Beyond mono-method symptom assessment: multimethod extension of the trilevel model of anxiety and depression

Abstract

The wide array of symptoms of, and high comorbidity rates between, unipolar depressive and anxiety disorders have raised questions about the relations among their symptoms. Factor analysis is a methodology to examine these relations yet factor analytic symptom measurement models have relied on mono-method measurement and do not always replicate. We conceptually replicate and extend the tri-level model of symptoms of anxiety and depression to encompass dimensional interviewer-rated symptoms. In the tri-level model, symptom-specific items load on three levels of factors: a narrow (or disorder-specific) factor, an intermediate-breadth factor, and a general distress factor. The tri-level model fit well in this sample and fit better than comparison models that eliminated one of the three levels. Extension analysis successfully integrated interviewer-rating variables into the trilevel model—particularly for the broad and narrow levels. These results provide some support the tri-level model and the use of dimensional interviewer-ratings of symptoms. Implications for research and treatment are discussed.

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ORCID for Nicholas J. Kelley: orcid.org/0000-0003-2256-0597

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