Examining Anxiety and Depression Comorbidity Among Chinese and European Canadian University Students

Clark and Watson's tripartite model of comorbidity between anxiety and depression has been well-supported by empirical evidence among European descent samples in North America. Its applicability to Chinese biculturals remains to be challenged due to two Chinese-specific symptom reporting style in somatization and under-endorsement of positive affect. The current study began with an evaluation of a revised Clark and Watson's tripartite model of comorbidity by adopting a comprehensive assessment of anxiety- and depression-specific component, and by incorporating cognitive aspects of symptomatology. The revised model's applicability to a Chinese Canadian university sample was then empirically tested, followed by an investigation of the potential impact of cultural experiences on symptomatology. Item response theory (IRT)-informed statistical analyses were applied to each of the 14 anxiety and depression symptom measures that 251 European Canadian and 206 Chinese Canadian university student participants completed to remove items that functioned differentially across samples. Sample-specific exploratory factor analyses identified a two-factor structure (Affective-Somatic and Cognitive) among the Chinese Canadian sample, and a three-factor structure (Mixed, Cognitive, and Autonomic Hyperarousal) among the European Canadian sample. Worry and Autonomic Hyperarousal scales reflected the most between-group structural differences. These results indicated that different cultural groups responded differently to clinical assessment items commonly used in North America, and that applicability of the tripartite model of comorbidity across cultural groups was limited. Symptom factors were found related to specific (i.e., negative acculturative experiences and collective self-esteem) but not to generic indicators of acculturation (i.e., Chinese or Canadian Orientation).