The DOI matches its Crossref record; 122 of the 123 references it cites were found in a registry or an index.
Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications
Abstract
We review psychometric and other evidence relevant to mixed anxiety-depression. Properties of anxiety and depression measures, including the convergent and discriminant validity of self- and clinical ratings, and interrater reliability, are examined in patient and normal samples. Results suggest that anxiety and depression can be reliably and validly assessed; moreover, although these disorders share a substantial component of general affective distress, they can be differentiated on the basis of factors specific to each syndrome. We also review evidence for these specific factors, examining the influence of context and scale content on ratings, factor analytic studies, and the role of low positive affect in depression. With these data, we argue for a tripartite structure consisting of general distress, physiological hyperarousal (specific anxiety), and anhedonia (specific depression), and we propose a diagnosis of mixed anxiety-depression.
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In the citing paper
“In contrast, a cluster referred to as anxious arousal, characterized by physiological hyperarousal, is specific to anxiety (Clark & Watson, 1991).”
From Mapping Mindfulness Facets Onto Dimensions of Anxiety and Depression (2013) · cites this paper as Clark & Watson, 1991
In the citing paper
“According to the tripartite model of Clark and Watson 139 , neuroticism is a core risk factor shared across anxiety and depressive disorders, with the added component of anxious arousal being more specific to anxiety conditions, and anhedonia being more characteristic of depression 140 .”
From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [139]
In the citing paper
“Anxiety and low mood correlate highly but there is evidence that they are distinct constructs.”
From Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis (2021) · cites this paper as Clark et al., 1991
In the citing paper
“In the tripartite model of depression and anxiety, depressive symptoms are generally characterized by high negative and low positive affect”
From Adolescent Loneliness and Negative Affect during the COVID-19 Pandemic: The Role of Extraversion and Neuroticism (2023) · cites this paper as Clark & Watson, 1991
In the citing paper
“low positive affect (anhedonia) plus negative affect is present in depression”
From Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis (2021) · cites this paper as Clark et al., 1991
In the citing paper
“According to the tripartite model of depression and anxiety, negative affect is common to both”
From Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis (2021) · cites this paper as Clark et al., 1991
In the citing paper
“high physiological arousal plus negative affect is present in anxiety alone”
From Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis (2021) · cites this paper as Clark et al., 1991
In the citing paper
“cross-sectional covariation of emotional disorders can be accounted for by a small set of latent variables, including high negative affectivity/neuroticism, low positive affectivity, and high autonomic arousal.[26][27][28][29]”
From The Classification of Anxiety and Fear-Related Disorders in the ICD-11: Review: Anxiety and Fear-Related Disorders in ICD-11 (2016) · cites this paper as [27]
In the citing paper
“the option to focus assessment at the level of the internalizing spectrum allows researchers and clinicians to account for the nonspecific emotional and cognitive symptoms of internalizing disorders, thus capturing the shared feature of negative affectivity [25, 26]”
From Trajectories of Maternal and Paternal Internalizing Symptoms from Pregnancy to 2 Years Postpartum: Identifying Modifiable Risk and Protective Factors (2024) · cites this paper as [26]
In the citing paper
“Adolescence is also a risk period for the new onset of anxiety and depressive disorders, psychopathologies which have long been associated with disruptions in regulation of positive and negative emotions.”
From Positive and Negative Emotion Regulation in Adolescence: Links to Anxiety and Depression (2019) · cites this paper as [7]
In the citing paper
“In tripartite structural theories of internalizing disorders (e.g., Clark & Watson, 1991), the development of anxiety and depression can be understood in terms of a general factor (e.g., negative affect or neuroticism) that confers risk for both disorders, as well as disorder-specific factors, such as anxious arousal or low positive affect, which specifically confer risk for anxiety or depression,”
From Eye tracking of attention in the affective disorders: a meta-analytic review and synthesis (2012) · cites this paper as Clark & Watson, 1991
In the citing paper
“The depression-specific factor most commonly cited is low positive affect (e.g., Clark & Watson, 1991), which involves difficulty experiencing pleasure and reduced sensitivity to rewards.”
From Eye tracking of attention in the affective disorders: a meta-analytic review and synthesis (2012) · cites this paper as Clark & Watson, 1991
In the citing paper
“but these emotional disorders can also be distinguished by physiological hyper-arousal (specific to anxiety) versus the absence of positive affect (specific to depression).”
From Personality traits and postnatal depression: The mediated role of postnatal anxiety and moderated role of type of birth. (2019) · cites this paper as Clark and Watson, 1991
In the citing paper
“This model states that anxiety and depression share a common component of negative affect”
From Personality traits and postnatal depression: The mediated role of postnatal anxiety and moderated role of type of birth. (2019) · cites this paper as Clark and Watson, 1991
Citations
Cites
The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Radloff, L. S. (1977) · Applied Psychological Measurement · doi:10.1177/014662167700100306 · Cited by 53,267
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139
An inventory for measuring depression
BECK, A. T. (1961) · Archives of General Psychiatry · doi:10.1001/archpsyc.1961.01710120031004 · Cited by 38,032
Hamilton, M. (1960) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.23.1.56 · Cited by 32,817
(1970) · Cited by 24,983
An inventory for measuring clinical anxiety: Psychometric properties.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.6.893 · Cited by 14,407
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988) · Clinical Psychology Review · doi:10.1016/0272-7358(88)90050-5 · Cited by 11,696
The assessment of anxiety states by rating
HAMILTON, M. (1959) · British Journal of Medical Psychology · doi:10.1111/j.2044-8341.1959.tb00467.x · Cited by 11,455
A self-rating depression scale
ZUNG, W. W. K. (1965) · Archives of General Psychiatry · doi:10.1001/archpsyc.1965.01720310065008 · Cited by 9,813
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1 of the 123 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
The validity of the Hospital Anxiety and Depression Scale
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(01)00296-3 · Cited by 9,779
Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., Amtmann, D., Bode, R., Buysse, D., Choi, S., et al. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.04.011 · Cited by 5,128
“PROMIS adopted a hierarchical structure to explain the relationships between self-reported symptoms of anxiety, depression, and anger [20,21].”
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008) · Perspectives on Psychological Science · doi:10.1111/j.1745-6924.2008.00088.x · Cited by 5,172
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998) · Psychological Assessment · doi:10.1037/1040-3590.10.2.176 · Cited by 4,874
Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., Brown, T. A., Carpenter, W. T., Caspi, A., Clark, L. A., et al. (2017) · Journal of Abnormal Psychology · doi:10.1037/abn0000258 · Cited by 3,335
Self-citation
Metadata
- Authors
- Clark, L. A., & Watson, D.
- Affiliations
- Southern Methodist University (US)
- Venue
- Journal of Abnormal Psychology
- Published
- 1991-08
- Volume
- 100
- Issue
- 3
- Pages
- 316-336
- ISSN
- 0021-843X (ISSN-L)
- 1939-1846
- OpenAlex
- W2148916146
- Cited by
- 4,601
- References
- 123
- Citations by year
- 2026: 172 · 2025: 173 · 2024: 176 · 2023: 171 · 2022: 204 · 2021: 195 · 2020: 230 · 2019: 182 · 2018: 189 · 2017: 181 · 2016: 176 · 2015: 226 · 2014: 223 · 2013: 195 · 2012: 221
- FWCI
- 37.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Abnormal Psychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- mixed anxiety-depressive disorder, anxiety, depression, tripartite model, anhedonia, hyperarousal, convergent and discriminant validity, inter-rater reliability, factor structure, positive affect, diagnosis
- MeSH terms
- Anxiety Disorders, Depressive Disorder, Diagnosis, Differential, Humans, Psychiatric Status Rating Scales, Psychometrics, Syndrome
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