European Journal of Personality, Vol. 2, 113-120 (1988) The concepts of depression, anxiety, and neuroticism in questionnaires FRANS LUTEIJN and THEO K, BOUMAN gen, The Netherlands Abstract In this study, the relations among depression, anxiety, and neuroticism measured by self-report questionnaires were investigated, Subjects were 207 psychiatric patients High correlations were found among self-report scales purporting to measure depression, anxiety, and neuroticism. Results of a content analysis showed considerable overlap among these scales, A division of items into six content categories did not result in lower correlations compared to the original seales INTRODUCTION Many self-report questionnaires have been developed purporting to measure aspects of negative emotionality, both psychological and physical. In this study, we focused on measures of depression and their relations with anxiety and neuroticism scales, The main question addressed in this study was whether these seemingly diverse concepts can be distinguished statistically as well as in terms of their content. Most depression instruments are operationalizations of the severity of the depressive syndrome as a whole, rather than one of its aspects, for example, mood (Bouman, 1987; Boyle, 1985). Beck’s Depression Inventory (BDI; Beck, Ward, Mendelson, Mock and Erbaugh, 1961), the Self-Rating Depression Scale (Zung, 1965), and the depression scales of the MMPI (Dahlstrom, Welsh and Dahlstrom, 1972) are among the most frequently used. Some authors define anxiety as a subjective negative emotional state (Costa, 1985), whereas others (Jablensky 1985) distinguish various dimensions of anxiety, and try to define it in more operational terms. Spielberger’s State-Trait Anxiety Scale (STAI, Spielberger. Gorsuch and Lushene, 1970), the IPAT anxiety scales (Cattell and Scheier, 1963), All correspondence should be addressed to Frans Luteijn, University of Groningen, Section of Clinical Psychology, Academic Hospital, Oostersingel 59, 9713 EZ Groningen, The Netherlands. This article is part of a research project supported by the Netherlands Foundation for the Advancement of Pure Research (ZWO). 0890-2070/88/0201 13-08$05.00 Received 26 April 1987 © 1988 by John Wiley & Sons, Ltd Accepted 2 October 1987114 F. Luteijn and T.K. Bownan and Taylor’s Manifest Anxiety Scale (Taylor, 1953) are well-known anxiety measures. Neuroticism, on the other hand, usually refers to a much broader concept than depression or anxiety. According to Eysenck’s theory (Eysenck. 1970, 1973), it refers to individual differences in instability and vulnerability to breaking down while under stress, thus it is linked to a lability of the autonomous nervous system Many concepts proposed by other writers bear a remarkable resemblance to Eysenck’s original concept. For example, ‘neurotic lability’ (Wilde, 1970). ‘emotional instability’ (Mcites, Lovallo and Pishkin, 1980), “Vulnerability” (H. sanych, Eccleston and Davidson, 1981), and ‘general psychopathology’ (Gotlib, 1984). Recently, Watson and Clark (1984) proposed the higher order concept of Negative Affectivity (NA) for a mood-dispositional dimension pertaining to “pervasive individual differences in negative emotionality and self-concept’ (p 465). They consider this a unitary concept with a predominant endogenous character, which is closely related to depression and (trait) anxiety. In addition, Tellegen (1985) and Watson and Tellegen (1985) distinguish a Positive Affectivity (PA) dimension which is orthogonal to its Negative counterpart. Both the NA and the PA constructs have received ample empirical support. The NA concept is less contaminated by the connotations which ‘Neuroticism’ has obtained over the course of time. The lack of an unequivocal definition of the latter concept precludes a clear content area for neuroticism scales. Hence, content overlap may, and in fact does, occur between this and other types of scales in the affective domain. At an operational level, high correlations are generally found between various scales relating to negative emotionality (Dobson, 1985: Gotlib, 1984), Dobson (1985) observed that part of these high correlations may be accounted for by content overlap between scales with different names The aim of the present study is to investigate the relations among various depression, anxiety, and neuroticism scales, both extent statistically and in terms of their content Subjects A group of 207 heterogencous psychiatric patients was available for our study These patients were receiving treatment at seven Dutch institutions for mental health care. All subjects were considered testable. and agreed to partici voluntarily. Theit mean age was 36.4 years (SD = 13.2, range 19-74 years); 63 per cent were female, 71 per cent were in-patients, and 33 per cent had completed a low, 27 per cent a middle, and 40 per cent a high level of education Materials Alll subjects completed the following self-report questionnaires: Beck's Depression Inventory (BDI) The 1979 version (Beck, Rush, Hollon and Emery, 1979) of this state measure of depression was used in a Dutch translation (Bouman, Luteijn, Albersnagel andDepression, anxiety, and neuroticism — 1 Van Der Ploeg, 1985). Its 21 items were scored on a four-point scale: 0 (Absence) to 3 (Severe), Depression Symptom Inventory (DSI) (Bouman, 1987) The DSI was developed after a content ani questionnaires for depression, and it consists of 22 symptoms, chara depression. The subject rates the occurrence of each symptom during the previous weck on a five-point scale [*Not at all’ (1) to ‘Extremely’ (5)]. The DSI purports to be a state measure for depression and can be considered as a parallel test of the BDI. ysis of the items of 19 self-report cteristic of Depression Questionnaire (DQ) (Bouman, 1987). The DQ was also developed after a content analysis of depression questionnaires, and contains 36 items on which a subject rates how he/she feels in general. Scoring is on a three-point scale: True—?—False. The scores on six items need to be reflected because of their content. The DQ purports to be a trait measure of depression Dutch Personality Questionnaire (NPV) (Luteijn, Starren and Van Dijk. 1985) ‘This questionnaire measures seven personality characteristics, one of which is neutoricism. The neuroticism scale (IN-scale) is a reliable and valid parallel test of Eysenck’s EPI-N scale (Eysenck and Eysenck, 1964). It contains 21 items, to be answered on a three-point scale (True—?—False, scoring 2. 1. 0) State-Trait Anxiety Inventory (STAI) (Van Der Ploeg, Defares and Spielberger. 1980) Research showed the Dutch authorized adaptation of the STAI to be a reliable and valid instrument. It consists of two subscales referring to state and trait anxiety, respectively, each containing 20 items which are answered on a four-point scale RESULTS Correlations Table 1 shows that the correlations among the scales are substantial. In view of the equally high alpha coefficients these correlations increase only slightly after correction for attenuation. Content analysi: In order to examine the causes of the high correlations among potentially different seales we inspected their content in greater detail via the following procedure, The 140 items of the five self-report questionnaires were rated by five judges: two male clinical psychologists. both aged 33 years, two female clinical psychology students. aged 24 and 25 years and one male clinical psychology student, aged 34 years. These judges allocated each item to one of the seven content categories used by Bouman (1987) to classify depression, anxiety, and neuroticism items.