The Underlying Role of Negative Affect in the Association between PTSD, Major Depressive Disorder, and Generalized Anxiety Disorder

  • Brianna M. Byllesby
  • Ruby Charak
  • Tory A. Durham
  • Xin Wang
  • Jon D. Elhai


Clinicians and researchers have found differential diagnosis to be difficult, particularly for conceptually similar disorders. One category of particular interest has been distress or internalizing disorders, theorized to be related via an underlying construct of generalized distress or negative affect. The present study attempted to address the comorbidity of three distress disorders - posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) - using latent analyses by controlling for the variance attributable to negative affect. The sample consisted of 265 trauma-exposed individuals who completed self-report measures of PTSD, MDD, GAD, and negative affect. Confirmatory factor analysis was used to test initial model fit. Next, the model was re-computed, controlling for negative affect by regressing negative affectivity at the item-level. Results indicated that a significant amount of variance within and between these diagnostic categories is attributable to negative affect at both the item- and factor-level. The hypothesis that MDD’s non-somatic/affective factor and the GAD factor would have the highest attenuations in factor loadings after controlling for negative affect was supported. Therefore, negative affect significantly influences the co-occurrence of PTSD, MDD, and GAD clinically, emphasizing the need for transdiagnostic interventions for trauma victims.


Posttraumatic stress disorder Major depressive disorder Generalized anxiety disorder Comorbity Confirmatory factor analysis 


Compliance with Ethical Standards

Conflict of Interest

Brianna M. Byllesby, Ruby Charak, Tory A. Durham, Xin Wang and Jon D. Elhai declare that they have no conflict of interest.

Experiment Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Brianna M. Byllesby
    • 1
  • Ruby Charak
    • 2
  • Tory A. Durham
    • 1
  • Xin Wang
    • 3
  • Jon D. Elhai
    • 1
    • 3
  1. 1.Department of PsychologyUniversity of ToledoToledoUSA
  2. 2.Department of PsychologyUniversity of Nebraska at LincolnLincolnUSA
  3. 3.Department of PsychiatryUniversity of ToledoToledoUSA

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