Invest Clin 61(4): 301 - 315, 2020 https://doi.org/10.22209/IC.v61n4a01

Positive and Negative Affect Schedule (PANAS): psychometric properties

of a Venezuelan Spanish version in medical students.

Trino Baptista1, Olga Vargas2, Rosani Colmenares2 and Javier Piñero2

1Department of Physiology, Universidad de Los Andes Medical School, Mérida, Venezuela.

2Department of Psychiatry, Universidad de Los Andes Medical School, Mérida, Venezuela.

Key words: affect; feelings; healthy volunteers; reliability; scales; validity.

Abstract. The study of affect covers a wide range of interests in psychiatry and psychology. The PANAS (positive and negative affect scale) is widely used to explore and monitor affect. In this study, the psychometric features of an on- line, Spanish version of the PANAS in Venezuela are described. The PANAS com- prises 10 items exploring positive (PA) and 10 exploring negative (NA) pointers of affect. After back translation and content validity by expert opinion, the scale was administered to a probabilistic sample of 100, fifth-year medical students. We assessed factor and internal consistency analysis, 15-day apart test-retest, and concurrent validity with locally validated scales of depression (GE-DEPRE) and anxiety (ANSILET), and the Ryff’s scale of psychological well-being (PWB). The PANAS displayed good content validity (validity ratio = 0.91) and internal consistency (Crochan alfa, PA = 0.89, NA = 0.88). A forced factor analysis produced two, 10-item components of PA and NA each. The PANAS behaved poorly in the test-retest analysis, with marginally significant correlation in the PA dimension only (p = 0.055). The NA subscale positively correlated with the ANSILET scale (p = 0.03) and negatively with the PWB scale (p = 0.049). The PA only showed marginal convergent validity with the “personal relations” dimension of the PWB scale. We confirmed the two dimensions of the PANAS. Its inconsistent repeatability and construct validity support the definition of this scale as a dynamic instrument, relatively independent from depression and anxiety dimensions, and with specific value for monitoring elemental compo- nents of affect.

Corresponding autor: Trino Baptista. Department of Physiology, Universidad de Los Andes Medical School, Mérida, Venezuela. E-mail: trinbap@yahoo.com

Escala de Afectividad Positiva y Negativa (PANAS): propiedades psicométricas de una versión venezolana en español

en estudiantes de medicina.

Invest Clin 2020; 61 (4): 301-315

Palabras clave: afecto; emociones; voluntarios sanos; confiabilidad; escalas; validez.

Resumen. El estudio del afecto es de interés en diversas áreas de la psico- logía y la psiquiatría. La escala de afectos positivos (AP) y negativos (AN) (PA- NAS) explora y monitorea la afectividad. En el presente estudio se describen las propiedades psicométricas de PANAS online en español en Venezuela. Luego de la traducción y evaluación de la validez de contenido mediante el juicio de ex- pertos, se administró la escala a 100 estudiantes del 5° año de la carrera de me- dicina. Realizamos análisis factorial, consistencia interna, test-retest a los 15 días, y validez concurrente y divergente con escalas de depresión (GE-DEPRE),

ansiedad (ANSILET) y bienestar psicológico de Ryff’s (PWBs). La escala demos-

tró buena validez de contenido (coeficiente de validez = 0,91) y consistencia interna (alfa de Crochan, AP = 0,89, AN = 0,88). El análisis factorial forzado arrojó 2 factores de 10 componentes cada uno (AP y AN). En el test-retest solo se observó una correlación positiva marginal en la dimensión de AP (p = 0,055). La subescala de AN se correlacionó positivamente con la ANSILET (p = 0,03) y negativamente con la PWBs (p = 0,049). La subescala de AP solo arrojó

correlación positiva marginal con la dimensión de “relaciones interpersonales”

de la PWBs (p = 0,08). Confirmamos los dos factores de la PANAS. Las incon- sistencias detectadas en la confiabilidad y validez de constructo apoyan la con- ceptualización de la escala como un instrumento dinámico, con independencia relativa de las dimensiones de ansiedad y depresión y con un valor específico para monitorear componentes elementales de la afectividad.

Received: 22-07-2020 Accepted: 02-11-2020

INTRODUCTION

The term affect is a psychological con- struct referring to mental states involving evaluative feelings such as feeling good-bad, liking-disliking a given situation, and several other experiences (1). The scientific study of affect is a crucial topic in contemporary psychiatry, given its relevance for the study of the biological and social basis of mental functions, human relationships, psychopa- thology, and psychotherapy.

Convergent evidence points at describ- ing the affective experience as constituted by two dominant dimensions: positive affect (PA) and negative affect (NA) (1). Among the available schedules to measure affect, the Positive and Negative Affect Schedule (PNAS) developed by Watson et al., in 1988

(2) is one of the most comprehensive and frequently used. The PANAS is a short while comprehensive, and friendly scale, compris- ing 10 terms denoting positive affect (PA) and 10 representing negative affect (NA).

The PA items are interested, excited, strong, enthusiastic, proud, alert, inspired, deter- mined, attentive and active. The NA entries are distressed, upset, guilty, scared, hostile, irritable, ashamed, nervous, jittery, and afraid (2).

Martin Seligman, a leader in contem- porary psychology pointed out that many psychotherapeutic schools expect that, in a particular subject, PA and NA balance would spontaneously emerge as psychotherapy progress (3). While this is certainly a fact in some patients, Seligman, among many other authors, strongly advocated for a more ac- tive approach in managing affect in the aver- age patient, who surely will improve her core psychopathology, but still would benefit by directly approaching her affect dimension (3). In operational terms it refers to imple- menting procedures that directly address PA and NA with a relative independence of the specific psychotherapeutic technique. It is here where a reliable instrument for measur- ing affect has a central role.

The PANAS was originally designed in English in North America, and it has been translated and validated in diverse ethnic groups such as African-Americans (4) and countries such as Argentina (5), Brazil (6), Canada (7), Spain (8), Hungary (9), India

(10), Korea (11), Mexico (12), Pakistan (13), Peru (14) and Turkey (15). An online ver- sion is available in Spanish (1). In addition to validation studies in healthy subjects, mostly adults, the PANAS has been studied in chil- dren (16), subjects with cocaine addiction (17), fibromyalgia (18), in meditation, work- ing memory and meditative training (19-21). There are also some studies about the dynam- ics of PANAS in subjects with major mental- and personality disorders (1,22,23).

The psychometric and linguistic prop- erties of the PANAS have not been evaluated in Venezuela. This precludes its use in clini- cal and research settings because the test comprehension is sensitive to specific word- ing among diverse Spanish-speaking coun-

tries (1, 5, 12, 14). We here thus, report the psychometric properties of the PANAS in medical students in Venezuela. For conver- gent and divergent validity assessment, the scales evaluating depression (GE-DEPRE), anxiety (ANSILET) and psychological well- being (Ryff’s scale) were used.

METHODS

The study was designed and conducted in the University Hospital, Universidad de Los Andes Medical School, Mérida, Venezue- la, between January and July of 2018. It was approved by the Hospital Ethics Committee; the subjects read and signed an informed consent of voluntary participation.

Validation measures

The positive and negative affect scale (PANAS) (2)

Translation

The Mexican version (12) was used as a reference, because most items are similar with those used in Venezuela. A bilingual lin- guist, who was unfamiliar with the question- naire, translated the scale back into English. After confirming the correspondence among the original scale (2), the Mexican- and the back-translated versions, two independent, bilingual psychiatrists set the definitive scale. It differed from the Mexican version in the items distressed, upset, scared, hostile, jittery, and afraid. Table I shows verbatim for the original English version and our defini- tive Spanish version.

The 20 items are rated on a scale rang- ing from 1 (“very slightly or not at all”) to 5 (“extremely”). Subjects are asked to rate how they felt (a) “right now (that is, at the present moment)”; (b) “today”; (c) “dur- ing the past few days”; (d) “during the past week”; (e) “during the past few weeks”; (f) “during the past year”; and (g) “in general, that is, on the average” (2). In this study, we used the “during the past week” and “in general” time-frame reference.

TABLE I

POSITIVE AND NEGATIVE AFFECT SCALE: ORIGINAL ITEMS IN ENGLISH AND THEIR TRANSLATION INTO SPANISH IN VENEZUELA.

ANSILET; a scale to assess anxiety

This is a one-factor scale consisting of 15 anxiety-related items. It was validated in 264 Venezuelan university students and re- ported a Cronbach alpha coefficient of 0.82 and a Pearson correlation coefficient of 0.59 vs the self-esteem Rosenberg scale (25).

The GE-DEPRE and ANSILET scales were used, since they were designed and vali- dated for university students in our country. Thus, an adequate comprehension of these scales were expected, given a culturally con- gruent wording in all the instruments.

Ryff ’s scale of psychological well-being (PWB)

The Ryff Scale (26), validated by Diaz et al., in Spain (27), was used. It comprises six factors: autonomy, environmental mas- tery, personal growth, positive relations with others, purpose in life, and self-acceptance (26,27). This scale consists of an extended version of 39 items PWB-E and a reduced version of 29 items (PWB-R), this last one included in the former. We administered the 39-item version, but analyzed both, the PWB-E and PWB-R models.

The GE-DEPRE, the ANSILET and the PWB scales were scored with a 6-point liker- type scale from 0 = complete disagreement to 6 = complete agreement and no neutral score. These scales did not include a cut- off point but are aimed at assessing chang- es over time in a continuous scale. All the scales are available at request.

sion

GE-DEPRE; a scale to assess depres-

This is a two-factor scale consisting of

Participants and procedure

The study was conducted in a universe of 190 medical students in their fifth year of their career. This group was selected to

16 depression-related items. It was validat- ed in 249 Venezuelan subjects and reported a Cronbach alpha coefficient of 0.88, and Pearson correlation coefficients of 0.65 vs a scale on aggression, of 0.68 vs an anxiety scale, and of 0.65 vs a general scale of psy- chological adjustment (24).

improve follow-up, because they were do-

ing their psychiatric clerkship in our Unit. A 100-subject probabilistic sample was ob- tained by selecting every two names from an alphabetically ordered list. The inclusion/ exclusion criteria were to sign a written con- sent of voluntary participation, and to have internet availability.

We personally explained the procedure to the universe sample in a classroom and sent the instruments via e-mail. The partici- pants answered all the scales immediately after reception. Fifteen days later, they only filled the PANAS for the retest procedure, Participants personally returned the in- formed consent, and this pointed the end of the study. Considering the PANAS, subjects were asked to rate how they felt “during the past week” and “in general, that is, on the average”. The other scales implicitly rate how people feel “in general”.

Validity and reliability of the PANAS

Content validity (evaluation by sub- ject matter experts)

The PANAS was evaluated by five re- searchers, all of them psychiatrists, who rat- ed the following three sentences with a 1-7 liker scale, where 1 = complete agreement and 7 = complete disagreement:

1. Ten terms of the scale properly explore positive affect.

2. Ten terms of the scale properly explore negative affect.

3. The 20 items of the PANAS are unders- tandable and are commonly used in Ve- nezuela.

c

The following formula to get a corrected Content Validity Ratio (CVR ) was used (28):

Where:

(CVRi = content validity ratio

for each item.

N = number of items (questions). j = number of experts.

A CVRc of 0.91 was obtained, which is considered as “excellent” (28).

In the next step, we assessed the PANAS Construct Validity be means of Factor Analy-

sis, Convergent and Divergent measures by correlating PANAS scores “in general”, with those obtained in the ANSILET, GE-DEPRE and the PWB scale. PANAS reliability was as- sessed with the Cronbach coefficient of in- ternal consistence and test-retest analysis.

Statistical analysis

The SPPS IBM 20.0 program was used for factor analysis and Cronbach coefficient calculation. The two-tailed t test for inde- pendent samples and the Mann-Whitney U test were used to compare between-sex scale scores. The Pearson and the Kendall tau b bivariate correlation coefficients were used for test-retest analysis, convergent and diver- gent validity analysis. Results were conside- red significant when p <0.05.

RESULTS

Sample description

All the 100 subjects of the estimated sample returned the questionnaires. Near three quarters of the sample were women; age did not differ between sexes: 71 females (71%; age: [average ± SD] = 25.5 ± 1.7 y); 21 men (21%; age: 25.9 ± 2.0 y). All respon- dents were single. The authors did not re- quest any other personal information.

Reliability analysis Internal consistency

The analysis was conducted with the data obtained in the first evaluation, refer- ring to the affect assessment “during the past week”. Internal consistency Cronbach alpha for the total sample was 0.89 for the PANAS-P and 0.88 for the PANAS-N; for women, PANAS-P = 0.89; PANAS-N = 0.87; for men: PANAS-P = 0.87; PANAS-N = 0.76.

Tables II and III display Cronbach alphas when omitting items, corrected correlations between each item and the total score, and correlations between the items on PANAS-P and PANAS-N, respectively. Most items within each PANAS dimension displayed significant positive correlations, except the association

TABLE II

306

CRONBACH ALPHA IF ITEM IS DELETED, CORRECTED ITEM-TOTAL SCORE CORRELATIONS, AND CORRELATIONS BETWEEN ITEMS OF THE POSITIVE AFFECT SUBSCALE (PANAS-P)

Item Crochan alfa if item deleted

Corrected item

total correlation Correlations between items

All correlations were statistically significant at p < 0.05 (two-tailed), except that between items 12 and 17 (shaded in grey).

TABLE III

CRONBACH ALPHA IF ITEM IS DELETED, CORRECTED ITEM-TOTAL SCORE CORRELATIONS, AND CORRELATIONS BETWEEN ITEMS OF THE NEGATIVE AFFECT SUBSCALE (PANAS-N)

Item Crochan alfa if item deleted

Corrected item-

total correlation Correlations between items

Baptista et al.

Investigación Clínica 61(4): 2020

All correlations were statistically significant at p < 0.05 (two-tailed), except those between items 13 and items 4, 8, 11 and 18 (shaded in grey).

between items 12 (Alert) and 17 (Attentive) in the positive dimension, and between item 13 (Ashamed) and items 4 (Upset), 8 (Hos- tile), 11 (Irritable) and item 18 (Jittery).

Test-retest

Participants answered the PANAS at baseline and after 15 days and comprised an affect self-evaluation “during the last week” and “in general”. The following Pearson cor- relations were observed:

Positive affect subscale

1. First vs. second “during the last week” evaluation: r (100) = 0.19, p = 0.055.

2. First vs. second “in general” evaluation: r = -0.01, p = 0.9.

Negative affect subscale

1. First vs. second “during the last week” evaluation: r = -0.09, p = 0.4.

2. First vs. second “in general” evaluation: r = 0.08, p = 0.4.

The analysis discriminating by sex did not show significant or marginally signifi- cant correlations between the pre- and post tests (data not shown).

To further explore the reasons behind the low-test stability or repeatability, Table IV shows Kendall tau b correlation coeffi- cients of every item in the first vs. the second evaluation. While the strength of association of the Kendall coefficient is not as straight- forward as with the Spearman’s correlation coefficient, values between 0.1-0.3 are con- sidered as low; between 0.3-0.5 as moderate and > 0.5 as strong. Accordingly, the items alert, enthusiastic, excited, inspired, active and interested in the PA side, and guilty, afraid, and distressed in the NA dimension, showed the lowest stability.

Factor analysis

A principal components analysis (PCA) was carried out on the 20-item PANAS. The suitability of PCA was assessed prior to analy- sis. The overall Kaiser-Meyer-Olkin (KMO) mea-

TABLE IV

WITHIN-ITEM CORRELATION

IN THE TEST-RETEST EVALUATION.

Values represent the Kendall tau b correlation coeffi- cient for every item in the test-rests analysis. For all items except (a), p <0.05.

sure was 0.84 with individual KMO measures all greater than 0.7, qualifying as ‘middling’ to ‘meritorious’ according to Kaiser (1974) (29). Bartlett’s test of sphericity was statistically sig- nificant (p <.0005), indicating that the data was suitable for factorization.

PCA revealed three components that had eigenvalues greater than one and which explained 30.2%, 20.1% and 9.5% of the to- tal variance, respectively. Visual inspection of the screen plot indicated that three com-

ponents should be retained. In addition, a three-component solution met the inter- pretability criterion and were retained.

The three-component solution ex- plained 59.7% of the total variance. A Vari- max orthogonal rotation was employed to aid interpretability. The rotated solution exhibited ‘simple structure’. The first fac- tor comprised all the ten items considered as indicating positive affect. The second and third factor comprised 7 and 6 items respec- tively considered ad negative affect (Table V). Component loadings and communalities of the rotated solution are also presented in Table V. The items Alert and Distressed showed the lowest, while significant inter- item correlations.

We used the forced factor extraction procedure to obtain two factors. The over- all Kaiser-Meyer-Olkin (KMO) measure was

0.83 with individual KMO measures all greater than 0.7, qualifying as ‘middling’ to ‘meritorious’. Bartlett’s test of spheric- ity was statistically significant (p <0.005). Factor one explained 30.2% of the total vari- ance and comprised the 10 positive-affect items; factor two explained 20.1% of the total variance and comprised all the ten negative affect items as well. Component loadings and communalities of the rotated solution are presented in Table VI. The item Alert showed the lowest, while significant inter-item correlation.

TABLE V

ROTATED STRUCTURE MATRIX WITH VARIMAX ROTATION OF THE THREE-COMPONENT PANAS.

Investigación Clínica 61(4): 2020

TABLE VI

ROTATED STRUCTURE MATRIX WITH VARIMAX ROTATION OF THE TWO-COMPONENT PANAS.

Communalities 0.658

0.675

0.589

0.583

0.597

0.525

0.539

0.441

0.333

0.306

0.647

0.534

0.519

0.508

0.501

0.498

0.658

0.466

0.402

0.273

Convergent and divergent validity

The Positive and Negative sections of the PANAS in the “in general evaluation” dis- played a negative, significant correlation (p

= 0.007). Table VII shows data for the whole sample. Results when controlling by sex are described in the text below.

PANAS and anxiety

The Positive Affect section of the PA- NAS in the whole sample did not significant- ly correlate with the ANSILET (Table VII). However, unexpectedly, when discriminating by sex, males showed positive correlations: r (29) = 0.28, p = 0.041.

The Negative Affect section of the PA- NAS in the total sample showed a significant

positive correlation with the anxiety scale (p = 0.03). When discriminating by sex, the positive correlation was observed only in fe- males: r (71) = 0.30, p = 0.01.

PANAS and depression

None of the PANAS’s subscales dis- played significant or marginally significant correlations with the depression scale, in the total sample or discriminated by sex (the lat- ter data not shown).

PANAS and the psychological well-be- ing scale

The PA in the total sample only dis- played a non-significant, positive correlation with the “positive personal relations” dimen-

310

TABLE VII

CORRELATIONS OF PANAS-P AND PANAS-N WITH CONVERGENT AND DIVERGENT VALIDITY MEASURES.

PANAS-P PANAS-N ANSILET GE-DEPRE PWB-E PWB-PG PWB-SA PWB-A PWB-PR

PANAS-P 1 -0.27

0.007

0.09

0.3

0.02

0.8

0.1

0.3

0.1

0.3

0.15

0.12

-0.01

0.9

0.17

0.08

PANAS-N 1 0.15*

0.03

0.019

0.9

-0.14* 0.049

-0.2

0.04

-0.11

0.13

-0.17

0.02

-0.06

0.6

ANSILET 1 0.21*

0.003

-0.07

0.5

-0.05

0.6

-0.05

0.6

-0.1

0.3

-0.17

0.5

GE-DEPRE 1 -0.02

0.8

-0.01

0.9

-0.04

0.7

-0.04

0.7

0.09

0.5

PWB-E 1 0.97

0.000

0.8

0.000

0.7

0.000

0.5

0.000

PWB-R 1 0.7

0.000

0.6

0.000

0.51

0.000

PWB-SA 1 0.24

0.01

0.28

0.017

PWB-A 1 0.06

0.5

PWB-PR 1

Baptista et al.

Investigación Clínica 61(4): 2020

Values represent the Kendall tau b correlation coefficient. PANAS-P = positive and negative affect scale, positive dimension; PANAS-N = positive and negative affect scale, negative dimension; ANSILET = anxiety scale; GE-DEPRE = depression scale; PWB-E = psychological well-being, extended version; PWB-PG = psychological well-being, personal growth; PWB-SA = psychological well-being self-acceptation dimension; PWB-A = psychological well-being autonomy dimen- sion; PWB-PR = psychological well-being, positive relations. (*) = p <0.05.

sion (p =0.08) (Table VII). When discrimi- nated by sex, in men the PA only showed a marginal, positive correlation with the PWB- E: r = 0.33, p = 0.07, and significant, posi- tive correlations with the PWB-R scale: (r = 0.45, p = 0.014). In women, we did not de- tect any significant or marginally significant correlation.

The NA subsection in the whole sample showed significant negative correlations with the PWB-E scale (p = 0.04), with the “personal growth” (p = 0.04) and the “au- tonomy” dimensions (p = 0.02) (Table VII).

When discriminated by sex, in males, the NA subscale showed negative, significant correlation with the “self-acceptance” sub- scale: r (21) = -0.40, p = 0.015, and margin- ally significant inverse correlations with the subscales of “positive personal relations”: (r

= -0.34, p = 0.064) and positive correlation with “autonomy”: r = 0.36, p = 0.053. In females, the NA subscale showed negative, marginally significant correlations with the PWB-E scale: r (71) = -0.22, p = 0.065, with the “purpose in life” subscale: r = -02, p =

0.09 and significant inverse correlation with that of “autonomy dimension”: r = -0.32, p

= 0.007.

Scales scores and correlations with gender and age

The PANAS-P, PANAS-N, anxiety, and depression scores did not differ between

the sexes. Men had slightly, but significant higher scores than women in the PWB scale, extended and reduced (p<0.05) (Table VIII).

In the Pearson correlation analysis, age and PANAS-P scores (in general) positively cor- related in the whole sample (r (100) = 0.27, p = 0.006) and in females: r (791) = 0.24, p

= 0.046; in males, the figure reached marginal significance; r (29) = 0.32, p = 0.08).

No significant correlations were ob- served between the PANAS-N and age, nei- ther in the whole sample nor when discrimi- nating by sex.

DISCUSSION

We assessed the psychometric prop- erties of an online, Spanish version of the PANAS. While online and paper scales’ ad- ministration display strong correlations, they may differ in their psychometric prop- erties (30). Hence, the results obtained in this study will be compared with those of Diaz-García et al. (1), which, to the best of our knowledge, is the only online-admin- istered Spanish PANAS version, and whose psychometric properties have been pub- lished. While the two studies are compara- ble in sex-distribution, -67% in Diaz-Garcia et al and 71% in our sample-, our subjects were all single and aged 25.4 ± 1.8 yrs., but theirs were mostly married or lived with a partner, and aged 37.4 ± 12.5 yrs.

TABLE VIII

SCALES SCORES ACCORDING TO SEX.

PANAS-P = positive and negative affect scale, positive dimension; PANAS-N = positive and negative affect scale, negative dimension; ANSILET = anxiety scale; GE-DEPRE = depression scale; PWB-E = psychological well-being, extended version; PWB-R = psychological well-being, reduced version.

Our PANAS version showed an excellent Validity of Content by experts (Content va- lidity Ratio = 0.91), and high Internal Con- sistence, as assessed by the alfa Cronbach coefficient (0.88 for the PANAS-N and 0.89 for the PANAS-P). However, the items Alert, Attentive, in the PANAS-P and Ashamed, Upset, Hostile, Irritable and Jittery, in the PANAS-N, showed low inter-item correlation coefficients. The “Attentive”, “Ashamed”, “Hostile” and “Irritable” items also showed the lowest correlation in the study of Diaz- Garcia et al. (1). Hence, these low-correla- tion items may represent a subset of terms with a rather low comprehensibility in young people, despite attending a very demanding career.

Factor analysis confirmed a two-compo- nent model, but a three-component model also emerged, with a main factor of Posi- tive Affect, and two Negative-Affect compo- nents. Separate analysis of the small, third negative-affect component, did not improve repeatability or convergent validity (data not shown). The PA and NA subscales correlated negatively (Table VII, p = 0.007) contrasting with the findings of Watson et al., [1] in the scale development study.

The PANAS repeatability (stability), as

measured by the test-retest conducted 15 days apart, only showed marginally signifi- cant, positive correlation for the PANAS-P dimension in “the last week” evaluation (p

=0.055). This is surprising, given that tests stability rises with increased temporal ag- gregation, [2] and a minimal repeatability was rather detected in the short-term aggre- gation. We do not have a satisfactory expla- nation of such a low test-retest coefficient and point to a relative independence of the diverse items within each scale dimension. An ordered list of the strength of associa- tion within every positive and negative item was presented, and identified those with low test-retest correlations. These items may have been poorly understood by our relative- ly young sample or might be associated to

relatively unstable affect dimensions. Any of the two explanations are of theoretical and practical interest. On the theoretical side, those items require further evaluation and refinement if necessary; on the practical side, such an item instability should be con- sidered when assessing therapeutic interven- tions.

The PANAS-P subscale showed diver- gent validity with the Anxiety and Depres- sion scales and a minimal convergent valid- ity with the Psychological Well-Being scales. At this time, there is not a satisfactory expla- nation for the unexpected positive correla- tion between the PANAS-P and the ANSILET in male students. We speculate that some PA items such as “alert and active” may have been reciprocally interpreted as “anxiety” by some subjects, and it requires further explo- ration.

The PANAS-N subscale displayed sig- nificant convergent validity with the Anxiety and Well-Being scales, but divergent validity with the Depression scale. The negative PA- NAS dimension thus, showed better conver- gent validity than the positive dimension.

The better convergent validity of the negative dimension compared with the posi- tive one contrasts with most studies pub- lished so far. For convergent validity assess- ment and in order to take into account the cultural particularities in wording, we used anxiety (24) and depression (25) scales de- signed and validated in Venezuela, whereas most studies have used the internationally- used Beck depression or anxiety inventories (1,2,12). Our depression and anxiety scales have not been tested against the Beck’s in- ventories, but they showed a positive, signifi- cant correlation with the Zung’s depression and anxiety scales (31). In addition, the PA- NAS was tested in outpatients with minor depression and found negative significant correlations between the PANAS-P and the ANSILET and GE-DEPRE scales and sig- nificant, positive correlations between the PANS-N and those depression and anxiety

scales: p <0.05 (Baptista T, personal com- munication).

Hence, we do not have grounds to sus- pect that the lack of convergence validity of our PANAS-P could be related to specific features of the external depression and anxi- ety scales. The PANAS-N subscale by showing significant, negative correlations with the anxiety and well-being inventories, had more consistent properties than the PANAS-P when compared with most previous studies.

The participant sample in this study was constituted by likely healthy medical stu- dents under high academic pressure. Hence, this might be associated with increased neg- ative feelings and decreased positive ones, without clear-cut relationships with depres- sion or anxiety, as indirectly suggested by our results.

Nevertheless, importantly, these results agree with the proposal that the PANAS di- mensions, while related to mood states, are relatively independent from depression and anxiety, as clinically defined. Hence, it is conceivable that a given subject, while clini- cally depressed or anxious, still may have a relatively healthy balance of positive and negative feelings. The opposite is also plau- sible (32). Besides, it is a well-known fact in physiology, psychology and philosophy, that discomfort is more salient than well-being (33). Accordingly, people in a usual, non-re- flective state, might be more aware of nega- tive than of positive affect.

However, in the spirit of a comprehen- sive psychology, the relative dissociation be- tween positive and negative feelings and clini- cally defined mood disorders, support the use of specific techniques for a simultaneous ap- proach of feelings (affect) and disorders (3).

In summary, the Venezuelan, Span- ish version of the PANAS displayed the well- known, two component model, but also a three-component model, with a small third, negative-affect component. The question- naire showed good validity content and in- ternal consistence, but low repeatability and convergent validity, particularly the PANAS-

P subscale. Despite a wording close to most Spanish versions, some items showed low cor- relation coefficients and need further investi- gation. Two relevant limitations of our study that hampers its generalizability are the sam- ple’s young age and the use of anxiety and depression scales validated only in Venezuela.

ACKNOWLEDGMENTS

This study was the Thesis of Dr. O. Var- gas to obtain her tittle of Specialist in Psy- chiatry, at Universidad de Los Andes, Méri- da, Venezuela.

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