Negative affectivity in pediatric behavioral health outpatients: A preliminary investigation Nathan Chow, M.S.  Robert D. Friedberg, Ph.D., ABPP  Micaela A. Thordarson, B.S.  Lisa Hoyman, B.S.  Benjamin Schnare, B.A.  Julia Nunan-Saah, B.A.  Nicholas Madian, B.A Introduction Table 1 MANOVA results for SCARED and CDI (including factor scores) Depression and anxiety are two of the most debilitating conditions, as well as two of the most common dually diagnosed disorders (Murray & Lopez, 1997, Avenevoli et al., 2001). Their frequent co-morbidity raises questions regarding the shared and unique variance between them. One construct that permeates both disorders is negative affectivity, which is viewed as a general distress factor marked by a tendency to experience negative emotions such as worry, anxiety, fear, sadness, guilt, and anger (Chorpita, 2002; Ollendick et al., 2003). Chorpita (2002) found that negative affectivity was common to childhood depression, generalized anxiety disorder, social anxiety, panic, and OCD. With such a high prevalence in conditions of childhood, gaining clarity on negative affectivity is imperative to both assessment and treatment. The purpose of this study is to shed light on the presence of negative affectivity in children at a pediatric behavioral health clinic. It was hypothesized that children diagnosed with internalizing disorders would exhibit more negative affectivity than those with externalizing disorders via higher scores on the Children’s Depression Inventory (CDI) (Kovacs, 1992) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) (Birmaher et al, 1997), as well as their component factors. Additionally, it was predicted that females would display higher total scores on the CDI and SCARED than their male counterparts. Dependent Variable df Mean Square F Significance SCARED 2 382.694 2.145 0.128 Panic 44.61 2.363 0.104 GAD 23.20 1.643 0.205 Separation 31.345 2.335 0.107 Social Anxiety 10.126 0.604 0.551 School Anxiety 0.586 0.187 0.830 CDI 42.223 0.873 0.424 Negative Mood 4.307 .990 .379 Interpersonal Problems 2.598 2.448 .097 Ineffectiveness 1.739 .528 .593 Anhedonia 7.897 1.799 .176 Negative Self Esteem 6.003 1.524 .227 Table 2 t-test results of gender and CDI and SCARED Measure Mean SD t Significance SCARED -0.07 0.945 Male 25.19 13.19 Female 25.47 14.99 CDI 0.97 0.337 10.97 7.13 9 6.51 Methods Participants 54 patients (male n=37; female n=17) treated at a pediatric behavioral health outpatient clinic in an academic medical center participated in the study. The children were sorted into three groups based on their diagnoses: internalizing, externalizing, or mixed internalizing/externalizing. Thus, the groups represented both homotypic and heterotypic co-morbidities. Diagnoses were determined by semi-structured clinical interviews.  All the children completed the SCARED and the CDI. Results from the SCARED and CDI were not determinative in the diagnostic process. Measures The CDI is the most cited and researched child assessment measure (Finch, Saylor & Edwards, 1985). It is a 27-item self-report measure of depressive symptoms. Items are rated on a 3-point scale ranging from the least severe to the most severe. The CDI has five factor scores including negative mood, interpersonal difficulties, negative self-esteem, anhedonia, and ineffectiveness. The SCARED is a 41-item self-report measure of anxiety symptoms. Each item is scored on a 3-point scale, ranging from “not true/hardly ever true” to “very true/often true”. The SCARED is comprised of 5 factor scores, which are panic/somatic, generalized anxiety, separation anxiety, social anxiety, and school refusal. Both measures display strong psychometric properties (Birmaher et al, 1997; Kovacs, 1992). Discussion Treatment of mental health conditions should be as parsimonious and beneficial to the patient as possible. The results of this preliminary study provide greater clarity in this regard. The results indicated that children’s self-report of anxious and depressed moods did not vary as a function of their diagnostic group membership, demonstrating that the construct of negative affectivity permeates most diagnostic categories. Therefore, negative affectivity could be an ideal target for treatment interventions in children. In addition, no gender differences were found, lending to the idea that negative affectivity is a viable target in most children presenting for treatment. References Avenevoli, S., Stolar, M., Li, J., Dierker, L., & Ries Merikangas, K. (2001). Comorbidity of depression in children and adolescents: models and evidence from a prospective high-risk family study. Biological Psychiatry, 49(12), 1071-1081. Birmaher, B., Kheterpal, S., Brent, D.A., Cully, M., Balach, L., Kaufman, J., & Neer, S.M. (1997). The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale construction and psychometric characteristics. Journal of American Academy of Child and Adolescent Psychiatry, 36, 545-553. Chorpita, B. F. (2002). The tripartite model and dimensions of anxiety and depression: An examination of structure in a large school sample. Journal Of Abnormal Child Psychology, 30(2), 177-190. Kovacs, M. (1992). The Children’s Depression Inventory. Tonawanda, NY: Multi- Health Systems. Murray, C. J., & Lopez, A. D. (1997). Mortality by cause for eight regions of the world: Global burden of disease study. The Lancet, 349, 1269-1276. Ollendick, T. H., Seligman, L. D., Goza, A. B., Byrd, D. A., Singh, K. (2003). Anxiety and depression in children and adolescents: A factor-analytic examination of the tripartite model. Journal of Child and Family Studies, 12(2), 157-170. Results A Multivariate Analysis of Variance (MANOVA) was applied to the data to provide a conservative statistical test of the hypotheses.  Table 1 indicates that there were no significant differences between the three diagnostic groups on the SCARED F(2, 51)=2.145; p=NS and CDI total scores F(2, 51)=.873, p=NS. Second and third MANOVAs examining diagnostic group differences in the multiple CDI and SCARED subfactors revealed no statistically significant differences. Table 2 shows no statistically significant gender differences for the CDI (Male Mean=10.9; Female Mean=9.0) or the SCARED (Male Mean=25.19; Female Mean=25.47). Address correspondence to Nathan Chow at nchow@paloaltou.edu.