Accepted Manuscript

Examining characteristics of worry in relation to depression, anxiety, and suicidal

ideation and attempts

Julia Y. Gorday, Megan L. Rogers, Thomas E. Joiner

PII: S0022-3956(18)30265-6
DOI: 10.1016/j.jpsychires.2018.10.004
Reference: PIAT 3476

To appear in: Journal of Psychiatric Research

Received Date: 1 March 2018

Revised Date: 20 August 2018
Accepted Date: 3 October 2018

Please cite this article as: Gorday JY, Rogers ML, Joiner TE, Examining characteristics of worry in
relation to depression, anxiety, and suicidal ideation and attempts, Journal of Psychiatric Research
(2018), doi: https://doi.org/10.1016/j.jpsychires.2018.10.004.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to
our customers we are providing this early version of the manuscript. The manuscript will undergo
copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please
note that during the production process errors may be discovered which could affect the content, and all
legal disclaimers that apply to the journal pertain.
 ACCEPTED MANUSCRIPT
Running Head: WORRY FEATURES AND PSYCHOPATHOLOGY 1

PT
RI
Examining Characteristics of Worry in Relation to Depression, Anxiety, and Suicidal Ideation

SC
and Attempts

U
Julia Y. Gorday
AN
Megan L. Rogers, M.S.

Thomas E. Joiner, Ph.D.

M

Florida State University

D
TE
C EP
AC

Author Note

Correspondence concerning this article should be addressed to Julia Y. Gorday,

Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL

32306-4301. Email: jyg15@my.fsu.edu

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 2

Abstract

Background: Pathological worry is defined as worry that is excessive, pervasive, and

uncontrollable. Although pathological worry is related to depression, anxiety, and suicidal

ideation, less is understood about what specific features of worry confer risk for these mental

PT
health conditions. The current study examined associations between four characteristics of

RI
worry—frequency, duration, controllability, and content—and self-reported symptoms of

depression, anxiety, suicidal ideation, and lifetime suicide attempts.

SC
Methods: A sample of 548 community participants (53.6% female, 45.4% male, 0.5%

U
transgender male, 0.2% transgender female, and 0.2% gender non-binary), aged 19 to 98 years
AN
(M = 36.54, SD = 12.33), was recruited via Amazon’s MTurk and completed a battery of self-

report questionnaires online.

M

Results: Results indicated that controllability of worry was uniquely associated with depression,
D

anxiety, and suicidal ideation above and beyond other characteristics of worry, demographic
TE

variables, negative affect, and future-oriented repetitive thinking. Lifetime suicide attempts were

found non-significant to these mental health outcomes. Frequency of worry was also positively
EP

related to depression.

Limitations: This study utilized a cross-sectional design with exclusive self-report measures.
C
AC

Conclusions: Overall, these findings suggest that controllability of one’s thoughts may be a key

transdiagnostic factor that confers risk for a variety of psychopathology-related concerns.

Clinical relevance includes identifying potential risk factors for varying psychopathology.

Future research should examine relationships between worry controllability and anxiety,
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 3

depression, suicidal ideation, and attempts, within clinical samples and utilizing a variety of

methodologies.

Keywords: worry; anxiety; depression; suicide; repetitive thinking; perceived control

PT
RI
U SC
AN
M
D
TE
C EP
AC
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 4

Introduction

Worry, defined as a series of future-oriented thoughts and images involving uncertain and

potentially negative outcomes (Sibrava & Borkovec, 2006), is universally experienced. Although

the vast majority of people experience worry in some capacity, for some the experience of worry

PT
can become pathological, namely excessive and uncontrollable worry that results in high levels

RI
of distress and impairment (Barlow, 2002). Such worry is widely regarded as the cardinal

symptom of generalized anxiety disorder (GAD; American Psychiatric Association [APA],

SC
2013). Moreover, worry is a transdiagnostic process related to numerous other

psychopathologies (Barlow et al., 2004), including depression and suicidality (Bentley et al.,

U
2016; Diefenbach et al., 2001; Yook et al., 2010), panic disorder (Casey, et al., 2004; Gladstone
AN
et al., 2005), and obsessive-compulsive disorder (Comer et al., 2004; Wells & Papageorgiou,

1998). In addition, pathological worry is also associated with physical health consequences,
M

including cardiovascular health (Kubzansky et al., 1997; Tully et al., 2013), immune response
D

(Segerstrom et al., 1998; Segerstrom et al., 1999), and sleep quality and duration (Danielsson et
TE

al., 2013; Kelly, 2002). Overall, this indicates the need to better understand the processes by

which worry influences these conditions.

EP

Numerous cognitive, affective, and attentional factors have been posited to explain the

onset and maintenance of worry (see Davey & Meeten, 2016, for review). For instance,
C

individuals who experience high levels of anxiety and worry tend to have cognitive biases in
AC

attending to perceived threats (Mathews, 1990; Mathews & MacLeod, 2002) and in interpreting

emotionally ambiguous situations as threatening (Eysenck et al., 1991; Mathews & Mackintosh,

2000). Such biases may increase the frequency of worry (Hirsch & Mathews, 2012) and decrease

the ability to exert control over worry (Hayes et al., 2008). Further, individuals with high levels
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 5

of worry tend to have poorer mood (Startup & Davey, 2001) and perseverative thinking styles

(Davey & Levy, 1998), above and beyond a mood congruency effect.

Less understood, on the other hand, are associations between various characteristics of

worry and mental health outcomes, such as depression, anxiety, and suicidal ideation.

PT
Pathological worry, as theorized by and examined in previous research (Borkovec et al., 1983;

RI
Hirsch et al., 2013; Hoyer et al., 2001), includes several features, including the frequency (i.e.,

the rate at which intrusive worry thoughts occur), duration (i.e., the amount of time spent

SC
worrying), controllability (i.e., perceived ability to control worry), and content of worry. Most

research to date has been conducted in individuals with GAD, for whom pathological worry is a

U
key feature. Indeed, those with GAD have been shown to worry more frequently, for a longer
AN
duration, with lower subjective controllability, and about a higher number of content areas than

individuals without GAD (Dupuy et al., 2001; Hoyer et al., 2001). However, Rief and colleagues
M

(2012) also observed that frequency of health-related worries was significantly related to the
D

severity of depression. Moreover, some studies have found a nearly identical frequency and
TE

intensity of worry among patients with GAD and those with depression (Starcevic, 1995).

Similarly, worry duration has been linked to the somatic symptoms of stress and anxiety, such
EP

that reducing the duration of worries may reduce such somatic symptoms (Brosschot & van der

Doef, 2006). However, the duration of worry, specifically, has not been examined in relation to
C

depression and suicidality.

AC

Perceived controllability, on the other hand, is a key feature of various emotion-based

disorders (Craske et al., 1989). According to the triple diathesis model of psychopathology, a

lack of perceived control over emotional experiences and events translates to a generalized

psychological vulnerability for emotional disorders (Barlow, 2002). Accordingly, numerous

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 6

studies have investigated the role of perceived control in psychological disorders. For instance,

perceived control has been shown to directly relate to symptoms of panic disorder (Bentley et al.,

2013) and GAD diagnostic status (Hirsch et al., 2013; Stapinski et al., 2010). Further, although

uncontrollability of worry has not been directly examined in relation to depression and

PT
suicidality, other forms of uncontrollable negative repetitive thinking, such as rumination, have

RI
been strongly associated with these psychiatric conditions, cross-sectionally and longitudinally

(Nolen-Hoeksema et al., 2008; Rogers & Joiner, 2017). Likewise, controllability of suicidal

SC
thinking has been linked to the likelihood of making a future suicide attempt (Miranda et al.,

2014).

U
Additionally, the content of worry may relate to emotional disorders. As noted
AN
previously, Hoyer and colleagues (2001) found that among GAD patients, for whom worry is the

core feature, worrying about daily hassles was particularly notable, as well as a greater overall
M

number of different worry topics. Similarly, Roemer and colleagues (1997) found that GAD
D

patients reported significantly more topics of worry than control participants. The impact of
TE

cognitive content of worry, however, to our knowledge has not yet been investigated in the

context of depression and suicidal ideation and behavior.

EP

Given that these findings have implicated a link between these four features of worry and

the symptom severity of emotion-based psychopathologies (namely depression, anxiety, and

C

suicidal thoughts and actions), an important next step is understanding the relative impact of
AC

each feature of worry on symptoms of each of these clinical constructs. As such, the purpose of

the present study was to examine relationships between the four aforementioned characteristics

of worry—frequency, duration, controllability, and range of content—and (1) symptoms of

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 7

depression, anxiety, and suicidal ideation, and (2) lifetime suicide attempts, with the ultimate

goal of determining which worry features may confer the most risk for these conditions.

Materials and Methods

Participants

PT
Participants included 548 individuals (53.6% female, 45.4% male, 0.5% transgender

RI
male, 0.2% transgender female, and 0.2% gender non-binary), aged 19 to 98 years (M = 36.54,

SD = 12.33), who were recruited from Amazon’s Mechanical Turk (MTurk). All data were

SC
collected from May 29, 2017, to May 31, 2017. MTurk is a quick data collection tool for large

and diverse samples (Buhrmester et al., 2010). Previous research has found that samples

U
collected through MTurk tend to be more racially, ethnically, and socioeconomically
AN
representative of the general population than local convenience samples (Behrend et al., 2011)

and other Internet-collected samples (Casler et al., 2013; Gosling et al., 2004). Moreover, and
M

importantly, recent findings suggest that MTurk samples exhibit above average levels of
D

psychopathology, especially social anxiety and depression (Arditte et al., 2015; Shapiro et al.,
TE

2013), making MTurk an ideal data collection avenue for the current study. Of the current

sample, most participants self-identified as White/European American (80.8%), 10.2% as

EP

Black/African American, 7.3% as Asian, 6.2% as Hispanic/Latino, 1.8% as American

Indian/Native American, 0.4% as Pacific Islander, and 0.4% as another race/ethnicity.

C

Procedures
AC

Prospective participants were given a description of the study, followed by the option to

participate. Those who opted to participate provided electronic informed consent and completed

a battery of self-report measures through a secure online survey platform (Qualtrics). Participants

who completed the study were provided with a randomized code to verify participation on
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 8

MTurk; these participants were compensated with $2.00. All study protocols were approved by

the university’s Institutional Review Board.

Measures

Worry Features. Characteristics of worry were assessed using individual items designed

PT
to assess the frequency (i.e., “How often do you worry about things that might happen in the

RI
future?”), duration (i.e., “When you worry about things that might happen in the future, how long

do you spend worrying?”), controllability (i.e., “How often do you feel like your worry is

SC
difficult-to-control?”), and content of worry (i.e., “What types of things that might happen in the

future do you worry about?”, with 11 response options and a space for additional worries).

U
Participants rated items assessing frequency, duration, and controllability on a 7-point scale
AN
ranging from 1 (Never for frequency and controllability, A few seconds for duration of worry) to

7 (Always for frequency and controllability, Always – I never stop worrying for duration of
M

worry), with higher scores reflecting more severe problems with worry. The content item was
D

designed to assess an individuals’ range of worries; response options included family, friends,
TE

things at school/work, finances, illness/health, physical threat, daily/routine struggles,

religion/politics, success/failures, society and world, inability to stop worrying, and other (please
EP

specify). Content areas selected by the participants were summed into a total score. With regard

to convergent validity, items were analyzed along with the Anxiety Sensitivity Index – 3 (ASI;
C

Taylor et al., 2007) and the Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, &
AC

Borkovec, 1990). each of these items were significantly related to scores on the ASI (r = .26 to

.59, p < .001) and PSWQ (r = .49 to .73, p < .001), as well as related yet distinct from each other

(rs = .258 - .729).

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 9

Beck Anxiety Inventory (BAI; Beck et al., 1988). The BAI is a 21-item self-report

measure that assesses anxiety symptoms (e.g., shakiness, sweating). Participants indicated the

degree to which they experienced each symptom within the past two weeks on a 4-point scale

ranging from 0 (Not at all) to 3 (Severely). Previous research has demonstrated that the BAI

PT
possesses strong psychometric properties (Beck et al., 1988b; Osman et al., 1997). Internal

RI
consistency in the present study was excellent (α = .96).

Beck Depression Inventory–II (BDI-II; Beck., 1996). The BDI-II is a 21-item self-

SC
report measure that assesses the presence/severity of depression symptoms within the past two

weeks. Each item was rated on a 4-point scale ranging from 0 to 3, with higher scores reflecting

U
greater depression severity. The BDI-II has demonstrated strong psychometric properties in past
AN
research (Beck et al., 1996). In the present study, the BDI-II had excellent internal consistency (α

=.96).
M

Beck Scale for Suicide Ideation (BSS; Beck & Steer, 1991). The BSS is a 21-item self-
D

report measure that assesses suicidal ideation within the past week. Respondents rated each item
TE

on a 3-point scale ranging from 0 to 2, with higher scores reflecting greater levels of suicidal

ideation. The first 19 items of the BSS are summed into a total score, whereas items 20 and 21
EP

assess frequency and qualities of past suicide attempts. The BSS has demonstrated strong

psychometric properties in past research (Beck et al., 1999; Beck et al., 2006). Internal
C

consistency was high in the present study (α = .94).

AC

Lifetime suicide attempts. To assess the presence of lifetime suicide attempts,

participants were asked, “Have you ever made a suicide attempt with at least some intent to die?”

with Yes/No response options.

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 10

The Future-Oriented Repetitive Thought Scale (FoRT; Miranda et al., 2017). The

FoRT is a 16-item self-report measure that assesses the degree to which individuals repetitively

think about the likelihood of both positive and negative future events. Specifically, items on the

FoRT focus on the frequency with which an individual thinks about the future in the indicated

PT
way. Participants responded to each item on a 4-point scale, ranging from 0 (Never) to 3 (Almost

RI
always). Preliminary evidence provided information on the reliability and validity of the FoRT

(Miranda et al., 2017); in the current study, internal consistency was good (α = .86). The FoRT

SC
was included to ensure that effects were not merely accounted for by future-oriented repetitive

thinking.

U
Positive and Negative Affect Schedule – Negative Affect Scale (PANAS-NA; Watson
AN
et al., 1988). The PANAS-NA is a 10-item subscale of the PANAS that assesses general

negative affect. The degree to which participants generally experience each affective state (e.g.,
M

distressed, irritable) was rated on a 5-point scale ranging from 1 (Very slightly or not at all) to 5
D

(Extremely). The PANAS has been found to possess strong reliability and validity (Crawford &
TE

Henry, 2004). In this study, the PANAS-NA had high internal consistency (α = .92). The

PANAS-NA was included to ensure that effects were not better accounted for by negative affect.
EP

Data Analytic Strategy

Descriptive statistics and bivariate correlations were first computed to examine the
C

normality and interrelatedness of all variables. Variables with significant (> 2) positive skew or
AC

kurtosis were transformed using a logarithmic transformation to correct for non-normality. Next,

a set of three hierarchical linear regressions were conducted to test associations between each

worry feature and depression, anxiety, and suicidal ideation. Lastly, a logistic regression was

conducted to examine the relations between each worry feature and suicide attempts. Age,
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 11

gender, negative affect, and future-oriented repetitive thinking were entered as covariates due to

their established associations with depression, anxiety, and suicidality. Worry features were

entered in step 1 as predictor variables, and covariates were entered in step 2 to determine

whether findings were maintained. Depression, anxiety, and suicidal ideation were outcome

PT
variables in separate regression analyses. Missing data were minimal (0.9%) and handled via list-

RI
wise deletion; all analyses were conducted in SPSS 22.0.

Results

SC
See Table 1 for descriptive statistics and bivariate correlations of all variables. Suicidal

ideation was positively skewed and leptokurtic and was log-transformed to correct for non-

U
normality, resulting in moderately reduced skewness (1.70) and kurtosis (1.37). We refer to non-
AN
transformed descriptive statistics for ease of interpretation, but all multivariate analyses were

conducted after the transformation of suicidal ideation. All bivariate correlations were significant
M

at the p < .001 level. Importantly, multicollinearity indices (TOL and VIF) were within normal
D

limits (> .2 and < 4, respectively) in all subsequent analyses.

TE

Associations between Worry Features and Depression

The overall model (see Table 2) accounted for 56.4% of the variance in depression
EP

symptoms. The first model step, containing age, gender, negative affect, and future-oriented

repetitive thinking, was significant (F[4, 508] = 138.15, p < .001). Negative affect (p < .001) and
C

future-oriented repetitive thinking (p < .001) were positively associated with depression
AC

symptoms, whereas age (p = .798) and gender (p = .825) were unrelated. In the second model

step (F[8, 504] = 81.42, p < .001), in which the four worry features were added to the model,

frequency (p = .033) and controllability (p < .001) of worry remained significantly associated

with depression symptoms, and duration (p = .912) and content (p = .798) remained unrelated.
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 12

Additionally, negative affect (p < .001) and future-oriented repetitive thinking (p = .045) were

significantly positively associated with depression symptoms; age (p = .391) and gender (p =

.917) were not.

Associations between Worry Features and Anxiety

PT
When anxiety symptoms were entered as the outcome variable, the overall model (see

RI
Table 3) explained 57.8% of the variance. In the first model step (F[4, 507] = 154.18, p < .001),

including age, gender, negative affect, and future-oriented repetitive thinking; age (p = .025),

SC
negative affect (p < .001), and future-oriented repetitive thinking (p < .001) were each uniquely

associated with severity of anxiety symptoms, whereas gender was not (p = .106). The four

U
worry features were added in the second model step; in this model (F[8, 503] = 85.95, p < .001),
AN
only controllability (p = .002) of worry was related to anxiety, whereas frequency (p =

.293),duration (p = .084), and content of worry (p = .250) were not.

M

Associations between Worry Features and Suicidal Ideation

D

The model examining relations between worry features and suicidal ideation (see Table
TE

4) explained 19.7% of the variance in suicidal ideation. In the first model step (F[4, 508] =

28.90, p < .001), containing age, gender, negative affect, and future-oriented repetitive thinking,
EP

age (p = .007) and negative affect (p < .001) were significantly related to suicidal ideation,

whereas gender (p = .471) and future-oriented repetitive thinking (p = .186) were unrelated. With
C

the addition of the four worry features, controllability of worry was significantly associated with
AC

suicidal ideation (p = .017), whereas frequency (p = .827), duration (p = .953), and content (p =

.955) were unrelated.

Associations between Worry Features and Suicide Attempts

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 13

The overall model explained 9.5% of the variance (Nagelkerke R2) in the presence of a

lifetime suicide attempt. In the first model step (χ2[5] = 21.20, p < .001), suicidal ideation (p =

.012) and gender (p = .002) were significantly related to increased odds of the presence of a

lifetime suicide attempts; age (p = .470), negative affect (p = .883), and future-oriented repetitive

PT
thinking (p = .333) were unrelated. In Step 2, worry frequency (p = .483), duration (p = .092),

RI
controllability (p = .924), and content (p = .206) were unrelated to the odds of a lifetime suicide

attempt, above and beyond suicidal ideation (p = .016) and gender (p = .004).

SC
Discussion

Pathological worry has myriad influences on mental health conditions, including

U
depression (Yook et al., 2010), anxiety (APA, 2013; Casey et al., 2004), and suicidal ideation
AN
(Bentley et al., 2016), but specific influences of particular worry features are less well studied.

The present study examined the relationships between four characteristics of worry—frequency,
M

duration, controllability, and content—and symptoms of depression, anxiety, suicidal ideation,

D

and the presence of a lifetime suicide attempt, controlling for the influences of age, gender,
TE

negative affect, and future-oriented thinking. Overall, perceived controllability of worry was

robustly associated with depression, anxiety, and suicidal ideation, above and beyond all other
EP

worry characteristics and covariates.

These findings corroborate those of past research that found that perceived ability to
C

control one’s thoughts correlated negatively with symptoms of psychopathology, including trait
AC

anxiety, neuroticism, worry, and symptoms of depression (Luciano et al., 2005); these findings

remained significant above and beyond the influence of demographic characteristics and

perceived stress (Peterson et al., 2009). Moreover, as compared to those without GAD,

individuals with GAD have reported less perceived control over worries (Hirsch et al., 2013).
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 14

Maintaining a sense of control more generally over one’s thoughts, feelings, and actions has been

linked to one’s sense of well-being, social functioning, and quality of life (de Quadros-Wander et

al., 2014; Infurna et al., 2011). Thus, as a whole, it appears that perceived controllability may be

an important transdiagnostic feature that influences the course of a variety of mental health

PT
conditions.

RI
Importantly, these findings were significant over the influences of negative affect and

future-oriented repetitive thinking more generally. This suggests that uncontrollability of one’s

SC
thoughts may be particularly pernicious, beyond the effects of one’s mood and repetitive

thinking, each of which have been linked to various forms of psychopathology, including suicide

U
(Law & Tucker, 2018; Nicolai et al., 2016). Indeed, uncontrollability of suicidal thinking has
AN
been linked to the likelihood of making a suicide attempt (Nock et al., 2018), although such a

finding was not found in this sample utilizing worry-related controllability, specifically. Overall,
M

the frequency and duration with which worry occurs, as well as the content and range of worries,
D

may be less problematic than the sense of control one has over their thoughts. Future research
TE

should test this proposition and examine potential mechanisms through which controllability of

thoughts may have on mental health outcomes.

EP

Notably, the overall regression models tested in the present study explained a significant

portion (> 50%) of the variance in depression and anxiety symptoms, but only explained 19.7%
C

of the variance in suicidal ideation and 9.5% of the variance in a lifetime suicide attempt. This is
AC

consistent with past research demonstrating that worry is a core feature of both depression and

anxiety, independently (Kertz et al., 2012). In contrast, suicidal ideation and behaviors are,

themselves, much less prevalent than depression and anxiety (Nock et al., 2008); past research

has also demonstrated that worry and negative affectivity are unrelated to suicidal ideation after
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 15

covarying out depression symptoms (Rogers et al., 2016). Overall, it is possible that while worry

is a central component to anxiety and depression, it is one of many factors potentiating suicidal

thoughts and behaviors and thus has a relatively smaller impact.

It is also worth considering the significant impact of worry frequency on depression

PT
symptoms. Preliminary evidence indicated that worry frequency and severity were equivalent in

RI
individuals with GAD and major depressive episodes (Starcevic, 1995), though the combination

of comorbid anxiety and depressive disorders may be particularly pernicious with regard to

SC
worry frequency (Starcevic et al., 2007). Rumination, similar to worry in repetitive thinking

about negative self-relevant topics in often quasi-verbal or abstract forms (Hirsch & Mathews,

U
2012; Nolen-Hoeksema, 1991), and indistinguishable from worry in factor analyses (Segerstrom
AN
et al., 2000), has been strongly associated with depression cross-sectionally and longitudinally

(Nolen-Hoeksema, 1991; Nolen-Hoeksema et al., 2008), and may underscore the possibility that
M

the frequency of negative repetitive thought, whether past- or future-oriented, confers risk for
D

depression symptoms.
TE

Moreover, the robustness of our covariates, negative affect and future-oriented repetitive

thinking, in association with these symptoms, deserves attention. Consistent with previous
EP

literature, negative affect was significantly related to depression, anxiety, and suicidal ideation.

Negative affect has consistently been linked to a broad range of anxious and depressive
C

symptoms and diagnoses (Watson et al., 1988), as well as suicidal thoughts and behaviors (Stein
AC

et al., 1998; Yamokoski et al., 2011), suggesting that negative affect may serve as a common

vulnerability factor (Brown et al., 1998). Similarly, in this study, future-oriented repetitive

thinking was uniquely associated with depression and anxiety symptoms. This, in part, replicates

recent findings that future-oriented repetitive thinking was moderately positively correlated with
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 16

depression and anxiety symptoms (Miranda et al., 2017). In contrast to Miranda and colleagues

(2017), however, future-oriented negative thinking was unrelated to suicidal ideation and

attempts after taking into account the four worry features and negative affect. It is possible that

negatively-valenced repetitive thinking accounts for the link between future-oriented repetitive-

PT
thinking and suicidal thoughts and behaviors. Indeed, negative repetitive thinking has been

RI
associated with depression, anxiety, anger, shame, and general distress (McEvoy et al., 2010)

and increases one’s vulnerability for anxious/depressive disorders (McEvoy et al., 2013).

SC
Overall, it appears that negative affect and having negative repetitive thoughts may have an

important role in the development and co-occurrence of depression, anxiety, and suicidality.

Limitations and Future Directions

U
AN
A number of limitations of the current study should be considered and addressed in future

research. First, the present study was conducted utilizing a non-clinical sample from MTurk.
M

Although recent evidence suggests that MTurk participants endorse higher rates of depression
D

and anxiety symptoms than the general population (Arditte et al., 2015), the use of a clinical
TE

sample in follow-up studies would be ideal to ensure the generalizability of these findings. On

that note, despite gathering information about symptoms and current functioning via self-report,
EP

we were unable to administer standardized interviews to formally assess psychiatric diagnoses of

participants in the current study. Future studies should utilize mixed-methods approaches to
C

understand the nature of worry in relation to symptoms of psychopathology.

AC

Further, all data collected in the present study were cross-sectional and via exclusive use

of self-report measures. The introduction of objective data collection including physiological

measures and experimental manipulations of worry features would likely be informative, as

opposed to recalling general levels of worry retroactively. Likewise, limitations associated with
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 17

the use of a single, dichotomous, item to assess lifetime suicide attempts have been noted (Hom,

Joiner Jr., & Bernert, 2016; Millner, Lee, & Nock, 2015), as self-reported suicide attempts may

not adequately capture the presence of actual suicide attempts (as opposed to interrupted or

aborted attempts). In addition, possibly most importantly, the items utilized to assess worry

PT
characteristics were not part of a standardized scale. Given that each feature of worry was

RI
measured through a single item, these findings should be viewed as preliminary dependent upon

replication and extension. One possibility is that the worry feature items may be tapping into

SC
other domains, such as the controllability of thoughts more generally. Perceived control of

thoughts serves as a buffer to stress (Rothbaum, Weisz, & Snyder, 1982), and it may be worth

U
disentangling controllability of worry from controllability of thoughts to better understand the
AN
nature of these relationships. Similarly, it is possible that the worry controllability item may be

tapping into other worry domains, in addition to controllability of worry or thoughts. As alluded
M

to previously, it would be beneficial for future research to validate these items further. Moreover,
D

it is possible that individuals have limited insight on particular features of worry (e.g., duration),
TE

likely because different types of worries may fluctuate in severity or presence. Future studies

should consider examining frequency, duration, and controllability of particular worry topics to
EP

further elucidate the nature of these relationships. Finally, it would be beneficial for future work

in this area to focus on controllability of thoughts as a potential transdiagnostic factor that

C

influences not only the presentation, but also the etiology and course, of a variety of mental
AC

health conditions (including other transdiagnostic factors, like hopelessness).

Conclusions

Nonetheless, despite these limitations, our findings provide support for the role of

perceived controllability in severity of depression, anxiety, and suicidal ideation, above and
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 18

beyond frequency, duration, and content of worry, negative affect, and future-oriented repetitive

thinking. Given that perceived control of worry may be an important component of the clinical

presentation of numerous conditions and may be a potential intervention target, we look forward

to research that replicates and extends our findings in clinical samples utilizing a variety of

PT
methodologies.

RI
U SC
AN
M
D
TE
C EP
AC
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 19

Acknowledgements

This work was in part supported by the Military Suicide Research Consortium, an effort

supported by the Department of Defense (W81XWH-10-2-0181; W81XWH-16-20003).

Opinions, interpretations, conclusions, and recommendations are those of the authors and are not

PT
necessarily endorsed by the Military Suicide Research Consortium or the Department of

RI
Defense.

U SC
AN
M
D
TE
C EP
AC
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 20

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (DSM-5)

(5th ed.). American Psychiatric Association.

PT
Arditte, K. A., Çek, D., Shaw, A. M., & Timpano, K. R. (2015). The importance of assessing clinical

phenomena in Mechanical Turk research. Psychological Assessment, 28, 684–691.

RI
https://doi.org/10.1037/pas0000217

Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.).

SC
New York, NY: Guilford Press.

Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders.

U
Behavior Therapy, 35, 205–230. https://doi.org/10.1016/S0005-7894(04)80036-4
AN
Beck, A. T., Brown, G. K., Steer, R. A., Dahlsgaard, K. K., & Grisham, J. R. (1999). Suicide ideation at its
M

worst point: A predictor of eventual suicide in psychiatric outpatients. Suicide & Life-Threatening

Behavior, 29, 1–9.

D

Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988a). An inventory for measuring clinical anxiety:
TE

Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897.

https://doi.org/10.1037//0022-006x.56.6.893
EP

Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988b). An inventory for measuring clinical anxiety:

Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.

C

Beck, A. T., & Steer, R. A. (1991). Manual for the Beck Scale for Suicide Ideation. San Antonio, TX:
AC

Psychological Corporation.

Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of Beck Depression Inventories-IA

and-II in psychiatric outpatients. Journal of Personality Assessment, 67, 588–597.

https://doi.org/10.1207/s15327752jpa6703_13
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 21

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio,

TX: Psychological Corporation.

Beck, A. T., Steer, R. A., & Ranieri, W. F. (2006). Scale for Suicide Ideation: Psychometric properties of a

self-report version. Journal of Clinical Psychology, 44, 499–505. https://doi.org/10.1002/1097-

PT
4679(198807)44:4<499::AID-JCLP2270440404>3.0.CO;2-6

RI
Behrend, T. S., Sharek, D. J., Meade, A. W., & Wiebe, E. N. (2011). The viability of crowdsourcing for

survey research. Behavior Research Methods, 43, 800. https://doi.org/10.3758/s13428-011-

SC
0081-0

Bentley, K. H., Franklin, J. C., Ribeiro, J. D., Kleiman, E. M., Fox, K. R., & Nock, M. K. (2016). Anxiety and its

U
disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Clinical
AN
Psychology Review, 43, 30–46. https://doi.org/10.1016/j.cpr.2015.11.008

Bentley, K. H., Gallagher, M. W., Boswell, J. F., Gorman, J. M., Shear, M. K., Woods, S. W., & Barlow, D. H.
M

(2013). The interactive contributions of perceived control and anxiety sensitivity in panic
D

disorder: A triple vulnerabilities perspective. Journal of Psychopathology and Behavioral

Assessment, 35, 57–64. https://doi.org/10.1007/s10862-012-9311-8

TE

Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry:
EP

Some characteristics and processes. Behaviour Research and Therapy, 21, 9–16.

Brosschot, J. F., & van der Doef, M. (2006). Daily worrying and somatic health complaints: Testing the
C

effectiveness of a simple worry reduction intervention. Psychology & Health, 21, 19–31.
AC

https://doi.org/10.1080/14768320500105346

Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among dimensions of the

DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and

autonomic arousal. Journal of Abnormal Psychology, 107, 179–192.

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 22

Buhrmester, M., Kwang, T., & Gosling, S. D. (2011). Amazon’s Mechanical Turk: A new source of

inexpensive, yet high-quality, data? Perspectives on Psychological Science, 6, 3–5.

https://doi.org/10.1177/1745691610393980

Casey, L. M., Oei, T. P. S., & Newcombe, P. A. (2004). An integrated cognitive model of panic disorder:

PT
The role of positive and negative cognitions. Clinical Psychology Review, 24(5), 529–555.

RI
https://doi.org/10.1016/j.cpr.2004.01.005

Casler, K., Bickel, L., & Hackett, E. (2013). Separate but equal? A comparison of participants and data

SC
gathered via Amazon’s MTurk, social media, and face-to-face behavioral testing. Computers in

Human Behavior, 29, 2156–2160. https://doi.org/10.1016/j.chb.2013.05.009

U
Comer, J. S., Kendall, P. C., Franklin, M. E., Hudson, J. L., & Pimentel, S. S. (2004). Obsessing/worrying
AN
about the overlap between obsessive–compulsive disorder and generalized anxiety disorder in

youth. Clinical Psychology Review, 24(6), 663–683. https://doi.org/10.1016/j.cpr.2004.04.004

M

Craske, M. G., Rapee, R. M., Jackel, L., & Barlow, D. H. (1989). Qualitative dimensions of worry in DSM-
D

III-R generalized anxiety disorder subjects and nonanxious controls. Behaviour Research and

Therapy, 27, 397–402.

TE

Crawford, J. R., & Henry, J. D. (2004). The Positive and Negative Affect Schedule (PANAS): Construct
EP

validity, measurement properties and normative data in a large non-clinical sample. British

Journal of Clinical Psychology, 43, 245–265. https://doi.org/10.1348/0144665031752934

C

Danielsson, N. S., Harvey, A. G., Macdonald, S., Jansson-Fröjmark, M., & Linton, S. J. (2013). Sleep
AC

disturbance and depressive symptoms in adolescence: the role of catastrophic worry. Journal of

Youth and Adolescence, 42(8), 1223–1233. https://doi.org/10.1007/s10964-012-9811-6

Davey, G. C., & Levy, S. (1998). Catastrophic worrying: Personal inadequacy and a perseverative iterative

style as features of the catastrophizing process. Journal of Abnormal Psychology, 107, 576–586.
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 23

Davey, G. C., & Meeten, F. (2016). The perseverative worry bout: A review of cognitive, affective and

motivational factors that contribute to worry perseveration. Biological Psychology, 121, 233–

243. https://doi.org/10.1016/j.biopsycho.2016.04.003

de Quadros-Wander, S., McGillivray, J., & Broadbent, J. (2014). The influence of perceived control on

PT
subjective wellbeing in later life. Social Indicators Research, 115, 999–1010.

RI
https://doi.org/10.1007/s11205-013-0243-9

Diefenbach, G. J., McCarthy-Larzelere, M. E., Williamson, D. A., Mathews, A., Manguno-Mire, G. M., &

SC
Bentz, B. G. (2001). Anxiety, depression, and the content of worries. Depression and Anxiety,

14(4), 247–250.

U
Dupuy, J. B., Beaudoin, S., Rhéaume, J., Ladouceur, R., & Dugas, M. J. (2001). Worry: Daily self-report in
AN
clinical and non-clinical populations. Behaviour Research and Therapy, 39, 1249–1255.

https://doi.org/10.1016/S0005-7967(01)00011-0
M

Eysenck, M. W., Mogg, K., May, J., Richards, A., & Mathews, A. (1991). Bias in interpretation of
D

ambiguous sentences related to threat in anxiety. Journal of Abnormal Psychology, 100, 144–

150.
TE

Gladstone, G. L., Parker, G. B., Mitchell, P. B., Malhi, G. S., Wilhelm, K. A., & Austin, M. P. (2005). A Brief
EP

Measure of Worry Severity (BMWS): Personality and clinical correlates of severe worriers.

Journal of Anxiety Disorders, 19, 877–892. https://doi.org/10.1016/j.janxdis.2004.11.003

C

Gosling, S. D., Vazire, S., Srivastava, S., & John, O. P. (2004). Should we trust web-based studies? A
AC

comparative analysis of six preconceptions about Internet questionnaires. American

Psychologist, 59, 93–104. https://doi.org/10.1037/0003-066X.59.2.93

Hayes, S., Hirsch, C., & Mathews, A. (2008). Restriction of working memory capacity during worry.

Journal of Abnormal Psychology, 117, 712–717. https://doi.org/10.1037/a0012908

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 24

Hirsch, C. R., & Mathews, A. (2012). A cognitive model of pathological worry. Behaviour Research and

Therapy, 50, 636–646. https://doi.org/10.1016/j.brat.2012.06.007

Hirsch, C. R., Mathews, A., Lequertier, B., Perman, G., & Hayes, S. (2013). Characteristics of worry in

Generalized Anxiety Disorder. Journal of Behavior Therapy and Experimental Psychiatry, 44,

PT
388–395. https://doi.org/10.1016/j.jbtep.2013.03.004

RI
Hom, M. A., Joiner Jr., T. E., & Bernert, R. A. (2016). Limitations of a single-item assessment of suicide

attempt history: Implications for standardized suicide risk assessment. Psychological

SC
Assessment, 28, 1026–1030. https://doi.org/10.1037/pas0000241

Hoyer, J., Becker, E. S., & Roth, W. T. (2001). Characteristics of worry in GAD patients, social phobics, and

U
controls. Depression and Anxiety, 13, 89–96. https://doi.org/10.1002/da.1021
AN
Infurna, F. J., Gerstorf, D., Ram, N., Schupp, J., & Wagner, G. G. (2011). Long-term antecedents and

outcomes of perceived control. Psychology and Aging, 26, 559–575.

M

https://doi.org/10.1037/a0022890
D

Kelly, W. E. (2002). Worry and sleep length revisited: worry, sleep length, and sleep disturbance ascribed

to worry. The Journal of Genetic Psychology, 163(3), 296–304.

TE

https://doi.org/10.1080/00221320209598685
EP

Kertz, S. J., Bigda-Peyton, J. S., Rosmarin, D. H., & Björgvinsson, T. (2012). The importance of worry

across diagnostic presentations: Prevalence, severity and associated symptoms in a partial

C

hospital setting. Journal of Anxiety Disorders, 26, 126–133.

AC

https://doi.org/10.1016/j.janxdis.2011.10.005

Klonsky, E. D., & May, A. M. (2014). Differentiating suicide attempters from suicide ideators: A critical

frontier for suicidology research. Suicide and Life-Threatening Behavior, 44, 1–5.

https://doi.org/10.1111/sltb.12068
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 25

Kubzansky, L. D., Kawachi, I., Spiro, A., Weiss, S. T., Vokonas, P. S., & Sparrow, D. (1997). Is worrying bad

for your heart? A prospective study of worry and coronary heart disease in the Normative Aging

Study. Circulation, 95(4), 818–824.

Law, K. C., & Tucker, R. P. (2018). Repetitive negative thinking and suicide: A burgeoning literature with

PT
need for further exploration. Current Opinion in Psychology, 22, 68–72.

RI
https://doi.org/10.1016/j.copsyc.2017.08.027

Luciano, J. V., Algarabel, S., Tomás, J. M., & Martínez, J. L. (2005). Development and validation of the

SC
Thought Control Ability Questionnaire. Personality and Individual Differences, 38, 997–1008.

https://doi.org/10.1016/j.paid.2004.06.020

U
Mathews, A. (1990). Why worry? The cognitive function of anxiety. Behaviour Research and Therapy, 28,
AN
455–468.

Mathews, A., & Mackintosh, B. (2000). Induced emotional interpretation bias and anxiety. Journal of
M

Abnormal Psychology, 109, 602–615.

D

Mathews, A., & MacLeod, C. (2002). Induced processing biases have causal effects on anxiety. Cognition

and Emotion, 16, 331–354. https://doi.org/10.1080/02699930143000518

TE

McEvoy, P. M., Mahoney, A. E. J., & Moulds, M. L. (2010). Are worry, rumination, and post-event
EP

processing one and the same? Development of the repetitive thinking questionnaire. Journal of

Anxiety Disorders, 24, 509–519. https://doi.org/10.1016/j.janxdis.2010.03.008

C

McEvoy, P. M., Watson, H., Watkins, E. R., & Nathan, P. (2013). The relationship between worry,
AC

rumination, and comorbidity: Evidence for repetitive negative thinking as a transdiagnostic

construct. Journal of Affective Disorders, 151, 313–320.

https://doi.org/10.1016/j.jad.2013.06.014

Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the

penn state worry questionnaire. Behaviour research and therapy, 28(6), 487-495.
 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 26

Millner, A. J., Lee, M. D., & Nock, M. K. (2015). Single-item measurement of suicidal behaviors: Validity

and consequences of misclassification. PloS One, 10, e0141606.

https://doi.org/10.1371/journal.pone.0141606

Miranda, R., Ortin, A., Scott, M., & Shaffer, D. (2014). Characteristics of suicidal ideation that predict the

PT
transition to future suicide attempts in adolescents. Journal of Child Psychology and Psychiatry,

RI
and Allied Disciplines, 55, 1288–1296. https://doi.org/10.1111/jcpp.12245

Miranda, R., Wheeler, A., Polanco-Roman, L., & Marroquín, B. (2017). The Future-Oriented Repetitive

SC
Thought (FoRT) Scale: A measure of repetitive thinking about the future. Journal of Affective

Disorders, 207, 336–345. https://doi.org/10.1016/j.jad.2016.09.055

U
Nicolai, K. A., Wielgus, M. D., & Mezulis, A. (2016). Identifying risk for self-harm: Rumination and
AN
negative affectivity in the prospective prediction of nonsuicidal self-injury. Suicide and Life-

Threatening Behavior, 46, 223–233. https://doi.org/10.1111/sltb.12186

M

Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., … Williams, D. (2008).
D

Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British

Journal of Psychiatry, 192, 98–105. https://doi.org/10.1192/bjp.bp.107.040113

TE

Nock, M. K., Millner, A. J., Joiner, T. E., Gutierrez, P. M., Hwang, I., King, A., … Kessler, R. C. (2018). Risk
EP

factors for the transition from suicide ideation to suicide attempt: Results from the Army Study

to Assess Risk and Resilience in Servicemembers (Army STARRS). Journal of Abnormal

C

Psychology, 127, 139–149.

AC

Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive

episodes. Journal of Abnormal Psychology, 100, 569–582.

Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on

Psychological Science, 3, 400–424. https://doi.org/10.1111/j.1745-6924.2008.00088.x

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 27

Osman, A., Kopper, B. A., Barrios, F. X., Osman, J. R., & Wade, T. (1997). The Beck Anxiety Inventory:

Reexamination of factor structure and psychometric properties. Journal of Clinical Psychology,

53, 7–14. https://doi.org/10.1002/(SICI)1097-4679(199701)53:1<7::AID-JCLP2>3.0.CO;2-S

Paolacci, G., Chandler, J., & Ipeirotis, P. G. (2010). Running experiments on Amazon Mechanical Turk.

PT
Judgment and Decision Making, 5, 411–419.

RI
Peterson, R. D., Klein, J., Donnelly, R., & Renk, K. (2009). Predicting psychological symptoms: The role of

perceived thought control ability. Cognitive Behaviour Therapy, 38(1), 16–28.

SC
https://doi.org/10.1080/16506070802561215

Rief, W., Glaesmer, H., Baehr, V., Broadbent, E., Brähler, E., & Petrie, K. J. (2012). The relationship of

U
modern health worries to depression, symptom reporting and quality of life in a general
AN
population survey. Journal of Psychosomatic Research, 72, 318–320.

https://doi.org/10.1016/j.jpsychores.2011.11.017
M

Roemer, L., Molina, S., & Borkovec, T. D. (1997). An investigation of worry content among generally
D

anxious individuals. The Journal of Nervous and Mental Disease, 185, 314–319.

Rogers, M. L., & Joiner, T. E. (2017). Rumination, suicidal ideation, and suicide attempts: A meta-analytic
TE

review. Review of General Psychology.

EP

Rogers, M. L., Stanley, I. H., Hom, M. A., Chiurliza, B., Podlogar, M. C., & Joiner, T. E. (2016). Conceptual

and empirical scrutiny of covarying depression out of suicidal ideation. Assessment.

C

https://doi.org/10.1177/1073191116645907
AC

Segerstrom, S. C., Glover, D. A., Craske, M. G., & Fahey, J. L. (1999). Worry affects the immune response

to phobic fear. Brain, Behavior, and Immunity, 13(2), 80–92.

https://doi.org/10.1006/brbi.1998.0544

Segerstrom, S. C., Solomon, G. F., Kemeny, M. E., & Fahey, J. L. (1998). Relationship of worry to immune

sequelae of the Northridge earthquake. Journal of Behavioral Medicine, 21(5), 433–450.

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 28

Segerstrom, S. C., Tsao, J. C. I., Alden, L. E., & Craske, M. G. (2000). Worry and rumination: Repetitive

thought as a concomitant and predictor of negative mood. Cognitive Therapy and Research, 24,

671–688. https://doi.org/10.1023/A:1005587311498

Shapiro, D. N., Chandler, J., & Mueller, P. A. (2013). Using Mechanical Turk to study clinical populations.

PT
Clinical Psychological Science, 1, 213–220. https://doi.org/10.1177/2167702612469015

RI
Sibrava, N. J., & Borkovec, T. D. (2006). The cognitive avoidance theory of worry. In G. C. L. Davey & A.

Wells (Eds.), Worry and its psychological disorders: Theory, assessment and treatment. Sussex,

SC
UK: John Wiley & Sons.

Stapinski, L. A., Abbott, M. J., & Rapee, R. M. (2010). Fear and perceived uncontrollability of emotion:

U
Evaluating the unique contribution of emotion appraisal variables to prediction of worry and
AN
generalised anxiety disorder. Behaviour Research and Therapy, 48, 1097–1104.

https://doi.org/10.1016/j.brat.2010.07.012
M

Starcevic, V. (1995). Pathological worry in major depression: A preliminary report. Behaviour Research
D

and Therapy, 33, 55–56.

Starcevic, V., Berle, D., Milicevic, D., Hannan, A., Lamplugh, C., & Eslick, G. D. (2007). Pathological worry,
TE

anxiety disorders and the impact of co-occurrence with depressive and other anxiety disorders.
EP

Journal of Anxiety Disorders, 21, 1016–1027. https://doi.org/10.1016/j.janxdis.2006.10.015

Startup, H. M., & Davey, G. C. (2001). Mood as input and catastrophic worrying. Journal of Abnormal
C

Psychology, 110, 83–96.

AC

Stein, D., Apter, A., Ratzoni, G., Har-Even, D., & Avidan, G. (1998). Association between multiple suicide

attempts and negative affects in adolescents. Journal of the American Academy of Child and

Adolescent Psychiatry, 37, 488–494. https://doi.org/10.1097/00004583-199805000-00011

 ACCEPTED MANUSCRIPT
WORRY FEATURES AND PSYCHOPATHOLOGY 29

Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., ... & Coles, M. (2007).

Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety

Sensitivity Index-3. Psychological assessment, 19(2), 176.

Tully, P. J., Cosh, S. M., & Baune, B. T. (2013). A review of the affects of worry and generalized anxiety

PT
disorder upon cardiovascular health and coronary heart disease. Psychology, Health & Medicine,

RI
18(6), 627–644. https://doi.org/10.1080/13548506.2012.749355

Watson, D., Clark, L. A., & Carey, G. (1988). Positive and negative affectivity and their relation to anxiety

SC
and depressive disorders. Journal of Abnormal Psychology, 97, 346–353.

Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive

U
and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–
AN
1070.

Wells, A., & Papageorgiou, C. (1998). Relationships between worry, obsessive-compulsive symptoms and
M

meta-cognitive beliefs. Behaviour Research and Therapy, 36(9), 899–913.

D

Yamokoski, C. A., Scheel, K. R., & Rogers, J. R. (2011). The role of affect in suicidal thoughts and

behaviors. Suicide and Life-Threatening Behavior, 41, 160–170. https://doi.org/10.1111/j.1943-

TE

278X.2011.00019.x
EP

Yook, K., Kim, K.-H., Suh, S. Y., & Lee, K. S. (2010). Intolerance of uncertainty, worry, and rumination in

major depressive disorder and generalized anxiety disorder. Journal of Anxiety Disorders, 24(6),
C

623–628. https://doi.org/10.1016/j.janxdis.2010.04.003
AC
 ACCEPTED MANUSCRIPT

Table 1

Descriptive Statistics and Bivariate Correlations between all Variables

PT
Variable 1 2 3 4 5 6 7 8 9

RI
1. WF – Frequency 1
2. WF – Duration .72 1

SC
3. WF – Controllability .67 .75 1
4. WF – Content .48 .38 .40 1
5. BDI .53 .53 .62 .39 1

U
6. BAI .53 .56 .61 .30 .70 1

AN
7. BSS .27 .28 .35 .15 .56 .39 1
8. PANAS-NA .50 .54 .62 .35 .70 .69 .40 1
9. FORT .51 .52 .53 .32 .46 .52 .22 .46 1

M
Mean 4.34 3.36 3.38 4.87 13.99 14.25 2.29 18.99 21.28
SD 1.58 1.64 1.90 2.77 13.58 13.90 5.41 8.59 8.88

D
Range 1-7 1-7 1-7 1-11 0-58 0-63 0-32 9-46 0-48

TE
Skewness -.14 .61 .38 .50 .98 1.04 2.72 1.00 .25
Kurtosis -.51 -.40 -.93 -.69 .27 .36 7.14 .21 .44
EP
Note: All correlations were significant at the p < .001 level. WF = Worry Features; BDI = Beck Depression Inventory – II; BAI =
Beck Anxiety Inventory; BSS = Beck Scale for Suicide Ideation; PANAS-NA = Positive and Negative Affect Scale – Negative Affect
Subscale; FORT = Future-Oriented Repetitive Thinking Scale; SD = Standard Deviation
C
AC
 ACCEPTED MANUSCRIPT

Table 2

Hierarchical Regression Model Predicting Depression Symptoms

Variable R2 B SE(B) β sr2 95% CI
Step 1 .52***
Age -.00 .04 -.01 .00 -.08, .06

PT
Gender .17 .78 .01 .00 -1.36, 1.70
Negative Affect 1.00 .06 .63 .31 .89, 1.10
Future Thinking .27 .05 .17 .02 .16, .37

RI
Step 2 .56***
WF-Frequency .88 .41 .10* .00 .07, 1.68
WF-Duration -.05 .41 -.01 .00 -.85, .76

SC
WF-Controllability 1.61 .36 .22*** .02 .91, 2.32
WF-Content .04 .17 .01 .00 -.29, .38
Age .03 .03 .03 .00 -.04, .10

U
Gender -.08 .75 -.00 .00 -1.56, 1.40
Negative Affect .78 .06 .49*** .13 .65, .90
AN
Future Thinking .11 .06 .07* .00 .00, .22
Note: * p < .05, ** p < .01, *** p < .001; WF = Worry Feature
M
D
TE
C EP
AC
 ACCEPTED MANUSCRIPT

Table 3

Hierarchical Regression Model Predicting Anxiety Symptoms

Variable R2 B SE(B) β sr2 95% CI
Step 1 .55***
Age -.08 .03 -.07 .00 -.15, -.01
Gender 1.25 .78 .05 .00 -.27, 2.78

PT
Negative Affect .92 .06 .56 .25 .81, 1.03
Future Thinking .42 .05 .27 .06 .32, .53
Step 2 .58***
WF-Frequency .44 .41 .05 .00 -.38, 1.25

RI
WF-Duration .71 .41 .08 .00 -.10, 1.52
WF-Controllability 1.11 .36 .15** .01 .40, 1.82
WF-Content -.20 .17 -.04 .00 -.54, .14

SC
Age -.04 .03 -.04 .00 -.11, .02
Gender 1.08 .76 .04 .00 -.41, 2.57
Negative Affect .74 .06 .46*** .12 .62, .87
Future Thinking .29 .06 .19*** .02 .18, .41

U
Note: * p < .05, ** p < .01, *** p < .001; WF = Worry Feature
AN
M
D
TE
C EP
AC
 ACCEPTED MANUSCRIPT

Table 4

Hierarchical Regression Model Predicting Suicidal Ideation

Variable R2 B SE(B) β sr2 95% CI
Step 1 .19***
Age -.01 .00 -.11 .01 -.02, .37

PT
Gender -.05 .07 -.03 .00 -.19, -.00
Negative Affect .04 .01 .37 .11 .03, .09
Future Thinking .01 .01 .06 .00 -.00, .05

RI
Step 2 .20***
WF-Frequency -.01 .04 -.01 .00 -.09, .07
WF-Duration -.00 .04 -.00 .00 -.08, .08

SC
WF-Controllability .08 .03 .16* .01 .02, .15
WF-Content -.00 .02 -.00 .00 -.03, .03
Age -.01 .00 -.09* .01 -.01, -.00

U
Gender -.06 .07 -.04 .00 -.21, .08
Negative Affect .03 .01 .30*** .05 .02, .05
AN
Future Thinking .00 .01 .02 .00 -.01, .01
Note: * p < .05, ** p < .01, *** p < .001; WF = Worry Feature
M
D
TE
C EP
AC
 ACCEPTED MANUSCRIPT

Table 5

Hierarchical Logistic Regression Model Predicting Lifetime Suicide Attempts

PT
Variable R2 B SE(B) Wald OR 95% CI
Step 1 .08

RI
Suicidal Ideation .34 .13 6.34 1.40* 1.08, 1.83
Age -.01 .01 .52 .99 .97, 1.02

SC
Gender .75 .25 9.25 2.11** 1.30, 3.41
Negative Affect .00 .02 .02 1.00 .97, 1.04
Future Thinking .02 .02 .94 1.02 .98, 1.05

U
AN
Step 2 .10

M
Suicidal Ideation .33 .14 5.81 1.39* 1.06, 1.81
Age -.01 .01 .52 .99 .97, 1.02
Gender .71 .25 8.16 2.03** 1.25, 3.30

D
Negative Affect -.01 .02 .27 .99 .95, 1.03

TE
Future Thinking .00 .02 .02 1.00 .97, 1.04
WF-Frequency -.11 .15 .49 .90 .67, 1.21
EP
WF-Duration .23 .13 2.84 1.25 .96, 1.63
WF-Controllability -.01 .12 .01 .99 .78, 1.25
WF-Content .07 .06 1.60 1.08 .96, 1.26
C
AC

Note: * p < .05, ** p < .01; WF = Worry Feature; R2 = Nagelkerke R2

 ACCEPTED MANUSCRIPT

Highlights

• Worry features are examined with depression, anxiety, and suicide

• 548 community participants completed a battery of online surveys
• Controllability of worry was most strongly related to all psychopathology except
suicide attempts
• Frequency of worry was positively related to depressive symptoms

PT
RI
U SC
AN
M
D
TE
C EP
AC