An empirical investigation of the structure of anxiety and depressive symptoms in late adolescence: Cross-sectional study using the Greek version of the revised Clinical Interview Schedule Petros Skapinakis a,b, ⁎, Fotios Anagnostopoulos c , Stefanos Bellos a , Konstantina Magklara a , Glyn Lewis b , Venetsanos Mavreas a a Department of Psychiatry, University of Ioannina School of Medicine, Greece b Academic Unit of Psychiatry, University of Bristol, UK c Department of Psychology, Panteion University of Social and Political Sciences, Athens, Greece abstract article info Article history: Received 22 July 2009 Received in revised form 19 August 2010 Accepted 19 August 2010 Available online xxxx Keywords: Comorbidity Anxiety disorders/diagnosis/ epidemiology/psychology Mood disorders/diagnosis/ epidemiology/psychology Psychiatric status rating scales Epidemiology Adolescent Several studies in the past have examined whether the hierarchical structure of anxiety and depressive symptoms can explain the high comorbidity between them but more studies are needed from other settings and with different methods. The present study aimed to examine the structure of common anxiety and depressive symptoms in adolescents 16–18 years old attending secondary schools using the Greek version of the revised Clinical Interview Schedule (CIS-R), a fully structured psychiatric interview. A total of 2431 adolescents were interviewed with the computerized version of the CIS-R. The hierarchical structure of 12 depressive and anxiety symptoms was examined with confirmatory factor analytical methods. Four alternative models of increasing complexity were tested. The best-fitting model included three first-order factors, representing the dimensions of anxiety, depression and non-specific distress respectively. A model with a higher-order factor representing the broader internalizing dimension was less supported by the data. The findings of this and other studies should be taken into account in future classifications of psychiatric disorders and may have clinical practical implications. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Several epidemiological studies of the past 30 years have helped to establish the public health importance of the common mental disorders both in adults and in children/adolescents (Prince et al., 2007; Patel et al., 2007). The common mental disorders are characterized by a varying mixture of anxiety and depressive symptoms (Goldberg et al., 1987), are more prevalent in women (Alonso et al., 2004; Verhulst et al., 2003) and tend to co-occur both within and across time (de Graaf et al., 2002). Phenomenological (Clark and Watson, 1991, Mineka et al., 1998), epidemiological (Regier et al., 1984) and psychopharmacological (Klein, 1964) research during the second half of the 20th century led to the prevailing categorical view of anxiety and depression that is reflected in the official psychiatric nomenclature. According to Diagnostic and Statistical Manual of Mental Disorders, fourth Edition (DSM-IV) and International Classification of Diseases, 10th revision (ICD-10), common mental disorders are grouped into anxiety and mood disorders and the latter are clearly distinguished from each other (Clark and Watson, 1991). This notion however has been challenged by the research finding of considerable comorbidity between (and within) the two diagnostic classes (Kessler et al., 1994) and by the clinical observation that patients usually present with mixed anxiety and depressive symptoms (Barlow and Campbell, 2000). As the categorical model of anxiety and depression is problematic for explaining the observed comorbidity researchers turned to alternative dimensional conceptualizations. It was argued that the common psychiatric symptoms have a continuous distribution in the population and there is no clear cut-off to distinguish between cases and non-cases. Goldberg et al. (1987) in an early study reported that two highly correlated dimensions could explain most of the shared variance between symptoms. The first dimension consisted of anxiety-related symptoms and the second of depressive related symptoms. The high correlation between the two dimensions supported the idea of a broader latent dimension which is behind depression and anxiety. This higher-order dimension is analogous to the concept of neuroticism (Eysenck, 1990), or that of the internal- izing disorders in the children and adolescent literature (Achenbach, 1978, King et al., 1991). It is also compatible with the “negative affectivity” part of the tripartite model (Clark and Watson, 1991), a more elaborate dimensional model that has been suggested for the Psychiatry Research xxx (2010) xxx–xxx ⁎ Corresponding author. Department of Psychiatry, University of Ioannina, School of Medicine, Ioannina 45110, Greece. Tel.: + 30 26510 07748; fax: 30 26510 07049. E-mail address: p.skapinakis@gmail.com (P. Skapinakis). PSY-06629; No of Pages 8 0165-1781/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2010.08.023 Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres Please cite this article as: Skapinakis, P., et al., An empirical investigation of the structure of anxiety and depressive symptoms in late adolescence: Cross-sectional study using the Greek version..., Psychiatry Research (2010), doi:10.1016/j.psychres.2010.08.023