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Positive and Negative Affectivity and Their Relation to Anxiety and Depressive Disorders

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Positive and Negative Affectivity and Their Relation to Anxiety and Depressive Disorders Journal of Abnormal Psychology Copyright 1988 by the American Psychological Association. Inc. 1988, Vol. 97, No. 3, 346-333 0021-843X/88/$00.75 Positive and Negative Affectivity and Their Relation to Anxiety and Depressive Disorders David Watson and Lee Anna Clark Southern Methodist University Greg Carey Institute for Behavioral Genetics, University of Colorado Distinguishing between depression and anxiety has been a matter of concern and controversy for some time. Studies in normal samples have suggested, however, that assessment of two broad mood factors—Negative Aflect (NA) and Positive Affect (PA)—may improve their differentiation. The present study extends these findings to a clinical sample. As part of an ongoing twin study, 90 inpa- tient probands and 60 cotwins were interviewed with the anxiety and depression sections of the Diagnostic Interview Schedule (DIS; Robins, Helzer, Croughan, & Ratcliff, 1981). Respondents also completed trait NA and PA scales. Consistent with previous research, NA was broadly correlated with symptoms and diagnoses of both anxiety and depression, and acted as a general predictor of psychiatric disorder. In contrast, PA was consistently related (negatively) only to symptoms and diagnoses of depression, indicating that the loss of pleasurable engagement is a distinctive feature of depression. The results suggest that strengthening the PA component in depression measures may enhance their discriminative power. Oinicians have long been concerned by the conceptual and as they are among themselves, and thus often load on a single, empirical overlap between anxiety and depression, and have re- undifferentiated factor, together with measures of hostility and cently devoted considerable attention to their differentiation anger, neuroticism, physical complaints, repression-sensitiza- (e.g., Akiskal, 1985; Breier, Charney, & Heninger. 1985). Al- tion, irrational beliefs, and (on the opposite pole) with ego though the association is strong enough to suggest to some re- strength and social desirability (e.g., Dobson, 1985; Gotlib, searchers that they are variants of a single disorder, most clini- 1984; Mendels et al., 1972; Tanaka-Matsumi & Kameoka, cians and researchers in the area continue to believe that the 1986). Many investigators have concluded that all of these mea- basic distinction is valid (e.g., Akiskal, 1985;Foa&Foa, 1982). sures tap a common, underlying construct of Negative Affectiv- A complete discussion of this literature is beyond the scope of ity, Neuroticism, or General Psychological Distress (Eysenck, our article, but we will present evidence illustrating the magni- 1970; Gotlib, 1984; Watson & Clark, 1984; Zurawski & Smith, tude of the problem. 1987). Numerous studies have demonstrated that self-report anxiety These findings obviously cause interpretive problems for re- and depression scales are highly correlated, typically in the search involving self-report scales and suggest that they offer range of .40 to .70. This finding is, moreover, both robust and little help in differential diagnosis. Indeed, "anxiety" scales general: Such correlations have been reported in college stu- have been found to correlate as highly with clinical ratings of dents (Dobson, 1985; Gotlib, 1984;Nezu,Nezu,&Nezu, 1986; depression as they do with anxiety; and conversely, "depres- Tanaka-Matsumi & Kameoka, 1986), children (Blumberg & sion" scales are as strongly correlated with clinically rated anxi- Izard, 1986; Wolfe et al., 1987), normal adults (Orme, Reis, & ety as depression (e.g., Deluty, Deluty, & Carver, 1986; Zucker- Herz, 1986), and diverse patient samples (Bouman & Luteijn, man, Persky, Eckman, & Hopkins, 1967). It would be a mistake, 1986; Mendels, Weinstein, & Cochrane, 1972; Zurawski & however, to conclude that these data simply reflect the limita- Smith, 1987). The correlations are often high enough to suggest tions of self-report. Clinicians' and teachers' ratings of anxiety that they tap a single construct. In fact, different measures of and depression are also strongly correlated (Deluty et al., 1986; anxiety and depression are as highly correlated with each other Foa et al., 1983; Lipman, Rickels, Covi, Derogatis, & Uhlen- huth, 1969; Wolfe etal., 1987;Zuckermanetal., 1967), anxious and depressive symptoms co-occur in many patients (Dero- This research was supported in part by National Institute of Mental gatis, Klerman, & Lipman, 1972; Roth, Guraey, Garside, & Health Grant MH14677. Kerr, 1972), and comorbidity of the full clinical syndromes oc- We are deeply indebted to Irving I. Gottesman, Codirector of the curs in about half of all patients with anxiety or depressive diag- Washington University Twin Series, for his help in securing the data noses (e.g., Breier, Charney, & Heninger, 1986; Woodruff, Guze, used in this study. & Clayton, 1972; for reviews, see Breier et al., 1985; Clark, in Correspondence concerning this article should be addressed to David Watson, Department of Psychology, Southern Methodist University, press; Gersh & Fowles, 1979). Dallas, Texas 75275. Taken together, these data demonstrate a substantial degree 346 POSITIVE AND NEGATIVE AFFECTIVITY 347 of overlap between anxiety and depression, regardless of the pected, the NA and PA scales each defined a factor. The anxiety level considered. However, the data by no means imply that a and depression scales had significant loadings on both factors; distinction between anxiety and depression cannot be made. however, the anxiety scale loaded more strongly on the NA fac- Correlations in the .40 to .70 range leave much variance unac- tor, whereas the depression scale was a much better marker of counted for, and half of all patients with anxiety or depressive low PA. Similarly, Blumberg and Izard (1986) used self-report disorders show relatively pure syndromes. Furthermore, one mood scales to predict scores on measures of depression and can point to distinct subgroups of patients within each class, anxiety. Several of the negative emotion scales (most notably and to subjective and physiological correlates that are unique Sadness and Fear) contributed to the prediction of both mea- to each type of disorder (e.g., the disturbance of rapid eye move- sures, but the positive emotion scales (Joy and Interest) added ment [REM] sleep in depression, but not anxiety; see Akiskal, significantly only to the prediction of depression. The mood 1985; Kupfer et al., 1983). Even proponents of differentiability, data therefore suggest that PA may be an important factor in however, recognize the aforementioned problems, and agree on differentiating anxiety from depression (Tellegen, 1985; Watson the need for ftirther research to identify factors that will im- & Tellegen, 1985). prove their distinction. These studies, however, were conducted with normal subjects In this article we will report on one such factor. Specifically, and did not involve trait measures. Two studies have reported we will relate symptoms and diagnoses of anxiety and depres- supportive results using clinical samples. First, Hall (1977) ob- sion to two general mood-based personality factors, Positive tained diagnostic data and clinicians'ratings of anxiety and de- Affectivity and Negative Affectivity. We will show that Positive pression on a sample of 108 male outpatients. She found ratings Affectivity—but not Negative Affectivity—can be clinically and diagnoses of anxiety to be significantly correlated with NA, useful in distinguishing these two classes of disorder. but not PA, whereas ratings and diagnoses of depression were more highly related to (low) PA than NA. Second, Bouman and Positive and Negative Affect Luteijn (1986) examined three groups of patients: (a) major de- pressives, (b) dysthymics, and (c) nondepressives. Scores on a Extensive evidence demonstrates that two broad mood fac- number of mood and personality scales were factor analyzed, tors—Positive Affect and Negative Affect—are the dominant and two factors were extracted and interpreted as NA and PA. dimensions in self-reported mood (Watson, Clark, & Tellegen, Consistent with the model outlined earlier, the major depres- 1984; Watson & Tellegen, 1985). Although their names might sives had significantly lower PA scores than the dysphoric pa- suggest that they are opposite poles of the same dimension, Pos- tients, who were, in turn, lower on PA than the nondepressed itive and Negative Affect are in fact highly distinctive dimen- group. The latter data do not permit any comparison between sions that can be meaningfully represented as orthogonal (un- anxiety and depression, however. correlated) factors. Both mood factors can be measured either Our study provides the most comprehensive test of the model as a state (i.e., transient fluctuations in mood) or as a trait (i.e., to date. We examined the relation of trait PA and NA scores to stable individual differences in general affective tone). Our arti- symptoms and diagnoses of depression and anxiety in a clinical cle will focus on the traits, which Tellegen (1982) has termed patient population. On the basis of the data we have reviewed, Negative Affectivity (NA) and Positive Affectivity (PA). we predicted that NA scores would be significantly correlated Negative Affect is a general factor of subjective distress, and with both anxiety and depression, whereas PA scores would be subsumes a broad range of negative mood states, including fear, associated only with the latter. anxiety, hostility, scorn, and disgust. Mood states related to de- pression such
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