Temperament and character profiles of Japanese university students with depressive episodes and ideas of suicide or self-harm: a PHQ-9 screening study

Prevalence and correlates of depressive symptoms among matriculated university students in Singapore during Covid-19 pandemic: findings from a repeated cross-sectional analysis

BACKGROUND

Depression is a common issue among university students and has been particularly exacerbated during the COVID-19 pandemic. However, limited research has specifically focused on depression among university entrants.

OBJECTIVES

This study aimed to determine the prevalence of depression severity and identify associated factors during different phases of the COVID-19 pandemic using health screening questionnaires completed by matriculated university students in Singapore.

METHODS

A repeated cross-sectional study was conducted at a public university in Singapore. Data from health screening questionnaires administered in 2020 and 2021, involving 15,630 newly enrolled university students, were analyzed. The questionnaires covered students' sociodemographic information, physical health status, own and family medical history, lifestyle behaviours, and the Patient Health Questionnaire (PHQ-9). The PHQ-9 was used to measure the severity of depressive symptoms, categorizing into moderate to severe depressive symptoms (MSDS), mild depressive symptoms (MDS), or no depressive symptom (NDS). Multinomial logistic regression was used to assess the sociodemographic, physical and behavioural correlates of depression.

RESULTS

The prevalence of MSDS was 1% in both 2020 and 2021, while the rates for MDS were 1.93% in 2020 and 1.64% in 2021. In the 2020 cohort, male freshmen who reported better health had a lower likelihood of experiencing depression. Conversely, students of Malay ethnicity, those majoring in Engineering, those with multiple chronic diseases, monthly alcohol consumers, current smokers, and those with a family history of mental disorder had a higher likelihood of experiencing depression. Moreover, students who lived on-campus in the 2021 cohort were less likely to experience depression than those living off-campus. However, the associations between academic majors, alcohol consumption, and smoking with depression were not significant in the 2021 cohort.

CONCLUSIONS

This study reported a low prevalence of both MSDS and MDS among university entrants in Singapore. The study further identified three categories of factors associated with depression: sociodemographic, physical, and behavioural. This study suggests policy interventions to enhance targeted social support that address each student group's specific requirements and susceptibilities. A more extensive and comprehensive study is warranted to assess the changes in student mental health status post-COVID-19 pandemic.

Preventive Effects of Group Cognitive Behavioral Therapy in First-Year University Students at Risk for Depression: A Non-Randomized Controlled Trial

High scores on Harm Avoidance (HA) on Cloniger's Temperament and Character Inventory (TCI) have been identified as a risk factor for depression. Group cognitive-behavioral therapy (GCBT) has been found effective in preventing depression and improving depressive symptoms among university students. However, no randomized controlled trials of GCBT have been conducted with university students with high HA. Although we initiated a randomized controlled trial in this study, some participants submitted incomplete questionnaires at baseline interfering with assured randomization; therefore, we report this study as a non-randomized controlled trial. We evaluated whether a GCBT intervention would be effective at reducing HA and, thereby, preventing depression in university students with high HA. We performed final analysis of data on 59 participants in the intervention group and 60 in a control group. We used scores on the Beck Depression Inventory-II (BDI-II) as the primary outcome measure and analysis of covariance to assess group differences on mean BDI-II change scores before the intervention and at six months and one year after the intervention. The intervention group had lower BDI-II scores than the control group at six months after the intervention. GCBT may have facilitated cognitive modification in individuals with high HA, or GCBT may have fostered mutual modeling by group participants. Thus, GCBT may contribute to reducing depressive symptoms in university students with high HA, and associated risk for developing depression.

Temperament and Character Profiles of Ankylosing Spondylitis Patients Compared With Major Depression Patients and Healthy Controls

BACKGROUND/OBJECTIVE

Depressive disorder is common in patients with ankylosing spondylitis (AS), who exhibit specific brain imaging abnormalities resembling those in major depression (MD). We compared temperament and character profiles between patients with AS and MD.

METHODS

The study involved 36 patients with AS, 40 with MD, and 36 healthy controls (HCs). The participants were age-, sex-, and education-matched. Depression, anxiety, temperament, and character were evaluated using the Temperament and Character Inventory and physician-rated Hamilton Depression and Anxiety Scales. Disease severity was assessed using the Bath Ankylosing Spondylitis Disease Activity, Radiology, Metrology, and Functionality Indexes; erythrocyte sedimentation rate; and C-reactive protein.

RESULTS

Depression and anxiety scores were highest in MD, lowest in HCs, and intermediate in AS (p < 0.001). Harm avoidance was significantly higher in MD and AS than HCs (p = 0.01). Reward dependency was lower (p = 0.011) and self-transcendence higher in AS only (p = 0.034). Bath Ankylosing Spondylitis Radiology Index was negatively correlated with depression (p = 0.020). Bath Ankylosing Spondylitis Radiology Index and Bath Ankylosing Spondylitis Metrology Index were negatively correlated with harm avoidance (p < 0.05). Disease duration was negatively correlated with self-transcendence (p = 0.027). Harm avoidance was correlated with depression score (p = 0.029). Patients under tumor necrosis factor α inhibitor treatment had lower cooperativeness score (p = 0.022).

CONCLUSIONS

Patients with AS had a specific Temperament and Character Inventory pattern. Harm avoidance was common in both AS and MD. In AS, harm avoidance and depression decreased in patients with progression, probably because progressive fusion of the spinal segments causes decrease in pain. Harm avoidance (fear of pain) seemed to be an acting factor for occurrence of depressive symptoms in AS.

Character configuration, major depressive episodes, and suicide-related ideation among Japanese undergraduates

Aim

To enable early identification of university students at high risk for suicide, we examined personality as a predictive factor for major depressive episodes and suicide-related ideation.

Methods

From 2011 to 2013, we administered the Patient Health Questionnaire-9 (PHQ-9) and the Temperament and Character Inventory (TCI) to 1,997 university students at enrollment (T1). We previously conducted a study using the same data set; this is a re-analysis of the dataset. To prevent contamination of data, participants diagnosed with a depressive episode were excluded at T1. Three years after enrollment (T2), we re-administered the PHQ-9 to the same students. We statistically compared TCI scores at T1 among depressive episode groups and suicide-related ideation groups. Two-way ANOVA and Cochran-Armitage trend tests were used to analyze the relationships between personality traits, depressive episodes, and suicide-related ideation.

Results

The PHQ-9 summary scores at baseline (T1) were 3.0 (±2.7), with female students scoring 4.6 (±2.9) and male students 2.9 (±2.6, p = 0.025). The major depressive episode group at T2 had lower self-directedness (SD) scores at T1 than the non-depressive episode control group. The suicide-related ideation (SI) group at T2 also had higher harm avoidance (HA), lower SD, and lower cooperativeness (C) scores than the non-SI group at T1. The Cochran-Armitage trend tests revealed significant associations between character configurations composed of SD and C, and both depressive episodes at T2 and SI at T2.

Conclusion

The temperament feature of high HA at baseline and character configurations of low SD and low C at baseline are the most contributory predictors for the novel development of depressive episodes and SI among Japanese university students.

Reinforcement sensitivity, depression and anxiety: A meta-analysis and meta-analytic structural equation model

Reinforcement Sensitivity Theory (RST) posits that individual differences in reward and punishment processing predict differences in cognition, behavior, and psychopathology. We performed a quantitative review of the relationships between reinforcement sensitivity, depression and anxiety, in two separate sets of analyses. First, we reviewed 204 studies that reported either correlations between reinforcement sensitivity and self-reported symptom severity or differences in reinforcement sensitivity between diagnosed and healthy participants, yielding 483 effect sizes. Both depression (Hedges' g = .99) and anxiety (g = 1.21) were found to be high on punishment sensitivity. Reward sensitivity negatively predicted only depressive disorders (g = -.21). More severe clinical states (e.g., acute vs remission) predicted larger effect sizes for depression but not anxiety. Next, we reviewed an additional 39 studies that reported correlations between reinforcement sensitivity and both depression and anxiety, yielding 156 effect sizes. We then performed meta-analytic structural equation modeling to simultaneously estimate all covariances and control for comorbidity. Again we found punishment sensitivity to predict depression (β = .37) and anxiety (β = .35), with reward sensitivity only predicting depression (β = -.07). The transdiagnostic role of punishment sensitivity and the discriminatory role of reward sensitivity support a hierarchical approach to RST and psychopathology.

Parents' Attitudes Toward and Experience of Non-Suicidal Self-Injury in Adolescents: A Qualitative Study

BACKGROUND

Non-suicidal self-injury (NSSI) is prevalent in adolescents and brings a series of serious consequences to their well-being. However, little is known about parents' attitude toward NSSI in Chinese adolescents. The study aims to investigate the parents' attitudes toward and perceptions of adolescents who have engaged in NSSI behaviors, and the impact of NSSI on their parents.

METHODS

Purposive sampling was used in the study. The biological parents of adolescents with NSSI were recruited from the psychiatric ward of a tertiary hospital in China. Semi-structured interviews were conducted which contained three aspects, that is the history of NSSI, the process of seeking or maintaining help and the impacts on the family. Each interview typically lasted 40-50 min. All of the interviews were audio-recorded. Their responses were analyzed by the thematic analysis.

RESULTS

Twenty participants completed the interview, consisting of 16 mothers and 4 fathers. Three themes and eight sub-themes were extracted: (1) the attitudes to children's NSSI behaviors (ignorance, shame, and stereotype); (2) coping strategies of parents (the initial response to adolescents' NSSI, and the way of help-seeking); (3) the impacts on family (altered parenting and communication styles, limited personal lives, and increased psychological pressure).

CONCLUSION

The results showed that parents lack the knowledge about NSSI and its treatment and are suffering great emotional stress. It is recommended to expand the popularization of knowledge of NSSI in adolescents and more interventions adapted to China's sociocultural climate are required for the well-being of parents and NSSI in adolescents.

Relevance of hoarding behavior and the traits of developmental disorders among university students: a self-reported assessment study

Background

Previous studies have shown that hoarding behavior usually starts at a subclinical level in early adolescence and gradually worsens; however, a limited number of studies have examined the prevalence of hoarding behavior and its association with developmental disorders in young adults. The aims of this study were to estimate the prevalence of hoarding behavior and to identify correlations between hoarding behavior and developmental disorder traits in university students.

Methods

The study participants included 801 university students (616 men, 185 women) who completed questionnaires (ASRS: Adult ADHD Self-Report Scale version 1.1, AQ16: Autism-Spectrum Quotient with 16 items, and CIR: Clutter Image Rating).

Results

Among 801 participants, 27 (3.4%) exceeded the CIR cut-off score. Moreover, the participants with hoarding behavior had a significantly higher percentage of ADHD traits compared to participants without hoarding behavior (HB(+) vs HB(−), 40.7% vs 21.7%). In addition, 7.4% of HB(+) participants had autism spectrum disorder (ASD) traits, compared to 4.1% of HB(−) participants. A correlation analysis revealed that the CIR composite score had a stronger correlation with the ASRS inattentive score than with the hyperactivity/impulsivity score (CIR composite vs ASRS IA, r = 0.283; CIR composite vs ASRS H/I, r = 0.147).

Conclusions

The results showed a high prevalence of ADHD traits in the university students with hoarding behavior. Moreover, we found that the hoarding behavior was more strongly correlated with inattentive symptoms rather than with hyperactivity/impulsivity symptoms. Our results support the concept of a common pathophysiology behind hoarding behavior and ADHD in young adults.

Prevention of depression in first-year university students with high harm avoidance: Evaluation of the effects of group cognitive behavioral therapy at 1-year follow-up

High harm avoidance (HA) scores on the temperament and character inventory appear to be a risk factor for depressive disorders and suicide. Since 2012, we have conducted group cognitive behavioral therapy (G-CBT) interventions for students at Nagasaki University with high HA and without depressive disorders, with the aim of preventing depression. Here, we report on the effects of the G-CBT at 1-year follow-up for the 2012 to 2015 period.Forty-two participants with high HA were included in the final analysis. Outcomes were measured with the Beck Depression Inventory II, Manifest Anxiety Scale, 28-item General Health Questionnaire, and Brief Core Schema Scales at baseline, and at 6-month, and 1-year follow-ups.Repeated-measures analyses of variance revealed a significant decrease in mean depressive symptom scores at the 6-month follow-up point; this decrease was maintained at 1 year. Improvements in cognitive schemas were also seen at 6 months and 1 year.We observed improvements in cognitive schemas associated with depression as a result of the G-CBT intervention, with effects maintained at 1 year post-intervention. This intervention may be effective in positively modifying the cognitions of students with HA and preventing future depression.

Prediction of major depressive episodes and suicide-related ideation over a 3-year interval among Japanese undergraduates

Background

Suicide has been a leading cause of death among young adult populations in Japan. The aim of this study was to predict major depressive episodes (MDEs) and suicide-related ideation among university students using the Patient Health Questionnaire-9 (PHQ-9) and the Temperament and Character Inventory (TCI).

Methods

The subjects were 2194 university students who completed the PHQ-9 and TCI in the 1st year (T1) and the PHQ-9 in the 4th year (T2) of university. Multiple logistic regression analysis was performed to predict MDEs and suicide-related ideation at T2. Moreover, recursive partitioning analyses were conducted to reveal the future risk of MDEs and suicide-related ideation.

Results

The multiple logistic regression analyses of MDEs and suicide-related ideation at T2 revealed that depressive episodes, suicide-related ideation, and low self-directedness(SD) scores at T1 were significant predictors. The area under the curve of the model for MDEs was 0.858 and that for suicide-related ideation was 0.741. The recursive partitioning analyses revealed that a PHQ-9 summary score ≥15 at T1 predicted a high risk of MDEs at T2 and that both a PHQ-9 summary score ≥5 and a PHQ-9 #9 score ≥1 predicted a high risk of suicide-related ideation at T2.

Conclusions

MDEs, suicide-related ideation, and low SD scores are significant predictors of future MDEs and suicide-related ideation.

Temperament and character profile of college students who have suicidal ideas or have attempted suicide

OBJECTIVE

Suicide is a major cause of death in university students. Personality traits have been suggested as possible risk factors for suicidal behaviors. This study looked at the relationship between the personality dimensions of the Temperament and Character Inventory (TCI) and suicidal behaviors.

METHOD

A total of 5644 college students took the TCI test and the suicidality module of the M.I.N.I. The students were divided into the suicidal ideation group (n = 302; 5.4%) and the suicide attempt group (n = 301; 5.3%). Each group's TCI dimension and sub-dimension scores were compared with one another. To find out which TCI dimension affects suicide risk when depressed, regression analysis and mediation analysis were conducted.

RESULTS

First, we adjusted for age, sex and depressive mood and compared the TCI scores of the participants based on their suicide risk. After the adjustment, self-directedness decreased in the suicidal ideation group while novelty seeking and persistence increased in the suicide attempt group. It turned out that self-directedness has a partial mediating effect between depressive symptom and suicide risk (β = -0.068 P < 0.001).

CONCLUSION

We adjusted for depressive mood and it turned out that the suicidal ideation group is affected by character whereas the suicide attempt group is affected by temperament. Among the character dimensions, self-directedness was found to reduce the effect of depressive mood on suicide risk. Therefore, when evaluating suicide risk, assessing character dimensions, especially self-directedness along with depressive mood, a risk factor, will be helpful.

Association between suicide-related ideations and affective temperaments in the Japanese general adult population

BACKGROUND

Suicide rates are vastly higher in Japan than in many other countries, although the associations between affective temperaments and suicide-related ideations in the general adult population remain unclear. Therefore, we aimed to elucidate these associations in the present study.

METHODS

We analyzed data from 638 Japanese volunteers who completed both the Patient Health Questionnaire (PHQ-9) and the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A). Participants were then divided into three groups based on PHQ-9 summary scores and responses to the suicide-related ideation item: non-depressive control group (NC; N = 469), depressive symptoms without suicide-related ideations group (non-SI; N = 135), and depressive symptoms with suicide-related ideations group (SI; N = 34). The depressive symptoms were defined for PHQ-9 summary scores ≥5, and the suicide-related ideations were defined for PHQ-9 #9 score ≥1. We then compared TEMPS-A scores among the groups using Kruskal-Wallis tests. Then the 95% confidence intervals of differences in TEMPS-A subscale scores between the NC and non-SI groups, or between NC and SI groups, were calculated.

RESULTS

Participants of the SI group exhibited significantly higher scores on the depressive, irritable, and anxious temperament subscales than those of the non-SI group. Similarly, women of the SI group exhibited significantly higher scores of the depressive and irritable temperament subscales than women of the non-SI group, while men of the SI group exhibited significantly higher depressive temperament scores than those of the non-SI group. Among all participants and only men, cyclothymic subscale scores were higher in those of the SI group than the non-SI group (not significant), although the 95% confidence intervals did not overlap.

LIMITATIONS

The cross-sectional study design was the main limitation.

CONCLUSIONS

Depressive, irritable, and anxious temperaments are significant risk factors for suicide-related ideations in the Japanese general adult population. Furthermore, irritable temperament in women and depressive temperament in men are associated with suicide-related ideations.

The moderator effects of affective temperaments, childhood abuse and adult stressful life events on depressive symptoms in the nonclinical general adult population

BACKGROUND

We recently demonstrated in the structural equation modeling that four of five affective temperaments, as measured by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-questionnaire version (TEMPS-A), are strong mediators between childhood abuse and depressive symptoms in the nonclinical general adult population. In this study, we hypothesized that affective temperaments, childhood abuse, and adult life events have moderator effects that interact with one another on depressive symptoms. The hierarchical multiple regression analysis was used to analyze this interaction model.

METHODS

The 286 participants from the nonclinical general adult population were studied using the following self-administered questionnaire surveys: the Patient Health Questionnaire-9 (PHQ-9), Life Experiences Survey (LES), TEMPS-A, and Child Abuse and Trauma Scale (CATS). The data were analyzed using hierarchical multiple regressions with interactions.

RESULTS

Depressive temperament enhanced and hyperthymic temperament inhibited the depressogenic effects of childhood abuse, while irritable temperament enhanced and hyperthymic temperament inhibited the depressogenic effects of adult negative (stressful) life events. Adult positive life events had an inhibitory moderator effect on depressive symptoms that was increased by cyclothymic and anxious temperaments. Neglect, punishment, and total childhood abuse enhanced the effects of negative life events on depressive symptoms.

LIMITATIONS

As the subjects of this study were nonclinical, the findings should not be generalized to patients with mood disorders. In this cross-sectional study, there may be interdependence between the measured variables.

CONCLUSIONS

This study, using the hierarchical multiple regression analysis with interaction, demonstrated the positive and negative interactions between any two of affective temperaments, childhood abuse, and adult life events, and the influence on depressive symptoms in the nonclinical general adult population. Important moderator roles for affective temperaments, childhood abuse, and adult life events on depressive symptoms were suggested.

The influence of childhood abuse, adult stressful life events and temperaments on depressive symptoms in the nonclinical general adult population

BACKGROUND

Previous studies have shown the interaction between heredity and childhood stress or life events on the pathogenesis of major depression. We hypothesized that childhood abuse, affective temperaments, and adult stressful life events interact and influence depressive symptoms in the general adult population and tested this hypothesis in this study.

METHODS

The 294 participants from the nonclinical general adult population were studied using the following self-administered questionnaire surveys: the Patient Health Questionnaire-9 (PHQ-9), Life Experiences Survey (LES), Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego auto-questionnaire (TEMPS-A), and Child Abuse and Trauma Scale (CATS). The data were analyzed with single and multiple regressions and structural equation modeling (Amos 20.0).

RESULTS

Childhood abuse indirectly predicted the severity of the depressive symptoms through affective temperaments measured by TEMPS-A in the structural equation modeling. Four temperaments - depressive, cyclothymic, irritable, and anxious - directly predicted the severity of depressive symptoms and the negative appraisal of life events during the past year. The negative appraisal of life events during the past year mildly, but significantly, predicted the severity of depressive symptoms.

LIMITATIONS

The subjects of this study were nonclinical. The findings might not be generalized to patients with mood disorders.

CONCLUSIONS

This study suggests that childhood abuse, especially neglect, indirectly increased depressive symptoms through increased affective temperaments, which, in turn, increase the negative appraisal of stressful life events. An important role of affective temperaments in the effect of childhood abuse and stressful life events on depressive symptoms was suggested.