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In order to better reflect this overlap, dimensional approaches seek to clarify whether these symptoms reflect a single underlying construct of general distress or a more complex multidimensionality. The aim was to examine the underlying structure of depression and anxiety symptoms, measured by the PHQ\u20109 and GAD\u20107, by estimating and comparing three factor models: one\u2010factor, two\u2010factor correlated, and bifactor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data from 1704 primary care (PC) patients from the PsicAP clinical trial were analysed. Dimensionality was assessed using hierarchical Exploratory Graph Analysis (EGA), and models were estimated using Exploratory Structural Equation Modelling (ESEM). Model fit was compared using the\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      , CFI, TLI, RMSEA, and SRMR indices.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The bifactor model offered the most acceptable comparative fit to the data (CFI\u00a0=\u00a00.956; TLI\u00a0=\u00a00.928; RMSEA\u00a0=\u00a00.076; SRMR\u00a0=\u00a00.028). Bifactor indices revealed a relevant but not dominant general factor (ECV\u00a0=\u00a00.40), indicating it does not account for sufficient variance to justify an essentially unidimensional interpretation. Furthermore, the specific factors of depression and anxiety emerged as well\u2010defined constructs (\n                      <jats:italic>H<\/jats:italic>\n                      \u00a0&gt;\u00a00.75) with modest reliable specific variance (\u03c9HS: 0.22 and 0.27, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The findings suggest a hierarchical structure where a general factor of distress coexists with specific factors. This suggests the potential utility of considering a multi\u2010level perspective in clinical assessment, accounting for both shared distress and specific symptom profiles.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mpr.70089","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:35:17Z","timestamp":1781238917000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Latent Structure of Depression and Anxiety Symptoms: A Bifactor Exploratory Structural Equation Model of the PHQ\u20109 and GAD\u20107 in Primary Care"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4110-2356","authenticated-orcid":false,"given":"Gabriel","family":"Esteller\u2010Collado","sequence":"first","affiliation":[{"name":"Department of Personality Assessment and Psychological Treatments, Faculty of Psychology University of Valencia  Valencia 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