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Cited by 26Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Research TopicsPersonality Disorders and Psychopathology

Disentangling depression and anxiety in relation to neuroticism, extraversion, suicide, and self−harm among adult psychiatric inpatients with serious mental illness.

Subica, Andrew M., Allen, Jon G., Frueh, B. Christopher, Elhai, Jon D., Fowler, J. Christopher·2016·British Journal of Clinical Psychology
DOI 10.1111/bjc.12098
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Abstract

OBJECTIVES: Little is known about depression-anxiety comorbidity and its association with personality traits and suicide/self-harm in adult psychiatric inpatients with serious mental illness (SMI), impacting clinical assessment and treatment. This study sought to determine the symptom structure of depression-anxiety comorbidity and its relation to neuroticism, extraversion, and suicide/self-harm behaviour in this high-risk population. DESIGN: Nine hundred and sixty-two adults receiving inpatient care at a private psychiatric hospital completed questionnaires at admission. METHODS: Confirmatory factor analyses compared a bifactor solution specifying a general distress factor and two specific depression and anxiety factors against unidimensional and correlated factors solutions. The bifactor solutions' factors were subsequently correlated with neuroticism and extraversion subscales and pre-hospitalization suicide/self-harm behaviours. RESULTS: The bifactor model rendered superior fit to sample data and a robust general factor - accounting for 77.61% of common item variance - providing the first evidence for a tripartite structure of depression and anxiety among adult inpatients. The bifactor solution-outputted independent general distress, depression, and anxiety factors positively correlated with neuroticism, the personality dimension corresponding to trait negative affectivity. The general distress and depression factors associated with recent self-harm, but factors showed no associations with prior suicidal behaviour. CONCLUSIONS: In adult psychiatric inpatients, general distress substantially underlies comorbid depression and anxiety symptom variation and may contribute to recent incidence of self-harm. Transdiagnostic assessments and interventions targeting general distress may temper depression, anxiety, and self-harm in adult inpatients. PRACTITIONER POINTS: Clinical implications Depression-anxiety comorbidity symptomology in adult psychiatric inpatients is primarily composed of general distress. General distress and specific depression are associated with recent self-harm but not suicidal behaviour. Assessing and treating general distress rather than depression or anxiety specifically may best mitigate comorbid depression and anxiety, and reduce self-harm behaviour in this clinical population. Cautions and limitations The large sample lacked ethnocultural diversity, and data were cross-sectional. The use of brief self-report measures to assess depression and anxiety may have reduced measurement range.

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  • Research supports a bifactor model of negative emotionality, consisting of a general factor in addition to distinct, but correlated, narrow factors.

    “Although negative emotionality is composed of facets (narrow traits), research supports of bifactor model of negative emotionality, consisting of a general factor in addition to distinct, but correlated, narrow factors (Subica et al., 2016; Brandes et al., 2019; Fournier et al., 2019).”

    From Predicting the Severity of Symptoms of the COVID Stress Syndrome From Personality Traits: A Prospective Network Analysis (2021) · cites this paper as Subica et al., 2016

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Authors
Subica, A. M., Allen, J. G., Frueh, B. C., Elhai, J. D., & Fowler, J. C.
Affiliations
  • Loyola Marymount University (US)
  • Baylor College of Medicine (US)
  • University of Toledo (US)
Corresponding author
Subica, Andrew M.
ORCID
Venue
British Journal of Clinical Psychology
Publisher
Wiley
Published
2015-12-30
Volume
55
Issue
4
Pages
349-370
ISSN
  • 0144-6657 (ISSN-L)
  • 2044-8260
DOI
10.1111/bjc.12098
OpenAlex
W2216894489
Cited by
26
References
125
Citations by year
2026: 2 · 2025: 5 · 2024: 2 · 2023: 3 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 6
FWCI
4.02
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • British Journal of Clinical 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 › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
comorbid depression and anxiety, general distress, bifactor model, neuroticism, extraversion, self-harm, suicide, severe mental illness, psychiatric inpatients, transdiagnostic assessment, negative affectivity, symptom structure
MeSH terms
Neuroticism, Adult, Anxiety, Anxiety Disorders, Cross-Sectional Studies, Depression, Depressive Disorder, Extraversion, Psychological, Factor Analysis, Statistical, Female, Hospitals, Psychiatric, Humans, Inpatients, Male, Middle Aged, Psychiatric Status Rating Scales, Surveys and Questionnaires, Stress, Psychological, Suicide, Comorbidity, Self-Injurious Behavior, Suicidal Ideation

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