Depression, anxiety, and stress as hierarchical factors of general distress in Hispanic young adults.

Transcription

1 Depression, anxiety, and stress as hierarchical factors of general distress in Hispanic young adults. Thom Taylor, JoséCabriales, Theodore V. Cooper, Yvette Güereca, Justin Kepple, & Francisco Salgado-Garcia

2 The Paso del Norte Region

3 INTRODUCTION

4 Hispanic Psychological Distress Hispanics experience frequent distress (10.5% ) May be partially mediated by socio-economic status (SES) Low SES associated with 2 times the likelihood of experiencing psychological distress across all ethnicities Potentially higher exposure to stressors in Hispanics Psychological distress associated with other negative outcomes in Hispanics Substance use in young adults Lower school engagement Centers for Disease Control, 2004; Brown, Meadows, & Elder Jr., 2007; USDHHS, 2004; Swanson et al., 1992; Roberts, Roberts, & Chen, 1997; Herman-Stahl, Krebs, Kroutil, & Heller, 2007; Close & Solber, 2008; Brown et al., 2007

5 Conceptualizations of Distress Often includes: Anxiety Depression Comorbid anxiety and depression Mixed anxiety-mood diagnosis urged in DSM-IV iterations Non-specific symptoms may also be present: Negative affect symptoms Stress symptoms (reactions to stressors) Widiger & Clark, 2000; Lustman, Sowa, & O Hara, 1984; Cervantes, Salgado de Snyder, & Padilla, 1989; Roy-Byrne et al., 1994

6 Tripartite Model Framework Depression: lesser positive affect Anxiety (arousal symptoms): physiological arousal Stress reaction anxiety (negative affect): inferiority, rejection, self-consciousness, social distress, and anxious mood (stress and negative affect) Clark & Watson, 1991, p.329 ; Mineka, Watson, & Clark, 1998; Chorpita, Albano, & Barlow, 1998; Zinbarg & Barlow, 1996

7 Measurement of Distress Depression, Anxiety, and Stress Scale (DASS) Supported by Tripartite model Recently suggested to have an overarching general distress component Clinical samples General population (non-clinical) Lovibond & Lovibond, 1995; Brown, Chorpita, Korotitsch, & Barlow, 1997; Page, Hooke, & Morrison, 2007; Henry & Crawford, 2005; Crawford & Henry, 2003

8 THE PRESENT STUDY

9 Aims and Hypotheses AIM: To better understand general psychological distress within Hispanics Depression Anxiety Stress Hypotheses 1.Existence of a hierarchical structure of general psychological distress with sub-factors of depression, anxiety, and stress 2.Sub-factors will load equally on general distress (after correlated errors among items are accounted for)

10 Hypothesized Model: 3 Sub-factors to General Distress General Distress = = = Depression Anxiety Stress

11 The DASS in Detail Common and in the open domain 42 item measure (21 item measure also exists) Range of each item is 0 3 Total scores for each subscale (DEP, ANX, STR) can range between 0 42 Higher scores indicate higher levels of the distress constructs Example items: I couldn t seem to experience any positive feeling at all (DEP) I was aware of dryness of my mouth (ANX) I found myself getting upset by quite trivial things (STR) Lovibond & Lovibond, 1995; Ng et al., 2007; Bados, Solanas, & Andrés, 2005

12 Sampling and Approach To Analysis Cross-sectional survey of Hispanic young adults Hierarchical Confirmatory Factor Analysis (CFA) Theoretical approach ANX, DEP, and STR loading on a broader General Distress (GD) factor Correlated item disturbances Equality constraints imposed for model difference testing Eigenvalues estimated from entire data set Empirical approach Principal component eigenvalues >1.00 (Kaiser rule) Minimum Average Partial Correlation (MAP) Kaiser, 1960; Velicer, 1976

13 RESULTS

14 Descriptive Statistics of Sample n= % Female 87% Mexican American/Other Hispanic; 13% Mexican National Continuous Variables M SD Range Overall α Age DASS Depression DASS Anxiety DASS Stress

15 Unconstrained Stnd. Factor Loadings General Distress Depression Anxiety Stress Model Fit χ²(763) = , p <.001 CFI =.92 NNFI =.91 RMSEA =.05 SRMR =.05 Note: Items loaded on putative factors; Factor loadings of DASS items, as well as errors and correlation among errors available upon request

16 Equality of Factor Loadings Model (λ Constraint) χ²(df) AIC BIC D = A (764) D = S (764) A = S (764) Any 2 of 3 λs constr (765) D = A, D = S, A = S Underidentified-no convergence Unconstrained (763) Note: D = Depression; A = Anxiety; S = Stress AIC = Akaike Information Criterion; BIC = Bayesian Information Criterion

17 Unequal Hierarchical Loadings General Distress Depression Anxiety Stress

18 DASS Performance: Blank Slate Approach Kaiser Rule (eigenvalues >1.00) suggests 6 factors MAP estimation suggests 4 factors Eigenvalue sizes may indicate 1 factor No. Guassian Normal Categorical MAP MAP = Min. Average Partial Correlation of Components

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21 DISCUSSION

22 Nuances of General Distress Hierarchical GD factor largely supported for Hispanics Strong evidence for GD factor encompassing DEP, ANX, and STR Associations among DASS DEP, ANX, and STR are stronger in Hispanics relative to other ethnicities Anxiety symptomology (particularly autonomic arousal related symptomology) may be most distressing for healthy young adult Hispanics Henry & Crawford, 2005; Norton, 2007; Roy-Byrne et al., 1994; Zinbarg & Barlow, 1996;

23 Implications for Mental Health DASS conceptualization of mental health fits reasonably with Tripartite Model 3 sub-factors supported in Hispanic population Still, multiple sub-factors to GD, DEP, ANX, and STR may exist (3 level structure) Possibility that sub-clinical symptoms become more focused over time (i.e., more perceptible and/or detectable) Higher scores on DASS among treatment seeking samples relative to non-clinical samples ANX DEP significantly more than DEP ANX at the population level Chorpita, Albano, & Barlow, 1998; Power & Tarsia, 2007; Hinden,Compas, Howell, & Achenbach, 1997; Clark & Watson, 1991; Brown et al., 1997; Mineka et al., 1998

24 Analogy: Hurricane Development Well developed eye: Clinical symptomology Strengthening: More specific symptom clusters Early stages: Diffuse, but focusing symptoms present

25 Future Directions Longitudinal tracking (e.g., National Latino and Asian American Study) of Hispanics across time Specific symptom cluster development patterns Brief measures that are sensitive to nuances of language usage on U.S./México border Representativeness (other ethnicities, ages) Monitoring and effective treatment and prevention resources Evidence based care Hispanics and U.S./México border region generally resource deprived Young, Klap, Sherbourne, & Wells, 2001; USDHHS, 2004; Riolo, Nguyen, Greden, & King; Mikolajczyk, Bredehorst, Khelaifat, Maier, & Maxwell, 2007; Kessler et al., 2002

26 Acknowledgements This research project was supported by: The Hispanic Health Disparities Research Center, Grant 1P20MD A Smoke Free Paso del Norte: An Initiative of the Paso del Norte Health Foundation Grant # Members of the PATCH Lab past and present PREVENTION AND TREATMENT IN CLINICAL HEALTH

27 THANK YOU! WHAT QUESTIONS DO YA LL HAVE?