The relationship between anxiety and depression as measured by the Hamilton scales
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Abstract
Considerable evidence suggests that anxiety and depression are closely related yet distinct psychological constructs. To account for their relationship, the categorical model of psychopathology maintains that anxiety disorders include depressive symptoms and depressive disorders include anxiety symptoms. A dimensional model of psychopathology maintains that anxiety and depression exist on separate dimensions across patients. The most widely used scales measuring these phenomena include the Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D). Traditional scoring of these scales follows the categorical approach, while factors obtained from the two scales combined (Combined Hamilton Factors) represent a dimensional approach. The present study empirically tested the categorical versus the dimensional approach by conparing the validity of traditional Hamilton scores and the Combined Hamilton Factors.
Traditional Hamilton scores and Combined Hamilton Factors measuring somatic anxiety, cognitive anxiety and depression were calculated for a large sample of primarily anxious and primarily depressed patients. Multitrait-multimethod matrices were constructed to compare the degree to which each set of scores correlated with measures of similar psychopathology (convergent validity) and were distinct from measures of dissimilar psychopathology (discriminant validity). Traditional Hamilton scores and Combined Hamilton Factors were also compared on their measurement of the outcome of treatnent of primarily anxious and primarily depressed patients with the antidepressant imipramine, the anxiolytic chlordiazepoxide and placebo.
Results of the present study indicated that Combined Hamilton factors derronstrated greater convergent and discriminant validity overall than traditional Hamilton scores. In several comparisons, Combined Hamilton factors were also more sensitive than traditional Hamilton scores to the effects of drug treatment. These findings suggested the superiority of the dimensional approach to accounting for the relationship between anxiety and depression and support the conception of anxiety and depression as related but distinct. Such a dimensional approach has implications for the etiology, measurement and clinical assessment of anxiety and depression.
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Dissertation (Ph.D.)--Boston University
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