Development and validation of the Dimensional Anhedonia Rating Scale (DARS) in a community sample and individuals with major depression

Anhedonia, a core symptom of Major Depressive Disorder (MDD), is predictive of antidepressant non-response. In contrast to the definition of anhedonia as a "loss of pleasure", neuropsychological studies provide evidence for multiple facets of hedonic function. The aim of the current study was to develop and validate the Dimensional Anhedonia Rating Scale (DARS), a dynamic scale that measures desire, motivation, effort and consummatory pleasure across hedonic domains. Following item selection procedures and reliability testing using data from community participants (N=229) (Study 1), the 17-item scale was validated in an online study with community participants (N=150) (Study 2). The DARS was also validated in unipolar or bipolar depressed patients (n=52) and controls (n=50) (Study 3). Principal components analysis of the 17-item DARS revealed a 4-component structure mapping onto the domains of anhedonia: hobbies, food/drink, social activities, and sensory experience. Reliability of the DARS subscales was high across studies (Cronbach's α=0.75-0.92). The DARS also demonstrated good convergent and divergent validity. Hierarchical regression analysis revealed the DARS showed additional utility over the Snaith-Hamilton Pleasure Scale (SHAPS) in predicting reward function and distinguishing MDD subgroups. These studies provide support for the reliability and validity of the DARS.

Measurement equivalence of the Toronto Structured Interview for Alexithymia across language, gender, and clinical status

The Toronto Structured Interview for Alexithymia (TSIA) has been translated into Dutch, German, and Italian and validated in clinical and nonclinical populations. In order to make valid comparisons across different population groups, it is important to establish measurement equivalence across variables such as language, gender, and clinical status. Our objective in this study was to establish measurement equivalence in relation to language (English, Dutch, German, and Italian), gender, and clinical status (non-clinical, psychiatric, and medical) using differential item functioning (DIF). The sample was composed of 842 adults representing the four language groups, all of whom had undergone the TSIA assessment as part of several earlier studies. Ordinal Logistic Regression was employed to explore DIF of the TSIA items. Although several items were found to exhibit DIF for language, gender, or clinical status, all of these effects were within an acceptable range. These findings provide support for the measurement equivalence of the TSIA, and allow researchers to reliably compare results from studies using the TSIA across the four language groups, gender, and clinical status.

Illuminating the theoretical components of alexithymia using bifactor modeling and network analysis

Alexithymia is a multifaceted personality construct that reflects deficits in affect awareness (difficulty identifying feelings, DIF; difficulty describing feelings, DDF) and operative thinking (externally oriented thinking, EOT; restricted imaginal processes, IMP), and is associated with several common psychiatric disorders. Over the years, researchers have debated the components that comprise the construct with some suggesting that IMP and EOT may reflect constructs somewhat distinct from alexithymia. In this investigation, we attempt to clarify the components and their interrelationships using a large heterogeneous multilanguage sample (N = 839), and an interview-based assessment of alexithymia (Toronto Structured Interview for Alexithymia; TSIA). To this end, we used 2 distinctly different but complementary methods, bifactor modeling and network analysis. Results of the confirmatory bifactor model and related reliability estimates supported a strong general factor of alexithymia; however, the majority of reliable variance for IMP was independent of this general factor. In contrast, network analysis results were based on a network comprised of only substantive partial correlations among TSIA items. Modularity analysis revealed 3 communities of items, where DIF and DDF formed 1 community, and EOT and IMP formed separate communities. Network metrics supported that the majority of central items resided in the DIF/DDF community and that IMP items were connected to the network primarily through EOT. Taken together, results suggest that IMP, at least as measured by the TSIA, may not be as salient a component of the alexithymia construct as are the DIF, DDF, and EOT components. (PsycINFO Database Record

Linking trait-based phenotypes to prefrontal cortex activation during inhibitory control

Inhibitory control is subserved in part by discrete regions of the prefrontal cortex whose functionality may be altered according to specific trait-based phenotypes. Using a unified model of normal range personality traits, we examined activation within lateral and medial aspects of the prefrontal cortex during a manual go/no-go task. Evoked hemodynamic oxygenation within the prefrontal cortex was measured in 106 adults using a 16-channel continuous-wave functional near-infrared spectroscopy system. Within lateral regions of the prefrontal cortex, greater activation was associated with higher trait levels of extraversion, agreeableness and conscientiousness, and lower neuroticism. Higher agreeableness was also related to more activation in the medial prefrontal cortex during inhibitory control. These results suggest that personality traits reflecting greater emotional stability, extraversion, agreeableness and conscientiousness may be associated with more efficient recruitment of control processes subserved by lateral regions of the prefrontal cortex. These findings highlight key links between trait-based phenotypes and neural activation patterns in the prefrontal cortex underlying inhibitory control.

Interaction effects in comorbid psychopathology

PURPOSE

Comorbidity in psychopathology is the norm. Despite some initial evidence, few studies have examined if the presence of comorbid conditions changes the expression of the pathology, either through increased severity of the syndrome(s) or by expanding to symptoms beyond the syndrome(s) (i.e., symptom overextension). The following report provides an illustration of interactive effects and overextension in comorbid pathology.

METHOD

A large pool of patients from a university hospital were assessed using SCID-I/P interviews. Of these, 230 patients diagnosed with major depressive disorder, social phobia, or both were included in the study.

RESULTS

Symptoms not belonging to either index condition (major depressive disorder or social phobia) reliably overextended in comorbid cases (odds ratios between 2.82 and 15.75).

CONCLUSIONS

Current research methodologies (e.g., structured interviews) do not allow for the examination of overextended symptoms. The authors make a call for future psychopathological research to search systematically for interactive effects by adopting more inclusive or flexible assessments.

Motivational pathways from reward sensitivity and punishment sensitivity to gambling frequency and gambling-related problems

Motives for gambling have been shown to have an important role in gambling behavior, consistent with the literature on motives for substance use. While studies have demonstrated that traits related to sensitivity to reward (SR) and sensitivity to punishment (SP) are predictive of substance use motives, little research has examined the role of these traits in gambling motives. This study investigated motivational pathways from SR and SP to gambling frequency and gambling problems via specific gambling motives, while also taking into account history of substance use disorder (SUD). A community sample of gamblers (N = 248) completed self-report questionnaires assessing SR, SP, gambling frequency, gambling-related problems, and motives for gambling (social, negative affect, and enhancement/winning motives). Lifetime SUD was also assessed with a structured clinical interview. The results of a path analysis showed that SR was uniquely associated with all 3 types of gambling motives, whereas SP and SUD were associated with negative affect and enhancement/winning motives but not social motives. Also, both negative affect and enhancement/winning motives were associated with gambling problems, but only enhancement/winning motives were significantly related to gambling frequency. Analyses of indirect associations revealed significant indirect associations from SR, SP, and SUD to gambling frequency mediated through enhancement/winning motives and to gambling problems mediated through both negative affect and enhancement/winning motives. The findings highlight the importance of SR and SP as independent predictors of gambling motives and suggest that specific motivational pathways underlie their associations with gambling outcomes.

Latent classes of nonresponders, rapid responders, and gradual responders in depressed outpatients receiving antidepressant medication and psychotherapy

BACKGROUND

We used growth mixture modeling (GMM) to identify subsets of patients with qualitatively distinct symptom trajectories resulting from treatment. Existing studies have focused on 12-week antidepressant trials. We used data from a concurrent antidepressant and psychotherapy trial over a 6-month period.

METHOD

Eight hundred twenty-one patients were randomized to receive either fluoxetine or tianepine and received cognitive-behavioral therapy, supportive therapy, or psychodynamic therapy. Patients completed the Montgomery-Åsberg depression rating scale (MADRS) at the 0, 1, 3, and 6-month periods. Patients also completed measures of dysfunctional attitudes, functioning, and personality. GMM was conducted using MADRS scores and the number of growth classes to be retained was based on the Bayesian information criterion.

RESULTS

Criteria supported the presence of four distinct latent growth classes representing gradual responders of high severity (42% of sample), gradual responders of moderate severity (31%), nonresponders (15%), and rapid responders (11%). Initial severity, greater use of emotional coping strategies, less use of avoidance coping strategies, introversion, and less emotional stability predicted nonresponder status. Growth classes were not associated with different treatments or with proportion of dropouts.

CONCLUSIONS

The longer time period used in this study highlights potential overestimates of nonresponders in previous research and the need for continued assessments. Our findings demonstrate distinct growth trajectories that are independent of treatment modality and generalizable to most psychotherapy patients. The correlates of class membership provide directions for future studies, which can refine methods to predict likely nonresponders as a means to facilitate personalized treatments.

Cross-cultural examination of measurement invariance of the Beck Depression Inventory-II

Given substantial rates of major depressive disorder among college and university students, as well as the growing cultural diversity on many campuses, establishing the cross-cultural validity of relevant assessment tools is important. In the current investigation, we examined the Beck Depression Inventory-Second Edition (BDI-II; Beck, Steer, & Brown, 1996) among Chinese-heritage (n = 933) and European-heritage (n = 933) undergraduates in North America. The investigation integrated 3 distinct lines of inquiry: (a) the literature on cultural variation in depressive symptom reporting between people of Chinese and Western heritage; (b) recent developments regarding the factor structure of the BDI-II; and (c) the application of advanced statistical techniques to the issue of cross-cultural measurement invariance. A bifactor model was found to represent the optimal factor structure of the BDI-II. Multigroup confirmatory factor analysis showed that the BDI-II had strong measurement invariance across both culture and gender. In group comparisons with latent and observed variables, Chinese-heritage students scored higher than European-heritage students on cognitive symptoms of depression. This finding deviates from the commonly held view that those of Chinese heritage somatize depression. These findings hold implications for the study and use of the BDI-II, highlight the value of advanced statistical techniques such as multigroup confirmatory factor analysis, and offer methodological lessons for cross-cultural psychopathology research more broadly.

Distinct profiles of behavioral inhibition and activation system sensitivity in unipolar vs. bipolar mood disorders

Psychiatric outpatients with mood disorders (n=275) and community controls (n=733) completed a measure of Behavioral Inhibition System (BIS) and Behavioral Activation System (BAS) sensitivity; psychiatric outpatients also completed measures of mood symptom severity. All patients scored higher on BIS compared to controls; patients with bipolar disorders scored higher on BAS scales compared to patients with depressive disorders. BIS and BAS demonstrated unique patterns of association with mood symptoms. Results support the clinical utility of the BIS/BAS.

Openness to experience, intellect, schizotypal personality disorder, and psychoticism: resolving the controversy

Section III of DSM-5 includes an alternative model for personality disorders comprising five higher-order pathological personality traits, four of which resemble domains from the Big Five/Five-Factor Model of Personality (FFM). There has, however, been considerable debate regarding the association of FFM Openness-to-Experience/Intellect (OE/I) with DSM-5 Psychoticism and Schizotypal Personality Disorder (STPD). The authors identify several limitations in the literature, including inattention to (a) differences in the conceptualization of OE/I in the questionnaire and lexical traditions and (b) the symptom heterogeneity of STPD. They then address these limitations in two large patient samples. The results suggest that OE/I per se is weakly associated with Psychoticism and STPD symptoms. However, unique variance specific to the different conceptualizations of OE/I demonstrates much stronger associations, often in opposing directions. These results clarify the debate and the seemingly discrepant views that OE/I is unrelated to Psychoticism and contains variance relevant to Psychoticism.

Alexithymia and adult attachment representations: associations with the five-factor model of personality and perceived relationship adjustment

Several studies have demonstrated associations between alexithymia, adult attachment styles, personality traits, and relationship adjustment. Only two studies, however, have explored associations between alexithymia and attachment representations. As part of a larger investigation of maternal and infant attachment, the current study explored this association in a sample of 97 pregnant women; in addition, measures of alexithymia and domains of the five-factor model (FFM) of personality were compared in predicting attachment security, assessed with the Adult Attachment Interview Coherence of Mind mind scale, and perceived relationship adjustment. Alexithymia negatively predicted coherence of mind; the domains of the FFM did not add significantly to the prediction. The Openness-to-Experience domain predicted relationship adjustment better than alexithymia. Contrary to findings from studies that assessed adult attachment styles, coherence of mind was unrelated to relationship adjustment and the FFM. The results suggest that alexithymia does not uniquely predict relationship adjustment beyond the domains of the FFM.

Acute and chronic stress exposure predicts 1-year recurrence in adult outpatients with residual depression symptoms following response to treatment

BACKGROUND

One of the strongest predictors of depression recurrence in those who respond to treatment is the presence of residual depressive symptoms. Our goal was to examine stressful life event exposure as a mechanism of recurrence in previously depressed patients with residual depression symptoms. That is, we predicted that higher levels of residual symptoms will significantly predict exposure to acute life events that will then heighten prospective recurrence risk.

METHODS

Participants included 68 adult outpatients with major depression (42 women; age 18-60) who completed a 12-month naturalistic follow-up after achieving remission in a 20-week randomized, open label trial of interpersonal psychotherapy, cognitive-behavioral therapy, or antidepressant medication. Depression recurrence was defined as the reemergence of an episode of major depression as determined by structured interview. Acute life events and chronic stressors were assessed at the end of follow-up using a contextual interview.

RESULTS

Posttreatment depression scores significantly prospectively predicted an increased risk for recurrence, and acute life events in the follow-up period. Cox regression survival analyses modeling life events as time-dependent covariates showed that life event exposure mediated the relation of residual symptoms to recurrence even controlling for chronic stress.

CONCLUSIONS

Our findings implicate residual symptoms in heightening depression recurrence risk through exposure to stressful life events. Depression recurrence adds significantly to the burden of the disorder. Therefore, rigorous follow-up of patients targeting the stressful context has the potential to prevent a lifelong pattern of illness.

Assessing DSM-5 Section III Personality Traits and Disorders With the MMPI-2-RF

An alternative model for diagnosing personality disorders (PDs) appears in DSM-5 Section III. This model includes a set of dimensional personality traits, which along with impairment in personality functioning can be configured to represent one of six PDs. Although specific assessment instruments for these personality traits have already been developed (e.g., the Personality Inventory for DSM-5 [PID-5]), clinicians will likely continue to use omnibus measures of psychopathology that are familiar to them to inform diagnostic decision making. One such measure, the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF), will likely remain in the test armamentarium of many practitioners and be employed to assess the DSM-5 dimensional traits. In the current investigation, we examined the associations between MMPI-2-RF scale scores and the PID-5 trait scores and DSM-5 Section III PDs in a combined sample of university students ( n = 668) from the United States and Canada. Our results indicated that the MMPI-2-RF scale scores mostly converge with PID-5 dimensional traits as well as the Section III PDs in a conceptually expected manner. As such, we conclude that the MMPI-2-RF is a potentially useful instrument in assessing personality psychopathology as conceptualized in DSM-5 Section III.

Interpersonal problems and impacts: further evidence for the role of interpersonal functioning in treatment outcome in major depressive disorder

INTRODUCTION

Empirical research has converged to support the concurrent association between social difficulties and psychiatric symptoms; yet, longitudinal associations between interpersonal problems and treatment outcome require clarification. The current investigation evaluated the influence of interpersonal problems assessed prior to treatment on interpersonal impacts assessed during treatment as well as on treatment outcome in outpatients with major depressive disorder (MDD).

METHOD

125 participants with a primary diagnosis of MDD were randomized to receive cognitive behavioural therapy or interpersonal therapy. Participants completed the Beck Depression Inventory-II, Hamilton Depression Rating Scale, and Inventory of Interpersonal Problems Circumplex before and after treatment. Therapists completed the Impact Message Inventory during and after treatment.

RESULTS

Interpersonal distress improved over the course of treatment; all other interpersonal changes were non-significant when distress was taken into account. Pre-treatment rigidity and agentic problems predicted less reduction in depressive symptoms, whereas agentic and communal impacts upon therapists during treatment predicted greater symptom change. Overall interpersonal distress was only indirectly associated with treatment response later in treatment, through its association with agentic style. Results did not differ across therapy type, and were replicated across self-report and interviewer-rated measures of depression severity.

LIMITATIONS

Limitations include the brief duration of treatment, lack of medication arm, and potentially restricted generalizability of patients in a randomized control trial to those in routine practice.

CONCLUSIONS

Interpersonal style demonstrated a trait-like stability over treatment, and appears to fluctuate due to co-occurring distress. Yet, specific interpersonal styles were negative prognostic indicators, even within therapy specifically targeting interpersonal functioning.