 1999). The initial


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version was originally validated by the developers in 1999 using a community sample

of 700 school children in grades four to eight from Illinois, in the United States of

America. The initial validation included an extended item list which was reduced after

factorial analysis to a 27 item format with 12 PA items and 15 NA items (Laurent, et al.,

1999). Subsequent development resulted in an amended 30 item version of the measure

that included 15 items for each dimension (Laurent & Ettelson, 2001). In order to

establish a measure that was truly representative of the TRAD model, Laurent and

colleagues (2004)developed a third dimension for the model to assess physiological

hyperarousal (PH). After development and psychometric testing, the Physiological

Hyperarousal for Children (PH-C) eventually became an 18-item measure of autonomic

arousal symptoms based largely on the DSM-IV-TR criteria for panic disorder (DSM-

IV-TR; American Psychiatric Association, 2000; Laurent, et al, 2004).

The two dimensional PANAS-C was then combined with the PH-C to create the

PH-PANAS-C - a three dimensional measure of anxiety and depression reflective of the

theories of the TRAD model.

Respondents are identified as belonging to one of four categories based on the

profile of the scores reported on the three dimensions of the PH-PANAS-C (Laurent, et

al., 2011). A profile with high NA, low PA and normal or low levels of PH

characterises depression. Adolescents and children who experience depression may

exhibit- sadness, irritability, low self-esteem, increased anxiety, and feelings of

helplessness and hopelessness which may permeate through various parts of their lives

(McLean, 2009). Anxiety is characterised by high NA and high levels of PH. Children

with anxiety disorders often exhibit introverted behaviours, reduced peer interaction,

attention deficits, and be subject to increased severe and frequent negative somatic

responses (Rubin, Coplan, & Bowker, 2009). A respondent with a mixed anxiety-


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depression would be likely to report high NA, low PA, and high PH. Respondents who

do not fit any of the three diagnostic profiles are then considered to be clear or below

diagnostic threshold. In this way the measure is directly reflective of the TRAD model

in that all disordered affect is characterised by high levels of NA, and differentiated by

the additional presence of either low PA (in the case of depression) or high PH (for

anxiety). The development of an effective and efficient screening tool for disordered

affect in young people was considered vital as the evidence began to mount that

childhood depression and anxiety may progress throughout development and persist or

reoccur during adulthood (Laurent, et al., 2004;Shankman et al., 2009).

Further evidence has shown that childhood affective disorder was a strong

predictor of a number of physical illnesses in later life with the link between early-onset

affective disorder and poor physical health shown to be robust (Clark, Caldwell, Power,

& Stansfeld, 2010;Flaherty et al., 2006;Thabrew, de Sylva, & Romans, 2012). A

general association with poor health as well as illness-specific links have been reported

including chronic headache (Anda, Tietjen, Schulman, Felitti, & Croft, 2010); heart and

pulmonary diseases (Anda et al., 2008;Dong et al., 2004); some cancers (D. W. Brown,

Young, Anda, Felitti, & Giles, 2006); diabetes (Sepa, Wahlberg, Vaarala, Frodi, &

Ludvigsson, 2005); and faster aging (Surtees et al., 2011). Finally, the development of

such a screening tool was considered vital as the evidence revealed that individuals who

experience multiple episodes of disordered affect during development are at

significantly increased risk for early mortality (D. W. Brown, et al., 2006;Dube, Felitti,

Dong, Giles, & Anda, 2003)with individuals with six or more adverse affective

experiences during development likely to die up to 20 years earlier than those without.

Thus, Laurent and colleagues (1999; 2004)argued that it was crucial to diagnose and

treat children and adolescents with affective disorders to help reduce potential


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impairments of physical, social, academic, and emotional functioning (Uba, Yaacob,

Juhari, & Talib, 2012).

Laurent and colleagues (1999)further argued that previous symptom-oriented

self-report measures, used to assess mood in children lacked sensitivity. According to

Laurent et al. (1999)and a number of subsequent assessments, many of these

instruments did not adequately distinguish between types of internalising disorders, and

displayed poor discriminant validity. That is to say that previous measures were able to

detect disordered affect however, they could not differentiate between sub-types such as

anxiety and depression (Chorpita, et al., 2000).

Recent research that assessed a large sample of North American high school and

college students found that young people are reporting a higher prevalence of anxiety

and depression than in previous decades (Twenge et al., 2010). This trend further

indicated that the development of a measure such as the PH-PANAS-C was necessary to

address what was clearly becoming, as Laurent and colleagues (1999)had claimed, a

critical public health issue ( p. 326).

The PH-PANAS-C was developed as a screening tool for school and community

populations (Laurent, et al., 2004), and for use as a diagnostic tool in clinical

populations (Laurent, et al., 2011). Large clinical and non-clinical samples of children

have been utilised to develop the measure using both EFA and principal component

analysis (PCA) processes. Subsequent hypothesis driven research has shown the TRAD

model accurately predicts levels of NA, PA, and PH reported on the PH-PANAS-C by

specific clinical samples (Laurent & Ettelson, 2001).The literature shows that the PH-

PANAS-C is more sensitive, accurate, and reliable in both community and clinical

populations than other TRAD-based child measures (Kiernan, et al., 2001). Finally, the


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cross-cultural applicability of the measure has been shown in a large-scale, multi-

country European study (Kiernan, et al., 2001). In essence, the PH-PANAS-C is a child

version of the earlier adult PANAS instrument. It utilises a restructured version of adult

PA and NA scales with the addition of a new PH dimension which are theoretically and

psychometrically underpinned by the TRAD model (Laurent, et al., 2011).

Psychometrics

In order to utilise a large number of valid and reliable items in its construction,

the PA and NA items of the PH-PANAS-C were drawn from previous TRAD

instruments (Laurent, et al., 1999). The selected items were then evaluated in a small

child sample on the basis of the childrens ability to read and understand them (Laurent,

et al., 1999). Eventually the scales were examined to assess their psychometric

properties and, after a number of modifications, the final PA and NA dimension items

(making up the initial PANAS-C measure) comprised 30 items (Laurent, et al., 1999).

The instrument was administered to a small clinical sample and 707 schoolchildren who

attended grades four to eight with the results indicating that both PA and NA items

loaded well on their respective factors with alpha coefficients ranging between .94 and

.92 for NA and .90 and .89 for PA (Laurent, et al., 1999). The measure was found to

exhibit good convergent and divergent validity with the interrelations between PA an

NA found to be similar to those of the adult PANAS (Laurent, et al., 1999). In a later

study conducted by Chorpita and Daleiden (2000)on 226 child and youth outpatients,

the PANAS-C compared favourably with a number of similar child measures of anxiety

and depression. In comparison, the PANAS-C was found to account for more of the

variance and was a significant predictor of anxiety and depression (Chorpita, et al.,

2000).


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The 18 items of the PH dimension were derived from the criteria for panic

disorder detailed in the fourth edition of the Diagnostic and Statistical Manual of Mental

Disorders (American Psychiatric Association, 2000). In combination with the DSM-IV-

TR criteria, a number of somatic items associated with generalised anxiety disorder

were also added (Laurent, et al., 2004). In combination with the PA and NA factors,

Laurent and colleagues (2004)validated the PH factor in a medium sized sample of

school children. Analysis showed that the correlations between PA and NA, and PA and

PH were almost zero, however the correlation between NA and PH was large due to

significant cross loadings of above .40 between items (Laurent, et al., 2004).

Nevertheless, the scale correlated well with similar measures (.56 to .64) used to assess

the TRAD factors (Laurent, et al., 2004;Tsang, Wong, & Lo, 2012).

Validity

Laurent and colleagues (1999, 2004, 2011)have reported that PA, NA and PH

dimensions show good convergent and discriminant validity and are significant

predictors of anxiety and depression in young people in a framework consistent with the

TRAD model (Laurent, et al., 2011). The structural validity of the three dimensions was

further supported by Chorpita et al. (2000). In a large culturally diverse sample of

school children, Chorpita et al. (2000)found that the dimension of PA was not

correlated to either NA or PH, while NA was correlated to PH. Younger populations

may have conceptualised specific negative items such as I just cant seem to get going

as being associated with anxiety which may explain the correlation between NA and

PH.

Item loadings supported independent dimensions with significant loadings onto

their respective factors of .38 to .61 (PA), .41 to .74 (NA), and .38 to .61 (PH)

(Chorpita, et al., 2000). Both Chorpita and colleagues (2000)and Laurent and


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colleagues (2004)found that NA and PH were positively correlated. It was posited by

both groups that this was due to a number of PH items being negatively valenced (e.g.

my heart beats too fast), and concluded that it may be difficult to construct a high

autonomic arousal scale that is completely independent of the dimension of NA.

Yang et al. (2006)found similar psychometric properties of the PA, NA, and PH

factors in a cross-cultural study of Korean school children aged eight to eighteen years.

In a subsequent CFA analysis, Yang and colleagues (2006)posited that the high

correlation (.64) between NA and PH may be due to an Asian tendency to express

negative emotions as somatic complaints. Chorpita et al. (2000)indicated that the

somatization of depression may be a possible factor in all child samples from Eastern

and Western cultures (Laurent, et al., 2004).

Reliability

The PH-PANAS-C dimensions have shown good to excellent reliability in both

clinical and community samples with CA coefficients ranging from .86 to .93 (Laurent,

et al., 2004; 2011). Similarly, test-retest reliability has been shown as good to excellent

with correlations ranging from .70 to .75 for PH, .92 to .94 for NA, and .89 to .90 for

PA (Kiernan, Gormley, & MacLachlan, 2004; Laurent, et al., 2004;Laurent, et al.,

1999; Laurent & Ettelson, 2001;Nakamura, 2004). The reliability of the PA and NA

items were likely to be found to be valid and reliable as they were predominantly drawn

from the adult PANAS measure and had already undergone extensive psychometric

analysis in both clinical and community samples (Watson & Clark, 1999).

Criticisms and ControversiesThe PH-PANAS-C

The PH-PANAS-C has been shown to have some weaknesses in younger

populations. In a large sample of school children in grades four to eleven, structural


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equation modelling (SEM) contradicted the TRAD models theory of dimensional

independence suggesting paths from PA to anxiety and from PH to depression (Jacques

& Mash, 2004). Further, Jacques and Mash (2004)found gender differences in

adolescents with females reporting lower PA and higher NA and PH than boys in a

Canadian high school sample. Finally, Jacques and Mash (2004)found that, in children,

PH was a significant predictor of both anxiety and depression. A recent Dutch study

supported this finding and the authors have suggested that, in young people, PH may be

characteristic of both depression and anxiety (De Bolle & De Fruyt, 2010).

A recurring criticism of the PH-PANAS-C throughout the literature is that the

PH dimension accounts primarily for panic disorder symptoms and therefore the PH-

PANAS-C is unable to account for all anxiety disorders (E. R. Anderson & Hope, 2008;

Chorpita, 2002;De Bolle, De Fruyt, et al., 2010). The inability to account for the

heterogeneity of anxiety disorders has been evidenced in both adult and child measures

using the TRAD model (E. R. Anderson & Hope, 2008;T. A. Brown, et al., 1998). The

literature suggests that these anomalies may indicate a need for further refinement of the

PH scales, a recognition that children may express depression more greatly through

somatic arousal than adults, and an acknowledgement that PH may be more interwoven

into the fabric of NA and consequent attempts to characterise PH as unique in child and

youth samples may be difficult (De Bolle, De Fruyt, et al., 2010).

Finally, although the PANAS was designed for adults, it has also performed well

in child and adolescent samples. This has prompted some discussion as to whether age-

specific TRAD-based measures are necessary for adult and child populations (Fox,

Halpern, Ryan, & Lowe, 2010).


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Psychometric Properties of TRAD in an Australian Sample 43

Part 2: Research Report

Validating Psychometric Properties of the Tripartite Model of Anxiety and Depression

(TRAD) in Australian Children and Adults

Michael Scott1

James Cook University, Department of Psychology, School of Arts and Social Sciences,

Cairns, Australia

1Corresponding Author:Michael ScottDepartment of PsychologySchool of Arts and Social SciencesJames Cook UniversityMcGregor Road, SmithfieldQueensland 4878, Australia

Email:[email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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community and clinical populations (Brown, Chorpita, & Barlow, 1998; J. Buckby, et

al., 2007;Chorpita, 2002; Cook, Orvaschel, Simco, Hersen, & Joiner, 2004;Joiner, et

al., 1996;Laurent & Ettelson, 2001;Yang, Hong, Joung, & Kim, 2006).

Although the TRAD model has received extensive empirical support (Crawford

& Henry, 2004;Joiner, et al., 1996;Ostir, Smith, Smith, & Ottenbacher, 2005), several

studies have identified issues relating to validity in specific populations and to the PH

dimension. In relation to the dimension of PH, it has been suggested that this dimension

may not be able to fully account for the heterogeneity of anxiety disorders (Anderson,

2007; J. Buckby, et al., 2007;De Bolle & De Fruyt, 2010). Initially identified by

Barlow (1996), replicated by Mineka, Watson, and Lee (1998), and supported by

several more recent studies, it was found that PH is more specifically related to panic

disorder and generalised anxiety disorder and is not as sensitive to other forms of

anxiety such as phobias and social anxiety disorders.

The ability of the model to sustain its three dimensional structure amongst

varied populations has also been questioned. For example, Buckby and colleagues

(2007)have reported that they were not able to demonstrate an acceptable fit for a three-

factor model in a principle components analysis (PCA) of the model in a clinical sample

of older adolescents and young adults. Further, the dimensional independence of the

three factors in the TRAD model has also been questioned in child and adolescent

samples. In a Dutch investigation by De Bolle and De Fruyt (2010)it was found that the

correlation between PA and NA was significantly higher in child samples than in adult

samples. In younger populations, further validity concerns relate to gender differences.

Jacques and Mash (2004)found significant interactions for gender and age revealing

that adolescent girls reported more symptoms of anxiety and depression and scored

higher on NA and PH, and lower on PA than age matched boys. This was supported by


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Joiner and colleagues (1999)who detected sex differences between males and females

in adolescent clinical populations. However, sex differences were not found in the same

sample when the analysis was conducted on adolescents with single disorder diagnoses

of either anxiety or depression (Voelz & Joiner, 2002).

Few studies have been conducted with Australian samples using the TRAD

model. The literature reports only two studies, each having used the first measure

developed to test the TRAD model - the Mood and Anxiety Symptom Questionnaire

(MASQ: Watson, et al., 1995).

The Australian studies reported factorial inconsistencies in adult and adolescent

clinical samples respectively (Boschen & Oei, 2006; J. A. Buckby, Cotton, Cosgrave,

Killackey, & Yung, 2008). In one of the Australian studies, Boschen and Oei (2006)

failed to show support for a three factor structure at either the item or scale level of

analysis in an adult clinical sample of 470 anxious and depressed participants. Contrary

to the psychometric properties and theoretical predictions of the TRAD model reported

by the developers, the results of the study revealed poor dimensional independence with

significant correlations identified between dimensions (Boschen & Oei, 2006). In the

second Australian study, Buckby and colleagues (2008)tested the fit of the three factor

TRAD model in an clinical sample of 150 youth. The results supported a two factor

model of NA and PA however, the two factors that accounted for anxiety and

depression were highly correlated (r= .88). (J. A. Buckby, et al., 2008).

Attempts to address some of the psychometric issues associated with measures

utilising the TRAD model have resulted in a number contemporary measures for both

adult and child assessment. Two contemporary self-report instruments that utilise the

TRAD model to measure anxiety and depression include the Positive and Negative

Affect Schedule (PANAS) developed for adults, and the Physiological Hyperarousal


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While both the PANAS and PH-PANAS-C have integrated psychometric

improvements on the original TRAD measure (MASQ), some issues have remained.

These include cross-loading of some items on the PA and NA scales, (De Bolle & De

Fruyt, 2010;Laurent & Ettelson, 2001)sex differences in male and female adolescents.

(Jacques & Mash, 2004), and stronger sensitivity for both Panic Disorder and General

Anxiety Disorder symptoms over other forms of anxiety disorder in scores on the PH

dimension of the PH-PANAS-C (Anderson, 2007; Anderson, Veed, Inderbitzen-Nolan,

& Hansen, 2010).

The aim of the present study was to investigate the TRAD model psychometric

properties in both adults and young people in an Australian sample to assess its factor

integrity, and gender and age-related response characteristics. The Adult PANAS and

the Child PH-PANAS-C were used to test three hypotheses. It was hypothesised that the

dimensional structure of the TRAD model and the dimensional independence of the

factors will be supported by the adult participants self-reported responses on the

PANAS, and child participants self-reported responses on the PH-PANAS-C. It was

further hypothesised that adolescent females will report higher levels of NA than

adolescent males on the PH-PANAS-C. The third hypothesis was that child and adult

participants who completed both tests would report different levels of NA and PA on

the PANAS compared to the levels of NA and PA they reported on the PH-PANAS-C.

Method

Participants

A community sample of 299 participants aged 7 - 73 were recruited in North

Queensland, Australia, using a combination of local media, community noticeboards,

and snowball promotion. During analysis the cohort was divided into adults (>18 years)

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Documents

Validation of the Tripartite Model of Anxiety and Depression (TRAD) in Australian Children and Adults Using the PANAS (Adult) and PH-PANAS-C (Child) Self-report Measures