Investigating the hierarchical structure of psychopathology and prospective associations between cognitive dysfunction and transdiagnostic symptom dimensions in 112,694 older adults from the UK Biobank

This study aimed to characterize the structure of psychopathology in older adults and determine whether cognitive dysfunction predicts transdiagnostic symptom dimensions throughout later life. Competing models of psychopathology (i.e., one-factor, correlated-factors, bi-factor, and higher-order models) were examined using confirmatory factor analysis (CFA) in participants aged 55-78 years old from the UK Biobank (N = 112,694, male = 44.6%, M = 65.05 years). Multigroup CFA was used to examine measurement invariance of the optimal model across four age groups (i.e., 55-59, 60-64, 65-69, and 70-78 years). Structural equation modelling was used to examine cognitive dysfunction as a predictor of transdiagnostic symptom dimensions in the full sample and across age-stratified subsamples. A higher-order model was selected as the optimal model of psychopathology, including a general factor and three lower-order factors (i.e., internalizing, externalizing/substance use, thought disorder). This model demonstrated acceptable model-fit (CFI = .932, TLI = .928, RMSEA = 0.047) and reliability of the lower-order factors (H = .850–.974). This model also demonstrated configural, lower-order metric/scalar, and higher-order metric/scalar invariance across age groups (change in CFI values ≤ .002). Cognitive dysfunction predicted greater general psychopathology and uniquely predicted internalizing and thought disorder in the full sample (βs = .066–.154, ps < .01) and across age-stratified subsamples (βs = .052–.143, ps < .01). There was no association with externalizing/substance use. Findings support the hierarchical organization of psychopathology throughout older adulthood and indicate that cognitive dysfunction is prospectively associated with general psychopathology and emotionally-focused (internalizing) and psychosis-like (thought disorder) symptom dimensions.