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

Using machine learning algorithms and techniques for defining the impact of affective temperament types, content search and activities on the internet on the development of problematic internet use in adolescents' population

Background

By using algorithms and Machine Learning - ML techniques, the aim of this research was to determine the impact of the following factors on the development of Problematic Internet Use (PIU): sociodemographic factors, the intensity of using the Internet, different contents accessed on the Internet by adolescents, adolescents' online activities, life habits and different affective temperament types.

Methods

Sample included 2,113 adolescents. The following instruments were used: questionnaire about: socio-demographic characteristics, intensity of the Internet use, content categories and online activities on the Internet; Facebook (FB) usage and life habits; The Internet Use Disorder Scale (IUDS). Based on their scores on the scale, subjects were divided into two groups - with or without PIU; Temperament Evaluation of Memphis, Pisa, Paris, and San Diego scale for adolescents (A-TEMPS-A).

Results

Various ML classification models on our data set were trained. Binary classification models were created (class-label attribute was PIU value). Models hyperparameters were optimized using grid search method and models were validated using k-fold cross-validation technique. Random forest was the model with the best overall results and the time spent on FB and the cyclothymic temperament were variables of highest importance for these model. We also applied the ML techniques Lasso and ElasticNet. The three most important variables for the development of PIU with both techniques were: cyclothymic temperament, the longer use of the Internet and the desire to use the Internet more than at present time. Group of variables having a protective effect (regarding the prevention of the development of PIU) was found with both techniques. The three most important were: achievement, search for contents related to art and culture and hyperthymic temperament. Next, 34 important variables that explain 0.76% of variance were detected using the genetic algorithms. Finally, the binary classification model (with or without PIU) with the best characteristics was trained using artificial neural network.

Conclusion

Variables related to the temporal determinants of Internet usage, cyclothymic temperament, the desire for increased Internet usage, anxious and irritable temperament, on line gaming, pornography, and some variables related to FB usage consistently appear as important variables for the development of PIU.

Cultural collectivism, intimate partner violence, and women's mental health: An analysis of data from 151 countries

Culture, defined as the distinctive, learned beliefs and patterns of behavior that are particular to a given group or community, is a key determinant of mental health. The cultural dimension of individualism-collectivism, which measures the extent to which a given society accords importance to individuals as opposed to larger groups, has been associated with cross-national variations in mental health outcomes such as depression and suicide. However, this cultural dimension is also associated with variations in the frequency of intimate partner violence (IPV), which has a significant and sustained adverse impact on women's mental health. This study examines the relationships between individualism-collectivism, the frequency of IPV, and rates of depression and suicide in women, based on data from 151 countries. In this data set, IPV was significantly associated with age-standardized rates of depression and suicide in women, even after adjusting for demographic variables. Cultural collectivism was positively correlated with IPV, but this relationship was significantly influenced by national income and women's educational attainment. In multivariate analyses, IPV, but not cultural collectivism, remained significantly associated with depression in women. These results highlight the importance of screening for and addressing IPV in women seeking mental health care, particularly in low- and middle-income countries where cultural and economic factors may both increase the risk of IPV and delay or impede its reporting.

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.

Does Culture Influence Antidepressant Response? A Preliminary Investigation of Randomized Controlled Trials of Fluoxetine

Background

Contemporary models of depression view the disorder as arising from an interaction between genetic vulnerability and adverse life experiences. The nature of these experiences is strongly influenced by social-cultural factors, and there is preliminary evidence that these factors may influence the response to treatment.

Methods

In this pilot study, pooled response rates obtained from 56 randomized controlled trials of fluoxetine for major depression, conducted across 21 countries, were analyzed in relation to Hofstede’s six dimensions of culture in these countries, while controlling for methodological quality.

Results

The cultural dimensions of power distance (r = .62, p = .002), masculinity (r = .45, p = .04) and indulgence (r = -.52, p = .016) were significantly correlated with antidepressant response rates, though only the first of these remained significant after correction for multiple comparisons. On linear regression analysis, the association between power distance and antidepressant response remained significant (β = .62, p = .002).

Conclusions

These preliminary results suggest that certain cultural factors may be significantly associated with cross-national variations in antidepressant response rates during clinical trials.

Nature and Nurture: Effects of Affective Temperaments on Depressive Symptoms Are Markedly Modified by Stress Exposure

BACKGROUND

Lack of proper consideration of the interaction between biological and environmental factors limits our understanding of the development of depression. Our cross-sectional study investigated whether recent stress influences the effect of affective temperaments on depressive symptoms.

METHODS

1015 general population participants completed the Brief Symptom Inventory to capture depressive symptoms, the List of Threatening Experiences Questionnaire to assess recent stressors, and the Temperament Evaluation of Memphis Pisa, Paris, and San Diego Autoquestionnaire to evaluate affective temperaments (TEMPS-A). Linear regression models were built to investigate the effect of temperament and stress on depression, temperament on stress, and the effect of temperament on depressive symptoms in different stress exposure groups.

RESULTS

Recent life events and anxious, depressive, cyclothymic, and hyperthymic temperaments significantly predicted depressive symptoms, and cyclothymic, and hyperthymic temperaments significantly predicted recent life event exposure. While in case of mild stress all affective temperaments except irritable predicted depression, in case of moderate exposure only the effect of depressive, cyclothymic, and hyperthymic temperament, while in the high exposure group only the effect of anxious temperament was significant.

LIMITATIONS

All measures were based on self-report, and subjective impact of life events was not considered. This was a cross-sectional study with a correlational nature which does not allow for causative conclusions.

CONCLUSIONS

The contribution of affective temperaments to depression is much higher compared to stress, and severity of exposure to life events influences the impact of affective temperaments on depressive symptoms, pointing to divergent pathways of emotional reactivity mediating the effects of stress on depression which can be exploited for prevention and treatment.

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.

Low affective temperament consistency during development: Results from a large retrospective study

BACKGROUND

Temperament is still regarded as a stable part of personality, an "endophenotype" developed early in life. However, how frequently temperament traits can change throughout life is not clear. The aim of this study was to investigate affective temperament changes from late childhood to adolescence and from late adolescence to adulthood.

METHODS

We used data from a cross-sectional web-based survey collected from the Brazilian Internet Study on Temperament and Psychopathology. We used the Affective and Emotional Composite Temperament Scale questionnaire to assess temperament at time of participation, and at age of 10-12 and 18 years, retrospectively, dividing affective temperaments into four major groups: internalized, externalized, stable and unstable. The final sample consisted of 36,255 participants from 24 to 40 years of age (71.9% women).

RESULTS

Most of the sample (66.2%) changed to a different affective temperament group at adulthood. We found a significant decrease in internalized temperaments from 10-12 to 18 years of age (34.5% to 25.0% in women and 31.8% to 26.7% in men), parallel with an increase of externalized temperaments (14.1% to 20.3% in women and 17.3% to 19.6% in men). From 18 years of age to adult life, stable temperaments decreased slightly in frequency (37.9% to 32.5% in women and 38.6% to 36.8% in men), while unstable types increased (16.9% to 24.0% in women and 15.3% to 18.4% in men).

LIMITATIONS

The retrospective design and self-reported evaluation may bias self-perception.

CONCLUSIONS

Affective temperaments often change over time, contrary to the classic view of temperament as a consistent phenotype.

Novel validity evidence of the Psychopathy Checklist- Revised (PCL-R) in a representative sample of Spanish inmates

Psychopathy Checklist-Revised (PCL-R) validation studies have been conducted mainly in non representative samples of North American adult male serious offenders. Research in other samples is needed to test the generalizability of PCL-R construct validity. PCL-R psychometric properties and construct validity were evaluated in a representative sample of 204 Spanish sentenced inmates. These inmates had served at least 6 months of their sentence at Pereiro de Aguiar prison. This sample was heterogeneous with respect to type of official charges and was representative, as all offenders who met the inclusion and exclusion criteria were invited to participate. Classical test theory indexes of reliability, correlations between PCL-R items, factors and facets, external correlations, and factor structure analysis demonstrated that PCL-R affective, interpersonal and lifestyle dimensions were more reliable and valid for the psychopathy than the antisocial construct in this Southern European sample.

Comparative analysis of affective temperament in patients with difficult-to-treat and easy-to-treat major depression and bipolar disorder: Possible application in clinical settings

BACKGROUND

Difficult-to-treat major depressive disorder (MDD-DT), which involves antidepressant refractoriness or antidepressant-related adverse psychiatric effects, is bipolar in nature; therefore, it may share common temperamental features with bipolar disorder. To examine this hypothesis, affective temperament was compared between MDD-DT, easy-to-treat major depressive disorder (MDD-ET), and bipolar disorder.

METHODS

Affective temperament was measured in 320 patients (69, 56, and 195 with MDD-ET, MDD-DT, and bipolar disorder, respectively) using the self-rated questionnaire version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A), with between-group differences examined using multiple logistic regression analysis controlling for confounders. Optimal cut-off points for TEMPS-A scores to discriminate between diagnostic groups were determined using receiver-operating characteristic analysis.

RESULTS

Of the five temperamental domains, the mode for cyclothymic temperament score was highest, followed by those of bipolar disorder, MDD-DT, and MDD-ET. The cyclothymic temperament score discriminated significantly between bipolar disorder and MDD-DT (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.04-1.20, p=0.0022), MDD-DT and MDD-ET (OR: 1.15, 95% CI: 1.01-1.31, p=0.0334), and bipolar and major depressive disorders (OR: 1.17, 95% CI: 1.07-1.28, p=0.0003). Optimal cut-off points for the cyclothymic temperament scores to discriminate between bipolar disorder and major depressive disorder and MDD-DT and MDD-ET were 9 (sensitivity: 64.6%, specificity: 76.0%) and 6 (66.1%, 62.3%), respectively.

CONCLUSIONS

MDD-DT has a quantitatively stronger bipolar temperamental feature, cyclothymic temperament, relative to that of MDD-ET. Cut-off points determined in this study could be clinically helpful. Because of our study design, longitudinal changes in temperamental scores during treatment cannot be fully excluded.

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.

The association of affective temperaments with smoking initiation and maintenance in adult primary care patients

BACKGROUND

Smoking behaviour and its course is influenced by personality factors. Affective temperaments could allow a more specific framework of the role trait affectivity plays in this seriously harmful health-behaviour. The aim of our study was to investigate if such an association exists in an ageing population with a special emphasis on gender differences.

METHODS

459 primary care patients completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Rating Scale (HAM-A). Subjects were characterized according to their smoking behaviour as current, former or never smokers. Univariate analysis ANOVA and logistic regression were performed to analyse differences in the three smoking subgroups to predict smoking initiation and maintenance.

RESULTS

Current smokers were younger and less educated than former or never smokers. Males were more likely to try tobacco during their lifetime and were more successful in cessation. Depressive, cyclothymic and irritable temperament scores showed significant differences between the three smoking subgroups. Irritable temperament was a predictor of smoking initiation in females whereas depressive temperament predicted smoking maintenance in males with a small, opposite effect of HAM-A scores independent of age, education, lifetime depression and BDI scores. Whereas smoking initiation was exclusively predicted by a higher BDI score in males, smoking maintenance was predicted by younger age and lower education in females.

LIMITATIONS

The cross-sectional nature of the study design may lead to selective survival bias and hinder drawing causal relationships.

CONCLUSIONS

Affective temperaments contribute to smoking initiation and maintenance independently of age, education, and depression. The significant contribution of depressive temperament in males and irritable temperament in females may highlight the role of gender-discordant temperaments in vulnerable subgroups.

Does temperature or sunshine mediate the effect of latitude on affective temperaments? A study of 5 regions in Japan

BACKGROUND

Previously, we compared the hyperthymic scores of residents in Sapporo, Koshigaya, and Oita (which are located at latitudes of 43°N, 36°N, and 33°N in Japan, respectively) using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire version (TEMPS-A). We found that residents who lived at lower latitudes had higher hyperthymic temperament scores; however, the mechanism of the effect of latitude on hyperthymic temperament remained unclear. The current study examined the mediators of the latitude effect in additional regions with different annual temperatures and amounts of ambient sunshine.

METHODS

The Japanese archipelago stretches over 4000 km from north to south and has four large islands: Hokkaido, Honshu, Shikoku, and Kyushu. In addition to the TEMPS-A previously reported data collected at Sapporo (latitude 43°N), Koshigaya (36°N), and Oita (33°N), we collected the TEMPS-A data of 189 and 106 residents from Takaoka (36°N) and Obihiro (42°N), respectively. Taken together, these five regions have different patterns (i.e., highs and lows) of annual ambient total sunshine (hours) and mean temperature (°C). The effect of latitude, sunshine, and temperature on affective temperaments was analyzed for five Japanese regions.

RESULTS

Multiple regression analyses revealed that latitude predicted significant variance in hyperthymic temperament. Ambient temperature, but not sunshine, significantly affected hyperthymic temperament.

LIMITATIONS

The light exposure that residents actually received was not measured. The number of regions studied was limited. The findings might not generalize to residents across Japan or other countries.

CONCLUSIONS

The present findings suggest that latitude affects hyperthymic temperament, and ambient temperature might mediate this effect.

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.

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.

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.

Affective temperaments and self-harm in adolescents: a cross-sectional study from a community sample

BACKGROUND

Adolescent self-harm (SH) is a major health problem potentially associated with poor outcomes including reduced life expectancy and risk of completed suicide in adulthood. Several studies point to the role of possible constitutional vulnerabilities that could predispose to this behavior. This study sets out to assess the relationship between SH and affective temperaments (AT) in adolescents.

METHODS

A cross-sectional sample of public school students (n=1713), with age limits between 12 and 20, was examined using anonymously completed self-report instruments including 'The Lifestyle & Coping Questionnaire' and the 'Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto-questionnaire' (TEMPS-A). SH was defined according to strict criteria through a two-stage procedure. Statistical significance of associations with SH for categorical variables was assessed in bivariate analysis. AT predictors of lifetime SH were examined in multivariate logistic regression analyses.

RESULTS

Lifetime SH was reported by 7.3%, being about three times more frequent in females. SH was associated, in both genders, with a significant deviation on depressive, cyclothymic and irritable dimensions of TEMPS-A. After multivariate logistic regression adjusted to family typology, smoking status, alcohol and drug consumption, only depressive temperament remained significantly associated as a predictor of SH in both genders.

LIMITATIONS

The use of self-rating instruments and the cross-sectional nature of the study limit our results.

CONCLUSIONS

Cyclothymic, irritable and especially depressive temperament might represent an important marker of vulnerability to SH in both male and female adolescents.

Hyperthymic temperament and brightness judgment in healthy subjects: involvement of left inferior orbitofrontal cortex

BACKGROUND

Hyperthymic temperament has been generally accepted as one of premorbid temperament of bipolar disorders. Since recent several studies indicate an association between illuminance and hyperthymic temperament, it can be hypothesized that more hyperthymic temperament subjects have a different threshold of brightness or darkness perception in comparison with less hyperthymic temperament subjects.

METHODS

We compared the threshold of brightness and darkness judgment between more and less hyperthymic subjects, and by simultaneously using fMRI we compared activations of whole brain between these subjects by two sample t-test. Furthermore, the association between the activations and hyperthymic temperament scores was analyzed.

RESULTS

Although there was no significant difference in the threshold of brightness or darkness judgment between more and less hyperthymic subjects, there was a significant difference in activations of the regions including left superior temporal gyrus, left inferior orbitofrontal cortex, left triangular inferior frontal gyrus and left insula between these subjects. Moreover, there was a significantly positive association between a cluster containing left inferior orbitofrontal cortex and hyperthymic temperament scores. The common activated region of these two analyses (categorical and continuous ones) was determined as left inferior orbitofrontal cortex.

LIMITATIONS

Limitation of the present study is a lack of brightness and darkness preference experiment between more and less hyperthymic subjects.

CONCLUSIONS

The present findings suggest that the threshold of brightness and darkness judgment is not different between more and less hyperthymic subjects, and that hyperthymic temperament may be associated with left inferior orbitofrontal cortex, which has been reported to be associated with bipolar disorder.

Affective temperaments and hopelessness as predictors of health and social functioning in mood disorder patients: a prospective follow-up study

BACKGROUND

Affective disorders are highly disabling illnesses constituting a significant burden for the patients, their family and the society. Therefore, it would be very useful to find tools which carefully subtype these conditions and have a strong and reliable predictive power concerning the course of illness and health and social functioning. To date, the role of hopelessness and affective temperaments in the prediction of health and social functioning and the course of affective disorders has not been studied. Thus, the aim of the present study was to assess whether affective temperaments and hopelessness, measured during hospitalization, can be useful in the prediction of global functioning (the severity of the illness and the presence and severity of psychosocial problems) at follow-up in inpatients with major depressive disorder and bipolar disorder (BD).

METHODS

The patients were 96 consecutive patients admitted to the inpatient psychiatric clinic of Sant'Andrea Hospital between January 2009 and December 2010. All patients completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A) and the Beck Hopelessness Scale on admission. They were contacted on average 14 months after discharge and were asked to complete a telephone interview based on the Health of the Nation Outcome Scales (HoNOS).

RESULTS

Two patients committed suicide before the follow-up assessment. Around 77% of the patients who completed the follow-up assessment were diagnosed as BD, and around 47% reported severe hopelessness. In the multivariate analyses, a factor derived from hopelessness and hyperthymia scores and unemployment, independently predicted severity of the illness and psychosocial functioning at the follow-up.

CONCLUSIONS

Screening for the affective temperament profile and for hopelessness has importance for designing the treatment and rehabilitation plans of affective disorder patients, as these variables are involved in the course and outcome of affective disorder patients and influence their health and social functioning.

Affective temperament, history of suicide attempt and family history of suicide in general practice patients

BACKGROUND

Untreated major affective disorders are strongly associated with suicidal behaviour; however, clinical, psychological and psycho-social risk factors also play a contributory role. Personal history and family history of suicide are also important predictors of suicidal behaviours, and are also a powerful marker of current major depressive episode in general practice patients. Affective temperaments, which can be considered the subaffective manifestations of major mood disorders also show a specific pattern of association with suicidal behaviour. In the present study our aim was to investigate the association between affective temperaments, personal history of suicide attempts and family history of completed suicide in primary practice patients.

METHODS

Five hundred and nine patients from 6 primary care practices completed the TEMPS-A, and were assessed concerning self-reported history of personal or family suicide.

RESULTS

We found that among those answering questions concerning suicide, 9.1% reported a family history of suicide in first and second degree relatives and 4.8% had at least one prior suicide attempt. Among those giving a positive answer to both questions, those who had a positive family history had significantly more frequent suicide attempts (15.4% vs. 4.0%). Patients with prior suicide attempts had a significantly higher score on the cyclothymic and depressive, and those with positive family history of suicide had on cyclothymic and anxious subscales.

LIMITATIONS

In the present study, personal and family history of suicide was assessed retrospectively and in a self-report way. The cross-sectional nature of this study and the facts that no current psychiatric morbidity has been investigated and only the documented history of depressive and anxiety disorders have been detected limit the generalisability of this study.

DISCUSSION

We found a significant relationship between depressive and cyclothymic affective temperament and personal history of suicide attempts, and between cyclothymic and anxious temperament and family history of completed suicide in first and second degree relatives. This is in line with previous findings showing a strong relationship between these affective temperaments and major mood episodes and that these temperaments are overrepresented among suicide attempters. Our findings also suggest that the presence of cyclothymic (and to lesser extent depressive) affective temperament in a patient with family history of completed suicide indicates a very high risk of suicidal behaviour.

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.