ARTICLES
Latent Class Analysis of Child Behavior Checklist Anxiety/Depression in Children and Adolescents

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ABSTRACT

Objective

Comorbidity of psychiatric problems such as anxiety and depression poses challenges to treatment and research. This study tested whether problem items from the Anxious/Depressed scale of the Child Behavior Checklist (CBCL) can be separated into distinct anxiety and depression classes or are continuously distributed throughout a population.

Method

A CBCL was completed by a parent or guardian of each of 1,987 children and adolescents selected to represent nonreferred children in the United States, as well as by a parent or guardian of each of a demographically matched sample of 1,987 clinically referred children and adolescents. Problem items from the Anxious/Depressed scale of the CBCL were subjected to latent class analysis.

Results

Analyses revealed three levels of problem presentation in both samples. Children in the nonreferred sample were classified as having no problems, mild problems, or moderate anxiety/depression problems. Children and adolescents in the referred group were classified as having mild, moderate, or severe levels of problems. No pure anxiety or depression classes were found, only classes containing a mixture of both anxiety and depressive problems. Age, gender, and sample differences were found in class groupings, with nonreferred adolescent girls showing elevated levels of problems.

Conclusions

Results suggest that the comorbid conditions of anxiety and depression, as assessed by the CBCL anxiety/depression problem items, can be thought of as part of the same continuum of problems. Implications for assessment and treatment utilization are discussed.

Section snippets

Purpose of the Present Study

To assess the latent class structure of the Anxious/ Depressed (A/D) syndrome of the CBCL, we subjected the A/D items to LCA. If anxiety and depression problems are completely distinct entities, we expect LCA to identify three or four distinct classes of item groupings in both nonreferred and referred samples: a pure anxiety group, a pure depression group, and a group without many problems, as well as a possible fourth group with both anxiety and depression.

We analyzed two large samples of

Samples

The two samples of children and adolescents analyzed in this study have been described by Achenbach, 1991a, Achenbach, 1991b. In brief, the nonreferred sample assessed in 1991 included 100 males and 100 females at each age from 4 to 18 years, selected to be representative of the U.S. population in terms of ethnicity, socioeconomic status (SES), geographic region, and area of residence. A second sample of children referred for mental health services was obtained from 52 outpatient mental health

RESULTS

A two-class model did not fit any data set. Although models including four or more classes slightly improved the fit statistically, they created clinically uninformative classes (e.g., some classes included <1.0% of the sample). There was no change in the natural log as a function of the degrees of freedom between three-and four-class solutions, indicating that the three-class solution was the best fit to the data. Therefore, three-class solutions were preferred as providing the most meaningful

DISCUSSION

We found that the items on the A/D scale of the CBCL tend to co-occur as a cohesive set that reflects the complexity of affective problems among children and adolescents. Although variations in profiles emerged, we found no clear problem-specific classes indicative of anything other than a mixed A/D syndrome. The latent classes did not reveal patterns suggestive of separate anxiety or depressive disorders. Instead, each class showed a wide variety of traditionally “anxious” and “depressive”

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    This work was supported by NIMH grant 40305.

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