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The structural integrity of the internalizing dimension across diverse samples
Background: Psychological disorders cluster together systematically. Through factor analysis of disorder comorbidity, investigators are establishing the latent dimensions that underlie the development of related syndromes. The internalizing dimension, presumed to be the substrate of anxiety and depression, is among the most replicable of these latent constructs. However, most evidence for the structural integrity of internalizing comes from community samples, and comorbidity patterns might vary widely across other populations.
Method: We assessed nearly 5,000 outpatients seeking treatment for emotional disorders with a semistructured diagnostic interview and nearly 150,000 university students who self-reported on their history of psychological disorders. These were the largest patient and student samples, respectively, as yet for an evaluation of the latent structure of psychological disorders. We compared several competing dimensional models of comorbidity via confirmatory factor analysis.
Results: An internalizing dimension did not account well for patients’ anxiety and depressive disorder comorbidity. In the student sample, an internalizing dimension fit well, but it could not be separated into distress and fear subfactors that have previously been extracted from comorbidity data.
Conclusions: The structure of the internalizing domain might vary across populations. This hypothesis has important implications for nosological, etiological, and treatment perspectives on anxiety and depression.