Anxiety sensitivity is a cognitive, individual difference variable that is differentiated by an individual's fear of anxiety sensations and centred on the belief that such sensations result in harmful consequences. In order to test anxiety sensitivity, Reiss, Peterson, Gursky, and McNally (1986) developed the Anxiety Sensitivity Index (ASI). However, one contentious issue in the area concerns the factor analytic structure of anxiety sensitivity and this has important consequences for the construct. Numerous investigations have been conducted using the ASI, and the results have varied appreciably with some researchers arguing for a unidimensional construct. However the general consensus now is that anxiety sensitivity is multidimensional. It has been argued that the repeated attempts to clarify the dimensionality of anxiety sensitivity, using the 16-item ASI, is problematic because the scale was never designed to measure a multidimensional construct in the first instance. Thus, the objective of the dissertation was to critically examine the anxiety sensitivity construct by using an expanded, multidimensional measure of anxiety sensitivity referred to as the Anxiety Sensitivity Index - Revised ([ASI-R] Taylor & Cox, 1998) and establish the psychometric properties of the measure by conducting a series of empirical investigations to assess the clinical utility of the measure. A series of three empirical investigations are presented in the current dissertation. The first investigation aimed to critically examine the factor structure and psychometric properties of the ASI-R. Confirmatory factor analysis using a clinical sample of adults revealed that the ASI-R could be improved substantially through the removal of 15 problematic items in order to account for the most robust dimensions of anxiety sensitivity. The modified measure was re-named the 21-item Anxiety Sensitivity Index (21-item ASI) and re-analysed with a large sample of nonclinical adults, revealing configural and metric invariance across groups. Further, comparisons with other alternative models that also include comparisons with previous published ASI models indicated the 21-item ASI to be the best fitting model for both groups. There was also evidence of internal consistency, test-retest reliability, and construct validity for both samples. The aim of the second investigation was to critically examine differences between and within various anxiety classifications, a mood disorder classification, and a nonclinical control sample, with respect to both general and specific dimensions of anxiety sensitivity as identified by the 21-item ASI. In most instances, the results revealed that the differences between and within the diagnostic groups were consistent with theoretical expectations. Finally, the third investigation aimed to examine differences within each diagnostic category before and after cognitive behavioural therapy in order to provide a further test of validity for the revised 21-item ASI. The results revealed significant differences within all but one diagnostic group on the pre and post-treatment scores, using the global and specific dimensions of the 21-item ASI. The strengths, theoretical contribution, limitations, and directions for future research are discussed. It is concluded that the overall findings relating to the series of empirical investigations presented in the current dissertation make a significant and valid theoretical contribution to the field of anxiety sensitivity in particular, and anxiety research in general, by enhancing our understanding of anxiety sensitivity and how the 21-item ASI can be used to improve therapeutic interventions in clinical practice.

Anxiety Sensitivity (AS) consists of beliefs that the experience of anxiety symptoms leads to illness or additional anxiety. The aim of the present study was to examine the factor structure of the Turkish version of Anxiety Sensitivity Index&amp / #8211 / Revised (ASI-R), and to investigate associations among AS, alcohol use and drinking motives in university students and alcohol dependent inpatients. The participants were 411 university students (225 females and 186 males) and 55 (3 females and 52 males) alcohol dependent inpatients. All participants were administered ASI-R, State-Trait Anxiety Inventory-Trait Form, Beck Depression Inventory, Drinking Motives Questionnaire-Revised, and Demographic Information Form. Exploratory factor analyses revealed four lower order factors of the ASI-R: (1) fear of respiratory symptoms / (2) fear of cardiovascular symptoms / (3) fear of cognitive dyscontrol / and (4) fear of publicly observable anxiety symptoms. ANOVA revealed that the frequency and amount of alcohol use were significantly higher in male students than females. Males reported more alcohol use for Coping and Conformity Motives than did females. Regression analyses revealed that only fear of cognitive dyscontrol significantly predicted hazardous alcohol use of students. Coping Motives significantly predicted alcohol use after controlling the effects of demographics, depression and ASI-R lower order factors in students using alcohol. Fear of publicly observable anxiety symptoms significantly predicted frequency of alcohol use in students using alcohol. Students reported using alcohol mostly for Enhancement, Social, Coping, and Conformity Motives, respectively. Students with high AS reported more alcohol use for Coping, Social and Conformity Motives than those with moderate and low AS. Fear of cognitive dyscontrol and fear of publicly observable anxiety symptoms explained a significant variance of drinking motives in students. In alcohol dependent inpatients, only fear of respiratory symptoms had a significant correlation with Coping Motives. Patients reported having used alcohol mostly for Coping, Enhancement, Social, and Conformity Motives, respectively. Coping and Enhancement Motives were significantly correlated with alcohol use. Results were discussed within the findings in the literature.

Os transtornos de ansiedade representam uma das formas mais comuns de psicopatologia em crianças e adolescentes e estão associados com prejuízos no funcionamento acadêmico, social e familiar. Porém, permanecem frequentemente subdiagnosticados e subtratados. O bullying escolar é muito comum e está associado com um amplo espectro de problemas psiquiátricos, incluindo sintomas de ansiedade. O principal objetivo desta tese foi examinar a prevalência de bullying em uma grande amostra comunitária de crianças e adolescentes brasileiros e investigar a associação entre bullying e sintomatologia ansiosa de acordo com o DSM-IV. Esse estudo transversal consistiu no preenchimento de um questionário sobre bullying e de sua frequência e de um instrumento auto-aplicativo de triagem para transtornos de ansiedade que é a Screen for Child Anxiety Related Emotional Disorders (SCARED) por 2.353 estudantes entre 9 e 18 anos provenientes de seis escolas pertencentes à área de captação da Unidade Básica de Saúde do Hospital de Clínicas de Porto Alegre. Um total de 22,9% da amostra relatou envolvimento com bullying frequente, como agressor (7,6%), como vítima (5,7%) ou como agressor-vítima (9,6%). Em geral, meninos foram mais envolvidos como agressores e como agressores-vítimas e meninas como vítimas. Nossos achados demonstraram que estudantes envolvidos com bullying, como vítimas ou agressores-vítimas, apresentavam maiores escores na SCARED total e em suas subescalas do que agressores ou do que os estudantes sem envolvimento com bullying. A prevalência do bullying encontrada no nosso estudo está na média quando comparada com estudos prévios na literatura. Vítimas e agressores-vítimas, mas não agressores, são grupos associados com uma sintomatologia ansiosa mais alta. Embora no Brasil as taxas para as prevalências dos transtornos de ansiedade na infância e adolescência sejam substanciais, há uma carência de instrumentos para avaliar os sintomas de ansiedade e constructos relacionados à ansiedade em crianças e adolescentes. Adicionalmente, essa tese avaliou as propriedades psicométricas de duas escalas que são utilizadas na avaliação da ansiedade em crianças e adolescentes. A SCARED é um instrumento auto-aplicativo que foi originalmente desenvolvido como uma ferramenta de triagem para avaliar os transtornos de ansiedade na infância e adolescência de acordo com o DSM-IV. Os resultados encontrados em nosso estudo evidenciam que a SCARED apresenta propriedades psicométricas apropriadas e é um instrumento válido e confiável para avaliar sintomas de ansiedade em jovens no Brasil. O Childhood Anxiety Sensitivity Index (CASI) é o principal instrumento utilizado para avaliar sensibilidade à ansiedade em crianças e adolescentes. A sensibilidade à ansiedade é um constructo temperamental que pode ser conceitualizado como o medo de que sintomas de ansiedade possam ter graves consequências físicas, psicológicas ou sociais para o indivíduo. A sensibilidade à ansiedade está associada com outras medidas de ansiedade, principalmente àquelas que avaliam sintomas relacionados ao transtorno do pânico, e pode ser considerada um fator de risco para o desenvolvimento de sintomas de ansiedade e de transtornos de ansiedade em jovens. Nossos achados demonstraram uma confiabilidade apropriada e evidência de validade convergente entre a CASI e a SCARED em uma subamostra do nosso estudo, sugerindo que a CASI possa ser uma ferramenta útil na avaliação da sensibilidade à ansiedade nessa população. Tendo em vista os limitados recursos em relação à saúde mental e a pouca atenção clínica aos transtornos de ansiedade, acredita-se que tais instrumentos possam 11 se tornar ferramentas úteis na triagem de crianças e adolescentes com sintomas de ansiedade e que poderão necessitar de avaliações adicionais e de tratamento. / Anxiety disorders are one of the most common forms of psychopathology among children and adolescents and are associated with impairments in academic, social, and family functioning. Although very prevalent, the anxiety disorders are often undetected or untreated. School bullying is common and is associated with a broad spectrum of psychiatric problems, including anxiety symptomatology. The main objective of this study was to examine the prevalence of bullying behaviors in a large communitarian sample of Brazilian children and adolescents and to investigate the association between bullying behaviors and DSM-IV anxiety symptomatology. This cross-sectional study involved completion of a self-report questionnaire about bullying behaviors and their frequency and the Screen for Child Anxiety Related Emotional Disorders (SCARED) that is also a self-report screening tool for childhood anxiety disorders by 2353 students aged 9-18 years from 6 schools located in the catchment area of the Primary Care Unit from the Hospital de Clínicas de Porto Alegre. A total of 22.9% of the sample reported frequent involvement in bullying, as a bully (7.4%), as a victim (5.7%), or as a bully-victim (9.5%). In general, boys were more likely to be involved as bully and as bully-victim, and girls were more likely to be involved as victims. Our findings showed that students involved in bullying behaviors, as victims or bully-victims, were more likely to have higher total scores in SCARED scale, as well as in its subscales than bullies and than uninvolved students. The prevalence of bullying behaviors found in our sample is about average when compared with previous studies described in the literature. Victims and bully-victims, but no bullies, are groups associated with higher anxiety symptomatology. Although prevalence rates of anxiety disorders in Brazilian youth are significant, there is a lack of validated instruments to assess anxiety symptoms and related constructs in children and adolescents. In addition, this study verified the psychometrics properties of two scales that are frequently used in the assessment of anxiety in children and adolescents. The SCARED is a self-report instrument that was originally developed as a screening tool for DSM-IV childhood anxiety disorders. Our study suggested that the SCARED has appropriate psychometric properties and is a useful and reliable instrument to assess anxiety symptoms in Brazilian youth. The Childhood Anxiety Sensitivity Index (CASI) is the principal instrument used to assess anxiety sensitivity in children and adolescents. Anxiety Sensitivity refers to the tendency to fear anxiety-related sensations and is thought to arise from beliefs about their harmful physical, cognitive, or social consequences. Anxiety sensitivity is associated with other anxiety measurements, mainly those evaluating panic symptoms. It is also considered a risk factor for the development of anxious symptomatology and anxiety disorders in youth. Our findings demonstrated an appropriate reliability and evidence of convergent validity in the CASI with the SCARED in a subsample of our study, suggesting that the CASI could be a suitable tool for evaluating anxiety sensitivity in this population. Given the limited mental health resources and the paucity of clinical attention to childhood anxiety disorders in Brazil, these instruments may be a valuable tool for screening Brazilian children and adolescents with anxiety symptoms who may need further assessment and treatment.

Os transtornos de ansiedade representam uma das formas mais comuns de psicopatologia em crianças e adolescentes e estão associados com prejuízos no funcionamento acadêmico, social e familiar. Porém, permanecem frequentemente subdiagnosticados e subtratados. O bullying escolar é muito comum e está associado com um amplo espectro de problemas psiquiátricos, incluindo sintomas de ansiedade. O principal objetivo desta tese foi examinar a prevalência de bullying em uma grande amostra comunitária de crianças e adolescentes brasileiros e investigar a associação entre bullying e sintomatologia ansiosa de acordo com o DSM-IV. Esse estudo transversal consistiu no preenchimento de um questionário sobre bullying e de sua frequência e de um instrumento auto-aplicativo de triagem para transtornos de ansiedade que é a Screen for Child Anxiety Related Emotional Disorders (SCARED) por 2.353 estudantes entre 9 e 18 anos provenientes de seis escolas pertencentes à área de captação da Unidade Básica de Saúde do Hospital de Clínicas de Porto Alegre. Um total de 22,9% da amostra relatou envolvimento com bullying frequente, como agressor (7,6%), como vítima (5,7%) ou como agressor-vítima (9,6%). Em geral, meninos foram mais envolvidos como agressores e como agressores-vítimas e meninas como vítimas. Nossos achados demonstraram que estudantes envolvidos com bullying, como vítimas ou agressores-vítimas, apresentavam maiores escores na SCARED total e em suas subescalas do que agressores ou do que os estudantes sem envolvimento com bullying. A prevalência do bullying encontrada no nosso estudo está na média quando comparada com estudos prévios na literatura. Vítimas e agressores-vítimas, mas não agressores, são grupos associados com uma sintomatologia ansiosa mais alta. Embora no Brasil as taxas para as prevalências dos transtornos de ansiedade na infância e adolescência sejam substanciais, há uma carência de instrumentos para avaliar os sintomas de ansiedade e constructos relacionados à ansiedade em crianças e adolescentes. Adicionalmente, essa tese avaliou as propriedades psicométricas de duas escalas que são utilizadas na avaliação da ansiedade em crianças e adolescentes. A SCARED é um instrumento auto-aplicativo que foi originalmente desenvolvido como uma ferramenta de triagem para avaliar os transtornos de ansiedade na infância e adolescência de acordo com o DSM-IV. Os resultados encontrados em nosso estudo evidenciam que a SCARED apresenta propriedades psicométricas apropriadas e é um instrumento válido e confiável para avaliar sintomas de ansiedade em jovens no Brasil. O Childhood Anxiety Sensitivity Index (CASI) é o principal instrumento utilizado para avaliar sensibilidade à ansiedade em crianças e adolescentes. A sensibilidade à ansiedade é um constructo temperamental que pode ser conceitualizado como o medo de que sintomas de ansiedade possam ter graves consequências físicas, psicológicas ou sociais para o indivíduo. A sensibilidade à ansiedade está associada com outras medidas de ansiedade, principalmente àquelas que avaliam sintomas relacionados ao transtorno do pânico, e pode ser considerada um fator de risco para o desenvolvimento de sintomas de ansiedade e de transtornos de ansiedade em jovens. Nossos achados demonstraram uma confiabilidade apropriada e evidência de validade convergente entre a CASI e a SCARED em uma subamostra do nosso estudo, sugerindo que a CASI possa ser uma ferramenta útil na avaliação da sensibilidade à ansiedade nessa população. Tendo em vista os limitados recursos em relação à saúde mental e a pouca atenção clínica aos transtornos de ansiedade, acredita-se que tais instrumentos possam 11 se tornar ferramentas úteis na triagem de crianças e adolescentes com sintomas de ansiedade e que poderão necessitar de avaliações adicionais e de tratamento. / Anxiety disorders are one of the most common forms of psychopathology among children and adolescents and are associated with impairments in academic, social, and family functioning. Although very prevalent, the anxiety disorders are often undetected or untreated. School bullying is common and is associated with a broad spectrum of psychiatric problems, including anxiety symptomatology. The main objective of this study was to examine the prevalence of bullying behaviors in a large communitarian sample of Brazilian children and adolescents and to investigate the association between bullying behaviors and DSM-IV anxiety symptomatology. This cross-sectional study involved completion of a self-report questionnaire about bullying behaviors and their frequency and the Screen for Child Anxiety Related Emotional Disorders (SCARED) that is also a self-report screening tool for childhood anxiety disorders by 2353 students aged 9-18 years from 6 schools located in the catchment area of the Primary Care Unit from the Hospital de Clínicas de Porto Alegre. A total of 22.9% of the sample reported frequent involvement in bullying, as a bully (7.4%), as a victim (5.7%), or as a bully-victim (9.5%). In general, boys were more likely to be involved as bully and as bully-victim, and girls were more likely to be involved as victims. Our findings showed that students involved in bullying behaviors, as victims or bully-victims, were more likely to have higher total scores in SCARED scale, as well as in its subscales than bullies and than uninvolved students. The prevalence of bullying behaviors found in our sample is about average when compared with previous studies described in the literature. Victims and bully-victims, but no bullies, are groups associated with higher anxiety symptomatology. Although prevalence rates of anxiety disorders in Brazilian youth are significant, there is a lack of validated instruments to assess anxiety symptoms and related constructs in children and adolescents. In addition, this study verified the psychometrics properties of two scales that are frequently used in the assessment of anxiety in children and adolescents. The SCARED is a self-report instrument that was originally developed as a screening tool for DSM-IV childhood anxiety disorders. Our study suggested that the SCARED has appropriate psychometric properties and is a useful and reliable instrument to assess anxiety symptoms in Brazilian youth. The Childhood Anxiety Sensitivity Index (CASI) is the principal instrument used to assess anxiety sensitivity in children and adolescents. Anxiety Sensitivity refers to the tendency to fear anxiety-related sensations and is thought to arise from beliefs about their harmful physical, cognitive, or social consequences. Anxiety sensitivity is associated with other anxiety measurements, mainly those evaluating panic symptoms. It is also considered a risk factor for the development of anxious symptomatology and anxiety disorders in youth. Our findings demonstrated an appropriate reliability and evidence of convergent validity in the CASI with the SCARED in a subsample of our study, suggesting that the CASI could be a suitable tool for evaluating anxiety sensitivity in this population. Given the limited mental health resources and the paucity of clinical attention to childhood anxiety disorders in Brazil, these instruments may be a valuable tool for screening Brazilian children and adolescents with anxiety symptoms who may need further assessment and treatment.

Os transtornos de ansiedade representam uma das formas mais comuns de psicopatologia em crianças e adolescentes e estão associados com prejuízos no funcionamento acadêmico, social e familiar. Porém, permanecem frequentemente subdiagnosticados e subtratados. O bullying escolar é muito comum e está associado com um amplo espectro de problemas psiquiátricos, incluindo sintomas de ansiedade. O principal objetivo desta tese foi examinar a prevalência de bullying em uma grande amostra comunitária de crianças e adolescentes brasileiros e investigar a associação entre bullying e sintomatologia ansiosa de acordo com o DSM-IV. Esse estudo transversal consistiu no preenchimento de um questionário sobre bullying e de sua frequência e de um instrumento auto-aplicativo de triagem para transtornos de ansiedade que é a Screen for Child Anxiety Related Emotional Disorders (SCARED) por 2.353 estudantes entre 9 e 18 anos provenientes de seis escolas pertencentes à área de captação da Unidade Básica de Saúde do Hospital de Clínicas de Porto Alegre. Um total de 22,9% da amostra relatou envolvimento com bullying frequente, como agressor (7,6%), como vítima (5,7%) ou como agressor-vítima (9,6%). Em geral, meninos foram mais envolvidos como agressores e como agressores-vítimas e meninas como vítimas. Nossos achados demonstraram que estudantes envolvidos com bullying, como vítimas ou agressores-vítimas, apresentavam maiores escores na SCARED total e em suas subescalas do que agressores ou do que os estudantes sem envolvimento com bullying. A prevalência do bullying encontrada no nosso estudo está na média quando comparada com estudos prévios na literatura. Vítimas e agressores-vítimas, mas não agressores, são grupos associados com uma sintomatologia ansiosa mais alta. Embora no Brasil as taxas para as prevalências dos transtornos de ansiedade na infância e adolescência sejam substanciais, há uma carência de instrumentos para avaliar os sintomas de ansiedade e constructos relacionados à ansiedade em crianças e adolescentes. Adicionalmente, essa tese avaliou as propriedades psicométricas de duas escalas que são utilizadas na avaliação da ansiedade em crianças e adolescentes. A SCARED é um instrumento auto-aplicativo que foi originalmente desenvolvido como uma ferramenta de triagem para avaliar os transtornos de ansiedade na infância e adolescência de acordo com o DSM-IV. Os resultados encontrados em nosso estudo evidenciam que a SCARED apresenta propriedades psicométricas apropriadas e é um instrumento válido e confiável para avaliar sintomas de ansiedade em jovens no Brasil. O Childhood Anxiety Sensitivity Index (CASI) é o principal instrumento utilizado para avaliar sensibilidade à ansiedade em crianças e adolescentes. A sensibilidade à ansiedade é um constructo temperamental que pode ser conceitualizado como o medo de que sintomas de ansiedade possam ter graves consequências físicas, psicológicas ou sociais para o indivíduo. A sensibilidade à ansiedade está associada com outras medidas de ansiedade, principalmente àquelas que avaliam sintomas relacionados ao transtorno do pânico, e pode ser considerada um fator de risco para o desenvolvimento de sintomas de ansiedade e de transtornos de ansiedade em jovens. Nossos achados demonstraram uma confiabilidade apropriada e evidência de validade convergente entre a CASI e a SCARED em uma subamostra do nosso estudo, sugerindo que a CASI possa ser uma ferramenta útil na avaliação da sensibilidade à ansiedade nessa população. Tendo em vista os limitados recursos em relação à saúde mental e a pouca atenção clínica aos transtornos de ansiedade, acredita-se que tais instrumentos possam 11 se tornar ferramentas úteis na triagem de crianças e adolescentes com sintomas de ansiedade e que poderão necessitar de avaliações adicionais e de tratamento. / Anxiety disorders are one of the most common forms of psychopathology among children and adolescents and are associated with impairments in academic, social, and family functioning. Although very prevalent, the anxiety disorders are often undetected or untreated. School bullying is common and is associated with a broad spectrum of psychiatric problems, including anxiety symptomatology. The main objective of this study was to examine the prevalence of bullying behaviors in a large communitarian sample of Brazilian children and adolescents and to investigate the association between bullying behaviors and DSM-IV anxiety symptomatology. This cross-sectional study involved completion of a self-report questionnaire about bullying behaviors and their frequency and the Screen for Child Anxiety Related Emotional Disorders (SCARED) that is also a self-report screening tool for childhood anxiety disorders by 2353 students aged 9-18 years from 6 schools located in the catchment area of the Primary Care Unit from the Hospital de Clínicas de Porto Alegre. A total of 22.9% of the sample reported frequent involvement in bullying, as a bully (7.4%), as a victim (5.7%), or as a bully-victim (9.5%). In general, boys were more likely to be involved as bully and as bully-victim, and girls were more likely to be involved as victims. Our findings showed that students involved in bullying behaviors, as victims or bully-victims, were more likely to have higher total scores in SCARED scale, as well as in its subscales than bullies and than uninvolved students. The prevalence of bullying behaviors found in our sample is about average when compared with previous studies described in the literature. Victims and bully-victims, but no bullies, are groups associated with higher anxiety symptomatology. Although prevalence rates of anxiety disorders in Brazilian youth are significant, there is a lack of validated instruments to assess anxiety symptoms and related constructs in children and adolescents. In addition, this study verified the psychometrics properties of two scales that are frequently used in the assessment of anxiety in children and adolescents. The SCARED is a self-report instrument that was originally developed as a screening tool for DSM-IV childhood anxiety disorders. Our study suggested that the SCARED has appropriate psychometric properties and is a useful and reliable instrument to assess anxiety symptoms in Brazilian youth. The Childhood Anxiety Sensitivity Index (CASI) is the principal instrument used to assess anxiety sensitivity in children and adolescents. Anxiety Sensitivity refers to the tendency to fear anxiety-related sensations and is thought to arise from beliefs about their harmful physical, cognitive, or social consequences. Anxiety sensitivity is associated with other anxiety measurements, mainly those evaluating panic symptoms. It is also considered a risk factor for the development of anxious symptomatology and anxiety disorders in youth. Our findings demonstrated an appropriate reliability and evidence of convergent validity in the CASI with the SCARED in a subsample of our study, suggesting that the CASI could be a suitable tool for evaluating anxiety sensitivity in this population. Given the limited mental health resources and the paucity of clinical attention to childhood anxiety disorders in Brazil, these instruments may be a valuable tool for screening Brazilian children and adolescents with anxiety symptoms who may need further assessment and treatment.