How to Tell if Someone May Be Anxious or Depressed

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Published in the Journal of Psychopathology and Clinical Science, a recent study has found both distinct and overlapping language patterns in two common psychological disorders: anxiety and depression. The study was authored by Stade et al. from the University of Pennsylvania, Stanford University, and the National Institute on Drug Abuse.

Investigating the Language of Anxiety and Depression

Sample: 486 participants; 65 percent female; 56 percent White; average age of 32 years old (range of 18 to 80 years).

The sample included 167 individuals diagnosed with generalized anxiety disorder and in the midst of a depressive episode, 106 with generalized anxiety disorder but without depression, 61 with depression but without generalized anxiety, and 152 with neither mental illness. Of participants who agreed to return to the lab for further tests, 184 had anxiety or depression, whereas 55 had neither.

Measures:

• Clinician-assessed anxiety and depression were measured using the Anxiety and Related Disorders Interview Schedule for DSM-5–Lifetime Version (ADIS-5L).
• Self-reported anxiety and depression were assessed (in returning participants) using self-report Mood and Anxiety Symptom Questionnaire (MASQ).

Anxiety and Depression Language Commonalities

Both clinician-assessed and self-reported findings showed a number of language features common to depression and anxiety—for instance, a greater use of perceptual processes words (e.g., say, looking), body words (e.g., sleep, head, heart), and feel words (e.g., felt, pain, hard). This language pattern likely indicates a preoccupation with internal states.

Here are other language commonalities between anxiety and depression—and the potential meaning of these commonalities:

• Fewer work words (education, employment, office): This may suggest a lack of employment, or perhaps greater attention given to internal states than to external events such as work and school.
• Increased causation language (because, why, since): This may signify a more evaluative and abstract way of processing information, and a greater focus on the reasons behind emotions or events.
• More prepositions (like, about): This may reflect a desire for precision.
• More interrogatives (what, where, when): This could reflect information search and uncertainty intolerance.
• Fewer articles (a, an, the): This finding may similarly indicate a lack of attention to the external world. Indeed, articles usually occur before concrete nouns, meaning nouns like chair or dog that refer to what can be detected by senses.
• Frequent use of common verbs (was, have, know): Often paired with I-usage (I was, I have, I know), this may suggest problems with self-distancing.
• Higher word count: This is generally associated with reporting a greater number of problems to the interviewer.

Negative Emotion Language in Anxiety vs. I-Usage in Depression

Though anxiety and depression had much in common, certain language features were more specific to one than another.

To illustrate, anxiety was associated with a broad range of negative emotion words, like anxious, worried, stress, worse, bad, difficult, or sick. Depression, in contrast, was associated mainly with words related to loneliness and sadness (sorry, low, lost), and a lack of positive emotion words (kind, good, pretty, better, love, care).

I-usage (I, my, me, myself, mine) was also more common in depression, even though I-usage has been previously linked to negative emotionality, general distress, and neuroticism, and, as a result, to both anxiety and depression.

I-usage generally indicates self-focused attention; that is, attending to inner thoughts and feelings instead of information coming from the environment. Because self-focused attention usually involves fixating on negative self-related content, this preoccupation with inner states can have negative personal consequences. For example, focusing narrowly on the negative inner experience prevents adopting a self-distanced perspective, which previous research has linked with reduced depression and a greater sense of meaning in life.

There are also negative social consequences. To illustrate, when the negative self-related content is expressed verbally in social situations—in the form of excessive sharing of negative thoughts or excessive reassurance seeking—it makes listeners uncomfortable, annoyed, or frustrated. Therefore, it may lead to rejection.

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Newly Discovered Language Features of Anxiety and Depression

The data also revealed language features related to depression and anxiety that had not been reported previously.

Specifically, individuals with depression appeared to use shorter words, potentially as a result of fatigue or psychomotor retardation. They were also more likely to reference eating/weight. This may be due to negative body image, high body dissatisfaction, or the appetite, weight, and gastrointestinal disturbances (e.g., constipation) that are common in depression.

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Individuals with generalized anxiety disorder, compared to those with depression, were less likely to use negations (e.g., no, don’t, nothing). On the surface, this finding can seem puzzling. However, we must remember that a greater use of negation in research interviews could suggest a tendency to deny problems. Therefore, a lack of negations likely indicates anxious people sharing more problems with the interviewer. And anxious people indeed have more problems to share, since the data showed they had more comorbid diagnoses than did those with depression alone.

The authors add that the “relationships of conjunctions (which may also index talking about problems) and interrogatives (perhaps reflecting searching for answers) with anxiety (before controlling for depression) provide further evidence that anxiety is expressed via discussing problems.”

Takeaway

Language features more specific to anxiety were:

• Lack of negation words (not, nothing)
• Greater use of negative emotion words (pain, difficult)
• Unique emotional language markers (anxiety, stress)

Language markers more specific to depression were:

• I-usage (I, me)
• Sadness words (lost, alone)
• Fewer positive emotion words (love, care)

To summarize, it is through talking about their recent problems and life difficulties that people express anxiety. In contrast, people express depression by sharing their internal feelings and experiences.

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