Neuroticism: a non-informative marker of vulnerability to psychopathology

Pathways From Personality to Happiness

Personal sense of uniqueness, a major construct in humanistic psychology, has been recently shown to be a robust correlate of happiness. Yet the antecedents of this experience are not known. To address this limitation, we focused on extraversion and openness to experience, the two traits referred to as plasticity in higher-order framework of personality, as predictors of uniqueness and happiness. In light of theory and past empirical research, we proposed that the two traits representing plasticity would promote a sense of uniqueness, which in turn influence happiness. This model was tested in a college sample ( N = 370) by relying on structural equation modeling. Results showed that uniqueness mediated the associations of extraversion and openness to experience with happiness. This model was supported when the effects of neuroticism, a marker of vulnerability to psychopathology, on uniqueness was taken into account. The implications of the findings for future research were addressed and sense of uniqueness as an element of a good life was highlighted.

Early motor developmental milestones and level of neuroticism in young adulthood: a 23-year follow-up study of the Copenhagen Perinatal Cohort

BACKGROUND

Studies investigating early developmental factors in relation to psychopathology have mainly focused on schizophrenia. The personality dimension of neuroticism seems to be a general risk factor for psychopathology, but evidence on associations between early developmental precursors and personality traits is almost non-existent. This study is therefore the first to investigate associations between early motor developmental milestones and neuroticism in adulthood. Method Mothers of 9125 children of the Copenhagen Perinatal Cohort recorded 12 developmental milestones during the child's first year of life. A subsample of the cohort comprising 1182 individuals participated in a follow-up when they were aged 20-34 years and were administered the Eysenck Personality Questionnaire (EPQ). Associations between motor developmental milestones and level of neuroticism, extraversion and psychoticism were analysed by multiple linear regression adjusting for for sex, single-mother status, parity, mother's age, father's age, parental social status and birth weight.

RESULTS

Among the 1182 participants with information on the EPQ, information on milestones was available for 968 participants. Infants who developed high levels of neuroticism as adults tended to sit without support, crawl, and walk with and without support significantly later than individuals with low levels of neuroticism (p values <0.05). These results remained significant after adjustment for the included covariates and for adult intelligence.

CONCLUSIONS

The findings are the first of their kind and suggest that delays in early motor development may not only characterize psychopathological disorders such as schizophrenia, but may also be associated with the personality dimension of neuroticism in adulthood.

Perceived primal threat, stress, and health: further examination of the role of perceived primal threat in the stress process

The general aim of the two studies presented here was to further examine the role of Perceived Primal Threat (PPT) in the stress process. PPT refers to threats against a four-component set of interdependent "primal" needs: self-preservation, social integration, personal identity and growth, and personal worldview. These threats are suggested to represent a pathway through which stress affects health. The first study (cross-sectional) was conducted in a sample of 216 healthy adults, while the second (prospective) in a sample of 137 chronically ill outpatients. The findings of both studies underlined the incremental and discriminant validity of PPT in relation to other stress-related variables. Furthermore, they provided support to the hypotheses that PPT is independently related to well-being and also mediates the relation of the stressful condition to well-being. Overall, the two studies underlined the important role of PPT in the stress process and indicated that PPT represents a promising research area.

Risk markers for affective disorder, a seven-years follow up study of a twin cohort at low and high risk for affective disorder

This study aims to investigate whether: familial history of affective disorder, subclinical depressive symptoms and life events (LEs) are predictive of a later development of mood disorder (onset). In a high-risk study, 234 healthy monozygotic and dizygotic twins with and without a co-twin history of affective disorder (high and low risk twins, respectively) were identified through nationwide registers and assessed from 2002 to 2005. Participants were followed longitudinally at 6-months intervals for up to nine years and finally reassessed with a personal interview to obtain information on whether they had an onset. During the follow-up period (mean time 7.0 years), 36 participants (15.4%) developed onset. Onset was significantly associated with risk status (Hazard ratio (HR) = 1.38, 95% CI 1.08-1.76), female sex, HR = 2.70, 95% CI 1.19-6.97, age HR = 0.97, 95% CI 0.93-0.99), and also with baseline Hamilton 17 score (HR = 1.30, 95% CI 1.13-1.48), Becks Depression Inventory 21 (HR = 1.14, 95% CI, 1.05-1.24) and neuroticism (HR = 1.08, 95% 1.02-1.12). Finally, the experience of LEs lifetime before baseline predicted onset (HR = 1.20, 95% CI 1.01-1.46) and the experience of LEs during follow-up also predicted onset (HR = 1.06, 95% CI 1.01-1.11). These findings suggest that young individuals at familial risk of affective disorders are at enhanced risk of onset and at further risk when having female sex and more subclinical depressive symptoms at baseline. Further, they seem to experience more LEs and to be more vulnerable to these.

Neuroticism and common mental disorders: meaning and utility of a complex relationship

Neuroticism's prospective association with common mental disorders (CMDs) has fueled the assumption that neuroticism is an independent etiologically informative risk factor. This vulnerability model postulates that neuroticism sets in motion processes that lead to CMDs. However, four other models seek to explain the association, including the spectrum model (manifestations of the same process), common cause model (shared determinants), state and scar models (CMD episode adds temporary/permanent neuroticism). To examine their validity we reviewed literature on confounding, operational overlap, stability and change, determinants, and treatment effects. None of the models is able to account for (virtually) all findings. The state and scar model cannot explain the prospective association. The spectrum model has some relevance, especially for internalizing disorders. Common causes are most important but the vulnerability model cannot be excluded although confounding of the prospective association by baseline symptoms and psychiatric history is substantial. In fact, some of the findings, such as interactions with stress and the small decay of neuroticism's effect over time, are consistent with the vulnerability model. We describe research designs that discriminate the remaining models and plea for deconstruction of neuroticism. Neuroticism is etiologically not informative yet but useful as an efficient marker of non-specified general risk.

The relationship between health promoting resources and work participation in a sample reporting musculoskeletal pain from the Nord-Trøndelag Health Study, HUNT 3, Norway

Background

Musculoskeletal pain (MSP) is one of the most frequent causes of sick leave from work, and is a common and potentially disabling condition. This study is based on the salutogenic perspective and investigates the relationship between personal, social, and functional health resources and work participation in a population reporting MSP.

Method

Analysis was performed on cross sectional data from the Nord-Trøndelag Health Study, HUNT 3, in Norway. The sample of n= 6702 was extracted from HUNT 3, including a total of N= 50807 participants. Self-reported health (SRH) and, personal, social, and functional resources were assessed by a questionnaire. Reported sick leave was collected by interview at the point of time when the data were collected, from October 2006 until June 2008.

Results

Logistic regression analysis demonstrated statistically significant differences between the work group and sick leave group in self-rated health, work support, work control, work load, and feeling strong, and the model predicted 68% of the cases correctly. Females had a lower statistically significant probability (B= −.53) to be in the work group then men when suffering from MSP, with odds of 41%.

Conclusion

There was a statistically significant relationship between health promoting resources such as SRH, feeling strong, absence of neuroticism, work load, work control, and work participation in MSP population.

Does Metacognition Make a Unique Contribution to Health Anxiety When Controlling for Neuroticism, Illness Cognition, and Somatosensory Amplification?

Somatosensory amplification (e.g., Barsky, 1992), illness cognition (e.g., Salkovskis & Warwick, 1986), and neuroticism (e.g., Noyes et al., 2003) have all been linked to health anxiety. The first two factors are disorder specific; however, neuroticism is a general vulnerability connected to a range of disorders. In the metacognitive model (Wells, 2009), beliefs about thinking have been implicated in the development of psychopathologies, but little is known about the contribution of individual differences in metacognition to health anxiety, specifically. A cross-sectional design was employed with convenience sampling used for participant selection. Participants (N = 351) completed a questionnaire battery and the following hypotheses were tested: (a) metacognition will show a significant positive correlation with health anxiety and (b) the relationship between metacognition and health anxiety will remain significant after controlling for variables normally associated with health anxiety (i.e., neuroticism, somatosensory amplification, and illness cognition). Hierarchical multiple regression analysis were run to test hypotheses and determine the best independent metacognitive predictors. The results supported each of the hypotheses and revealed three independent metacognitive predictors of health anxiety: “negative metacognitive beliefs about uncontrollability and danger,” “beliefs about the need for thought control,” and “cognitive confidence.” Overall, this study indicates that metacognition may have an important role in health anxiety, and the clinical implications are discussed.

The categorisation of dysthymic disorder: can its constituents be meaningfully apportioned?

BACKGROUND

Since its introduction in DSM-III, the validity of dysthymia has been debated. Our objective is to further examine the concept of dysthymia in an outpatient sample, and explore whether its constituents can be meaningfully apportioned.

METHODS

318 patients attending the Black Dog Institute Depression Clinic were assessed by the Mini-International Neuropsychiatric Interview, and completed several self-report measures, in addition to a clinical assessment by an Institute psychiatrist. The characteristics of patients with major depressive disorder (MDD), dysthymic disorder and double depression were examined. Latent Class Analysis (LCA) and Latent Profile Analysis (LPA) were then conducted with the aim of detecting distinct classes based on depressive symptomatology and personality domains, respectively. Finally, clinicians' formulations of the study patients were examined.

RESULTS

Depression groups mainly differed on parameters of severity. Although LCA and LPA analyses indicated the presence of distinct classes, these only moderately correlated with the MINI-diagnosed groups. Finally, there was evidence for considerable heterogeneity within clinicians' formulations of dysthymia.

LIMITATIONS

Inadequate sample numbers for various measures limited the power of the LPA and our sample was weighted to patients with a more severe depressive condition which may affect the detection of a distinct 'dysthymic' personality profile.

CONCLUSIONS

Despite employing a variety of techniques, we were unable to obtain a clear homogeneous picture of dysthymia. Rather, there was evidence for a distinct heterogeneity in clinician-derived diagnoses. These findings allude to the questionable discriminant validity of dysthymia and may encourage future research and discussion on this important topic.

Validation of the Long-term Difficulties Inventory (LDI) and the List of Threatening Experiences (LTE) as measures of stress in epidemiological population-based cohort studies

BACKGROUND

Stress questionnaires are included in many epidemiological cohort studies but the psychometric characteristics of these questionnaires are largely unknown. The aim of this study was to describe these characteristics for two short questionnaires measuring the lifetime and past year occurrence of stress: the List of Threatening Events (LTE) as a measure of acute stress and the Long-term Difficulties Inventory (LDI) as a measure of chronic stress.

METHOD

This study was performed in a general population cohort consisting of 588 females (53.7%) and 506 males (46.3%), with a mean age of 53.5 years (s.d.=11.3 years). Respondents completed the LTE and the LDI for the past year, and for the age categories of 0-12, 13-18, 19-39, 40-60, and >60 years. They also completed questionnaires on perceived stress, psychological distress (the General Health Questionnaire, GHQ-12), anxiety and depression (the Symptom Checklist, SCL-8) and neuroticism (the Eysenck Personality Questionnaire - Revised Short Scale, EPQ-RSS-N). Approximately 2 years later, 976 respondents (89%) completed these questionnaires for a second time.

RESULTS

The stability of the retrospective reporting of long-term difficulties and life events was satisfactory: 0.7 for the lifetime LDI and 0.6 for the lifetime LTE scores. The construct validity of these lists is indicated by their positive associations with psychological distress, mental health problems and neuroticism.

CONCLUSIONS

This study in a large population-based sample shows that the LDI and LTE have sufficient validity and stability to include them in major epidemiological cohort studies.

Are we witnessing the decline effect in the Type D personality literature? What can be learned?

After an unbroken series of positive, but underpowered studies seemed to demonstrate Type D personality predicting mortality in cardiovascular disease patients, initial claims now appear at least exaggerated and probably false. Larger studies with consistently null findings are accumulating. Conceptual, methodological, and statistical issues can be raised concerning the construction of Type D personality as a categorical variable, whether Type D is sufficiently distinct from other negative affect variables, and if it could be plausibly assumed to predict mortality independent of depressive symptoms and known biomedical factors, including disease severity. The existing literature concerning negative affect and health suggests a low likelihood of discovering a new negative affect variable that independently predicts mortality better than its many rivals. The apparent decline effect in the Type D literature is discussed in terms of the need to reduce the persistence of false positive findings in the psychosomatic medicine literature, even while preserving a context allowing risk-taking and discovery. Recommendations include greater transparency concerning research design and analytic strategy; insistence on replication with larger samples before accepting "discoveries" from small samples; reduced confirmatory bias; and availability of all relevant data. Such changes would take time to implement, face practical difficulties, and run counter to established practices. An interim solution is for readers to maintain a sense of pre-discovery probabilities, to be sensitized to the pervasiveness of the decline effect, and to be skeptical of claims based on findings reaching significance in small-scale studies that have not been independently replicated.

Sleep disturbance, personality and the onset of depression and anxiety: prospective cohort study

OBJECTIVE

Previous studies have shown associations between sleep disturbance and the onset of depression and anxiety. However, this relationship may reflect an underlying vulnerability, such as temperament or cognitive style, which accounts for an association between the two. This study aimed to evaluate the relationship between sleep disturbance and the onset of a mental disorder after a 4-year follow-up, and whether this was accounted for by ruminative style and neuroticism.

METHOD

The nine-item Patient Health Questionnaire was used to assess the criteria for major depression, generalized anxiety disorder (GAD) and panic disorder (PD) in a community cohort of 3636 young and middle-aged Australian adults, free of any disorder at baseline, over a 4-year period. Sleep disturbance was based on a factor derived from the sleep items of the Goldberg Depression and Anxiety Scales. The associations between baseline sleep disturbance and a new episode of the assessed disorders were estimated and the impact of temperament and cognitive style on these associations was evaluated.

RESULTS

Self-reported sleep disturbance was significantly associated with an onset of major depressive disorder [MDD; odds ratio (OR) = 1.33, p = 0.006], GAD (OR = 1.37, p < 0.001) and PD (OR = 1.62, p < 0.001) after 4 years. However, the relationship for MDD was attenuated to nonsignificance (OR = 1.19, p = 0.116) after adjusting for neuroticism (measured by the Eysenck Personality Questionnaire-Revised) and rumination (measured by the adapted Ruminative Style scale).

CONCLUSIONS

These data suggest that the often-observed association between sleep disturbance and depression onset may be linked to an underlying ruminative style and/or neuroticism. However, the fact that the effect of sleep disturbance on PD and GAD onset was not accounted for by personality factors is a novel finding and suggests a potential role of early identification in selective preventive interventions.

Neural mechanisms of attentional control differentiate trait and state negative affect

The present research examined the hypothesis that cognitive processes are modulated differentially by trait and state negative affect (NA). Brain activation associated with trait and state NA was measured by fMRI during an attentional control task, the emotion-word Stroop. Performance on the task was disrupted only by state NA. Trait NA was associated with reduced activity in several regions, including a prefrontal area that has been shown to be involved in top-down, goal-directed attentional control. In contrast, state NA was associated with increased activity in several regions, including a prefrontal region that has been shown to be involved in stimulus-driven aspects of attentional control. Results suggest that NA has a significant impact on cognition, and that state and trait NA disrupt attentional control in distinct ways.

Improving quality of life in patients with chronic kidney disease: influence of acceptance and personality

BACKGROUND

A low health-related quality of life (HQL) is associated with the evolution of chronic kidney disease (CKD) and mortality in patients in end-stage of the disease. Therefore research on psychological determinants of HQL is emerging. We investigate whether acceptance of the disease contributes to a better physical and mental health-related quality of life (PHQL and MHQL). We also examine the impact of personality characteristics on acceptance, PHQL and MHQL.

METHODS

In this cross-sectional study, patients from an outpatient clinic of nephrology completed self-report questionnaires on quality of life, acceptance and personality characteristics. We performed correlations, regression analyses and a path analysis.

RESULTS

Our sample of 99 patients had a mean duration of CKD of 10.81 years and a mean estimated Glomerular Filtration Rate (eGFR) by Modification of Diet in Renal Disease (MDRD)-formula of 34.49 ml/min (SD 21.66). Regression analyses revealed that acceptance had a significant positive contribution to the prediction of PHQL and MHQL. Neuroticism was negatively associated with acceptance and MHQL. Path analysis showed that 37% of the total effect of neuroticism on MHQL was mediated by acceptance.

CONCLUSIONS

Acceptance is an important positive variable in accounting for HQL, however, clinicians must be aware that if patients have a high level of neuroticism they are likely to have more difficulties with this coping strategy. These results provide a better understanding of psychological determinants of HQL in CKD, which can initiate another approach of these patients by nephrologists, specific psychological interventions, or other supporting public health services.

Personality profile of adult ADHD: the alternative five factor model

Attention-deficit/hyperactivity disorder (ADHD) is one of the most frequently diagnosed disorders in childhood affecting around 3% to 5% of adults worldwide. Most of the studies have been carried out using the Five Factor Model (FFM). Given the value and importance of describing adult ADHD in terms of general personality structure for a better conceptualization of this disorder, this study contributes adding new data on an Alternative Five Factor Model (AFFM) of personality. The aim of the present study is twofold: To assess the personality profile of adults with ADHD under the AFFM perspective, and to test the discriminant validity of the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) in differentiating ADHD subjects vs. normal range controls. A sample of 217 adults (64% male) meeting ADHD diagnosis (DSM-IV) was paired by age and sex with 434 normal-range controls. Logistic regression analysis showed that high scores on Neuroticism-Anxiety, Impulsivity and General Activity, and low on Work Activity were the most powerful predictors of being endorsed with an ADHD diagnosis. Results may suggest refinements in the personality assessment of ADHD as it seems that the ZKPQ provides more specific subscales for the description and conceptualization of this disorder.

Clinical relevance of comorbidity in anxiety disorders: a report from the Netherlands Study of Depression and Anxiety (NESDA)

BACKGROUND

To study the clinical relevance of type of comorbidity and number of comorbid disorders in anxiety disorders. Four groups were compared according to sociodemographic-, vulnerability- and clinical factors: single anxiety disorder, anxiety-anxiety comorbidity, anxiety-depressive comorbidity and "double" comorbidity (i.e. anxiety and depressive comorbidity).

METHODS

Data were obtained from the Netherlands Study of Anxiety and Depression (NESDA). A sample of 1004 participants with a current anxiety disorder was evaluated.

RESULTS

As compared with single anxiety, anxiety-anxiety comorbidity was associated with higher severity, greater chronicity and more treatment. Anxiety-anxiety comorbidity was associated with an earlier age of onset and a more chronic course compared with anxiety-depressive comorbidity, while anxiety-depressive comorbidity was associated with more severe symptoms and more impaired functioning than anxiety-anxiety comorbidity. "Double" comorbidity was associated with higher severity, greater chronicity, more treatment and increased disability. Sociodemographic and vulnerability factors were comparable among the four groups. Limitations A prospective design would be more appropriate to study the outcome. In this study no distinction was made between whether depression or anxiety disorder preceded the current anxiety disorder.

CONCLUSIONS

It is clinical relevant to diagnose and treat comorbidity among anxiety disorders as it is associated with higher severity and more chronicity. Whereas anxiety-anxiety comorbidity has an earlier age of onset and a more chronic course, anxiety-depressive comorbidity leads to more treatment and impaired functioning. "Double" comorbidity leads to even more severity, chronicity and impairment functioning compared with both anxiety-anxiety and anxiety-depressive comorbidity.

Clarifying domains of internalizing psychopathology using neurophysiology

Current initiatives such as the National Institute of Mental Health's Research Domain Criteria project aim to reorganize classification of mental disorders along neurobiological lines. Here, we describe how consideration of findings from psychiatric research employing two physiological measures with distinct neural substrates--the startle blink reflex and the error-related negativity (ERN)--can help to clarify relations among disorders entailing salient anxiety or depressive symptomatology. Specifically, findings across various studies and reviews reveal distinct patterns of association for both the startle blink reflex and the ERN with three key domains of psychopathology: (1) Fear (or phobic) disorders (distinguished by increased startle to unpleasant stimuli, but normal-range ERN). (2) Non-phobic anxiety disorders and negative affect (associated with increased ERN, increased startle across all types of emotional stimuli and increased baseline startle) and, more tentatively (3) Major depression (for which patterns of response for both startle and ERN appear to vary, as a function of severity and distinct symptomatology). Findings from this review point to distinct neurobiological indicators of key psychopathology domains that have been previously demarcated using personality and diagnostic data. Notably, these indicators exhibit more specificity in their relations with these three domains than has been seen in quantitative-dimensional models. Implications of these findings are discussed.

[Familial transmission of depression: the importance of harm avoidance]

BACKGROUND

Previous research about the aetiology of depression has analysed how depression-associated personality traits influence familial transmission. Using the community-based sample of the Greifswald Family Study, we investigated longitudinally to which extent the temperament factor harm avoidance influences the correlation between parent's depression and the depression of their offspring (with regard to possible sex differences).

METHODS

To test this familial transmission a structural equation model was conducted with the data of 193 children (mean age 19.5, SD=2.41) and their biological parents. Depression was assessed with structured clinical interviews, and harm avoidance with Cloninger's Temperament and Character Inventory (TCI, JTCI).

RESULTS

The harm avoidance scores of the mothers were significantly correlated with the harm avoidance scores of their children, but the correlation of the father's and children's scores did not reach significance. The extent of harm avoidance at the first assessment of the 14-year-old children predicted depression 5 years later.

CONCLUSION

These results indicate the importance of personality as a vulnerability marker for developing affective disorders. The results are discussed with respect to prevention programmes for children and parents with depression, especially if they exhibit strongly avoidant or anxious behaviour.

Psychopathology and thought suppression: a quantitative review

Recent theories of psychopathology have suggested that thought suppression intensifies the persistence of intrusive thoughts, and proposed that difficulty with thought suppression may differ between groups with and without psychopathology. The current meta-analytic review evaluates empirical evidence for difficulty with thought suppression as a function of the presence and specific type of psychopathology. Based on theoretical proposals from the psychopathology literature, diagnosed and analogue samples were expected to show greater recurrence of intrusive thoughts during thought suppression attempts than non-clinical samples. However, results showed no overall differences in the recurrence of thoughts due to thought suppression between groups with and without psychopathology. There was, nevertheless, variation in the recurrence of thoughts across different forms of psychopathology, including relatively less recurrence during thought suppression for samples with symptoms of Obsessive-Compulsive Disorder, compared to non-clinical samples. However, these differences were typically small and provided only mixed support for existing theories. Implications for cognitive theories of intrusive thoughts are discussed, including proposed mechanisms underlying thought suppression.

A load on my mind: evidence that anhedonic depression is like multi-tasking

Multi-tasking can increase susceptibility to distraction, affecting whether irrelevant objects capture attention. Similarly, people with depression often struggle to concentrate when performing cognitively demanding tasks. This parallel suggests that depression is like multi-tasking. To test this idea, we examined relations between self-reported levels of anhedonic depression (a dimension that reflects the unique aspects of depression not shared with anxiety or other forms of distress) and attention capture by salient items in a visual search task. Furthermore, we compared these relations to the effects of performing a concurrent auditory task on attention capture. Strikingly, both multi-tasking and elevated levels of anhedonic depression were associated with increased capture by uniquely colored items, but decreased capture by abruptly appearing items. At least with respect to attention capture and distraction, depression seems to be functionally comparable to juggling a second, unrelated cognitive task.

Determinants of mental health and well-being within rural and remote communities

BACKGROUND

The individual and contextual factors influencing current mental health and well-being within rural communities are poorly understood.

METHODS

A stratified random sample of adults was drawn from non-metropolitan regions of NSW, Australia. One-quarter (27.7%) of the 2,639 respondents were from remote/very remote regions. An aggregate measure of current well-being was derived from levels of distress and related impairment (Kessler-10 LM), self-reported overall physical and mental health, functioning, satisfaction with relationships, and satisfaction with life. Multivariate methods investigated the contributions to current well-being of demographic/dispositional factors, recent events and social support, individual exposure to rural adversity, and district/neighbourhood level characteristics.

RESULTS

Respondents from very remote regions tended to be younger and have lower education. Univariate associations were detected between well being and exposure to rural adversity (greater drought-related worry, lower perceived service and support availability, greater number of years living in the current district). Multivariate analysis (n = 2,462) accounted for 41% of the variance in well-being scores. The major contributing variables were dispositional factors (trait neuroticism, marital status), recent adverse events and indices of social support. However, no additional effects were detected for district-level variables (drought severity, regional socioeconomic categorisation, population change). Similar associations were detected using the K-10 alone as the outcome measure.

CONCLUSIONS

The chief determinants of current well being were those reflecting individual level attributes and perceptions, rather than district-level rural characteristics. This has implications for strategies to promote well being within rural communities through enhancing community connectedness and combating social isolation in the face of major adversities such as drought.

Positive and negative life events and personality traits in predicting course of depression and anxiety

OBJECTIVE

To examine the prognostic value of personality dimensions and negative and positive life events for diagnostic and symptom course trajectories in depressive and anxiety disorder.

METHOD

A total of 1209 subjects (18-65 years) with depressive and/or anxiety disorder were recruited in primary and specialized mental health care. Personality dimensions at baseline were assessed with the NEO-FFI and incidence and date of life events retrospectively with a structured interview at 2-year follow-up. DSM-IV-based diagnostic interviews as well as life chart assessments allowed course assessment at both the diagnostic and symptom trajectory level over 2 years.

RESULTS

Life events were significantly related to diagnostic and symptom course trajectories of depression and anxiety also after correcting for sociodemographic and clinical characteristics. Only negative life events prospectively predicted longer time to remission of depressive disorder. Prospective associations of neuroticism and extraversion with prognosis of anxiety and depression were greatly reduced after correcting for baseline severity and duration of index disorder. Personality traits did not moderate the effect of life events on 2-year course indicators.

CONCLUSIONS

Negative life events have an independent effect on diagnostic and symptom course trajectories of depression and to a lesser extent anxiety unconfounded by sociodemographic, clinical, and personality characteristics.

Interpreting neuroticism scores across the adult life course: immutable or experience-dependent set points of negative affect?

Neuroticism (N) scores predict psychopathology. Therefore, it is important to know how to best interpret N-scores. This paper reviews prior interpretations, the item content of N-measures and relevant empirical studies. We propose that N-scores reflect person-specific negative affect set points. We distinguish three possible set point models. (1) The immutable set point model in which N-scores fluctuate with short-term perturbations in reaction to positive and negative experiences but always return to their person-specific set point. (2) The experience-dependent model in which an individual's set point can change during any life stage when prompted by far-reaching experiences. (3) The mixed model, a combination of the first two models, which separates the variation in neuroticism into stable and changing components. The changing component is experience-dependent. Current evidence provides little support for the immutable model. Rather, the evidence, though inconclusive, suggests that the experience-dependent or mixed model may help to explain between- and within-subject differences in N-scores across the life span. In particular, the observation that the differential consistency of N-scores tends to drop over time, but has not been shown to approach zero, is consistent with the mixed model. We discuss implications of the models and how to distinguish them empirically.

Personality and depression: explanatory models and review of the evidence

Understanding the association between personality and depression has implications for elucidating etiology and comorbidity, identifying at-risk individuals, and tailoring treatment. We discuss seven major models that have been proposed to explain the relation between personality and depression, and we review key methodological issues, including study design, the heterogeneity of mood disorders, and the assessment of personality. We then selectively review the extensive empirical literature on the role of personality traits in depression in adults and children. Current evidence suggests that depression is linked to traits such as neuroticism/negative emotionality, extraversion/positive emotionality, and conscientiousness. Moreover, personality characteristics appear to contribute to the onset and course of depression through a variety of pathways. Implications for prevention and prediction of treatment response are discussed, as well as specific considerations to guide future research on the relation between personality and depression.

Neuroticism explained? From a non-informative vulnerability marker to informative person-context interactions in the realm of daily life

OBJECTIVES

Despite the well-replicated finding that neuroticism is associated with increased susceptibility for psychopathology, it remains unclear what 'vulnerability as indexed by neuroticism' represents in terms of everyday life emotional processes. This study examined the association between neuroticism and six phenotypes of daily life emotional responses: positive affect (PA), negative affect (NA), PA variability, NA variability, stress sensitivity, and reward experience, and investigated the contribution of genetic and environmental factors to these associations.

DESIGN

A prospective cohort study in a population-based sample of 416 adult female twins.

METHOD

A momentary assessment approach (experience sampling method) was used to collect multiple assessments of affect in daily life. Neuroticism was assessed with the Eysenck Personality Scale. Multi-level regression analyses were carried out to examine the association between neuroticism and the phenotypes of daily life emotional responses. Cross-twin, cross-trait analyses, and bivariate structural equation modelling (SEM) were performed in order to investigate the nature of these associations.

RESULTS

A high neuroticism score was associated with lower momentary PA levels and increased NA variability, independent of momentary NA, PA variability, stress sensitivity, and reward experience. Both the cross-twin, cross-trait analyses, and the bivariate SEM showed that unique, non-shared environmental factors drive the association between neuroticism and PA and that the association between neuroticism and increased NA variability is based on shared genetic factors as well as individual-specific environmental factors.

CONCLUSIONS

Neuroticism as measured by Eysenck questionnaire may index an environmental risk for decreased daily life PA levels and a genetic as well as an environmental risk for increased NA variability. Decomposing the broad measure of neuroticism into measurable persons-context interactions increases its 'informative' value in explaining psychopathology.

Chronic idiopathic urticaria and anxiety symptoms

Chronic idiopathic urticaria (CIU) is a frequently disabling disease with a negative influence on the quality of life, and can cause psychopathological symptoms, such as anxiety. Our aim is to study further anxiety symptoms on CIU patients. Both CIU patients and the control group were studied by means of validated scales for psychopathology symptoms, psychological variables and quality of life. In this study, we reported high levels of anxiety symptoms. We found statistically significant correlations between anxiety symptoms, some personality dimensions, insecure attachment styles, alexithymia and with some quality of life dimensions. CIU patients exhibit high levels of psychological distress that could potentiate difficulties at several domains, namely social, emotional, general health perception and interpersonal relationships.

The Role of Repetitive Negative Thoughts in the Vulnerability for Emotional Problems in Non-Clinical Children

The current study examined the role of repetitive negative thoughts in the vulnerability for emotional problems in non-clinical children aged 8-13 years (N = 158). Children completed self-report questionnaires for assessing (1) neuroticism and behavioral inhibition as indicators of general vulnerability (2) worry and rumination which are two important manifestations of repetitive negative thoughts, and (3) emotional problems (i.e., anxiety, depression, and sleep difficulties). Results demonstrated that there were positive correlations between measures of general vulnerability, repetitive negative thoughts, and emotional problems. Further, support was found for a model in which worry and rumination acted as partial mediators in the relation between neuroticism and symptoms of anxiety and depression. In the case of sleep difficulties, no evidence was obtained for such a mediation model. In fact, data suggested that sleeping difficulties are better conceived as an epiphenomenon of high symptom levels of anxiety and depression or as a risk factor for the development of other types of psychopathology. Finally, besides neuroticism, the temperamental trait of behavioral inhibition appeared to play a unique direct role in the model predicting anxiety symptoms but not in the models predicting depressive symptoms or sleep difficulties. To conclude, the current findings seem to indicate that worry and rumination contribute to children's vulnerability for anxiety and depression.

Regulated and unregulated forms of cortisol reactivity: a dual vulnerability model

OBJECTIVE

To test in a laboratory setting the hypothesis that the most problematic daily outcomes should be particular to individuals displaying higher cortisol reactivity and deficits in executive functioning as assessed in a task-switching paradigm.

METHODS

Thirty-eight volunteers completed a comprehensive assessment protocol. Individual differences in cortisol reactivity were quantified in an initial laboratory session involving a social stress speech task. Subsequently, individual differences in task-switching costs in a cognitive paradigm were assessed in a second session. Participants then reported on four problematic outcomes-error reactivity; worry; core aspects of negative emotionality; and aggression behavior frequency-for 15 consecutive days.

RESULTS

Levels of cortisol reactivity did not predict task-switching costs. Instead, and as hypothesized, individual differences in cortisol reactivity and task-switching costs interacted to predict the problematic daily outcomes. The highest levels of such problematic outcomes were particular to high cortisol reactors also exhibiting greater task-switching costs.

CONCLUSIONS

The findings support the dual vulnerability model proposed and are discussed from temperamental, health risk, and daily outcome perspectives. These findings indicate that cortisol is a risk factor, particularly when combined with deficiencies in task-switching.

Person-related protective and vulnerability factors of psychopathology symptoms in non-clinical adolescents

Psychopathology in youths is thought to originate from a dynamic interplay of a variety of protective and vulnerability factors. In this study, a large multi-ethnic sample of non-clinical adolescents (N = 376) completed questionnaires for measuring a wide range of person-related protective and vulnerability factors as well as psychopathology symptoms, in order to explore (a) the relations among various protective and vulnerability factors, and (b) the unique contributions of these protective and vulnerability factors to different types of psychological problems. Results indicated that the overlap among protective and vulnerability factors was quite modest. Further, it was found that factors clustered in theoretically meaningful components reflecting protection, vulnerability, and more specific aspects of coping and social support. Finally, data indicated that each type of psychopathology symptoms was associated with a typical set of protective and vulnerability factors. Although these results should be interpreted with caution because of the cross-sectional nature of the study, they may nevertheless guide future research exploring multifactorial models of psychopathology in youths.

Screening for depressive disorders using the Mood and Anxiety Symptoms Questionnaire Anhedonic Depression Scale: a receiver-operating characteristic analysis

The present study examined the utility of the anhedonic depression scale from the Mood and Anxiety Symptoms Questionnaire (MASQ-AD scale) as a way to screen for depressive disorders. Using receiver-operating characteristic analysis, we examined the sensitivity and specificity of the full 22-item MASQ-AD scale, as well as the 8- and 14-item subscales, in relation to both current and lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.) depressive disorder diagnoses in two nonpatient samples. As a means of comparison, the sensitivity and specificity of a measure of a relevant personality dimension, Neuroticism, was also examined. Results from both samples support the clinical utility of the MASQ-AD scale as a means of screening for depressive disorders. Findings were strongest for the MASQ-AD 8-item subscale and when predicting current depression status. Furthermore, the MASQ-AD 8-item subscale outperformed the Neuroticism measure under certain conditions. The overall usefulness of the MASQ-AD scale as a screening device is discussed, as are possible cutoff scores for use in research.

Temperamental emotionality in preschool-aged children and depressive disorders in parents: associations in a large community sample

Researchers and clinicians have long hypothesized that there are temperamental vulnerabilities to depressive disorders. Despite the fact that individual differences in temperament should be evident in early childhood, most studies have focused on older youth and adults. We hypothesized that if early childhood temperament is a risk factor for depressive disorders, it should be associated with better established risk markers, such parental depression. Hence, we examined the associations of laboratory-assessed positive emotionality (PE), negative emotionality (NE), and behavioral inhibition (BI) with semistructured interview-based diagnoses of parental depressive disorders in a community sample of 536 3-year old children. Children with higher levels of NE and BI had higher probabilities of having a depressed parent. However, both main effects were qualified by interactions with child PE. At high and moderate (but not low) levels of child PE, greater NE and BI were associated with higher rates of parental depression. Conversely, at low (but not high and moderate) levels of child NE, low PE was associated with higher rates of parental depression. Child temperament was not associated with parental anxiety and substance use disorders. These findings indicate that laboratory-assessed temperament in young children is associated with parental depressive disorders; however, the relations are complex, and it is important to consider interactions between temperament dimensions rather than focusing exclusively on main effects.

Predictors of incident major depression in diabetic outpatients with subthreshold depression

AIMS

The objective of the study was to determine rates and risks of major depression in diabetes outpatients with subthreshold depression.

METHODS

This study is based on data of a stepped care-based intervention study in which diabetic patients with subthreshold depression were randomly allocated to low-intensity stepped care, aimed at reducing depressive symptoms, or to care as usual. Patients had a baseline Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16, but no baseline major depression according to the Mini International Neuropsychiatric Interview (MINI). Demographic, biological and psychological characteristics were collected at baseline. The MINI was used to determine whether participants had major depression during 2-year follow-up. Predictors of major depression were studied using logistic regression models.

RESULTS

Of the 114 patients included at baseline, 73 patients were available at 2-year follow-up. The 2-year incidence of major depression was 42% (n=31). Higher baseline anxiety levels [odds ratio (OR)=1.25; 95% confidence interval (CI), 1.04-1.50; P=0.018] and depression severity levels (OR=1.09; 95% CI, 1.00-1.18; P=0.045) were predictors of incident major depression. Stepped care allocation was not related to incident major depression. In multivariable models, similar results were found.

CONCLUSIONS

Having a higher baseline level of anxiety and depression appeared to be related to incident major depression during 2-year follow-up in diabetic patients with subthreshold depression. A stepped care intervention aimed at depression alone did not prevent the onset of depression in these patients. Besides level of depression, anxiety might be taken into account in the prevention of major depression in diabetic patients with subthreshold depression.

Differences in neuroticism and extraversion between patients with bipolar I or II and general population subjects or major depressive disorder patients

BACKGROUND

Whether levels of neuroticism or extraversion differ between patients with bipolar disorder (BD), major depressive disorder (MDD) and subjects from the general population, or between BD I and BD II patients, remains unclear.

METHODS

BD patients (n=191) from the Jorvi Bipolar Study, and MDD patients (n=358) from both the Vantaa Depression Study and the Vantaa Primary Care Depression Study cohorts, were interviewed at baseline and at 18 months. A general population comparison group (n=347) was surveyed by mail. BD patients' neuroticism and extraversion scores, measured by Eysenck Personality Inventory, were compared at an index interview, when the levels of depression and mania were lowest, with scores of MDD patients and general population controls. Comparisons were also made between BD I (n=99) and BD II (n=92) patients.

RESULTS

In multinomial logistic regression, BD patients had higher neuroticism (OR=1.17, p<0.001) and lower extraversion (OR=0.92, p=0.003) than the general population. When entered simultaneously into the model, the effect of extraversion disappeared. In logistic regression, the levels of neuroticism and extraversion did not differ between BD and MDD patients, or between BD I and II patients.

LIMITATIONS

Patients' personality scores were not pre-morbid.

CONCLUSIONS

Levels of neuroticism and extraversion are unlikely to differ between BD and MDD patients, or between BD I and II patients. The overall level of neuroticism is moderately higher and extraversion somewhat lower in BD patients than in the general population. High neuroticism may be an indicator of vulnerability to both bipolar and unipolar mood disorders.

Serotonin transporter gene, childhood emotional abuse and cognitive vulnerability to depression

Meta-analyses evaluating the association between the serotonin transporter polymorphism (5-HTTLPR) with neuroticism and depression diagnosis as phenotypes have been inconclusive. We examined a gene–environment interaction on a cognitive vulnerability marker of depression, cognitive reactivity (CR) to sad mood. A total of 250 university students of European ancestry were genotyped for the 5-HTTLPR, including SNP rs25531, a polymorphism of the long allele. Association analysis was performed for neuroticism, CR and depression diagnosis (using a self-report measure). As an environmental pathogen, self-reported history of childhood emotional abuse was measured because of its strong relationship with depression. Participants with the homozygous low expressing genotype had high CR if they had experienced childhood emotional maltreatment but low CR if they did not have such experience. This interaction was strongest on the Rumination subscale of the CR measure. The interaction was not significant with neuroticism or depression diagnosis as outcome measures. Our results show that 5-HTTLPR is related to cognitive vulnerability to depression. Our findings provide evidence for a differential susceptibility genotype rather than a vulnerability genotype, possibly because of the relatively low levels of abuse in our sample. The selection of phenotype and environmental contributor is pivotal in investigating gene–environment interactions in psychiatric disorders.

Locating eating pathology within an empirical diagnostic taxonomy: evidence from a community-based sample

Existing structural models of psychopathology need to be expanded to include additional diagnostic constructs beyond mood, anxiety, substance use, and antisocial behavior disorders. The goal of this study was to locate eating disorders within a hierarchical structural model of psychopathology that is anchored by broad Internalizing and Externalizing factors. Participants were female adolescent twins (N = 1,434) from the Minnesota Twin Family Study. The authors compared the fit of 4 models in which eating disorders (a) defined their own diagnostic class, (b) represented a subclass within Internalizing, (c) formed a subclass within Externalizing, and (d) were allowed to cross-load on both Internalizing and Externalizing. In the best fitting model, eating disorders formed a subfactor within Internalizing. These findings underscore the value of developing more comprehensive empirically based models of psychopathology to increase researchers' understanding of diverse mental disorders.

Using derivative estimates to describe intraindividual variability at multiple time scales

The study of intraindividual variability is central to the study of individuals in psychology. Previous research has related the variance observed in repeated measurements (time series) of individuals to trait-like measures that are logically related. Intraindividual measures, such as intraindividual standard deviation or the coefficient of variation, are likely to be incomplete representations of intraindividual variability. This article shows that the study of intraindividual variability can be made more productive by examining variability of interest at specific time scales, rather than considering the variability of entire time series. Furthermore, examination of variance in observed scores may not be sufficient, because these neglect the time scale dependent relationships between observations. The current article outlines a method of using estimated derivatives to examine intraindividual variability through estimates of the variance and other distributional properties at multiple time scales. In doing so, this article encourages more nuanced discussion about intraindividual variability and highlights that variability and variance are not equivalent. An example with simulated data and an example relating variability in daily measures of negative affect to neuroticism are provided.

A hierarchical model for the relationships between general and specific vulnerability factors and symptom levels of generalized anxiety disorder

The present study examined a hierarchical model for the relationships between general and specific vulnerability factors and symptom manifestations of generalized anxiety disorder (GAD). A clinical sample of patients with GAD (N=137) completed a set of self-report questionnaires for measuring neuroticism, extraversion, intolerance of uncertainty, metacognitive beliefs, and symptoms of generalized anxiety (i.e., worry) and depression. A bootstrapping analysis yielded support for a model in which the relation between the general vulnerability factor of neuroticism and symptoms of GAD were mediated by the specific vulnerability factors of intolerance of uncertainty and negative metacognitions. Implications for the classification and treatment of GAD are discussed.

Cognitive reactivity mediates the relationship between neuroticism and depression

Although neuroticism has long been established as an important risk factor for depression, the mechanisms through which this temperamental predisposition translates into the occurrence of symptoms are still relatively unclear. This study investigated cognitive reactivity, i.e. the ease with which particular patterns of negative thinking are reactivated in response to mild low mood, as a potential mediator. Individuals with (N = 98) and without a previous history of depression (N = 83) who had provided neuroticism scores six years previously were assessed for cognitive reactivity and current symptoms of depression using self-report questionnaires. Tendencies to respond to mild low mood with ruminative thinking mediated the relation between neuroticism and current symptoms of depression in both groups. Reactivation of hopelessness and suicidal thinking occurred as an additional mediator only in those with a history of previous depression. The results suggest that neuroticism predisposes individuals to depression by generally increasing the likelihood of ruminative responses to low mood. In those with a history of depression in the past, neuroticism additionally increases risk of recurrence by facilitating reactivation of previously associated patterns such as suicidal thinking and hopelessness. These findings suggest potential targets for interventions to help preventing the occurrence, or recurrence of depression in those who due to their temperamental predisposition are at an increased risk.

Neuroticism, Negative Affect, and Negative Affect Instability: Establishing Convergent and Discriminant Validity Using Ecological Momentary Assessment

Few investigations have examined the role of affective instability within a broad model of general personality functioning. The present study employed self-report and ecological momentary assessments (EMA) to examine the relations between self-reported Five-Factor Model Neuroticism, EMA average negative affect, and EMA negative affect instability. Results suggest that Neuroticism and negative affect instability are related yet distinct constructs, and that Neuroticism better represents average negative affect across time. Results also suggest that negative affect instability is related to low Agreeableness and specific externalizing facets of Neuroticism, such as Angry Hostility and Impulsiveness. The implications of these findings and potential areas for future research are discussed.