Changes in General and Specific Psychopathology Factors Over a Psychosocial Intervention

Stephen Basil Cuthbert Scott, Matthew Constantinou, Ian Goodyer, Ivan Eisler, Stephen Butler, Abdullah Kraam, Stephen Pilling, Elizabeth Simes, Rachel Ellison, Eizabeth Allison, Peter Fonagy

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19 Citations (Scopus)
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Recent research suggests that comorbidity in child and adolescent psychiatric symptoms can be explained by a single general psychopathology (“p”) factor and more specific factors summarizing clusters of symptoms. This study investigated within- and between-person changes in general and specific psychopathology factors over a psychosocial intervention.

A secondary analysis was conducted of the Systemic Therapy for At-Risk Teens study, a pragmatic randomized controlled trial that compared the effects of multisystemic therapy with those of management as usual for decreasing antisocial behavior in 684 adolescents (82% boys; 11–18 years old at baseline) over an 18-month period. The general p factor and specific antisocial, attention, anxiety, and mood factors were estimated from a symptom-level analysis of a set of narrowband symptom scales measured repeatedly during the study. General and specific psychopathology factors were assessed for reliability, validity, and within- and between-person change using a parallel process multilevel growth model.

A revised bi-factor model that included a general p factor and specific anxiety, mood, antisocial, and attention factors with cross-loadings fit the data best. Although the factor structure was multidimensional, p accounted for most of the variance in total scores. The p, anxiety, and antisocial factors predicted within-person variation in external outcomes. Furthermore, the p and antisocial factors showed within-person declines, whereas anxiety showed within-person increases, over time. Despite individual variation in baseline factor scores, adolescents showed similar rates of change.

The bi-factor model is useful for teasing apart general and specific therapeutic changes that are conflated in standard analyses of symptom scores.
Original languageEnglish
Pages (from-to)776-786
Number of pages11
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number8
Early online date14 Jan 2019
Publication statusPublished - 1 Aug 2019


  • bi-factor
  • general psychopathology
  • intervention
  • p factor
  • psychotherapy


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