Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire - Abbreviated (PSWQ-A).

OBJECTIVE: The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A). DESIGN: Longitudinal assessment of GAD symptoms pre- and posttreatment. PARTICIPANTS: Participants were 259 older adults aged 60-86 years with a diagnosis of GAD who were assessed before and after treatment. INTERVENTION: Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions. MEASUREMENTS: Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A. RESULTS: Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status. CONCLUSIONS: Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.

The Penn State Worry Questionnaire for Children: Age, Gender and Clinical Invariance.

The Penn State Worry Questionnaire for Children (PSWQ-C) is one of the most frequently used instruments to assess worry in children. The current study examines the measurement invariance of the PSWQ-C in a Romanian sample. Participants (n = 759) were recruited from both community and clinical populations. Our findings have replicated the good psychometric properties of the PSWQ-C and of the short PSWQ-C (the original scale with the negative items deleted). Multigroup confirmatory factor analysis has supported measurement invariance (configural, metric, scalar) across gender, age and clinical diagnosis. Convergent validity with other assessment measures has also been established. Finally, the implications of the use of the PSWQ-C in the assessment of anxiety in children and adolescents are discussed.

Abbreviated version of Penn State Worry Questionnaire for Chinese adolescents: Age, gender and longitudinal invariance.

The abbreviated version of Penn State Worry Questionnaire (PSWQ-A) has been widely used to assess worry. However, its measurement invariance has been not yet warranted. With a cross-sectional and a longitudinal sample of Chinese adolescents (N1 = 1,329, N2 = 408), this study examined age, gender, and longitudinal invariance of PSWQ-A. Results supported strict invariance, including configural, metric, scalar, and error level, across gender and age in the cross-sectional sample; strict longitudinal measurement invariance was also supported in the longitudinal sample. This study suggests the application of the PSWQ-A in measuring adolescent worry and a basis for comparisons of different populations and occasions for worry.

Factor Structure, Measurement Invariance, and Concurrent Validity of the Penn State Worry Questionnaire Across Development, Psychopathology, and Culture.

The Penn State Worry Questionnaire (PSWQ) is a widely used assessment of excessive worry. American undergraduate samples have predominately been used to evaluate its factor structure, which may not generalize to other developmental, cultural, and psychopathology populations. The present study tested the PSWQ's factor structure across three diverse samples: American undergraduate students (n = 3,243), Dutch high school students (n = 3,906), and American adults with psychopathology (n = 384). Exploratory, confirmatory, and multigroup confirmatory factor analyses were conducted. Measurement invariance and concurrent validity were also tested. Method-factor and two-factor models were largely equivalent and superior to a one-factor model. Invariance tests supported configural and metric invariance but only partial scalar invariance. Positively worded items but not negatively worded items demonstrated concurrent validity with anxiety and depression symptom measures and diagnoses. Overall, the PSWQ appears to measure a unitary construct. Present results warrant further testing of the PSWQ across diverse samples.

Pathological Worry is Related to Poor Long-Term Pharmacological Treatment Response in Patients With Panic Disorder.

OBJECTIVE: Several predictors of unfavorable pharmacological treatment response (PTR) in panic disorder (PD) patients have been suggested, such as the duration of the illness, presence of agoraphobia, depression, being a woman, and early trauma. This study aimed to examine whether pathological worry is associated with PTR in PD patients. METHODS: This study included 335 PD patients and 418 healthy controls (HCs). The Penn State Worry Questionnaire (PSWQ), the Early Trauma Inventory Self Report-Short Form (ETISR-SF), Beck Depression Inventory (BDI), Panic Disorder Severity Scale (PDSS), and Anxiety Sensitivity Inventory-Revised (ASI-R) were administered. We measured the PTR at 8 weeks and 6 months. Student t-test, chisquare tests, Pearson's correlation analyses, and binary logistic regression model were used. RESULTS: Our results showed that the total scores of the PSWQ correlated with the ETISR-SF, BDI, and ASI-R were significantly higher in patients with PD compared with HCs. The PSWQ and BDI could predict unfavorable PTR at 6 months in PD patients. CONCLUSION: This is the first study to demonstrate that pathological worry may contribute to poor long-term PTR in PD patients. Therefore, our research suggests that clinicians must be aware of worry to optimize PTR for PD patients.

Reliability and validity of the Korean version of the Penn State Worry Questionnaire in primary school children.

Worry is a generalized psychological phenomenon seen among most people. When worry is excessive and nearly uncontrollable, people usually suffer psychological pain. The Penn State Worry Questionnaire for Children (PSWQ-C) was developed to measure worry objectively. It comprises 14 items for measuring excessive, generalized, and uncontrollable worry in children. This study, conducted with a large group of elementary children (3rd through 6th graders, ages 8-12 yr; N=973), investigated the reliability and validity of the Korean version of the Penn State Worry Questionnaire for Children (PSWQ-CK). The PSWQ-CK showed high reliability by test-retest and also excellent internal consistency results. To examine the validity of the PSWQ-CK, we calculated its correlation with the Revised Children's Manifest Anxiety Scale (RCMAS). The PSWQ-CK had a higher correlation with the worry/oversensitivity factor than with other subscales of the RCMAS, and it showed no correlation with the lie factor. When 3 reversed PSWQ-CK items were eliminated, the instrument showed higher internal consistency. However, this did not improve its correlation with other anxiety-measuring tools. In conclusion, the PSWQ-CK's reliability and validity were satisfactory, and it is a useful tool for objectively measuring the worry of Korean children of this age group.

Structure and Psychometric Properties of the Penn State Worry Questionnaire for Children in Chinese Adolescents.

The present research introduced the Penn State Worry Questionnaire for Children (PSWQ-C) to China and evaluated its structure and psychometric properties in Chinese adolescent samples. The PSWQ-C is a 14-item self-report questionnaire designed to measure the generality, excessiveness, and uncontrollability aspects of pathological worries in children and adolescents. Factor analysis results suggested that the three reverse-scored items represented one or more unknown factors rather than worry; thus, they were discarded and the remaining 11 positively worded items formed the Chinese version of the PSWQ-C (CH-PSWQ-C). The CH-PSWQ-C was found to have acceptable internal consistency reliability and favorable convergent and divergent validity by examining its correlations with measures of anxiety, depression, and some personality characteristics. To illustrate the utility of the CH-PSWQ-C in Chinese adolescent samples, we used the CH-PSWQ-C to explore the moderating effect of neuroticism on the relationship between earthquake experiences and worry; the results suggested that adolescents with high neuroticism were more vulnerable to worry after experiencing serious disasters.

Screening for Problematic Worry in Adults With a Single Item From the Penn State Worry Questionnaire.

As the rapid assessment of mental health is a growing need, a quick and valid tool for the early detection of symptoms that can be flexibly deployed across a range of contexts may be especially beneficial. This is particularly true of anxiety problems, which when undetected contribute to health care costs and lost work productivity. Data from more than 10,000 respondents (primarily female undergraduates) were used to test whether a single item from the popular Penn State Worry Questionnaire could serve as a screening tool in settings where administration of the full scale is undesirable. Items were evaluated by examining item response theory models, screening capabilities, stability over time, convergence with other anxiety and depression measures, and a response time analysis that assessed how quickly participants responded to each item. Item 15 ("I worry all the time") emerged as the strongest item: It was the most discriminating and reliable item, had sensitivity and specificity similar to the full scale, had the highest 1-month and 1-year retest coefficients, the highest convergent correlations with measures of anxiety and depression, and was responded to significantly faster than any other item. We suggest that in time-limited contexts, this item is suitable for screening.

The verbal nature of worry in generalized anxiety: Insights from the brain.

Background: The Cognitive Avoidance Theory of Worry argues that worry is a cognitive strategy adopted to control the physiological arousal associated with anxiety. According to this theory, pathological worry, as in Generalized Anxiety Disorder (GAD), is verbal in nature, negative and abstract, rather than concrete. Neuroimaging studies link the expression of worry to characteristic modes of brain functional connectivity, especially in relation to the amygdala. However, the distinctive features of worry (verbal, abstract, negative), and their relationship to physiological arousal, have not so far been mapped to brain function. Methods: We addressed this omission by undertaking a resting-state functional magnetic resonance neuroimaging study of 19 patients with GAD and 21 controls, before and after induction of perseverative cognitions, while measuring emotional bodily arousal from heart rate (HR). Seed-based analyses quantified brain changes in whole brain functional connectivity from the amygdala. Results: In GAD, the induction increased negative thoughts and their verbal content. In line with predictions, the verbal expression of worry in GAD was associated with higher HR at baseline and attenuated HR increases after induction of perseverative cognitions. Within brain, the increased use of words during worry, and the associated dampening of HR after induction were mediated by the strength of functional connectivity between the amygdala and default mode network 'hubs' and the opercular cortex. The negative content of worry was further related to functional communication between amygdala and cingulo-opercular and temporal cortices. Conclusions: Findings provide a neurobiological basis for the impact of verbal worry on HR in GAD.

Reduced hippocampal N-acetyl-aspartate (NAA) as a biomarker for overweight.

OBJECTIVE: We previously demonstrated an inverse relationship between both dentate gyrus neurogenesis - a form of neuroplasticity - and expression of the antiapoptotic gene marker, BCL-2 and adult macaque body weight. We therefore explored whether a similar inverse correlation existed in humans between body mass index (BMI) and hippocampal N-acetyl-aspartate (NAA), a marker of neuronal integrity and putatively, neuroplasticity. We also studied the relationship of a potentially neurotoxic process, worry, to hippocampal NAA in patients with generalized anxiety disorder (GAD) and control subjects (CS). METHODS: We combined two previously studied cohorts of GAD and control subjects. Using proton magnetic resonance spectroscopy imaging ((1)H MRSI) in medication-free patients with GAD (n = 29) and a matched healthy control group (n = 22), we determined hippocampal concentrations of (1) NAA (2) choline containing compounds (CHO), and (3) Creatine + phosphocreatine (CR). Data were combined from 1.5 T and 3 T scans by converting values from each cohort to z-scores. Overweight and GAD diagnosis were used as categorical variables while the Penn State Worry Questionnaire (PSWQ) and Anxiety Sensitivity Index (ASI) were used as dependent variables. RESULTS: Overweight subjects (BMI ≥ 25) exhibited lower NAA levels in the hippocampus than normal-weight subjects (BMI < 25) (partial Eta-squared = 0.14) controlling for age, sex and psychiatric diagnosis, and the effect was significant for the right hippocampus in both GAD patients and control subjects. An inverse linear correlation was noted in all subjects between right hippocampal NAA and BMI. High scores on the PSWQ predicted low hippocampal NAA and CR. Both BMI and worry were independent inverse predictors of hippocampal NAA. CONCLUSION: Overweight was associated with reduced NAA concentrations in the hippocampus with a strong effect size. Future mechanistic studies are warranted.

Comparison of the Penn State Worry Questionnaire (PSWQ) and abbreviated version (PSWQ-A) in a clinical and non-clinical population of older adults.

The Penn State Worry Questionnaire (PSWQ) is a widely used measure of worry severity. An 8-item abbreviated version (PSWQ-A) has been developed as a brief screening measure, although there are limited studies assessing the psychometric properties of this measure in a large geriatric population. The aim of this study was to assess the utility of the PSWQ-A compared to the full PSWQ, to identify pathological worry in an older adult sample (N=108) of clinically anxious and depressed older adults, compared to a non-clinical sample (N=53). The PSWQ and PSWQ-A were found to have similarly adequate reliability and validity. The factor structure of the PSWQ-A was replicated, but not for the PSWQ. Both measures accurately distinguished between clinical and non-clinical status with similar sensitivity and specificity. These findings indicate the PSWQ-A is a useful measure for screening or epidemiological studies assessing worry in geriatric populations.

Screening for Generalized Anxiety Disorder in inpatient psychosomatic rehabilitation: pathological worry and the impact of depressive symptoms.

OBJECTIVE: Pathological worry is considered to be a defining feature for Generalized Anxiety Disorder (GAD). The Penn State Worry Questionnaire (PSWQ) is an instrument for assessing pathological worry. Two earlier studies demonstrated the suitability of the PSWQ as screening instrument for GAD in outpatient and non-clinical samples. This study examined the suitability of the PSWQ as a screening instrument for GAD in a German inpatient sample (N=237). Furthermore, a comparison of patients with GAD and patients with depression and other anxiety disorders regarding pathological worry and depression was carried out in a sub-sample of N=118 patients. METHOD: Cut-off scores optimizing sensitivity, optimizing specificity and simultaneously optimizing both sensitivity and specificity were calculated for the PSWQ score by receiver operating characteristic analysis (ROC). Differences regarding pathological worry and depression measured by the PSWQ and the Beck Depression Inventory (BDI) across five diagnostic subgroups were examined by conducting one-way ANOVAs. The influence of depression on pathological worry was controlled by conducting an ANCOVA with BDI score as a covariate. RESULTS: The ROC analysis showed an area under the curve of AUC=.67 (p=0.02) with only 54.4% of the patients correctly classified. Comparison of diagnostic subgroups showed that after controlling the influence of depression, differences referring to pathological worry between diagnostic subgroups no longer existed. CONCLUSIONS: Contrary to the earlier results we found that the use of the PSWQ as a screening instrument for GAD at least in a sample of psychotherapy inpatients is not meaningful. Instead of that, the PSWQ can be used to discriminate high from low worriers in clinical samples. Thus, the instrument can be useful in establishing e.g. symptom-oriented group interventions as they are established in behavioural-medicine inpatient settings. Furthermore, our findings stress the influence of (comorbid) depressive symptoms on the process of worrying.