J Psychopathol Behav Assess (2008) 30:252–260
DOI 10.1007/s10862-008-9084-2
A Comparison of the Factorial Structure of DSM-IV Criteria
for Generalized Anxiety Disorder Between Younger
and Older Adults
Roberto Nuevo & Miguel A. Ruiz & María Izal &
Ignacio Montorio & Andrés Losada &
María Márquez-González
Published online: 23 February 2008
# Springer Science + Business Media, LLC 2008
Abstract The controversy concerning the validity and
reliability of generalized anxiety disorder (GAD) appears
to be particularly relevant in the elderly, since physical
symptoms associated with GAD can readily be considered
as the consequences of normal aging. This study aims to
analyze the structure invariance of a questionnaire assessing
the DSM-IV diagnostic criteria across samples of older
adults and college students. Ninety-seven adults aged 65 or
over and 130 college students completed the Worry and
Anxiety Questionnaire (WAQ). The results revealed that
factorial invariance could be assumed and, in addition, that
scores for severity of GAD symptoms were higher in
younger subjects than in older ones. The results support the
applicability of DSM-IV criteria for GAD in elderly people,
as the factorial structure of the WAQ was the same for this
age group as for younger adults. A higher degree of GAD
severity was found in the younger sample.
Keywords Diagnostic criteria . GAD . Anxiety disorders .
Worry . Elderly . Factor invariance
R. Nuevo : M. A. Ruiz : M. Izal : I. Montorio :
M. Márquez-González
Psychology Department, Universidad Autónoma de Madrid,
Madrid, Spain
A. Losada
Psychology Department, Universidad Rey Juan Carlos,
Madrid, Spain
R. Nuevo (*)
Facultad de Psicología, Universidad Autónoma de Madrid,
28049 Madrid, Spain
e-mail: roberto.nuevo@uam.es
Research into generalized anxiety disorder (GAD) and worry
has increased exponentially during the last two decades
(Heimberg et al. 2004). However, most of the former
studies, as well as the DSM-IV (Diagnostic and statistical
manual of mental disorders, 4th edition; American Psychi-
atric Association 1994) criteria for GAD, have been based
on samples of young adults. Very few studies have
analyzed GAD among older adults even though it is one
of the most frequent disorders among the elderly (Flint
1994). Changes that accompany normal aging may produce
significant differences in the presentation of various
disorders (Piguet et al. 2002). Focusing specifically on
GAD, age-related changes could affect the presentation of
this disorder, either with regard to the cognitive variables
and processes associated with worry or with regard to
worry contents (e.g., Montorio et al. 2003; Stanley et al.
2003). In this sense, differences have been found between
older and younger adults in the presentation of worry,
particularly in its contents and temporal orientation (Hunt
et al. 2003). Furthermore, the application of theoretical
models regarding the etiology of pathological worry in old
age remains controversial (Nuevo et al. 2004). Even when
there are significant misgivings about DSM-IV diagnostic
criteria being appropriate for elderly people, especially with
regard to GAD-related somatic symptoms, these criteria
continue to be applied (Fisher and Noll 1996; Fuentes and
Cox 1997; Palmer et al. 1997). Moreover, instruments
commonly used to assess GAD have not been specifically
designed for use with older adults and most of them have
not been sufficiently validated with this age group
(Wetherell and Gatz 2005).
Wetherell et al. (2003) recently analyzed the character-
istics of GAD in older adults. Applying DSM-IV criteria
(with severity assessed on metric scales of 0–8), older
J Psychopathol Behav Assess (2008) 30:252–260
adults seeking treatment for excessive worrying were
classified as GAD, subclinical GAD, or nonclinical, through
structured diagnostic interviews. By means of discriminant
analysis, Wetherell et al. (2003) found that distress and
impairment, frequency and controllability of worry, and
muscle tension and sleep disturbance were the key features
of GAD in old age. Demographics such as age, marital
status, work status, or cognitive impairment did not present
significant differences between groups and GAD patients
presented similar numbers of medical diseases. These
results were taken as evidence that GAD could not be
explained by age-associated changes, health problems,
cognitive impairment, widowhood, or retirement. Univari-
ate analyses revealed differences between GAD and
subclinical patients in all the DSM-IV criteria, except
sleep disturbance and difficulty concentrating. GAD and
subclinical patients differed from normal controls in all
symptoms except difficulty concentrating. This pattern
of results suggests that sleep problems and difficulty
concentrating could have limited value as indicators of
GAD in old age. Wetherell et al. (2003) concluded that,
although with unresolved doubts, GAD can be considered
a distinct psychopathological category in the elderly, and,
more importantly, GAD at this age is associated with
increased stress and impairment relative to normal aging.
The results of this study suggest that most DSM-IV
criteria for GAD could be applied to older adults, but
slight adjustments are needed in some somatic symptoms.
In addition, these findings highlight the need for further
empirical evidence supporting the applicability of GAD
criteria to older adults through comparisons between younger
and older samples.
This study aims to compare the factor structure of DSM-
IV criteria for GAD, as assessed by metric scales for the
severity of each diagnostic criterion, between a sample of
older adults and a sample of college students. Specifically,
interest was focused on testing the factor invariance in the
two samples through confirmatory factor analysis (CFA).
For this comparison, a unidimensional baseline model of
GAD was assumed, according to theoretical, empirical and
methodological considerations (e.g. Brown et al. 1994;
Wetherell et al. 2003). However, a bidimensional model
(cognitive and somatic symptoms loading into different
dimensions) was also tested and compared. The focus of the
work is on testing the presence of a similar structure of
GAD across ages, rather than on testing the structure of
GAD. In the event of measurement invariance being
demonstrated, it would be the first empirical evidence of
the lack of age-related changes in the structure of the
disorder, which, in turn, could be taken as preliminary
evidence of GAD factor invariance across age groups, even
in the presence of relevant changes in specific aspects such
as the severity or contents of worry.
253
Method
Sample
109 older adults living in the community (aged 65 and
older) and 130 college students participated in this study.
The older sample was randomly selected through stratified
sampling to be representative of the population by gender
and age. Population references were established from the
census data of an urban community in Madrid, Spain. The
mean age of the older sample was 73.4 years (S.D.=5.6;
range 65–90), and 56.7% of the participants were women.
Of the participants, 33.9% had not finished grade school,
26.6% had finished grade school, 22% had high-school
studies, and 17.4% had higher levels of education. The
presence of cognitive impairment was controlled through
the Mini-Mental State Examination (MMSE; Folstein et al.
1975; Spanish version of Lobo et al. 1979) using a cut-off
score of 25 (Del Ser and Peña-Casanova 1994). By
applying this criterion, 12 participants were excluded from
the final analysis. The younger sample was recruited from
undergraduate advanced psychology classes. The mean age
was 21.7 (SD=1.9; range 20–29), and 88.6% were women.
Measures
The Worry and Anxiety Questionnaire
The degree in which the participants met DSM-IV criteria
for GAD was measured by an abbreviated Spanish adapta-
tion of the Worry and Anxiety Questionnaire (WAQ; Dugas
et al. 2001), which assesses only the core GAD criteria. The
Spanish version of the scale has shown good psychometric
properties both in younger (Ibáñez et al. 2000) and older
adults (Nuevo 2005). Although the original WAQ consisted
of 16 Likert type items (0–8), only the 10 items directly
related to the DSM-IV diagnostic criteria are included in
the Spanish version. Specifically, 4 items assess the GAD
cognitive domain (perceived lack of control over worries,
extent to which they are perceived as excessive, interfer-
ence in daily life, and frequency of excessive worrying),
and 6 items assess somatic symptoms (restlessness or
“feeling keyed up” or “on edge,” being easily fatigued,
difficulty concentrating or mind going blank, irritability,
muscle tension, and sleep disturbance [difficulty falling or
staying asleep or restless, unsatisfying sleep]). The WAQ
can be used as a screening instrument to identify the
presence of GAD, with the same algorithm used in the
DSM-IV (score of five or over on the four cognitive
symptoms and on three or more of the somatic symptoms).
Although there has been a long-standing controversy in
psychopathology about whether disorders should be per-
ceived from a dimensional or a categorical perspective,
254
empirical evidence based on taxometric methodology
points out that worry and GAD can be assumed to be dis-
tributed along a continuum (Ruscio et al. 2001). Drawing on
this consideration, in this study WAQ scores are conceptu-
alized as metric measures of the degree of severity of each
criterion, thus representing a continuum.
Mini-Mental State Examination (MMSE)
One of the most widely used screening tools for cognitive
impairment is the Mini-Mental State Examination (MMSE)
(Chino et al. 2006; Folstein et al. 1975). This instrument,
originally designed to screen early dementia in elderly
people, is widely used in inpatient and outpatient medical
settings due to its brevity and ease of administration. It
has well-established normative data, internal consistency
(Tombaugh et al. 1996) and high inter-rater reliability
(Tombaugh and McIntyre 1992). The cognitive domains
are: orientation (to time and place), immediate recall, short-
term memory, attention and calculation (serial sevens),
ability to follow verbal and written instructions, and visual
constructional ability. The Spanish version of the MMSE
(Lobo et al. 1979) has demonstrated good properties as a
fast and easy procedure for detecting potential cases of
cognitive impairment in the elderly (Del Ser and Peña-
Casanova 1994). The total score ranges from 0 to 35 (two
items were added to the original English version in order
to increase the discriminative ability of the test: abstract
thinking, scored 0–2; and digits backward, scored 0–3)
and it is administered by the interviewer who codifies the
answer of the subject to each item as 0 or 1.
Procedures
In the older sample, participants were randomly selected,
stratifying by age (age groups: 65–69, 70–74, 75–79, 80–84
and 85–90 years) and sex (male and female) from the
electoral register. A letter was sent to the people selected
explaining that the city council was collecting information
about the concerns and worries of elderly people in the
town with the goal of improving city services. They were
subsequently contacted by telephone to schedule an
appointment with the interviewer. 186 people were selected
(10% of the people aged 65 or over in the urban locality
where the study was performed), but only 109 agreed to
participate in the initial interview. Therefore, the proportion
of participation was 58.6%. The reasons for which the rest
of the sample could not be interviewed were: 1) refusal to
participate due to lack of time or mistrust in psychological
studies (74.8%); 2) inability to contact the people by
telephone (18.4%); and 3) death (6.8%). Since it was
possible for appointments to be held in the individual’s own
home (28.4% of the interviews), health problems or mobility
J Psychopathol Behav Assess (2008) 30:252–260
difficulties were not significant reasons for declining to
participate.
Once the sample had been selected, the MMSE and the
WAQ were administered to the participants by specifically
trained psychologists in an individual interview format,
with no other people present. Printed cards with the
different response options were used in order to facilitate
understanding of the possible response options. The role of
the interviewer was merely to read the questions and record
the answers; no additional explanation was required.
In the younger sample, the WAQ was self-administered
in the initial classes of several psychopathology courses.
Students were asked to voluntarily participate, and partic-
ipants completed the questionnaire in classroom settings
with 15 people per session, with the supervision of a
researcher. Refusal to participate was not controlled, and
participants did not receive any kind of remuneration. In
both samples, information about the study was provided
orally by the investigator and verbal consent was obtained
from each participant, as is customary in Spanish studies
conducted with community samples. No institutional
review board approval was required for this study.
Statistical Analyses
Several different procedures were used to test the differ-
ences between age groups. Item-observed mean scores were
compared using t tests for independent samples. Correlation
and reliability analyses were carried out for all the WAQ
constituent items, with the following statistics being
computed for each separate sample: Pearson product-
moment, Cronbach’s alpha, item-total correlation, and
item-remainder correlations. Analyses were performed
using the program SPSS 13.0 for Windows.
Latent structure was compared using CFA (maximum like-
lihood estimation) with the AMOS 5.0 program (Arbuckle
2003). A baseline model was established in order to compare
competing nested models and to allow for statistically
assessing the fit reduction introduced by subsequent param-
eter restrictions. The selected baseline model was a two-
group unidimensional factor model with all parameters free
for estimation in each group. The only restrictions imposed
were those needed for identification (loading of item 1 in the
latent factor was set to 1, and error regression weights were
also set to 1). The unbiased variance–covariance matrix was
analyzed, and a sequence of progressively restrictive models,
imposing equalities between groups, was estimated. Firstly, a
nested model that imposed equal corresponding factor
loadings in both groups was estimated (equal measurement
weights model). Secondly, a nested and more stringent
model imposing latent factor variance and latent error
variance to be equal was tested (equal structural variances
model). Thirdly and finally, a model imposing equal error
J Psychopathol Behav Assess (2008) 30:252–260 255

variances across groups was estimated (equal measurement
residuals model). The saturated model (best possible fit) and
null model (worse possible fit) were also estimated. Since
models are nested, the decrease in model fit can be compared
by computing the difference between the respective chi-
square statistics. This follows a chi-square distribution
having degrees of freedom equal to the number of new
restrictions imposed. If a set of restrictions does not
introduce a lack in fit, then the test statistic should not be
significant, and the compared model can be considered to be
similar.
Latent factor means were compared to assess true GAD
level differences, implemented by several concurrent
procedures. The total GAD symptom severity scores,
computed as the simple item arithmetic mean, were
compared between groups using a t-test. In addition, factor
scores were estimated for the individuals, using the
regression procedure and maximum likelihood exploratory
factor analysis estimation. The structure and factor score
loadings were estimated in the older group and were used to
compute regression scores for both groups. In this way, the
elderly group attained a mean of zero, and the mean for the
younger group can be readily compared with a t-test.
Finally, a mean structure model was estimated.
A common model regarding the observed variable
intercepts was established for both groups, and measure-
ment loadings were left free to account for differences in
the observed means. Group means for the latent variable
and intercepts were estimated. All measurement intercepts
were fixed equally across groups in order to attain the
required degrees of freedom (Bentler 1995; Arbuckle and
Wothke 2003, 1999). The latent factor mean for the older
group was fixed at zero as a reference, and the latent factor
mean for the younger group was estimated (Jorekog and
Sorbom 1996). According to the usual recommendations on
using several indices to assess fit (e.g., Reise et al. 1993),
given the sensitivity to sample size shown by χ2, the
assessment of the model was based on multiple criteria: a)
χ2; b) comparative fit index (CFI); c) goodness-of-fit index
(GFI); d) Tucker–Lewis index (TLI) and e) root mean
square error of approximation (RMSEA). A good fit is
indicated by small values for χ2, values above .90 for CFI,
GFI and TLI, and values less than .06 for RMSEA (Bentler
1990). The expected cross-validation index (ECVI) was
used to compare the fit of unidimensional and bidimen-
sional baseline-models. Lower values of the ECVI suggest
best fit to the data and ECVI provides confidence intervals
improving the precision of the estimation (Browne and
Cudeck 1993). The degree of over-determination of the
model (10 variables and 1 factor) and the moderate-to-high
communalities of the variables indicate an adequate sample
size according to theoretical and empirical (with Monte
Carlo simulation) suggestions by MacCallum et al. (1999).
Results
The comparison of mean scores between samples in each
criterion through t-tests, revealed significant differences in
items 1–4, and 6–9 (see Table 1). The younger sample had
higher scores on all symptoms except for 2 somatic criteria
(restlessness and sleep problems). The total mean in the
GAD symptom severity score was significantly higher in
the younger sample. The results for correlation analyses are
shown in Tables 2 and 3, together with item-total
correlations and the Cronbach’s alphas of the total GAD
symptoms severity score, if an item was deleted. The
reliability of the total scale was good for both samples (.82
for younger, .85 for older adults). Interestingly, the lowest
correlations were exhibited by item 6 (fatigue) in both
samples.
The CFA analyses values suggested a good fit for the
baseline model (CFI=.941), but a detailed analysis of the
modification indices revealed a correlated measurement

Table 1 Descriptive data and t-tests for DSM-IV GAD criteria in younger and older samples

Items Younger sample Older Sample Total t p 95% CI

Mean SD Mean SD Mean SD

1. Excessiveness 3.38 1.94 2.64 2.15 3.07 2.06 2.73 .007 .21/1.28
2. Frequency 3.09 1.84 2.45 2.52 2.82 2.18 2.11 .036 .04/1.24
3. Uncontrollability 4.55 1.89 2.46 2.44 3.66 2.38 7.01 .000 1.50/2.68
4. Interference 3.23 1.84 1.66 2.06 2.56 2.08 6.03 .000 1.05/2.08
5. Restlessness 3.81 2.15 3.30 2.43 3.59 2.28 1.67 .097 −.09/1.11
6. Fatigue 1.95 2.14 1.01 1.87 1.55 2.08 3.51 .001 .40/1.47
7. Concentration lost 3.92 2.29 1.30 2.18 2.80 2.59 8.72 .000 2.03/3.22
8. Irritability 3.95 2.27 1.94 2.57 3.09 2.60 6.22 .000 1.37/2.64
9. Muscle tension 2.94 2.26 1.51 2.32 2.33 2.40 4.67 .000 .83/2.04
10. Sleep disturbance 2.68 2.58 2.96 2.76 2.80 2.66 .79 .430 −.98/.42
Total WAQ 33.50 13.17 21.23 15.21 28.26 15.31 6.50 .000 8.5/16.0
256 J Psychopathol Behav Assess (2008) 30:252–260

Table 2 Correlations between DSM-IV GAD criteria in younger adults, item total correlations and alpha if item was deleted

1 2 3 4 5 6 7 8 9 10

1. Excessiveness –
2. Frequency .56**
3. Uncontrollability .53** .56** –
4. Interference .31** .44** .41** –
5. Restlessness .40** .62** .59** .54** –
6. Fatigue .07 .42** .15 .24* .33**
7. Concentration lost .33** .43** .38** .49** .47** .30* –
8. Irritability .34** .34** .44** .45** .44** .22** .25*
9. Muscle tension .32** .39** .37** .22* .30* .31** .30** .36**
10. Sleep disturbance .24** .28** .27** .32** .39** .22* .30** .32** .19* –
Alpha if deleted .83 .82 .82 .83 .82 .85 .83 .83 .84 .85
Item-total correlation .53 .69 .64 .58 .71 .37 .54 .53 .46 .42

Values for the younger sample are listed above the diagonal; values for the older sample are listed below the diagonal. Cronbach’s alphas if an
item were removed are shown to the right for the younger and on the bottom for the older sample.
*p<.05; **p<.01.

error between items 1 and 2 in both samples (modification
index for younger sample=19.69; standardized expected
parameter change=.997), suggesting a potential improve-
ment of the model if the correlation between these 2 errors
were freely estimated. Therefore, a second CFA analysis
was run re-specifying the model to estimate the correlation
between those 2 errors, which resulted in a model with a
substantially better fit (e.g., χ2 (68) = 79.217, p=.166;
CFI=.981; CMIN/df=1.165; see Table 4). The ECVI
value was.725 (90% CI.676/.842). This re-specified model
was used as the baseline model. In Fig. 1, the unidimen-
sional structure of the WAQ is graphically represented,
and the standardized weights for both samples in this
baseline model are reported. Regarding the adequacy of
sample size, Hoelter’s critical N values, 252 (.05 level) and
280 (.01), suggest that the sample sizes are satisfactory, as
they are over the 200 limit proposed by Hoelter (1983).
A critical factor in the current results is the assumption
of a unidimensional model of the GAD structure as
measured with the WAQ. An alternative bidimensional
model (the four cognitive symptoms in a first dimension
and the six somatic symptoms in a second dimension) has
been proposed in previous works with the WAQ (Ibañez
et al. 2000) and can be argued theoretically from the
conception of the disorder by the DSM-IV. Therefore, a
CFA was performed with this bidimensional structure,
freely estimating the correlation between errors of items 1
and 2 (due to the reasons reported above). The fit indices
revealed a good fit: (χ2 (66) = 78.198, p=.145; CFI=.980;
CMIN/df=1.185), but slightly worse than the unidimen-
sional model, and the ECVI value was higher (.739, 90%
CI.684/.856). Although the two models are approximately
equivalent, the unidimensional structure was preferred for
further analyses.
Additionally, in order to test the potential role of gender
as a confounding variable (given that women usually report
higher levels of anxiety; see Craske 2003 for a review), a
confirmatory multi-group analysis was carried out, estab-
lishing the saturated model as baseline (the variance–
covariance matrix), estimated in the four groups of gender

Table 3 Correlations between DSM-IV GAD criteria in older adults, item total correlations and alpha if item was deleted

1 2 3 4 5 6 7 8 9 10

1. Excessiveness –
2. Frequency .56** –
3. Uncontrollability .37** .45** –
4. Interference .36** .47** .46** –
5. Restlessness .21* .35** .34** .48** –
6. Fatigue .12 .24** .19* .17 .29** –
7. Concentration lost .26** .37** .44** .52** .34** .29** –
8. Irritability .17 .31** .34** .56** .32** .21* .42** –
9. Muscle tension .28** .26** .30** .33** .33** .20* .34** .30** –
10. Sleep disturbance .21* .32** .22* .31** .28** .25** .31** .29** .32** –
Alpha if deleted .81 .80 .80 .79 .80 .82 .79 .80 .81 .81
Item-total correlation .43 .59 .54 .66 .52 .34 .59 .51 .47 .44
J Psychopathol Behav Assess (2008) 30:252–260 257

Table 4 Goodness-of-fit indi-

ces for each model and com- Baseline Measurement Structural Measurement
parisons between models in Model Weights Model Variances Model Residuals Model
relation to baseline model
χ2 79.217 95.466 97.940 118.567
df 68 77 78 89
P .166 .075 .063 .020
CMIN/df 1.165 1.240 1.256 1.332
CFI .981 .969 .967 .951
GFI .937 .923 .921 .904
TLI .975 .964 .962 .950
RMSEA .027 .033 .034 .038
Comparisons between each model and baseline model
Δχ2 Not applicable 16.249 18.723 39.350
Δdf Not applicable 9 10 21
P (Δ) Not applicable .0618 .044 .009

Fig. 1 Representation of the

1
WAQ structure with standard- waq1 E1
ized weights for baseline models
in both samples. Note: The first
,42/ ,26
value for factor loadings and
error correlation is for the 1
,44/ ,56
younger sample and the second waq2 E2
is for the older sample ,60/ ,75

1
waq3 E3
,61/ ,71

1
waq4 E4
,78/ ,64

1
,58/ ,80
waq5 E5

GAD
,35/ ,41 1
waq6 E6
,67/ ,59

1
,62/ ,57 waq7 E7

,49/ ,47 1
waq8 E8

,46/ ,45 1
waq9 E9

1
waq10 E10
258
and age separately. The fit statistics were acceptable (χ2
(110)=18.7; CMIN/df=1.64; CFI=.891; RMSEA=.054),
showing the influence of sample size. When all groups
were constrained to have the same variance–covariance
matrix, the loss of fit was not significant (χ2 (55) = 73.1;
p=.052) suggesting that, regardless of possible mean value
differences, the basic correlation structure could be consid-
ered similar in all groups.
A CFA was then carried out constraining the loadings for
all items to be equal across both samples. The increase in
chi-square was not significant (Δχ2 (9) = 16.25; p=.0618),
indicating the factorial invariance of the DSM-IV criteria
for GAD between the younger and the older samples.
Factor invariance is a prerequisite for more stringent
invariance tests across samples. In this sense, the fit of a
model in which both the loadings and the latent factor
variances were constrained to be equal across samples was
tested. This model still presented a good fit (χ2(78)=97.40;
p=.063; CMIN/ df=1.256), with a significant, but marginal,
increase in chi square in relation to the baseline model
(Δχ2(10) = 18.72; p = .044) but with a non-significant
increase if the measurement invariance model is assumed
to be correct (Δχ2(1)=2.47; p=.116). In an even more
stringent test of invariance, a model was estimated in
which additional constraints for equality between sam-
ples were imposed for the variances of the measurement
residuals and for the correlation between errors of items
1 and 2. Chi-square was significant for this model
(χ2(89)=118.567; p=.020), although the ratio between
this value and the degrees of freedom, together with other
fit indices, were acceptable (CMIN/df=1.332; CFI=.951).
Compared with previous models, there was a clearly
significant increase in chi-square when compared to the
baseline model (Δχ2(21)=39.35; p=.009) and a more
moderate increase against the equal measurement weights
model (Δχ2(12)=23.10; p=.027) and the equal latent
variances model (Δχ 2 (11) = 2.63; p = .037). Table 4
presents the goodness-of-fit indices for the four estimated
models and comparisons between them. Interestingly,
these patterns of results were approximately replicated in
additional analyses assuming a bidimensional model of
GAD xstructure1.
Table 1 shows that the total scores differ between both
groups (t225 = 6.50, p <.001), with the younger group
exhibiting a significantly higher score. This is the roughest,
but simplest, estimate of the true GAD symptom severity
score difference. The difference between factor scores was
also significant (t225 =6.12, p<.001), with a mean score
difference of.69 more points for the younger group. This is
1
These additional results are available upon request to the first author.
J Psychopathol Behav Assess (2008) 30:252–260
the weighted sum score accounting for communality
differences in the variables which comprise the WAQ scale.
The mean difference obtained by the SEM model attains
1.13 points in favor of the younger group (C.R.=5.28,
p<.001). The structural model has a reasonable fit (χ2 (77)=
118.792, p=.002, CMIN/df=1.53, CFI=.93), taking into
account the stringent restrictions imposed in order to test
latent means. All results point to the fact that the younger
group exhibits a higher mean level of GAD symptom
severity score. Discrepancies in the absolute difference
obtained by each comparison method are insignificant,
since they merely reflect changes in the metrics used to
compute the total score. Moreover, all critical ratio statistics
are similar, and their confidence intervals overlap between
method-specific estimates.
Discussion
Results support the validity of the DSM-IV criteria for
GAD when applied to older adults through an initial testing
of the factorial invariance of the Worry and Anxiety
Questionnaire between older and younger adult samples.
The excellent fit of the baseline models, which continues to
be maintained even under stringent conditions, provides
additional confidence in the adequacy of the DSM-IV
criteria for GAD in older adults as measured with the metric
scales used in the present study. Only under very stringent
conditions, with equality constraints for error terms (Byrne
2001), does the fit seem to decrease slightly, while still
maintaining adequate values for goodness-of-fit indices.
Despite previous empirical evidence of differences in the
presentation of GAD in the elderly, particularly with respect
to somatic symptoms, (e.g., Wetherell et al. 2003), the
present work provides evidence of factor invariance
between younger and older adults in the structure of the
DSM-IV GAD criteria. Evidence for the adequacy of GAD
structure is not provided; instead, the hypothesis that DSM-
IV criteria for GAD are invariant across age groups,
regardless of GAD true structure, is endorsed. In support
of this theory, the pattern of results remains similar when a
bidimensional model of GAD is assumed. Other models
mathematically equivalent to the unidimensional model
tested here could have been examined, and would, in all
probability, have produced the same results (Tomarken and
Waller 2003). This factor invariance can be considered as a
robust finding, as it could be assumed under more rigorous
testing, such as those of latent variance equality or
measurement residual invariance.
In addition, there is evidence of a significant difference
in latent means between younger and older adults. Whereas
generally lower scores have been reported for older adults
in previous studies when measuring worry and anxiety, the
J Psychopathol Behav Assess (2008) 30:252–260
real meaning of such differences is doubtful, as factor
invariance of the measurement must be shown prior to
comparisons between groups, especially when there is
reason to believe that the structure of the compared
dimension is different across groups. Moreover, compar-
isons between observed measurements are exposed to
measurement error and also depend on scale reliability.
This could be a relevant source of confusion in most of the
results reported in the available literature, as anxiety or
worry scales have been developed and validated for
younger adults and there is little research on their properties
in older adults. Only a comparison of the latent means can
indicate any real difference between groups, and the results
of this work provide initial empirical evidence for lower
levels of GAD severity in older adults. It seemed
reasonable to hypothesize that there would be a differential
distribution of GAD somatic symptoms in the older sample,
which could be explained by normal age-related changes.
However, the patterns of correlations between criteria and
factor weights are very similar in both samples, and the
excellent fit of the model testing the factor invariance
clearly indicates that the factor structure is the same in older
and younger samples.
Particular mention should be made of the meaning of the
correlated measurement error between items 1 (“Do you
believe your worries are excessive or exaggerated?”) and 2
(“During the last six months, how many days have you
been excessively or exaggeratedly worried”?), which was
freely estimated. An initial explanation could be due to the
relation between item contents, since excessiveness and
frequency of worry are assessing only slightly different
concepts (in fact, correlations between these items are
among the highest correlations between items in both
samples), and both items are related to the same DSM-IV
criterion for GAD (A). Additionally, this similarity is
probably further increased because of the contiguity of the
questions and the coincidence of the words “excessive or
exaggerated” that do not appear in the other items.
A central assumption of this work is the dimensional
distribution of the GAD criteria and the GAD latent factor,
that is, that worry is present in all people to some degree;
only those with higher scores on most of the criteria (those
necessary to fulfill the DSM-IV algorithm or over the total
WAQ cut-score for GAD) would have GAD. It is
noteworthy that the scores for the different criteria are
somewhat low, especially in the older sample. This pattern
is to be expected, given the nonclinical nature of the
sample. Inversely, it is significant that scores as high as
3.30 out of 8 (restlessness) in the older sample, or 4.55 out
of 8 (uncontrollability of worry) in the younger sample
were found in a nonclinical sample. Given that nonclinical
samples were used in this work, further research should try
to overcome this limitation by testing the factor invariance
259
of GAD symptomatology in samples of younger and older
individuals diagnosed with GAD or other emotional
disorders.
The older and younger samples differed from each other
in the way the assessment measures were administered (oral
versus written). As higher social desirability scores have
been found for older adults (particularly for women, Ray
1988), the type of administration may have affected the
differences in GAD symptom severity scores according to
age (lower scores for older adults). Further studies should
take into account social desirability. Finally, this work used
a self-reported measurement to assess the severity of DSM-
IV criteria for GAD, whereas previous research has used an
interview procedure. Although it could be a potential
source of bias, evidence of good psychometric properties
of the metric scales used here with older Spanish adults has
been reported (Nuevo 2005), including excellent reliability,
as well as high sensitivity and specificity for identifying the
presence of GAD.
In conclusion, additional evidence is needed on this
topic and further work should try to extend the present
analysis to clinical samples. It would be particularly
interesting to analyze differences in the structure of GAD
in old age in combination with depressive symptoms. If
GAD can be assumed to be invariant across ages, as
suggested by the results of the present work, several
implications for assessment, treatment, prevention and
experimental designs with older adults suffering from
GAD can be considered. In this sense, these results would
support the validity of application to older adults of
measures developed and validated with younger adults.
Moreover, validity of administration to the elderly popula-
tion of treatment packages for pathological worry empiri-
cally validated with younger adults would also be
reinforced. Given the relevance of GAD in the elderly and
the scant research on this topic in this age group,
demonstration of empirical support for the continuity or
maintenance of the structure of GAD across the life span
could represent a necessary first step in improving the
quality of research and applied work on this disorder within
this population.
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