Latent class analysis of Child Behavior Checklist Anxiety/Depression in children and adolescents

Objective: Comorbidity of psychiatric problems such as anxiety and depressi on poses challenges to treatment and research. This study tested whether pr oblem items from the Anxious/Depressed scale of the Child Behavior Checklis t (CBCL) can be separated into distinct anxiety and depression classes or a re continuously distributed throughout a population. Method: A CBCL was com pleted by a parent or guardian of each of 1,987 children and adolescents se lected to represent nonreferred children in the United States, as well as b y a parent or guardian of each of a demographically matched sample of 1,987 clinically referred children and adolescents. Problem items from the Anxio us/Depressed scale of the CBCL were subjected to latent class analysis. Res ults: Analyses revealed three levels of problem presentation in both sample s. Children in the nonreferred sample were classified as having no problems , mild problems, or moderate anxiety/depression problems. Children and adol escents 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 n onreferred adolescent girls showing elevated levels of problems. Conclusion s: 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.