In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented.

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Development and validation of brief measures of positive and negative affect: The PANAS scales.

Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.

The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research.

This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is suited for use with different age groups, and other potential uses of the scale are discussed.

The Satisfaction with Life Scale

This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is Suited for use with different age groups, and other potential uses of the scale are discussed.

The Satisfaction With Life Scale.

Background Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. Methods A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. Results A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. Conclusion The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/410326/ioi60000.pdf

A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7

Conventional clinical trials using parallel groups are relatively insensitive to the effects of psychotropic drugs, especially antianxiety agents. Experimental paradigms based on the single organism research strategy offer an alternative. A free operant avoidance procedure clearly distinguished representative psychotropic compounds, including diazepam and pentobarbital, in normal subjects, and a multiple crossover procedure clearly detected antianxiety effects of diazepam in 11 psychoneurotic patients and antipsychotic effects of chlordiazepoxide in individual schizophrenic patients. Such procedures may serve to evaluate the effectiveness of therapeutic interventions in clinical practice as well as in research.

Evaluating antianxiety agents in humans: experimental paradigms.

Nonpharmacologic factors affecting anxiety relief were compared in two independent samples of psychoneurotic patients treated four or six weeks with meprobamate or placebo. Patient reports of anxiety relief were analyzed with respect to medication, some 20 characteristics of patient and treatment, and the interaction of medication with each characteristic. The results indicate that anxious neurotic outpatients who are black and better educated are likely to respond best to the act of pill-taking in general, whereas the specific pharmacologic effect of meprobamate is likely to be most helpful with patients who are older and less enthusiastic about pill-taking. Patients taking meprobamate improved more in one sample, whereas patients taking placebo improved more in the second sample. The effect of more experienced therapists in the second sample probably washed out the effect of meprobamate in that sample.

Predicting the Relief of Anxiety With Meprobamate: An Attempt at Replication

Keller and colleagues, in their article in this issue ofThe Journal(see p 1848), assert that depression is undertreated and mistreated in the community. They suggest that the public and the medical profession are poorly informed about the treatments available for depression. They call for further research into the inappropriate behavior of patients and physicians, with a view toward providing corrective education for a prompt solution of this important public health problem. It is tempting to question the validity of the information available on the treatment of depression in the community by entering on a detailed critique of the methodological limitations of recent studies, particularly in the selection of samples and the identification of cases within these samples. Because the data of various flawed studies tend to converge, however, such criticism may be largely ritualistic. It is perhaps more useful here to consider some implications of the data. The

Depressives, doctors, and antidepressants.

Clinical variables in pharmacoepidemiology

Background. Anxiety disorders are associated with considerable disability in the domains of (1) work, (2) social, and (3) family and home interactions. Psychiatric comorbidity is also known to be associated with disability. Methods. Data from the Cross-National Collaborative Panic Study was used to identify rates of comorbid diagnoses, anxiety and depression symptom ratings, and Sheehan disability scale ratings from a clinical sample of 1165 adults with panic disorder. Results. Comorbid diagnoses of agoraphobia, major depression, and social phobia were associated with disability across the three domains of work, social, and family and home interactions. The symptom of agoraphobic avoidance makes the largest contribution to disability but there is no single symptom cluster that entirely predicts impairment and disability. Limitations. The findings about the relative contributions that comorbid diagnoses make to disability only apply to a population with panic disorder. Conclusions. Although panic disorder is not generally considered to be among the serious and persistent mental illnesses, when it is comorbid with other diagnoses, it is associated with considerable impairment. In particular, the presence of agoraphobic avoidance should alert the clinician to the likelihood of important functional impairment. When measuring the functional impact of comorbid anxiety disorders, both the categorical and the dimensional approaches to diagnosis make valuable contributions.

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Eberhard H. Uhlenhuth

Papers

Evaluating antianxiety agents in humans: experimental paradigms.

Predicting the Relief of Anxiety With Meprobamate: An Attempt at Replication

Depressives, doctors, and antidepressants.

Clinical variables in pharmacoepidemiology

Disability and comorbidity: diagnoses and symptoms associated with disability in a clinical population with panic disorder.