Associations between behavioral trait expression, anxiety, and depression in a multi-site recovery sample

Anxiety and depressive symptoms are commonly evaluated as indicators of psychological distress, yet less is known about how broader patterns of behavioral trait expression relate to these symptoms at the individual level. This study examined associations between overall trait expression and anxiety and depression among adults participating in recovery-oriented behavioral health programming.

A retrospective observational analysis was conducted using routine assessment data collected between August 2023 and May 2026 across multiple U. S. behavioral healthcare settings. Records from the Trait and Hero Discovery Assessment, Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9) were matched to the same participant and assessment occasion. The primary analytic sample included 278 matched assessment occasions representing 252 participants. Associations were evaluated using Pearson correlations, with Spearman correlations, participant-clustered regression, mixed-effects models, and alternative assessment-matching windows used as sensitivity analyses. Internal consistency was also evaluated for the study measures.

Higher Trait Index scores were moderately associated with lower anxiety (r = -0.471, 95% CI [-0.557, -0.372], p < 0.001) and lower depressive symptom severity (r = -0.508, 95% CI [-0.595, -0.408], p < 0.001). Findings remained consistent across nonparametric, clustered, mixed-effects, and alternative matching-window analyses. The strength of the trait-depression association did not differ reliably from the trait-anxiety association. Internal consistency was strong for the overall Trait Index (Cronbach's alpha = 0.901), GAD-7 (alpha = 0.922), and PHQ-9 (alpha = 0.925). Exploratory analyses of participants with repeated matched assessments did not establish temporal precedence between trait expression and psychological distress.

Greater expression of the assessed behavioral traits was consistently associated with lower anxiety and depressive symptoms at the individual level. These observational findings do not establish causality or directionality, but they support further longitudinal investigation into whether trait expression functions as an antecedent, consequence, or reciprocal correlate of psychological distress. The findings also suggest potential value in complementing symptom-focused assessment with attention to underlying behavioral strengths and capacities in applied behavioral health settings.