Psychometric properties of the Lebanese-Arabic TEMPS-A: a national epidemiologic study

Synthesising 30 years of clinical experience and scientific insight on affective temperaments in psychiatric disorders: State of the art

The concept of affective temperament has been extensively discussed throughout the history of psychopathology and represents a cornerstone in the study of mood disorders. This review aims to trace the evolution of the concept of affective temperaments (ATs) from Kraepelin's seminal work to the present day. In the 1980s, Akiskal redefined Kraepelin's concept of affective temperaments (ATs) by integrating the five recognized ATs into the broader framework of the soft bipolar spectrum. This conceptualization viewed ATs as non-pathological predispositions underlying psychiatric disorders, particularly mood disorders. Epidemiological and clinical studies have validated the existence of the five ATs. Furthermore, evidence suggests that ATs may serve as precursors to various psychiatric disorders and influence clinical dimensions such as disease course, psychopathology, and treatment adherence. Additionally, ATs appear to play a significant role in moderating phenomena such as suicide risk and stress coping. Incorporating an evaluation of temperamental bases of disorders into the multidimensional psychiatric diagnostic process could enhance treatment optimization and prognosis estimation.

Cross-cultural adaptation and psychometric properties of patient-reported outcome measures in Arabic speaking countries: A scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly recognized as an indicator of healthcare quality and safety. Over the past decades, there has been a growing interest in using PROMs in Arabic-speaking populations. However, there is a paucity of data regarding the quality of their cross-cultural adaptation (CCA) and measurement properties.

OBJECTIVES

To identify PROMs that have been developed, validated or cross-culturally adapted to Arabic and evaluate methodological qualities of CCA and measurement properties.

METHODS

MEDLINE, EMBASE, CINAHL, PsycINFO, IPA, and ISI Web of Science were searched using search terms 'PROMs', 'Arabic countries', 'CCA', and 'psychometric properties'. Measurement properties were evaluated using COSMIN quality criteria and CCA quality was assessed using the Oliveria rating method.

RESULTS

This review included 260 studies with 317 PROMs, focusing on psychometric testing (83.8%), CCA (75.8%), utilizing PROMs as outcome measures (13.4%), and developing PROMs (2.3%). Out of the 201 cross-culturally adapted PROMs, forward translation was the most frequently reported component of CCA (n = 178), followed by back translation (n = 174). Out of the 235 PROMs that reported measurement properties, internal consistency was the most frequently reported measurement property (n = 214), followed by reliability (n = 160) and hypotheses testing (n = 143). Other measurement properties were less reported, including responsiveness (n = 36), criterion validity (n = 22), measurement error (n = 12), and cross-cultural validity (n = 10). The strongest measurement property was hypotheses testing (n = 143), followed by reliability (n = 132).

CONCLUSION

There are several caveats regarding the quality of CCA and measurement properties of PROMs included in this review. Only 1 out of 317 Arabic PROMs met CCA and psychometric optimal quality criteria. Therefore, there is a need to improve the methodological quality of CCA and measurement properties of PROMs. This review provides valuable information for researchers and clinicians when choosing PROMs for practice and research. There were only 5 treatment-specific PROMs, indicating the necessity for more research focusing on development and CCA of such measures.

Validation of the Arabic version of the 35-item TEMPS-M in a community sample of adults

BACKGROUND

To our knowledge, no brief version of the Temperament Evaluation in Memphis Pisa and San Diego (TEMPS-M) is available so far in the Arabic language, which might have resulted in limited research in this field from Arab countries. We aimed through this study to validate the 35-item TEMPS-M into the Arabic language in a sample of non-clinical Lebanese adults.

METHODS

We used an online cross-sectional survey targeting non-clinical Lebanese adults from the general population. A confirmatory factor analysis was conducted to test the factorial structure of the TEMPS-M.

RESULTS

All five temperament subscales achieved good/very good internal consistencies in the present study (depressive: α = 0.78, cyclothymic: α = 0.86, hyperthymic: α = 0.83, irritable: α = 0.87, and anxious: α = 0.87). The five-factor solution of the TEMPS-M displayed a good CFI of 0.94, TLI of .94 and a GFI of .95, but a poor RMSEA of .10 [90% CI .10, .11]. The five affective temperaments showed positive correlations with personality dysfunction domains, thus attesting for convergent validity. In addition, positive correlations between all affective temperament dimensions and anxiety/depression scores were found. We also tested for gender invariance, and found that configural, metric, and scalar invariance were supported across gender.

CONCLUSION

Our data suggest that the psychometric properties of the Arabic TEMPS-M are good. Making this scale available in Arabic will hopefully encourage Arab researchers to investigate this under-explored topic in their countries, and advance knowledge on how culture impacts the prevalence, development and course of temperament.

Korean Validation of the Short Version of the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire) in Patients with Mood Disorders

BACKGROUND AND OBJECTIVES

The Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) is designed to assess affective temperaments. The short version of the TEMPS-A (TEMPS-A-SV) has been translated into various languages for use in research and clinical settings. However, no research has been conducted to validate the Korean version of the TEMPS-A-SV in patients with mood disorders. The goal of this study is to evaluate the reliability and validity of the TEMPS-A-SV in Korean mood disorder patients.

MATERIALS AND METHODS

In this cross-sectional retrospective study, a total of 715 patients (267 patients with major depressive disorder, 94 patients with bipolar disorder I, and 354 patients with bipolar disorder II) completed the Korean TEMPS-A-SV. Cronbach's alpha and McDonald's omega were used to assess the reliability. Exploratory factor analysis (EFA) was also performed. Spearman's correlation coefficient was used to examine associations between the five temperaments. The difference in five temperament scores between the gender or diagnosis groups was analyzed, and the correlation between five temperament scores and age was tested.

RESULTS

The Korean TEMPS-A-SV displayed good internal consistency (α = 0.65-0.88, ω = 0.66-0.9) and significant correlations between the subscales except one (the correlation between hyperthymic and anxious). Using EFA, a two-factor structure was produced: Factor I (cyclothymic, depressive, irritable, and anxious) and Factor II (hyperthymic). The cyclothymic temperament score differed by gender and the anxious temperament score was significantly correlated with age. All the temperaments, except for irritable temperament, showed significant differences between diagnosis groups.

CONCLUSIONS

Overall, the results show that the TEMPS-A-SV is a reliable and valid measurement that can be used for estimating Koreans' affective temperaments. However, more research is required on affective temperaments and associated characteristics in people with mood disorders.

Nomophobia and temperaments in Lebanon: Results of a national study

OBJECTIVES

Assess the association between nomophobia and temperaments in the Lebanese population.

METHODS

The cross-sectional study was conducted between January and July 2019 (N = 2260).

RESULTS

A total of 1089 of the participants (48.3%) appeared to have moderate nomophobia while 349 (15.5%) were found to exhibit severe nomophobia. Multivariable analysis showed that higher hyperthymic temperament (β = -0.34) was associated with less nomophobia, whereas higher irritable temperament (β = 0.43) was associated with more nomophobia.

PRACTICAL IMPLICATIONS

The findings obtained from our study showed that a more irritable temperament was significantly associated with a more severe nomophobia, while hyperthymic temperament was associated with less nomophobia. They open up new perspectives for the evaluation of the temperaments among nomophobics with a better focus on the personality model and how they can predict nomophobia.

Korean Validation of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire

OBJECTIVE

The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) has been validated in more than 30 languages and is noted for its broad application in research and clinical settings. This study presents the first attempt to examine the reliability and validity of the TEMPS-A in Korea.

METHODS

A total of 540 non-clinical participants completed the Korean TEMPS-A, which was adapted from the original English version via a comprehensive translation procedure. Reliability was assessed using Cronbach's α, and associations between temperaments were examined using Spearman's correlation coefficient. Exploratory factor analysis (EFA) was performed, and differences in TEMPS-A scores between the gender- and age-based groups were examined using Kruskal-Wallis analysis.

RESULTS

The Korean TEMPS-A exhibited excellent internal consistency (0.70-0.91) and significant correlations between subscales. EFA resulted in a two-factor structure: Factor I (depressive, cyclothymic, irritable, and anxious) and Factor II (hyperthymic). Gender and age group differences were observed.

CONCLUSION

Overall, our results suggest that TEMPS-A is a reliable and valid measure of affective temperaments for the Korean population. This study opens new possibilities for further research on affective temperaments and their related traits.

Temperaments and orthorexia nervosa: a cross-cultural study between Germany and Lebanon

The aim of this study was to explore the association between affective temperaments and orthorexic eating and whether temperament may explain cross-cultural differences in this behavior while considering the two dimensions of orthorexic eating, healthy (HeOr) and nervosa (OrNe). To accomplish this, 337 and 389 individuals were recruited in Lebanon and Germany, respectively. The brief version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego explored depressive, hyperthymic, cyclothymic, anxious and irritable temperaments, and the Teruel Orthorexia scale explored orthorexic eating. HeOr appeared comparable between countries but OrNe was higher in Lebanon. In terms of affective temperaments, the higher the depressive, cyclothymic, irritable, and anxious temperaments, the higher were the levels of OrNe. Only the hyperthymic temperament scale was positively associated with HeOr. Three-step regression analysis indicated only gender as a unique predictor for HeOr. By contrast, gender, depressive, hyperthymic, and anxious temperament as well as the two-way interactions country*depressive temperament and country*hyperthymic temperament were significant predictors of OrNe. The positive association between OrNe and depressive temperament was only found for the German sample while the negative association between hyperthymic temperament and OrNe was somewhat stronger in the Lebanese sample. Overall, a higher healthy interest in diet was linked to the hyperthymic temperament. Findings emphasized the role of temperaments in pathological orthorexic eating in general as well as in explaining cross-cultural differences in these behaviors. The assessment of temperaments could help to fit treatments for eating pathologies to individuals from different cultures, focusing interventions more on these aspects.

Affective temperaments of Lebanese patients with schizophrenia: comparison by gender and severity of psychosis

OBJECTIVES

Our aim in this study was to identify affective temperament differences utilizing the TEMPS-A in a large sample size of Lebanese patients with schizophrenia and compare them to healthy controls. Gender differences, demographic factors and degree of psychotic symptoms were also considered. A cross-sectional study was conducted at the Psychiatric Hospital of the Cross (PHC) from March to June 2019. Two-hundred fifty chronic patients with schizophrenia were compared to 250 healthy controls randomly chosen from the general population.

RESULTS

Patients with schizophrenia significantly had higher mean depressive, cyclothymic, irritable and anxious temperament scores compared to healthy controls. Healthy controls significantly had a higher mean hyperthymic temperament score compared to patients with schizophrenia. In the group of patients with schizophrenia exclusively, females scored higher in terms of depressive, cyclothymic and anxious temperaments compared to males. In the group of healthy controls, males scored higher in terms of hyperthymic and irritable temperaments compared to females, whereas a higher mean depressive and anxious temperament scores were significantly found in females compared to males. In addition, higher PANSS total scores, as well as higher positive, negative and general subscales scores were significantly associated with higher depressive, cyclothymic, irritable and anxious temperament scores.

Validation study of the Spanish brief version of TEMPS-A

INTRODUCTION

Identifying affective temperaments could be useful both for understanding the normal behavioral variations in the general population and to establish if there is a clinical predisposition to certain disorders. Five affective temperaments have been proposed: depressive, cyclothymic, hyperthymic, irritable and anxious. Original instrument for measuring them (TEMPS-A) is a 110-item scale but many short versions in different languages have been validated. The aim of this study was to obtain a short self-administered Spanish version of TEMPS-A with good psychometric properties.

MATERIALS AND METHODS

A sample of 550 students who answered the argentinean version of TEMPS-A was included, after psychometric analysis a comparison between inpatients with major depression and their matched controls by sex and age who answered the brief version was performed to get an external validation.

RESULTS

The sample was composed by 298 (54.2%) women. The mean age was 23.3 year (SD=6.2). A forced five factor analysis was performed. The 7 items with the highest factorial load (more than 0.350) for each subscale were included in the brief version. The Cronbach alpha's ranged from 0.690 to .800. The most prevalent temperament was hyperthymic followed by cyclothymic for students sample. Similarities between students and controls sample were observed, but not with patients with major depression.

CONCLUSIONS

This brief Spanish version of TEMPS-A (35 items) has good psychometric properties and can be used in general and clinical population.

Affective temperament, depressive symptoms and interleukins in patients with psoriasis

INTRODUCTION

Psoriasis is a chronic inflammatory skin disease, in which psychological factors play an important role. In the studies of common markers of psoriasis and depression, the abnormal function of the stress axis in both diseases is highlighted, whereas interleukin-6 (IL-6) and interleukin-1 are indicated as particularly important.

AIM

To evaluate the relationship between the affective temperament traits and the intensity of depressive symptoms in patients with psoriasis in the context of immunoenzymatic markers.

MATERIAL AND METHODS

The study included 208 subjects. Severity of psoriasis was assessed by PASI. TEMPS-A was applied for the evaluation of affective temperament and BDI was used for the assessment of the intensity of depressive symptoms. The level of cytokines was determined by means of the immunoenzymatic method.

RESULTS

Patients presented a specific profile of affective temperament, with higher scores on depressive, anxious and irritable dimensions. The severity of depressive symptoms correlated positively with the severity of psoriasis. A significant correlation was found between IL-6 and the severity of psoriasis in patients with depressive disorders and psoriasis. No similar correlation was found in patients without depressive disorder.

CONCLUSIONS

Results of the present study show common mechanisms for psoriasis and depression. Specific traits of affective temperament may play an important role in the clinical picture of both diseases. Higher levels of IL-6 in patients with psoriasis predispose to more frequent occurrence of depressive disorders and the depressive dimension of affective temperament.

Perceived stress, life events, fatigue and temperament in patients with psoriasis

Objective

To evaluate the perceived stress, life events, fatigue and temperament profile in patients with psoriasis and to investigate the relationship between these factors.

Methods

This cross-sectional study included patients with psoriasis and healthy control subjects. The two groups were compared regarding the number of life events, Perceived Stress Scale (PSS) and Multidimensional Assessment of Fatigue scores. The Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire was used to evaluate the personality traits among the two groups.

Results

A total of 75 patients with psoriasis (mean ± SD age, 44.94 ± 13.62 years) and 75 healthy controls (mean ± SD age, 41.10 ± 8.89 years) were included in the study. A statistically significant difference was found between the two groups in terms of the presence of life events, PSS score, fatigue and temperament profiles. Patients with psoriasis with depressive, cyclothymic and anxious temperament profiles were found to have higher PSS scores. In the psoriasis group, the PSS scores were positively correlated with the number of life events.

Conclusions

Stress and life events were found to be correlated with psoriasis. In the patients with psoriasis, depressive, cyclothymic and anxious temperament profiles seemed to be associated with higher perceived stress.

Affective temperaments in Lebanese people with substance use disorder

PURPOSE

To examine these temperaments among patients with substance use disorder (SUD) in the Lebanese population.

DESIGN

Case-control.

METHODS

Fifty-seven controls and 57 patients with SUD were enrolled between April and September 2017.

RESULTS

A significantly higher mean of depressive, irritable, and anxious temperaments was found in addicted patients as compared with the nonaddicts. However, the results of the multivariate analysis showed that anxious, hyperthymic, irritable temperaments would significantly increase the odds of addiction in participants (ORa = 25.20, 1.057, 1.168, 1.241, and 1.275). Cyclothymic temperament would significantly decrease the odds of addiction in participants (ORa = 0.817). Furthermore, suicidality was associated with depressive, anxious, and irritable temperaments.

PRACTICE IMPLICATIONS

Hyperthymic, irritable, and anxious temperaments were the main temperaments found in patients with SUD in Lebanon.

Spanish validation of the Barcelona TEMPS-A questionnaire in patients with bipolar disorder and general population

BACKGROUND

The Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego (TEMPS-A) is a self-administered questionnaire intended to assess five affective temperaments: depressive, cyclothymic, hyperthymic, irritable and anxious. Our objective was to examine the psychometric properties of the TEMPS-A using a sample comprised by patients with bipolar disorder (BD) and healthy controls (HC) and to determine cut-off scores for each temperament.

METHODS

Five hundred and ninety-eight individuals (327 BD and 271 HC) completed the TEMPS-A. Cronbach's alpha was used to examine internal consistency reliability. Test-retest reliability and association between different temperamental scales were assessed using Spearman correlation. To confirm factor structure a confirmatory factor analysis (CFA) was carried out. Cut-off scores indicating the presence of dominant temperament were also calculated.

RESULTS

Internal consistency was optimal for all temperament subscales (α: 0.682- 0.893). The questionnaire demonstrated good test-retest reliability (ρ: 0.594-0.754). The strongest positive associations were found between cyclothymic and anxious and between depressive and anxious temperaments. Hyperthymic and depressive as well as hyperthymic and anxious temperaments showed a strong negative correlation.

LIMITATIONS

The HC sample was not matched with the BD group. There were some sociodemographic and clinical differences between groups that may impact on the obtained results. A portion of patients with BD was recruited from tertiary centers.

CONCLUSIONS

The Spanish version of the Barcelona TEMPS-A questionnaire presents a good internal consistency and their results are stable in clinical population. The performance of the Barcelona TEMPS-A is as good as the original scale.

Challenging predictions between affective temperaments, depression and anxiety in a Kosovo student community sample

OBJECTIVE

The relationship between temperament and mental health problems is seen very important as we hope to explain the trajectory of this interaction. The aim of this study was to test the validity of affective temperaments for predicting psychiatric morbidity, by explaining the relationships between temperament, anxiety and depression in a community sample.

METHODS

This was a cross-sectional study. The present sample consisted of 960 participants (347 male, 622 female) with a mean age of M = 28.4 (SD = 10) randomly recruited. Affective temperaments were measured by the brief version of TEMPS-A, depression and anxiety measured with Beck Depression Inventory and Beck Anxiety Inventory.

RESULTS

The Cronbach alpha reliability coefficients for affective temperaments were between .72 and .81, for BDI and BAI, were .88 and .90. The study found significant gender differences on depressive [t(959) = -4.2, p<.001], cyclothymic [t(957) = -4.6, p < .001] and anxious temperament [t(957) = -8.2, p < .001], females having higher scores than males, and reverse results on hyperthermic temperament [t(958) = 2.1, p < .045], males having higher scores than females. No gender difference is found in irritable temperament [t(955) = -.581, p < .561]. Affective temperaments were found significant predictors for depression and anxiety. The combination of the depressive temperament and cyclothymic temperament explained the 32% variance of depression and the 25% variance of anxiety.

CONCLUSIONS

Study findings are consistent with some other studies and stress the importance of screening for effective temperament in order to early identify depression and anxiety. Further investigation is needed to understand what are other factors that influence the relationship between affective temperaments with depression and anxiety.

Association of suicidal risk with ratings of affective temperaments

BACKGROUND

Ratings of particular temperament-types with the TEMPS-A autoquestionnaire have been associated with suicidal risk, and combinations of such ratings may enhance the association. However, the predictive value of scores for individual temperaments and combinations remains to be quantified.

METHOD

We evaluated associations of TEMPS-A ratings for anxious (anx), cyclothymic (cyc), dysthymic (dys), hyperthymic (hyp) and irritable (irr) temperaments, with a history of suicidal acts or reported suicidal ideation in 882 patients with bipolar (BD; n = 509), major depressive (MDD; n = 268) or anxiety (ANX; n = 105) disorders.

RESULTS

With BD, scores for cyc and irr were highest and anx lowest; with MDD, dys scored highest, hyp lowest; anx was highest with ANX and MDD. Women (n = 497) had higher anx and cyc scores than men; scores for irr and hyp decreased with age. Scores for dys, anx, and cyc, were higher, and hyp lower, with greater HDRS₂₁ depression ratings. Among 347 suicidal subjects (112 with attempts), cyc, dys, and irr scores were higher, hyp lower. Pooled score [cyc+ dys+ irr - hyp] best distinguished subjects with suicide attempts versus nonsuicidal subjects, including in Receiver-Operating Characteristic (ROC) analysis (AUC for acts = 70.1% [64.9- 75.3]). Multivariable modeling associated suicidal acts with TEMPS-A [cyc+ dys+ irr - hyp] composite-score, depression severity, BD or MDD diagnosis, and older at illness-onset.

CONCLUSIONS

Subjects with suicidal acts or ideation were best distinguished by composite TEMPS-A score [cyc+ dys+ irr - hyp]. These factors should help to identify those at suicidal risk.

Mediators in the Association Between Affective Temperaments and Suicide Risk Among Psychiatric Inpatients

BACKGROUND

Affective temperaments have been shown to be related to psychiatric disorders and suicidal behaviors. Less is known about the potential contributory role of affective temperaments on suicide risk factors. In the present study, we investigated whether the effect of affective temperaments on suicide risk was mediated by other variables, such as hopelessness, mentalization deficits, dissociation, psychological pain, and depressive symptoms.

METHODS

Several assessment instruments, including the Mini International Neuropsychiatric Interview (MINI); the Temperament Evaluation of Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A); the Beck Hopelessness Scale (BHS); the Gotland Male Depression Scale (GMDS); the Dissociative Experiences Scale (DES); the Psychological Pain Assessment Scale (PPAS); and the Mentalization Questionnaire (MZQ), were administered to 189 psychiatrically hospitalized patients (103 women, 86 men) in Rome, Italy.

RESULTS

In single-mediator models, hopelessness, depressive symptoms, and mentalization, but not psychological pain or dissociation, were significant mediators in the association between prevalent temperament and suicide risk. In a multiple-mediator model, a significant indirect effect was found only for depression. Results demonstrated that patients with negative temperaments reported higher suicide risk, psychological pain, hopelessness, and depression, and less mentalization than patients with no prevalent temperament or hyperthymic temperaments.

CONCLUSIONS

Hopelessness, depression, and mentalization are all factors that mediate the relation between affective temperaments and suicide risk. Identifying factors that mediate the effects of affective temperamental makeup on suicide risk should enhance screening and intervention efforts.

Measuring affective temperaments: a systematic review of validation studies of the Temperament Evaluation in Memphis Pisa and San Diego (TEMPS) instruments

BACKGROUND

The assessment of affective temperaments has provided useful insights for the psychopathological understanding of affective disorders and for the conceptualization of bipolar spectrum disorders. The Temperament in Memphis Pisa and San Diego (TEMPS) instrument has been widely used in research, yet its psychometric properties and optimal factor structure are unclear.

METHODS

The PubMed/MEDLINE, PsycINFO, and EMBASE electronic databases were searched from inception until March 15th, 2016. Validation peer-reviewed studies of different versions of the TEMPS performed in adult samples were considered for inclusion.

RESULTS

Twenty-seven studies (N=20,787) met inclusion criteria. Several versions of the TEMPS have been validated in 14 languages across 15 countries. The 110-item self-reported version of the TEMPS has been the most studied version. Most studies (50%) supported a five factor solution although few studies performed confirmatory factor analyses. A five-factor solution has consistently been reported for the 39-item version of the TEMPS-A. Overall, evidence indicates that different versions of the TEMPS have adequate internal consistency reliability, while the TEMPS-A-110 version has acceptable test-retest reliability. The methodological quality of included studies varied.

LIMITATIONS

A meta-analysis could not be performed due to the heterogeneity of settings and versions of the TEMPS utilized.

CONCLUSIONS

Different versions of the TEMPS have been validated across different cultures. The short 39-item version of the TEMPS-A holds promise and merits further investigation. Culture-bound factors may influence the expression and/or assessment of affective temperaments with the TEMPS.

Affective temperaments, as measured by TEMPS-A, among self-poisoning nonlethal suicide attempters

Suicidal behaviors are serious public health problems. The prominent association of mood disorders with suicide, along with the renaissance of the spectrum concept of psychiatric disorders in the recent decades, prioritizes the investigation of temperament variants in suicidal individuals. This study aimed to explore the relationship between affective temperaments and nonviolent suicide attempts. We administered Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto questionnaire (TEMPS-A) to 141 (27 males and 114 females) consecutive self-poisoning non-lethal suicide attempters at a Medical Toxicology Center and a sex and age matched group of healthy individuals (28 males, 112 females). Female suicide attempters scored significantly higher in depressive, cyclothymic, irritable, and anxious temperaments compared with female controls, whereas male cases' scores were significantly higher in depressive and anxious subscales compared with control males. Except for hyperthymic temperament which did not reveal any significant effects, depressive (OR: 11.5), cyclothymic (OR: 3.8), irritable (OR: 2.3), and anxious (OR: 8.8) temperaments were predictors for nonviolent suicide attempts. Therefore, this study replicated the evidence for the strong association of depressive temperament with suicide attempts. The hyperthymic temperament appeared to have neither protective nor predisposing influence. Further studies are needed to identify the role of this independent temperament.

How Stable are Temperaments in the Clinical Setting: A Pilot Study

Background

An essential point in evaluating the utility of measuring temperaments is the stability of the instrument used especially in the presence of mental disorders. One of the most commonly used instruments in the clinical setting is the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS-A). To our knowledge, the TEMPS-A’s stability in an outpatient adult clinical setting has not been evaluated.

Objective:

To assess the stability of the effect of temperament, time and clinical intervention.

Methods:

A sample of 89 adult outpatients was assessed at baseline and follow-up on their TEMPS-A scores. Diagnoses of mental disorders were reached through clinical interviews, and the severity of the conditions was clinically assessed at baseline and follow-up on a Likert scale. Changes in scores were examined in terms of z-scores, and possible predictors of the change in scores were assessed.

Results:

Eighty-nine percent of all subjects’ temperaments scores did not change or changed less than one z-score, and specifically: 84.2% in the case of depressive, 89.9% for cyclothymic, 92.1% for hyperthymic, 92.2% for irritable, and 86.5% for anxious temperaments. For all of the five temperaments, age, gender, time difference between baseline and follow up, number of diagnoses, and percent improvement were not significantly associated with the change in temperament scores.

Limitations:

Well-established severity measures would add to the validity of any future findings.

Conclusion:

Shifts in temperament scores between baseline and follow-up were minor, thus proving the stability of temperaments and the TEMPS-A scale in a clinical setting.

A tale of two diatheses: Temperament, BIS, and BAS as risk factors for mood disorder

OBJECTIVE

Learning more about how biological traits, like temperament and sensitivity in the behavioral inhibition (BIS) and behavioral activation (BAS) systems, relate to mood pathology is consistent with the Research Domain Criteria initiative׳s goal of investigating mechanisms of risk.

METHOD

Korean young adults (n=128) and American young adults (n=630, of whom 23 has recent treatment for bipolar disorder, and 21for depression) completed self-report questionnaires, including the TEMPS-A, the BIS/BAS scales, Beck Depression Inventory (BDI), and Hypomanic Checklist (HCL-32). Linear regression quantified relations between mood symptoms, sample characteristics, temperament, and BIS/BAS.

RESULTS

Temperament styles explained 49% of the variance in BDI scores. BIS explained an additional 1% of the variance in BDI scores. BAS Fun and Reward (p<.01), in addition to cyclothymic and hyperthymic temperaments (p<.001) explained 21% of the variance in HCL-32 scores. Sample characteristics were not significant predictors in the full model.

LIMITATIONS

Differences in sample size, the cross-sectional study design, and lack of collateral report or behavioral measures of constructs are limitations.

CONCLUSIONS

Affective temperament and BIS/BAS are complementary but distinct constructs. Affective temperament, particularly cyclothymic, may represent a stronger diathesis for mood pathology, and seems potent irrespective of culture or diagnosis. Assessing temperament may help overcome some challenges in diagnosing mood disorders.

Affective temperaments in subjects with female-to-male gender dysphoria

BACKGROUND

Males and females have different temperaments. In individuals with gender dysphoria (GD) there is marked incongruence between a person׳s expressed/experienced gender and their biological sex. The present study aimed to investigate the most common affective temperaments in individuals with female-to-male (FtM) GD.

METHODS

We performed a prospective and comparative study investigating affective temperaments in subjects with FtM GD. Eighty subjects with FtM GD and 68 female controls were enrolled. The Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) was completed by all participants.

RESULTS

TEMPS-A scores were significantly higher in subjects with FtM GD for hyperthymic temperament (p≤0.001), whereas depressive (p≤0.001), anxious (p≤0.001), and cyclothymic (p=0.028) temperament scores were significantly higher in female controls.

LIMITATIONS

The study was limited by the lack of male-to-female subjects and male controls.

CONCLUSIONS

The results of our study indicate that individuals with FtM GD have significantly higher scores of hyperthymic temperament, measured by TEMPS-A. Biological basis underlying the development of gender identity independent from the biological sex might be related with affective temperaments.

The independence of schizotypy from affective temperaments--a combined confirmatory factor analysis of SPQ and the short TEMPS-A

Sparse evidence of a co-aggregation of the risk of schizophrenia and bipolar disorder provides support for a shared but nonspecific genetic etiology of bipolar disorder and schizophrenia. Temperaments are conceptualized as trait sub-syndromic conditions of major pathologies. This study set out to test the hypothesis of a continuum between schizotypy and affective temperaments versus the alternative hypothesis of their independence based on a cross-sectional, survey design involving 649 (males: 47%) college students. The short 39-item TEMPS-A and the SPQ were used as measures of the affective temperaments and of schizotypy, respectively. Confirmatory factor analyses were applied to a unidimensional model, to a standard correlate traits model, to second-order representations of a common latent structure, and to a bifactor model. Confirmatory bifactor modeling provided evidence against a complete independence of the dimensions subsumed by the affective and the schizotypal traits. The best solution distinguished between two sub-domains grouping positive symptoms and negative symptoms as measured by the SPQ subscales, and a sub-domain related to the affective temperaments as measured by the TEMPS-A. Limitations due to the use of subscales from two different tools should be taken into account.

Psychometric properties of the Hong Kong Chinese (Cantonese) TEMPS-A in medical students

BACKGROUND

The self-rated auto-questionnaire, the Temperament Scale of Memphis, Pisa, Paris and San Diego (TEMPS-A) is the latest development in the study of temperamental attributes. It has been used and validated in different cultures and countries. The current study aims at validating the Chinese (Cantonese) version of the TEMPS-A and comparing the psychometric properties of the long and short forms of the translated scale.

METHODS

The Chinese (Cantonese) version of TEMPS-A was prepared with the standard translation and back-translation method, and approved by the original authors (HSA & KKA). It was administered to medical students of the two local universities, and results were analyzed.

RESULTS

613 valid questionnaires were returned. The Cronbach-Alpha coefficients for the depressive, cyclothymic, hyperthymic, irritable and anxious temperament subscales were 0.63, 0.82, 0.78, 0.80, and 0.84, respectively. The strongest correlation was observed between the cyclothymic and irritable temperaments (R=0.600). Factor analysis yielded one large composite (depressive and anxious) and four homogenous factors, cyclothymic, anxious, hyperthymic and irritable. A newly reconstituted 43-item short form, based on methods suggested by the original authors yielded similar factor structure.

LIMITATIONS

The narrow age range of subjects somewhat limits generalization of the results. However, external and concurrent validations against other validated scales have been demonstrated for the original English versions as well as against the most commonly used languages of the world; furthermore, such validation has also been demonstrated for Chinese (Mandarin).

CONCLUSIONS

The Chinese (Cantonese) version of TEMPS-A and the reconstituted 43-item short form were found to have good internal consistency and factor structures comparable to those of other languages from diverse cultures across the planet. We propose that the Cantonese TEMPS-A is a useful tool for local use.

Characterization of patients with mood disorders for their prevalent temperament and level of hopelessness

BACKGROUND

Mood disorders (MD) are disabling conditions throughout the world associated with significant psychosocial impairment. Affective temperaments, as well as hopelessness, may play a significant role in the pathophysiology of MD. The present study was designed to characterize patients with MD for their prevalent affective temperament and level of hopelessness.

METHODS

Five hundred fifty-nine (253 men and 306 women) consecutive adult inpatients were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A), the Gotland Scale for Male Depression (GSMD), the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI).

RESULTS

Higher cyclothymia and irritable temperaments were found in bipolar disorder-I (BD-I) patients compared to those with other Axis I diagnoses. Major depressive disorder (MDD) patients had lower hyperthymia than BD-I and BD-II patients and higher anxiety than patients with other Axis I diagnoses. Severe "male" depression was more common in BD-II patients compared to BD-I and MDD patients. BD-I patients and those with other axis I diagnoses reported lower BHS ≥9 scores than those with BD-II and MDD.

LIMITATIONS

The study had the limitations of all naturalistic designs, that is, potentially relevant variables were not addressed. Furthermore, the cross-sectional nature of the study did not allow conclusions about causation, and the use of self-report measures could be potentially biased by social desirability.

CONCLUSION

MDD patients were more likely to have higher anxious temperament, higher hopelessness and lower hyperthymic temperament scores, while BD-I patients more often had cyclothymic and irritable temperaments than patients with other Axis I diagnoses. The implications of the present results were discussed.

Towards validation of the short TEMPS-A in non-clinical adult population in Serbia

BACKGROUND AND AIMS

This study represents the standardisation of the Serbian version of the TEMPS-A scale on non-clinical adult population, as well as external validation with TCI-R scale of temperaments which has already been evaluated on Serbian population.

METHODS

The TEMPS-A has been administered to 570 healthy adults without histories of mental disorders, 47% male, 53% female, aged between 20 and 76 (M=35.55; SD=14.14). In line with the state census data, the sampling was partially stratified according to gender, age categories, education and regional area of the participants.

RESULTS

In contrast to many other studies, six factors were extracted herein, including 41 items with loadings above .50, explaining 44.40% of the total variance. The internal consistency of the scale was α=.83, and the average test-retest coefficient (rho=.82) indicates a stable reliability. The highest positive correlations were obtained between the depressive and cyclothymic scales, depressive and anxious scales, and cyclothymic with anxious scales. The highest values were detected on hyperthymic and the lowest on depressive temperament. The highest positive correlations were reported between harm avoidance (measured by the TCI-R) and depressive, anxious, cyclothymic temperament, and between novelty seeking and hyperthymic temperament. The highest negative correlation was detected between harm avoidance and hyperthymic. Finally, females scored higher on depressive, cyclothymic and anxious, while males scored higher on hyperthymic temperament.

LIMITATIONS

The participants׳ educational background was slightly higher than that of the general population of Serbia. Since the scale is aimed at its administration in clinical population as well, it is necessary that its structure and validity be also tested on specific clinical subpopulations in the future.

CONCLUSIONS

The current study is significant in having confirmed that the TEMPS-A can be reliably and validly used in identifying affective temperaments in the adult nonclinical population in Serbia, which provides the basis and norms for future comparisons with clinical subpopulations.

Lesch typology and temperament in opioid dependence: a cross-sectional study

AIMS

The first aim of this study is to investigate the impact of different temperaments in opiate dependency patients. The second aim of this study is to define therapy relevant subgroups in opiate addiction for further basic clinical research and therapy.

METHODS

In the time period from September to November 2010, 101 patients (72 males and 29 females) which fulfilled the diagnosis of opiate dependency according to DSM-IV-TR were recruited consecutively. All patients were in treatment at the Oum El Nour rehabilitation center/Lebanon (Inpatient and Outpatient groups). Lesch Alcoholism Typology modified for assessment of opiate addicts, and the briefTEMPS-M, Arabic version were used.

RESULTS

The organic Type IV group was the most prevalent (48.5%) among the sample followed by the Affective Type III group (41.6%) and the minority represented the two other types (I & II). The organic Type IV group represented the major type in the cyclothymic and anxious temperament. In the contrary the other two groups (I & II) were the minority among the cyclothymics.

[Eating disorder and cyclothymic temperament: cross-sectional study about 107 Tunisian students]

Introduction

Les objectifs de notre étude ont été d'estimer la prévalence des troubles des conduites alimentaires (TCA) chez les jeunes tunisiens et étudier la relation entre le tempérament cyclothymique et les TCA.

Méthodes

Nous avons ainsi mené une étude transversale descriptive et analytique. Elle a concerné 107 étudiants de l'Institut de Presse et des Sciences de l'Information de la Manouba, Tunisie. Pour l’évaluation des TCA, nous avons procédé par la passation de l'auto questionnaire EAT 40, dans sa version validée en Tunisie. C'est l'outil le plus utilisé pour le dépistage des TCA dans le monde. Pour l’évaluation du tempérament cyclothymique, nous avons utilisé le TEMPS A dans sa version arabe validée. Une fiche épidémiologique associée a permis de recueillir quelques facteurs sociodémographiques et hygiéno-diététiques.

Résultats

La prévalence des troubles de conduites alimentaires a été de 24,3%. Le pourcentage des étudiants ayant un score de tempérament cyclothymique ≥14 a été de 37,4%. Une association a été trouvée entre les troubles de conduites alimentaires et le tempérament affectif cyclothymique que ce soit selon l'approche dimensionnelle (p=0,005) ou selon celle catégorielle (p=0,046). Le tempérament cyclothymique multiplie par deux le risque de développer un TCA chez les étudiants de sexe féminin (p=0,04).

Conclusion

Es TCA sont fréquents chez nos étudiants particulièrement de sexe féminin. De plus, la présence d'un tempérament cyclothymique associé permettrait de suspecter doublement une appartenance au spectre bipolaire et devrait conduire à une attention particulière de la part du clinicien pour définir au mieux les stratégies thérapeutiques.

Standardization of the TEMPS-A in the Greek general population

BACKGROUND

The current study evaluates the reliability and factor-structure replicability of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in its Greek Version.

METHODS

The TEMPS-A was administered to a convenient sample of 734 subjects from the general Greek population (436 females; 59.4% and 298 males; 40.6%). Their mean age was 40.80±11.48 years (range 25-67 years). The analysis included the calculation of Chronbach's alpha, the calculation of the threshold to define dominant temperaments (+2 standard deviations or 95th percentile), confirmatory factor analysis and the calculation of Pearson correlation coefficients between the temperament scales scores. Analysis of Covariance with age as covariate and post-hoc t-test was used to search for differences in temperament scores between males and females. Also a table of percentile values corresponding to a raw score was created.

RESULTS

Internal consistency was excellent for the various temperaments (0.72-0.88). The factor analysis confirmed the five factor solution as the best factor solution. All TEMPS items were included in the final version of the scale in the Greek language.

LIMITATIONS

The study sample included subjects from the general population, but it is a convenient and not representative sample. Although the authors tried to select them on the basis of being mentally healthy and without a psychiatric history, there is always a degree of uncertainty. There is also always the possibility some of them to manifest a mental disorder in the future, thus being currently in a premorbid state.

CONCLUSION

The Greek version of the TEMPS-A, has good internal consistency and factor structure similar to what was found in other translations. Overall our results are in accord with the literature and in line with theoretical considerations as well as with empirical evidence.

Confirmatory factor analysis and measurement invariance by gender, age and levels of psychological distress of the short TEMPS-A

BACKGROUND

The Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A) is a widely used self-reported tool aimed at measuring the affective temperaments that define the bipolar spectrum, with cyclothymic, depressive, irritable, hyperthymic, and anxious subscales. Confirmatory factor analysis (CFA) was rarely used to confirm the expected five-factor model. Measurement invariance was never tested.

METHODS

Cross-sectional, survey design involving 649 Italian college students (males: 47%). The short 39-item TEMPS-A and the 12-item General Health Questionnaire (GHQ-12) were used as measures of the affective temperaments and of psychological distress, respectively. CFA was applied to the TEMPS-A. Measurement invariance by gender, age and levels of psychological distress on the GHQ-12 was calculated with the establishment of subsequent equivalence constraints in the model parameters across groups.

RESULTS

The expected five-factor model had the best fit for all CFA indexes. Configural, metric and scalar invariance of the five-factor model of the TEMPS-A was proved across gender, age and levels of psychological distress of the participants. The hyperthymic temperament subscale has low or no links with the other affective temperament subscales, which were interrelated with medium to large effect sizes.

LIMITATIONS

College students might be not representative of the general population. No information on the clinical status of the students was available beyond self-report data.

CONCLUSION

The study proved the measurement invariance of the (short) TEMPS-A, which is a pre-requisite to compare groups or individuals in cross-sectional and longitudinal surveys. Generalizability cannot be assumed without replication of the findings in clinical samples.

Validation of the Temps-A in university student population in Serbia

BACKGROUND AND AIMS

The TEMPS-A scale is a self-evaluation measure which assesses five affective temperaments. This study is a comparative analysis of affective temperament types in different educational fields, and the first validation of the Serbian version of the TEMPS-A.

METHODS

The TEMPS-A questionnaire has been adapted following the translation-back translation methodology from English to Serbian. It was then administered to 770 undergraduate students from eight different faculties.

RESULTS

Five factors were extracted through Principal Component Analysis (Varimax rotation), each including ten items with loadings above 0.40. The internal consistency of this abbreviated 50-item scale was α=0.77 and the average test-retest coefficient (rho=0.82) indicates a stable reliability. The correlations among the temperaments ranged from weak to moderate, with the highest positive correlations obtained between the depressive and cyclothymic, and, depressive and anxious scales. The highest score was detected among the hyperthymic (0.64) and lowest among the depressive temperament (0.15). The male participants attained significantly higher scores for the hyperthymic temperament, while female scored significantly higher on the depressive and anxious temperaments. The students of physical education showed significantly lower results on the depressive and anxious subscales and higher on the hyperthymic, in comparison to other educational fields.

LIMITATIONS

The student sample is not representative of the general population, therefore further investigation in older population would be necessary for the evaluation of norms in additional age categories. The external validation with other personality scales has not been the subject of this research, but will be a part of some future studies.

CONCLUSIONS

The Serbian 50-item version of the TEMPS-A showed good overall internal consistency and reliability, and the results generally cohere with those from previously validated versions in other languages.

Psychometric properties of the Chinese (Mandarin) TEMPS-A: a population study of 985 non-clinical subjects in China

BACKGROUND

The TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego) is a 110-item auto-questionnaire (self-rated) which consists of five temperament scales: depressive, cyclothymic, hyperthymic, irritable and anxious temperaments. It has been translated into over 25 languages and validated in at least 12, with broad cross-cultural cogency. This is a first attempt to validate the TEMPS-A in a very large Chinese population speaking Mandarin.

METHODS

The Chinese TEMPS-A was adapted from the original English version following a rigorous process of forward translation and backward translation (after the approval of the English back translation by H.S.A. and K.K.A.), it was administered to 985 non-clinical Chinese subjects aged between 18-60 years (53.8% female) in four communities in Guangzhou City, China. A subset of 105 subjects was retested approximately six weeks later. Standard psychometric tests of reliability and validation were performed.

RESULTS

The test-retest reliability for depressive (0.74), cyclothymic (0.71), hyperthymic (0.67), irritable (0.66) and anxious (0.83) were respectively as shown in the parentheses. For internal consistency, Chronbach alphas coefficients were 0.68, 0.85, 0.82, 0.83 and 0.87, respectively. Exploratory factor analysis revealed 2 super factors, Factor I loading on anxious, cyclothymic, irritable, and depressive temperaments; and Factor II loading on hyperthymic. Depressive, cyclothymic, irritable and anxious temperaments were correlated with each other. Males had significantly higher scores than females for the hyperthymic and irritable temperaments. The prevalence of the dominant depressive (2.9%), cyclothymic (5.6%), hyperthymic (1.3%), irritable (7.0%) and anxious (5.3%) temperaments were respectively as shown in the parentheses.

LIMITATIONS

Although it is likely that generalizability of our scale is good for the entire Mandarin-speaking ethnic composition of China today, future research is needed to establish this conclusively.

CONCLUSION

The Chinese TEMPS-A standardized on one of the largest non-clinical samples in any of the other national studies to date, has good internal consistency, coheres well with validated versions in other languages. The findings suggest that it is a psychometrically sound instrument to assess affective temperaments in clinical and biological studies in China.

Psychometric properties of the Slovenian version of temperament evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A): temperament profiles in Slovenian university students

BACKGROUND

TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire) is a self-rated instrument that measures five affective temperaments: depressive, cyclothymic, hyperthymic, irritable, and anxious. The aim of our study was to examine the psychometric characteristics of the Slovenian TEMPS-A and to ascertain if temperament profile is related to the professions chosen by Slovenian students.

METHODS

892 Slovenian university students in six different professional fields (economics, geography, engineering, law, sports pedagogy and nursing) were included in our study.

RESULTS

Cronbach's reliability coefficients denoted acceptable internal consistency of the subscales. Principal component analysis revealed relatively good internal structure of the instrument. Nursing and geography students scored the highest on depressive temperament. Sports pedagogues as well as engineers demonstrated the most firm personality structure with distinctive hyperthymic temperament. Law students revealed the most irritable temperament, while nursing and law students scored the highest on anxious temperament.

LIMITATIONS

Sample of Slovenian students is not representative for general population. The structure of the sample was crucial as well, as it comprised mainly of younger students who just started their study.

CONCLUSIONS

The Slovenian version of the TEMPS-A proved to have relatively good internal consistency and internal structure. The questionnaire verified as a reliable and valid instrument and generally in line with previous studies. This study strengthens the perspective that professional areas could be associated with distinct affective temperament profile that could influence career decisions. The findings in students of economics, geography, and sport pedagogy are new as they have not been previously investigated by TEMPS researchers. The results open new possibilities for future research.

The relationship between temperament, diabetes and depression

BACKGROUND

Temperament is the stable core of personality and it may represent the underlying continuity between how the person typically is (trait) and how the person temporarily changes (state). Comorbid depression in patients with Type 2 diabetes is important because of the negative consequences on the prognosis of diabetes. Little research has explored the relationships between temperament, depression and type 2 diabetes. The aims of the present paper are first to describe current research that has examined the relationship between temperament, diabetes and depression, and second to make recommendations for future research.

METHODS

Literature search from Medline and references in published papers.

RESULTS

Current research has described the relationship of temperament with cyclothymia, bipolar disorder, mood instability and suicidality. Studies on the relationship between temperament and depressive disorders are scarce. Nevertheless, there is likely a continuum between depressive temperament and related personality traits and subthreshold and clinical depressive states and disorders and diabetes outcomes.

LIMITATIONS

The greatest limitation concerns the scarcity of papers on this issue. There are also methodological limitations in accurately assessing depressive temperament versus current depressive disorders and residual symptoms from these disorders.

CONCLUSION

Depressive temperament may be a promising construct to understand better the interplay between depression and diabetes.

Affective temperaments in general population: a review and combined analysis from national studies

BACKGROUND

The aim of this study was to investigate the characteristics of affective temperaments in general non-clinical population in different countries

METHOD

We performed a detailed search of published studies (one unpublished) investigating affective temperaments in non-clinical populations by administering the Temperament Evaluation of Memphis, Paris and San Diego Auto-questionnaire (TEMPS-A) in its 110-items version. We have included a total of six studies published from different countries (Argentina, Germany, Hungary, Korea, Lebanon, and Portugal) and one unpublished with preliminary data from Spain. We analyzed the combined data from the collected studies.

RESULTS

We found significant gender differences, with men scoring higher in irritable and hyperthymic, and women in anxious, depressive and cyclothymic temperaments. Age had a significant effect in women with depressive temperament. Correlations among temperament scores have shown positive associations between depressive and anxious, and cyclothymic and irritable.

CONCLUSIONS

There was a similarity in gender differences and the association between different affective temperaments. Our results indicate that affective temperaments show both universal and distinctive characteristics.

LIMITATION

The sample populations in different countries were not homogeneous for age and socio-economic composition. In the Korean study of Kang et al. the version of the TEMPS was not validated.

Affective temperaments: from neurobiological roots to clinical application

The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) has grown to be a clinically important outcome measure in the diagnosis and the clinical course of mood disorders. However, temperaments, which represent the biologically stable core of personality, are not just antecedents of major affective disorders, but also serve as a reservoir of genetically advantageous traits for the survival of different cultures. The rapidly growing body of research in psychiatric and non-psychiatric fields even raises the question of temperament as a common root in psychiatric and somatic disorders, providing a new meaning for the construct of psychosomatic disorders. In this review we aim to summarize current knowledge on both the neurobiological background and clinical importance of affective temperaments including implications for future research. Orv. Hetil., 2011, 152, 1879–1886.

Validation of the Brazilian brief version of the temperament auto-questionnaire TEMPS-A: the brief TEMPS-Rio de Janeiro

BACKGROUND

Over the last thirty years, Akiskal and collaborators have described and developed operationalized diagnostic criteria for five types of affective temperaments - cyclothymic, irritable, hyperthymic, depressive, and anxious. A 110-item, yes-or-no questionnaire, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A), was specifically developed for measuring temperamental variation. The TEMPS-A was translated into more than 25 languages and cross-culturally valid versions are now available in Italian, French, German, Japanese, Turkish, Arabic, Polish, Hungarian, Spanish and Portuguese. Recent studies in the US and in Europe, however, have suggested that shorter versions of TEMPS-A can be just as efficient as the full ones while potentially enhancing the compliance of respondents. The main objective of the present study was to validate a brief Brazilian Portuguese version of TEMPS-A (brief TEMPS-Rio de Janeiro).

METHODS

Our main sample consisted of 997 undergraduate students (female = 72.6%) from seven different universities located in the city of Rio de Janeiro, Brazil. An additional group of 167 healthy senior citizens (women = 83.8%) was recruited in senior community centers in the city of Rio de Janeiro, Brazil. All participants were asked to complete the 110-item, Brazilian translation of the full version of the TEMPS-A.

RESULTS

An exploratory factor analysis (PCA type 2, Varimax rotation) vying for a five-factor solution yielded mixed results, with cyclothymic traits, physical symptoms of anxiety and preoccupation with the well-being of a family member loading together on the first factor. When a forced six-factor solution was attempted, cyclothymic, irritable, hyperthymic, and depressive were delineated as predicted by the theory. The original generalized anxious temperament was split into two sharply delimited components, a "worrying" subscale and an abbreviated anxious subscale, which included physical symptoms of anxiety and concerns with the well-being of relatives. Based on the tripartite model of anxiety and depression, we proposed that the abridged anxious subscale, which includes physical symptoms of anxiety, represents the "true" generalized anxious temperament, while the "worrying" subscale corresponds to the "general distress factor". The internal consistency of the six subscales thus identified was generally good, ranging from 0.67 (anxious subscale) to 0.81 (worrying subscale), with cyclothymic, irritable, depressive, and hyperthymic subscales exhibiting intermediate values (0.74, 0.74, 0.72, and 0.7, respectively).

LIMITATIONS

The present study was based on a non-clinical sample that does not reflect accurately the characteristics of the Brazilian population. The relative uniformity of the sample in terms of age and education precluded a more in-depth analysis of the influence of these highly relevant factors. Further, we did not assess convergent, divergent or test-retest validity.

CONCLUSIONS

We believe that the brief Brazilian version of the TEMPS-A auto-questionnaire will provide Brazilian researchers and clinicians with a psychometrically sound instrument and thus contribute toward the creation of a worldwide research network dedicated to the investigation of affective temperaments.

From putative genes to temperament and culture: cultural characteristics of the distribution of dominant affective temperaments in national studies

BACKGROUND

Affective temperaments may carry distinct evolutionary advantages both on the individual or a group level, so we can expect that in different cultural and national samples the frequency of dominant affective temperaments will show characteristic differences. The aim of the present study was to investigate the characteristics of distribution of dominant affective temperaments in different national studies of general non-clinical population.

METHOD

In our study we included six studies published in different countries around the world (Argentina, Germany, Hungary, Korea, Portugal, and Lebanon) which investigated a large sample of non-clinical population using TEMPS-A, and reported frequencies for dominant affective temperaments. The frequencies of dominant affective temperaments were compared using chi square tests.

RESULTS

We found a significant difference in the frequency of affective temperaments among the different national studies in case of the cyclothymic, hyperthymic and irritable temperaments.

CONCLUSIONS

We found important parallels between the frequency of affective temperaments and cultural dimensions described by Hofstede (Hofstede and Hofstede, 2005). The characteristics encompassed by the depressive temperament show considerable similarities with Hofstede's individualism-collectivism dimension, while those of the hyperthymic temperament seem to be similar to uncertainty avoidance, and the irritable temperament shows similarities with Hofstede's power distance. Furthermore, the relative frequency of these dominant temperaments in case of the different national samples paralleled the relative scores of these countries on the corresponding cultural scales. Our results indicate an important relationship between affective temperaments and cultural dimensions, which suggests that these phenomena may be the manifestations of the same genetically determined predispositions in different forms.

LIMITATION

We included a study by Erfurth et al. (2005), in which affective temperaments were evaluated using the TEMPS-M. Also, in the Korean study the Korean version of the TEMPS-A was not validated.

Sex difference in symptomatology of manic episode

OBJECTIVE

Studies addressing sex differences in the symptoms and course of bipolar affective disorder had been investigated across different phase of bipolar affective disorder. There are few studies in manic phase that have reported inconsistent results. Therefore, we investigated sex difference in symptom presentation of manic episode.

METHODS

A total of 150 male and 50 female subjects meeting criteria for manic episode according to International Statistical Classification of Diseases, 10th Revision Diagnostic Criteria for Research, giving written informed consent, were included for the study. Those with comorbid major medical or psychiatric disorders were excluded. All the patients were assessed on Scale for Manic States.

RESULTS

Multivariate analysis of variance using all the items of Scale for Manic Symptoms showed significant sex difference (Pillai's Trace F(20,179) = 5.154, P < .001), with large effect size (η2 = .365). In men, there was significantly higher motor activity, psychosis, grandiosity, contact, and humor, whereas mood lability, depressed mood, guilt, suicide, anxiety, and dress scores were higher in women. Discriminant analysis showed that 84% of men and 72% of women could be correctly classified using the Scale for Manic Symptoms. Stepwise logistic regression analysis showed anxiety, guilt, and dress positively predicted female sex and the model explained 24% to 36% of variance.

CONCLUSION

Symptom presentation of mania differs across sex and a predominance of anxiety and depressive symptoms was found in women, whereas increased psychomotor activity was prevalent in men.

Validation of the Arab Youth Mental Health scale as a screening tool for depression/anxiety in Lebanese children

BACKGROUND

Early detection of common mental disorders, such as depression and anxiety, among children and adolescents requires the use of validated, culturally sensitive, and developmentally appropriate screening instruments. The Arab region has a high proportion of youth, yet Arabic-language screening instruments for mental disorders among this age group are virtually absent.

METHODS

We carried out construct and clinical validation on the recently-developed Arab Youth Mental Health (AYMH) scale as a screening tool for depression/anxiety. The scale was administered with 10-14 year old children attending a social service center in Beirut, Lebanon (N = 153). The clinical assessment was conducted by a child and adolescent clinical psychiatrist employing the DSM IV criteria. We tested the scale's sensitivity, specificity, and internal consistency.

RESULTS

Scale scores were generally significantly associated with how participants responded to standard questions on health, mental health, and happiness, indicating good construct validity. The results revealed that the scale exhibited good internal consistency (Cronbach's alpha = 0.86) and specificity (79%). However, it exhibited moderate sensitivity for girls (71%) and poor sensitivity for boys (50%).

CONCLUSIONS

The AYMH scale is useful as a screening tool for general mental health states and a valid screening instrument for common mental disorders among girls. It is not a valid instrument for detecting depression and anxiety among boys in an Arab culture.

Discriminant and convergent validity of TEMPS-A[P] correlation with MMPI and the emotional-affective state following a stressful situation

BACKGROUND

The temperament evaluation of the Memphis, Pisa, Paris and San Diego questionnaire (TEMPS), in its rater-wise and its self-evaluation forms, has been designed to evaluate temperamental characteristics in clinical and non-clinical populations. The validation process is currently in progress in various countries. In order to improve this validation process we have extended the area of correlations of its self-evaluation form (TEMPS-A[P]) to MMPI, and to a special RS that allows assessment of the emotional-affective state following a stressful situation.

METHODS

In 693 candidates applying to become cadets in the Italian Air Force we have assessed the correlation between the TEMPS-A[P] and the MMPI validity and clinical scales, and administered an emotional-affective state questionnaire (EAS-RS) after they had gone through the stressful challenge of taking an academy entrance examination.

RESULTS

As regards MMPI validity scales, TEMPS-A[P] depressive candidates tend to report their symptoms sincerely. Hyperthymic candidates tend to give false answers so that others will see them in a good light. Cyclothymic and irritable candidates tend to exaggerate symptoms. As regards the MMPI clinical scales, a low level of linkage between affective temperaments and abnormal personality traits was found. As regards EAS-RS: hyperthymic temperament on one hand, and cyclothymic and depressive temperaments on the other, are characterized by counter-polar emotional states following the test; these are desirable in the first case and undesirable in the other two.

CONCLUSIONS

The convergent and discriminant validity of TEMPS-A[P] was confirmed. From a personalistic point of view, temperaments seem to belong to the realm of normality rather than to that of pathology, in line with their putative adaptive role.

Polish validation of the TEMPS-A: the profile of affective temperaments in a college student population

BACKGROUND AND AIMS

The TEMPS-A scale is a self-evaluation measure to assess five affective temperaments: depressive, cyclothymic, hyperthymic, irritable and anxious. The scale has already been validated in over 10 languages. In this paper, the first report on the validation of the Polish version of TEMPS-A is presented.

METHODS

The TEMPS-A questionnaire version that includes 110 questions has been adapted following the translation-back translation methodology from English to Polish, checked by the originators of the five scales (H.S.A., K.K.A.). In the next step, the Polish version of TEMPS-A was administered to 521 Polish undergraduate students. Internal consistency of temperamental scales was measured with Cronbach-alpha coefficients. Correlation among the temperaments was examined using Pearson's bivariate correlation. Differences between sexes were tested with ANOVA.

RESULTS

The Cronbach-alpha and the Kuder-Richardson 20 reliability coefficients for the depressive, cyclothymic, hyperthymic, irritable and anxious temperaments were between 0.69 and 0.83. The percentage of subjects whose Z-scores were above 2 SD, was the highest among depressive (4%) and anxious (3.5%) temperaments, followed by the cyclothymic (2.9%), hyperthymic (1%), and irritable (0.6%). The strongest positive correlations between the temperamental scales were found between depressive and anxious, as well as between cyclothymic and irritable ones (correlation coefficients 0.63 and 0.57, respectively). Male subjects attained significantly higher scores for hyperthymic temperament, compared to females, while females scored significantly higher than males on cyclothymic and anxious temperaments.

LIMITATIONS

Our healthy young subjects are not representative of the Polish population. As external validation has been achieved in other language versions, it was not repeated in the present Polish version.

CONCLUSIONS

The Polish version of TEMPS-A has a good internal consistency. The findings generally cohere with those from previously validated versions in other languages.

The role of anxious and hyperthymic temperaments in mental disorders: a national epidemiologic study

Temperament has been demonstrated clinically to be linked to mental disorders. We aimed to determine the possible role of temperament in mental disorders in a national epidemiologic study. A nationally representative sample of adults (n=1320) was administered the Lebanese-Arabic version of the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A), and the Arabic CIDI 3.0, as part of the LEBANON study. The association among temperaments and DSM-IV mood, anxiety, and impulse control disorders was assessed. The anxious temperament was shown to be a robust predictor of most disorders, especially within the anxiety and depressive clusters. The hyperthymic temperament had a uniquely protective effect on most mental disorders, with the exception of separation anxiety, bipolar, substance abuse and impulse control disorders. These effects were moderated by age and education. Temperaments, previously largely neglected in epidemiologic studies, could play a major role in the origin of mental disorders.

Current research on affective temperaments

PURPOSE OF REVIEW

The aim of this review is to highlight the relationship between affective temperaments and clinical mood disorders and to summarize the earlier and most recent studies on affective temperaments in both clinical and nonclinical populations.

RECENT FINDINGS

Current research findings show that specific affective temperament types (depressive, cyclothymic, hyperthymic, irritable and anxious) are the subsyndromal (trait-related) manifestations and commonly the antecedents of minor and major mood disorders. Up to 20% of the population has some kind of marked affective temperaments; depressive, cyclothymic and anxious temperament is more frequent in women, whereas hyperthymic and irritable temperaments predominate among men. Molecular genetic studies show a strong involvement of the central serotonergic (depressive, cyclothymic, irritable and anxious temperaments) and dopaminergic (hyperthymic temperament) regulation, suggesting that the genetic potential of major mood episodes lies in these temperaments.

SUMMARY

Premorbid affective temperament types have an important role in the clinical evolution of minor and major mood episodes including the direction of the polarity and the symptom formation of acute mood episodes. They can also significantly affect the long-term course and outcome including suicidality and other forms of self-destructive behaviours such as substance use and eating disorders.

Description and validation of the Affective Temperament Questionnaire

BACKGROUND

Akiskal and Mallya (Psychopharmacol Bull. 1987;23:68-73) proposed criteria defining 4 affective temperaments-hyperthymic, irritable, cyclothymic, and dysthymic. This study aims to develop and validate, using a 3-point rating scale, a short questionnaire that assesses these temperaments.

METHODS

The Affective Temperament Questionnaire (ATQ) was administered to a family-based sample of individuals with major depressive disorder (MDD), bipolar disorder (BP), or no mood disorder (N = 378). Factor analyses, internal consistency, and analysis of variance were undertaken to examine the factorial structure and concurrent validity (relative to Axis I mood disorder diagnosis) of the ATQ. Affective Temperament Questionnaire data were evaluated with respect to raw scores and dominant affective temperament.

RESULTS

Three factors emerged--hyperthymia, cyclothymia, and dysthymia--which had moderate to high internal consistency. Support for the concurrent validity of ATQ was found, whereby temperament scores and rates of dominant affective temperaments differed with respect to mood disorder diagnosis. Hyperthymia and cyclothymia were more prevalent among individuals with BP than among individuals with MDD or no history of a mood disorder. Dysthymia occurred at a relatively similar rate among individuals with MDD or BP.

CONCLUSIONS

Our findings support the use of the ATQ for collecting information regarding affective temperaments and for furthering understanding regarding the links between affective temperament and mood disorders.