Factor structure and construct validity of the Anxiety Sensitivity Index among island Puerto Ricans

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Abstract

The factor structure and convergent and discriminant validity of the Anxiety Sensitivity Index (ASI) were examined among a sample of 275 island Puerto Ricans. Results from a confirmatory factor analysis (CFA) comparing our data to factor solutions commonly reported as representative of European American and Spanish populations indicated a poor fit. A subsequent exploratory factor analysis (EFA) indicated that a two-factor solution (Factor 1, Anxiety Sensitivity; Factor 2, Emotional Concerns) provided the best fit. Correlations between the ASI and anxiety measures were moderately high providing evidence of convergent validity, while correlations between the ASI and BDI were significantly lower providing evidence of discriminant validity. Scores on all measures were positively correlated with acculturation, suggesting that those who ascribe to more traditional Hispanic culture report elevated anxiety.

Introduction

Ethnicity has been suggested to be a potentially significant variable in the differential expression of psychopathology (Carter, Miller, Sbrocco, Suchday, & Lewis, 1999). For example, Carter et al. (1999) found that African Americans differ slightly from European Americans in the features that characterize anxiety sensitivity. Specifically, they noted that although anxiety sensitivity among African Americans is multidimensional, number and composition of the anxiety sensitivity dimensions exhibited by African Americans differ from those characteristic of European Americans.

Similarly, Smith, Friedman, and Nevid’s (1999) study on phenomenological differences between African American and European American patients with panic disorder with or without agoraphobia illustrates the plausible presence of ethnic differences in symptomatology. Results suggest that African American patients with panic disorder demonstrated a significantly later age of onset, and showed higher rates of PTSD comorbidity. In addition, African Americans reported greater panic attack symptom severity with more intense levels of numbing or tingling in the extremities, as well as a greater fear of dying or going crazy.

Empirical investigations examining the impact of Hispanic culture on psychopathology and assessment, however, have been limited in scope (Ortega, Rosenheck, Alegria, & Desai, 2000). In addition, several studies reported in the extant literature have ignored the subtle differences that may exist among Hispanic groups. This study aimed to address some of these gaps in the literature by examining influence of acculturation on the construct of anxiety sensitivity among island Puerto Ricans.

Examining the relationship between ethnicity and the development of psychopathology is increasingly important among Hispanics, as this population is currently the largest minority group in the United States (U.S. Bureau of the Census, 2003). The rapid growth of the Hispanic population has prompted the increased attention given to mental health issues specific to this population. In spite of the amount of evidence suggesting that ethnicity might play an important role in the epidemiology and differential expression of psychopathology (Carter, Sbrocco, & Carter, 1996; Carter et al., 1999), literature investigating the nature of psychological disorders among Hispanics has been limited in depth and comprehensiveness (Ortega et al., 2000).

To date, the most extensive source of data pertaining to ethnic minorities is the Epidemiologic Catchment Area (ECA) Program. Findings from the Los Angeles Epidemiologic Catchment Area Project (LAECA) compared prevalence of mental disorders between Mexican-Americans and non-Hispanic Whites and revealed that rates for most mental disorders were strikingly equivalent for both ethnic groups (Karno, Burnam, Hough, Escobar, & Golding, 1987). Contrary to the LAECA conclusions, Mirowsky and Ross (1987) reported significant ethnic differences in reported levels of distress. Specifically, it was determined that symptoms typically associated with malaise, anxiety and depression differ between Mexican and Anglo individuals. Overall results of this study suggested that individuals raised in Mexico report lower levels of distress compared to Mexican-Americans raised in the U.S., who in turn report less distress than Anglo individuals. Mirowsky and Ross (1987) posit that each culture’s emphasis on personal survival strategies was a key factor in the observed differences. Specifically, while Anglo culture stresses the independence and individuality of its members, Mexican culture emphasizes the importance of loyalty within interpersonal relationships and collectivism.

Dohrenwend (1969) conducted one of the first studies examining the incidence of psychiatric disorders, particularly rates of depressive symptoms, among African American, Jewish, Irish, and Puerto Rican individuals. Mainland Puerto Ricans reported significantly higher rates of depressive symptoms than did their counterparts, even after socioeconomic status was controlled. This conclusion has also been supported by other investigations over the last three decades (Escobar et al., 1983, Gaw, 1993, Haberman, 1976). Canino et al. (1987), however, found that an island-wide survey of mental disorders in Puerto Rico did not support the notion that Hispanics have higher psychopathology rates than non-Hispanics. An exception to this was a higher prevalence rate of somatization disorders among Puerto Ricans in relation to U.S. community members.

This strong somatization pattern was also reported by Sylva (1997) in a series of case studies of Puerto Rican, non-Hispanic Black, and non-Hispanic White women in New York City. Puerto Rican women displayed more severe somatic and psychological complaints than non-Hispanic Black women, who in turn display higher levels of somatic and psychological complaints than non-Hispanic White women. Sylva (1997) proposed that the inter-ethnic differences observed are associated with the socioeconomic and demographic disparity among groups. For instance, less education and a lower household income significantly increased the likelihood of both somatic and psychological complaints. Once these variables were controlled the only observable difference between Puerto Ricans and non-Hispanic Whites was a greater incidence of somatic complaints by Puerto Rican women. It has been suggest in previous investigations that somatization may represent a culturally sanctioned method for eliciting social and emotional support (Duran, 1995).

Studies examining the associations between Hispanic ethnicity and the risk of psychiatric disorders have been criticized because of two main limitations. First, social stressors have been overlooked (Ortega et al., 2000). For most Hispanics, the migration experience is synonymous with the estrangement from supportive interpersonal bonds (Rogler, Gurak, & Santana Cooney, 1987). And, second, earlier studies have not taken into account that there is significant diversity among Hispanic groups, including socioeconomic status and other demographic characteristics such as country of origin, urban or rural residence, and “specific cultural elements historically rooted in their respective nationalities” (Aponte & Wohl, 2000; Rogler, Cortes, & Malgady, 1991; Straussner, 2001). By subsuming different ethnocultural groups into one, important factors remain unexamined, as it is erroneously assumed that Hispanic groups may be viewed interchangeably and that generalizations can be applied to all (Flaherty, 1987). As such, this investigation was designed to focus solely on the manifestation of anxiety sensitivity among island Puerto Ricans.

Anxiety sensitivity (AS), defined as the fear of anxiety-related symptoms that result from the belief that these symptoms have harmful somatic, social, or psychological consequences, is said to be an amplification of the fear responding factor (Taylor, Koch, McNally, & Crockett, 1992). When individuals high in anxiety sensitivity become anxious, they are more likely to misinterpret the symptoms brought about by the anxiety, believing that these will have detrimental consequences. This produces the development of a cycle, whereby onset of initial anxiety produces additional anxiety, and may eventually result in the experience of a panic attack (Reiss, 1991, Carter et al., 1999).

Additionally, empirical research has shown that elevated AS constitutes as a cognitive risk factor in the development and maintenance of anxiety disorders (Maller & Reiss, 1992). Notably, it has been found that relative to participants low in AS, those individuals scoring high in AS are more likely to experience a panic attack and develop an anxiety disorder. Thus, as the predictability associated with AS serves as a way to anticipate panic-like reactions, one may speculate the presence of a possible link between ataque de nervios and elevated levels of AS among individuals who report the presence of ataques. Specifically, in the same way that elevated levels of AS have been shown to precede the development of panic attacks (Donnell & McNally, 1990), elevated AS may similarly precede onset of ataques. It is imperative to first consider the generalizability of the anxiety sensitivity construct across cultural profiles.

Findings from studies examining the factor structure of the Anxiety Sensitivity Index (ASI) among a mostly European American sample revealed a hierarchical factor structure with three discrete first-order factors (Mental Incapacitation Concerns, Physical Concerns, and Social Concerns) and a general higher order factor (Mohlman & Zinbarg, 2000, Zinbarg and Barlow, 1996; Zinbarg, Mohlman, & Hong, 1999). Conversely, in attempting to validate the construct of anxiety sensitivity among Spanish clinical populations, Sandin, Chorot, and McNally (1996) found evidence for a unifactorial structure of the Spanish ASI. Sandin and colleagues (2001) further replicated this finding when investigating the joint factor structure of the ASI and the trait version of the State–Trait Anxiety Inventory (STAI-T). As expected, a factor analysis yielded two distinct factors, one for each scale, further supporting the notion that anxiety sensitivity differs from trait anxiety and providing evidence that the ASI measures a single construct.

More recently, Zvolensky and colleagues (2003) found that a two-factorial solution for the Anxiety Sensitivity Index—Revised (ASI-R) was the most replicable across six different countries (Canada, France, Mexico, Spain, The Netherlands, and USA). Specifically, in each country, the two-factorial solution provided the best fit yielding a factor reflecting Fear of Somatic Symptoms (including cardiovascular, respiratory, and gastrointestinal) and a second reflecting Social-Cognitive Concerns. Based on study findings, the authors vigilantly suggest the uniformity of AS across geographical, linguistic and cultural backgrounds.

If, as Zvolensky et al. (2003) suggest, AS cuts across geographical, linguistic, and cultural boundaries, then we would expect that Sandin et al., 1996, Sandin et al., 2001 unifactorial ASI structure be replicated among analogous groups. However, caution should be exercised when making such an assumption, as Spaniards may not be representative of all Hispanic groups. Furthermore, although Spanish language serves as a common link between Spaniards and Puerto Ricans, factors such as geographic location, economic circumstances, national history, and political status, should not be underestimated in the degree of influence they have on the development of cultural identities and culturally specific manifestations of anxiety pathology.

In light of the apparent importance of anxiety sensitivity as a predisposing factor for the development of anxious pathology and the paucity of information currently available regarding anxiety sensitivity among Puerto Ricans, this investigation sought to explore the factor structure of the ASI among island Puerto Ricans, particularly in relationship to acculturation. Comparisons of the factor structure for Puerto Ricans was expected to be a better fit with the structure reported for Spaniards than that reported for mostly European American samples. Furthermore, it was predicted that anxiety level would be positively correlated with an acculturation measure. In other words, higher enculturation levels would parallel higher anxiety scores.

Section snippets

Participants

Two hundred and seventy-five Puerto Ricans currently residing in a metropolitan area of Puerto Rico participated in the current study. Participants ethnically self-identified as Puerto Ricans, and were 18 years of age or older. Participants who self-identified as other than Puerto Rican (n=39) were excluded from the study in order to maintain cultural homogeneity among the sample. Participants born outside Puerto Rico, but who currently resided on the island and self-identified as Puerto Ricans

Descriptive statistics

Descriptive information is presented in Table 2. In general, this sample was predominantly female (55.6%), with an average age of 35 years (S.D.=15.4). Scores on the ASI approximate a normal distribution with the majority of scores (75%) falling between 15 and 35, and approximately 8% falling below and above a score of 10 and 40, respectively. Mean ASI scores were higher than those typically reported for mostly European American samples (M=19.01, S.D.=9.11; Peterson & Plehn, 1999) and

Discussion

Results from this study were inconsistent with previous investigative efforts, which found evidence for single- and three-factor ASI solutions in predominantly European American and Spanish samples, respectively (Sandin et al., 1996, Zinbarg et al., 1997). Results from CFA revealed that neither solution provided a suitable fit for the present data set. An initial EFA extracted a three-factor solution that accounted for a significant percent of the variance. An examination of the composition of

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