The relationship between dimensional personality models and quality of life in psychiatric outpatients

Personality and quality-of-life improvement after apomorphine infusion in Parkinson's disease

People with Parkinson's disease with motor fluctuations can be treated by continuous subcutaneous apomorphine infusion (CSAI) to reduce their symptoms. Nonetheless, factors are lacking to predict patients' quality-of-life amelioration after CSAI. This pilot study aimed to evaluate associations between personality dimensions and quality-of-life improvement after 6 months of CSAI. Thirty-nine people with Parkinson's disease awaiting CSAI were included. Linear regression models between 'Temperament and Character Inventory' personality dimensions at baseline and percentage of change in Parkinson's Disease Questionnaire-39 scores after 6 months of CSAI were realized (n = 35). The Temperament and Character Inventory was also compared between patients awaiting CSAI and patients awaiting deep brain stimulation of the sub-thalamic nucleus (n = 39 from the PREDI-STIM study). Higher reward dependence scores were associated with a better quality-of-life outcome after 6 months of CSAI, while self-directedness scores were associated with a better quality of life before CSAI (as opposed to harm avoidance, reward dependence and self-transcendence scores associated with a worse quality of life). Moreover, people with Parkinson's disease awaiting deep brain stimulation of the sub-thalamic nucleus had similar Temperament and Character Inventory dimensions compared to patients awaiting CSAI. People with Parkinson's disease with higher reward dependence scores at baseline had the best quality-of-life improvement after 6 months of CSAI. This finding could be used to better prepare and accompany people with Parkinson's disease during CSAI establishment. Moreover, this result could serve as an orientation factor to second-line treatments.

The mediating effect of perceived stress on the relationship between big five personality traits and suboptimal health status in Chinese population: a nationwide survey in the framework of predictive, preventive, and personalized medicine

Background

The effects of psychological factors on suboptimal health status (SHS) have been widely described; however, mechanisms behind the complex relationships among the Big Five personality traits and SHS are unclear. Identifying people with specific traits who are susceptible to SHS will help improve life quality and reduce the chronic disease burden under the framework of predictive, preventive, and personalized medicine (PPPM / 3PM). This study investigated the relationships among personality traits and SHS. It also explored whether perceived stress plays a mediating role in SHS development.

Method

A nationwide cross-sectional survey based on multistage random sampling was conducted in 148 cities in China between June 20 and August 31, 2022. Personality traits, perceived stress, and SHS were evaluated using the Big Five Inventory-10 (BFI-10), the 4-item Perceived Stress Scale (PSS-4), and the Short-Form Suboptimal Health Status Questionnaire (SHSQ-SF), respectively. Pearson's correlation analysis was employed to examine the associations between personality traits, perceived stress, and SHS. Structural equation modeling (SEM) was used to discern the mediating role of perceived stress in the relationships among personality traits and SHS.

Result

A total of 22,897 participants were enrolled in this study, among whom the prevalence of SHS was 52.9%. SHS was negatively correlated with three trait dimensions (i.e., extraversion, agreeableness, and conscientiousness) but positively correlated with neuroticism. Meanwhile, stress was negatively correlated with extraversion, agreeableness, conscientiousness, and openness, whereas it was positively correlated with neuroticism. The SEM results showed that, when adjusting for covariates (i.e., gender, age, BMI, educational level, current residence, marital status, and occupational status), higher agreeableness (β =  - 0.049, P < 0.001) and conscientiousness (β =  - 0.103, P < 0.001) led to lower SHS prevalence, higher neuroticism (β = 0.130, P < 0.001), and openness (β = 0.026, P < 0.001) caused SHS to be more prevalent. Perceived stress played a partial mediating role in the relationships among personality traits and SHS, respectively, contributing 41.3%, 35.9%, and 32.5% to the total effects of agreeableness, conscientiousness, and neuroticism on SHS. Additionally, the mediating impact of stress was significant even though extraversion had no direct effect on SHS.

Conclusion

This study revealed a high prevalence of SHS in Chinese residents. Personality traits significantly influenced SHS rates, which perceived stress tended to mediate. From a PPPM perspective, early screening and targeted intervention for people with neuroticism (as well as stress alleviation) might contribute to health enhancement and chronic disease prevention.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-023-00349-x.

The relationship between big five personality and quality of life of people with disabilities: The mediating effect of social support

Objective

The quality of life of people with disabilities is of great significance to social stability and development. Increasing the quality of life among the disabled has become a worldwide topic. This study aims to examine the relationship between the big five personality and quality of life and the mediating effects of social support indicators in people with disabilities.

Methods

This was a cross-sectional study with 358 people with disabilities (193 women and 165 men). A questionnaire was utilized to measure big five personality, social support, and quality of life variables. Pearson's correlation analysis and structural equation modeling were used to examine the relation among big five personality, social support, and quality of life.

Results

QOL was positively correlated with social support (r = 0.402, p < 0.001), extraversion (r = 0.324, p < 0.001), agreeableness (r = 0.474, p < 0.001), conscientiousness (r = 0.482, p < 0.001), and openness (r = 0.498, p < 0.001). QOL was negatively correlated with neuroticism (r = -0.186, p < 0.001). The mediating effect of social support on the relationship between neuroticism and the quality of life of people with disabilities was not significant. Social support significantly mediated the relationship between extraversion, agreeableness, conscientiousness, openness, and quality of life. Overall, positive personality traits (extraversion, agreeableness, conscientiousness, and openness) in the Big Five Personality of people with disabilities could increase their quality of life by Perceiving social support. But social support could not significantly mediate the relationship between neuroticism and the quality of life of people with disabilities.

Conclusion

These new findings suggest that combining individual factors (personality) and environmental factors (social support) can better improve the quality of life of people with disabilities.

Personality Related to Quality-of-Life Improvement After Deep Brain Stimulation in Parkinson's Disease (PSYCHO-STIM II)

BACKGROUND

Deep brain stimulation of the sub-thalamic nucleus (DBS-STN) reduces symptoms in Parkinson's disease (PD) patients with motor fluctuations. However, some patients may not feel ameliorated afterwards, despite an objective motor improvement. It is thus important to find new predictors of patients' quality of life (QoL) amelioration after DBS-STN. We hypothesized that personality dimensions might affect QoL after DBS-STN.

OBJECTIVE

To evaluate associations between personality dimensions and QoL improvement one year after DBS-STN.

METHODS

DBS-STN-PD patients (n = 303) having answered the "Temperament and Character Inventory" (TCI) before surgery and the PDQ-39 before and one year after surgery were included, from the cohort study PREDI-STIM. Linear regression models were used to evaluate associations between TCI dimensions and change in PDQ-39 scores after DBS-STN.

RESULTS

Novelty Seeking and Cooperativeness scores before surgery were positively associated with PDQ-39 scores improvement after DBS-STN (FDR-adjusted p < 0.01). Moreover, paradoxically unimproved patients with deterioration of their PDQ-39 scores after DBS-STN despite improvement of their MDS-UPDRS-IV scores had lower Cooperativeness scores, while paradoxically improved patients with amelioration of their PDQ-39 scores despite deterioration of their MDS-UPDRS-IV scores had higher Reward Dependence scores.

CONCLUSION

Some presurgical personality dimensions were significantly associated with QoL amelioration and discrepancy between motor state and QoL changes after DBS-STN in PD. Educational programs before DBS-STN should take in account patient personality dimensions to better deal with their expectations.

The Relationship between Emotional Stability, Psychological Well-Being and Life Satisfaction of Romanian Medical Doctors during COVID-19 Period: A Cross-Sectional Study

Due to the COVID-19 pandemic, as well as the fast progression of modern society, occupational stress has recently reached alarming levels with consequences for doctors’ psychological well-being. The aim of this study was to analyze the relationship among emotional stability, psychological well-being, and life satisfaction of medical doctors. We conducted a cross-sectional study on 280 medical doctors from Romania between February 2021 and September 2021, in the period between the third and fourth pandemic waves, who were evaluated by the DECAS, ASSET, and Satisfaction with Life scales. Our results showed that emotional stability is negatively correlated with psychological well-being (r = −0.526, p < 0.000) and positively correlated with life satisfaction (r = 0.319, p < 0.0001). Between psychological well-being and life satisfaction, we found a negative correlation (r = −0.046, p < 0.001). This study shows that there is a correlation among emotional stability, psychological well-being, and life satisfaction, which is why it can be considered that Romanian doctors have generated coping mechanisms during the COVID-19 pandemic.

Personality Dimensions Are Associated with Quality of Life in Fluctuating Parkinson's Disease Patients (PSYCHO-STIM)

BACKGROUND

Parkinson's disease (PD) negatively affects patients' Quality of Life (QoL) which depends on both objective criteria such as physical health and subjective ones such as worries and norms according to personal believes. Therefore, QoL could be also associated to personality dimensions in chronic neurological diseases such as PD.

OBJECTIVE

Our objective was thus to study the potential association between personality dimensions and QoL in PD patients with motor fluctuations before Deep Brain Stimulation of the Sub-Thalamic Nucleus (DBS-STN).

METHODS

Data were obtained from the French multicentric cohort study Predi-Stim. All PD patients awaiting DBS-STN and responding to the inclusion criteria at the time of the study were included. All participants answered the "Temperament and Character Inventory" (TCI) and the PDQ-39 before surgery. Analyses were made using adjusted univariate generalized linear regression models to evaluate a potential association between TCI dimensions and PDQ-39 scores.

RESULTS

Three hundred thirty-three consecutive patients were included. The temperament Harm Avoidance was negatively associated with QoL (p = 1e-4, R2= 0.33), whereas the character Self-Directedness was positively associated with mental component of QoL (p = 2e-4, R2= 0.33) in PD patients with motor fluctuations awaiting DBS-STN.

CONCLUSIONS

PD patients with motor fluctuations, with lower Harm Avoidance and higher Self-Directedness scores have the best QoL mainly at an emotional and social level. Therapeutic education of these PD patients focusing on their personal resources may thus be important to improve their well-being.

The role of personality in posttraumatic stress disorder, trait resilience, and quality of life in people exposed to the Kiss nightclub fire

Objective

To evaluate the relationship among personality (according to Cloninger’s psychobiological model), posttraumatic stress disorder (PTSD) symptoms, trait resilience and quality of life (QoL) in people who were exposed to the Kiss nightclub fire.

Methods

188 participants were assessed with the Posttraumatic Checklist–civilian version (PCL-C), the Resilience Scale (RS), the Temperament and Character Inventory (TCI), the World Health Organization Quality of Life–Bref (WHOQOL-Bref), and the WHOQOL-100 Spirituality, religiousness, and personal beliefs (WHOQOL-100-SRPB). Data were analyzed in a dimensional approach, with correlation analysis, multiple linear regression and Structural Equation Modeling (SEM), with PCL-C, RS, and WHOQOL-Bref dimensions as dependent variables.

Results

Multiple linear regression showed that PTSD symptoms were predicted by harm avoidance (β = .34, p < .001), self-directedness (β = -.28, p < .01), and self-transcendence (β = .24, p < .01). Trait resilience was predicted by harm avoidance (β = -.38, p < .01), self-directedness (β = .20, p < .05), and self-transcendence (β = .18, p < .05). Also, PTSD symptoms had considerable negative effect on all dimensions of QoL. Self-transcendence was a positive predictor of subjective and spiritual QoL. SEM showed that QoL was predicted by PTSD symptoms (β = -.52, p < .001), trait resilience (β = .30, p < .001), cooperativeness (β = .135, p = 0.40), and self-directedness (β = .27, p < .01). The effect of self-directedness on QoL was mediated by PTSD symptoms and trait resilience. PTSD symptoms also mediated the relationship between trait resilience and QoL, and RS mediated the relationship of personality and PTSD symptoms.

Conclusion

The study gives insights on prediction of PTSD severity, trait resilience and QoL from temperament and character traits, in a sample of people exposed to the Kiss nightclub fire. Harm avoidance was the most influent trait on PTSD symptoms and trait resilience. Self-directedness was the most import trait related to QoL, still that it was more related to PTSD severity than personality traits. Self-transcendence had positive effects on both PTSD symptoms and trait resilience, indicating a coping style that may coexist with psychopathology.

Do Personality Traits Predict Functional Impairment and Quality of Life in Adult ADHD? A Controlled Study

OBJECTIVE

To examine the association of personality traits and characteristics on quality of life and functioning in adults with ADHD.

METHOD

Participants were adults with ( n = 206) and without ADHD ( n = 123) who completed the Temperament and Character Inventory (TCI), the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and the Social Adjustment Scale-Self-Report (SAS-SR). Participants also provided information on academic, motor vehicle operation, legal, social, familial, and occupational functioning. Outcomes were examined using stepwise linear regression, logistic regression (for binary outcomes), and negative binomial regression (for count outcomes) controlling for ADHD symptoms, psychiatric comorbidity, and executive dysfunction.

RESULTS

Adults with ADHD significantly differed from controls across nearly all TCI personality domains. On average, adults with ADHD endorsed more novelty seeking, harm avoidance, and self-transcendence, and less reward dependence, persistence, self-directedness, and cooperativeness. Personality traits and characteristics, especially self-directedness, significantly predicted functional impairments even after controlling for ADHD symptoms, executive function deficits, and current psychiatric comorbidities.

CONCLUSION

In adults with ADHD, personality traits exert unique associations on quality of life and functional impairment across major life domains, beyond the relations expected of and associated with ADHD symptoms and other associated psychiatric conditions and cognitive vulnerabilities. Addressing personality traits in adults with ADHD may lead to improvements in quality of life and reductions in functional impairment.

How is subjective well-being related to quality of life? Do we need two concepts and both measures?

Subjective well-being (SWB) and subjective quality of life (QoL) are key concepts describing experience, capacities, states, behaviours, appraisals, and emotional reactions to circumstances. Used widely in public discourse, policy, and research, their theoretical and empirical relations remain little explored. The present research aimed to develop an integrated model of SWB and QoL through empirically testing its overlapping and exclusive dimensions. Survey data was obtained from N = 2533 in 11 countries. Adults completed the WHOQOL Spirituality, Religion and Personal Beliefs (SRPB) instrument which assesses 33 QoL facets in 6 domains. The facets operationalize components of the hedonic SWB model, extended with eudaimonia, as SWB+. Network analyses, and regression models with random effect for cultural centre, assessed the differential contributions of SWB+ and QoL in predicting general QoL, explanatory power, and model parsimony. When all SWB+ and QoL variables are assessed together, the final model explains more variance in general QoL than either of the competing models; also it shows the most parsimonious fit. This fully integrated model contains only positive feelings from SWB+, with 13 other QoL facets drawn from all six domains, when adjusted for health status and educational level. These findings provide the foundation for a new Life Quality and Well-being (LQW) model that awaits confirmation. The LQW model improves on existing models of SWB+ and QoL by better explaining general QoL than facets of either model on its own. The 14 selected facets potentially offer a new, single measure with considerable conceptual breadth, and international foundations.

The Role of Personality in Daily Food Allergy Experiences

Food allergies present numerous challenges to coping in everyday life. Even simple things like planning a lunch with a friend can be stressful for people with food allergies. But are some people more adversely impacted by having a food allergy than other people? This paper addressed this question by investigating whether individual differences in the Big Five personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) are related to food allergy-related problems in everyday life among adults with food allergies. Participants were 108 adults (85% female; mean age = 40.2; age range 18-87) with a physician-diagnosed food allergy [most commonly to gluten (54.6%), peanuts (21.3%), cow's milk (16.7%), and shellfish/seafood (16.7%)]. Participants completed an initial online survey that measured demographics, food allergy information, and personality traits using the Big Five Inventory (John et al., 1991). For 2 weeks, participants completed a daily online survey that queried the occurrence of 25 food allergy issues that day and participants' overall stress and mood that day. Neuroticism did not predict more frequent allergy issues or greater stress/poorer mood on days with more allergy issues. Instead, higher openness to experience predicted a range of issues including going hungry because there is no safe food available, problems finding suitable foods when grocery shopping, feeling anxious at social occasions involving food, being excluded, and feeling embarrassed and poorly understood about their food allergy. Conscientious people were less embarrassed or self-conscious about their food allergy, but they had more problems eating out, and their positive mood was more impaired by allergy issues than their less conscientious peers. Extraversion and agreeableness played minor roles. Personality testing can identify people that may have difficulty living with food allergies-such as those higher in openness to experience.

Temperament and Character Traits Associated with Health-Related Quality of Life in Cancer Patients

Background

There is an increase in the attention to factors influencing the quality of life of cancer patients. The aim of the present study was to evaluate temperament and character traits related to health-related quality of life (HRQoL) in patients with cancer.

Methods

Two hundred and three inpatients from three Italian oncology departments filled in the Temperament Character Inventory (TCI-140) based on Cloninger's personality model, the SF-36 questionnaire assessing HRQoL, and the Hospital Anxiety and Depression Scale (HADS). Eighty percent of patients were undergoing chemotherapy.

Results

Lower levels of harm avoidance and higher levels of self-directedness were significantly correlated with a better HRQoL. Regression analysis controlling for psychopathology (anxiety and depression symptoms) showed that the influence of temperament and character traits on quality of life seemed to add little to the influence of psychopathology.

Conclusions

The present study demonstrates the existence of some relations between HRQoL and temperament and character traits assessed using the TCI-140 questionnaire. However, among the psychological factors, psychopathology seems to retain more influence on HRQoL of cancer patients.

The Mediation Effect of Coping Style on the Relations between Personality and Life Satisfaction in Chinese Adolescents

Previous findings showed the associations between each of the Big Five personality trait and adolescents' life satisfaction were different. Some traits (extraversion and neuroticism) correlated with adolescents' life satisfaction, while other traits did not have the same associations with adolescents' life satisfaction. In order to explain why the Big Five traits differed in their associations with adolescents' life satisfaction, the present study verified the relations between each of the Big Five personality traits and life satisfaction, and demonstrated the mediating effects of coping style on the relations between these personality traits and life satisfaction in a sample of 2,357 Chinese adolescents. The results demonstrated that four of the Big Five personality traits (extraversion, agreeableness, conscientiousness, and neuroticism) had significant associations with life satisfaction. Further, coping style partially mediated the relations between these four traits and life satisfaction, whereas coping style fully mediated the relation between openness to new experience and life satisfaction. The results implied a plausible explanation for why the Big Five traits differed in their associations with life satisfaction found among the previous literature: that there might be some partial or full mediation variables (such as coping style in this study) left unexamined. Theoretical and practical implications of this study on further research and educational practice are discussed.

Do spirituality and religiousness differ with regard to personality and recovery from depression? A follow-up study

BACKGROUND

The studies show that both spirituality and religiousness are protective for mental health. Personality is related with course and outcome of depression, as well as spirituality and religiousness, and their relations toward to recovery from depression are underresearched. This study followed influence of spirituality and religiousness on course and outcome of depression in patients with depressive episode, controlled for personality dimensions.

METHODS

The patients were assessed with self-report measures of depression (Beck Depression Inventory), spirituality (WHO-Quality of Life-Spiritual, Religious, Personal Beliefs), religiousness (Duke University Religion Index) and personality (Temperament and Character Inventory). Ninety nine patients finished a year long follow up.

RESULTS

Higher spirituality influenced recovery of depression in patients with depressive episode, but religiousness did not show to be significant predictor of recovery for depression. Dimension harm avoidance was significant predictor of improvement of depression in all points of measurement.

LIMITATIONS

Some limitations of this research are small sample size, usage of the self-report measures of depression in follow-up period, and the predominantly Catholic affiliation of the participants that can impact the generalizability of our data to other denominations.

CONCLUSION

Spirituality and dimension harm avoidance are significant predictors of recovery from depression during a year long follow up.

How temperament and character affect our career, relationships, and mental health

BACKGROUND

On the way toward an agreed dimensional taxonomy for personality disorders (PD), several pivotal questions remain unresolved. We need to know which dimensions produce problems and in what domains of life; whether impairment can be found at one or both extremes of each dimension; and whether, as is increasingly advocated, some dimensions measure personality functioning whereas others reflect style.

METHOD

To gain this understanding, we administered the Temperament and Character Inventory to a sample of 862 consecutively attended outpatients, mainly with PDs (61.2%). Using regression analysis, we examined the ability of personality to predict 39 variables from the Life Outcome Questionnaire concerning career, relationships, and mental health.

RESULTS

Persistence stood out as the most important dimension regarding career success, with 24.2% of explained variance on average. Self-directedness was the best predictor of social functioning (21.1%), and harm avoidance regarding clinical problems (34.2%). Interpersonal dimensions such as reward dependence and cooperativeness were mostly inconsequential. In general, dimensions were detrimental only in one of their poles.

CONCLUSIONS

Although personality explains 9.4% of life problems overall, dimensions believed to measure functioning (character) were not better predictors than those measuring style (temperament). The notion that PD diagnoses can be built upon the concept of "personality functioning" is unsupported.

Correlates of general quality of life are different in patients with primary insomnia as compared to patients with insomnia and psychiatric comorbidity

Chronic insomnia is known to have a negative influence on quality of life (QOL). To date, most studies on chronic insomnia have focused on health-related aspects of QOL. General QOL, which is a different construct, has not been studied in detail. Moreover, it is not known which factors are associated with general QOL in insomnia, and whether the presence of mental disorders, a condition known as comorbid insomnia, affects these variables. The present study focused on identifying sleep and psychosocial variables that might be associated with general QOL in primary and comorbid insomnia. Personality traits, coping variables, anxiety and depressive symptoms, fatigue and subjective sleep variables were assessed in 218 consecutive well-characterized patients with primary and comorbid insomnia, referred to a third line centre for sleep medicine. In primary insomnia, higher extraversion and lower discrepancies in social support were associated with higher QOL. Surprisingly, insomnia severity was not significantly associated with QOL in this group. However, lower fatigue, which can be seen as an important daytime consequence of insomnia was correlated with higher QOL in patients with primary insomnia. In both insomnia groups, low anxiety and depressive symptoms and low fatigue were associated with higher general QOL. In contrast with the primary insomnia group, lower insomnia severity was correlated with higher QOL in patients with comorbid insomnia. These results stress the importance of assessing and treating daytime fatigue in insomnia. In primary insomnia, improving social support might be an important treatment goal. Furthermore, this study supports the concept that treatment of insomnia should not be neglected in patients with comorbid insomnia. Indeed, both insomnia and indices of psychiatric disease are strongly associated with general QOL in this condition.

Association of Childhood Anxiety Disorders and Quality of Life in a Primary Care Sample

Anxiety disorders are associated with measurable deficits in quality of life (QOL) in adult samples. However, this association has largely been unexplored in pediatric samples. In this study, we examined relationships between child anxiety-including number of anxiety disorders (comorbidity), symptom severity, and subtypes of anxiety-and QOL in a pediatric primary care sample.

RESULTS

Anxiety comorbidity was common in the current sample (n = 73), with 3-quarters being diagnosed with more than one anxiety disorder. QOL in the current sample did not vary significantly by age, gender, or race/ethnicity. Both greater comorbidity and higher total anxiety symptom severity were inversely associated with QOL across multiple domains, although anxiety comorbidity did not reach significance in multivariate models adjusted for gender, income, and externalizing symptoms. On the anxiety severity subscales, both physical symptoms and social anxiety had independent associations with QOL.

CONCLUSIONS

Anxiety-related outcomes, as measured by anxiety comorbidity, symptom severity, and type of anxiety, are associated with significantly worse QOL in a pediatric sample. Providers should be aware that QOL is impacted by both severity and type of anxiety-related conditions, particularly social anxiety and somatic-related anxiety.

Personality compensates for impaired quality of life and social functioning in patients with psychotic disorders who experienced traumatic events

BACKGROUND

Patients with psychotic disorders who experienced childhood trauma show more social dysfunction than patients without traumatic experiences. However, this may not hold for all patients with traumatic experiences. Little is known about the potential compensating role of Five-Factor Model personality traits within this group, despite their strong predictive value for social functioning and well-being in the general population.

METHODS

Our sample consisted of 195 patients with psychotic disorders (74% diagnosed with schizophrenia) and 132 controls. Cluster analyses were conducted to identify and validate distinct personality profiles. General linear model analyses were conducted to examine whether patients with different profiles differed in social functioning and quality of life (QoL), while controlling for possible confounders. Mediation models were tested to assess potential causal links.

RESULTS

In general, patients with higher levels of self-reported traumatic experiences (PT+) showed lower QoL and more social withdrawal compared with patients with lower traumatic experiences (PT-). Two clusters reflecting personality profiles were identified. PT+ with the first profile (lower neuroticism and higher extraversion, openness, agreeableness, and conscientiousness) presented higher levels of QoL and better social functioning in several areas, including less withdrawal, compared with both PT+ and PT- with the second profile. PT+ and PT- with the first personality profile did not differ in QoL and social functioning. Mediation analyses suggested that personality traits mediate the relation between traumatic experiences and QoL and social withdrawal.

CONCLUSIONS

Our findings indicate that personality may "buffer" the impact of childhood traumatic experiences on functional outcome in patients with psychotic disorders.

The role of temperament and character in the outcome of depressive mood in eating disorders

OBJECTIVES

The aims were to see which temperament and character dimensions were associated with depression, mainly with its outcome at two-year follow up in eating disorders (EDs).

METHODS

Participants (N=151) were 44 Anorexia nervosa (AN), 55 Bulimia nervosa (BN) and 52 Eating disorders not otherwise specified (EDNOS) patients. The Beck Depression Inventory (BDI), State and Trait Anxiety Inventory (STAI), Rosenberg Self Esteem Questionnaire (RSE), Eating Disorder Inventory (EDI-2) and Temperament and Character Inventory (TCI) were administered.

RESULTS

Depression at the beginning (t0) was severe in 22% of the cases. Harm Avoidance and Novelty Seeking had an effect on depressed mood at t0, mediated by Ineffectiveness. Responsibility (SD1) was associated with scores on the BDI at two-year follow up (β=-0.37, 95% CI -2.6, -0.6, p<0.01).

CONCLUSION

The evaluation of personality dimension in EDs has therapeutic and prognostic implications: To enhance self-efficacy and self-directness is crucial for good clinical outcome.

Personality traits associated with suicidal behaviors in patients with depression: the CRESCEND study

The aim of the current study was to identify personality traits associated with suicidal behavior in patients with depression. Of the 1183 patients screened for an observational cohort study of depression, 334 (28.2%) who completed the Temperament and Character Inventory (TCI) were included in these analyses. To minimize the effect of current mood state, the TCI was performed 12 weeks after initiation of treatment, and we adjusted for the severity of depression. Of the 344 participants, 59 had a lifetime history of at least one suicide attempt, 37 had a lifetime history of multiple suicide attempts, and 5 attempted suicide during the 12-week study period. At baseline, patients with a lifetime history of at least one suicide attempt, a lifetime history of multiple suicide attempts, and a suicide attempt during the study period expressed more serious current suicidal ideation than did those without such a history, despite the absence of differences among the groups in the severity of depressive and anxiety symptoms. Of the seven personality scales of the TCI, lower scores on the self-directedness scale of the character dimension were associated with a history of at least one suicide attempt (OR [95% CI], 0.91 [0.87-0.96]; p<0.001), a history of multiple suicide attempts (0.91 [0.86-0.97]; p=0.003), and suicide attempts during study period (0.80 [0.69-0.94]; p=0.006). These findings suggest that depressed patients with a history of suicidal behavior differ from non-attempters with regard to personality traits, especially the character dimension of self-directedness. It is noteworthy that this result emerged after controlling for the effect of current mood state.

Temperament and character and quality of life in lung cancer patients

Aim

The aim of this study was to test whether personality variables are independently associated with health-related quality of life (HRQOL) in lung cancer patients.

Methods

In a cross-sectional study, 86 non-small cell lung cancer patients and 73 healthy subjects matched for gender and age were assessed with the Temperament and Character Inventory. In the patient group QOL was assessed with EORTC QLQ-C30. We used multiple linear regressions to determine whether personality dimensions predict HRQOL. Data on tumor stage, patient age, education and marital status were also collected.

Results

Lung cancer patients differed from healthy controls in the temperament dimension of persistence and the character dimension of self-transcendence. The temperament dimension of harm avoidance and the character dimension of cooperativeness were significant predictors of QOL functional scales and global health status.

Conclusions

In lung cancer patients, the personality dimensions of harm avoidance and cooperativeness showed associations with most QOL dimensions. Personality factors are relevant for patients' QOL perception and should be included in cancer patients' QOL assessment.

Personality traits, quality of life and perceived health in adolescents with congenital heart disease

This study investigated how the big five personality traits were related to quality of life and perceived health in adolescents with congenital heart disease (CHD). Adolescents with CHD were selected from the database of paediatric and congenital cardiology of the University Hospitals Leuven. A total of 366 adolescents (15-20 years) participated; 364 were matched on sex and age with community controls. Adolescents' personality was assessed using the quick big five, quality of life was measured using a linear analogue scale and several domains of perceived health were assessed using the paediatric quality of life inventory. Adolescents with CHD displayed similar big five levels as controls, except for a lower score on extraversion. Whereas disease-specific domains of perceived health were mainly related to emotional stability, several traits contributed to patients' quality of life and generic perceived health. Hence, the present findings demonstrate that the Big Five is a valuable framework for examining linkages between personality and disease adaptation in chronic disease populations. Moreover, these findings underscore the importance of examining patients' personality to shed light on their daily functioning. Future research should explore potential mechanisms detailing how personality influences disease adaptation over time in these patients.

Subjective Estimation of the Quality of Life in Relation to Neuroticism

It is generally agreed that personality variables have a relatively consistent influence on the subjective estimation of different situations in everyday life and the way people react to them. The aim of this review was to summarise our previously published findings on the relationship between subjective estimation of one's quality of life and the personality trait neuroticism-emotional stability. We used theWHO Quality of Life - BREFor SF-36 questionnaires for the assessment of the quality of life, Cornell Index for the assessment of neuroticism, and The Social Readjustment Rating Scale for the evaluation of common stressors. Our results have shown that more emotionally stable participants (lower neuroticism) perceive their life better in quality and are more satisfied with their work environment. In addition, our results support the findings from other studies that women have higher neuroticism and lower quality of life scores than men.

Quality of life of adolescents with asthma: the role of personality, coping strategies, and symptom reporting

OBJECTIVE

The aim of this study was to test which personality traits were related to quality of life (QOL) of adolescents with asthma, and whether relations between personality and QOL were mediated by coping strategies and symptom reporting.

METHODS

A sample of 405 12 to 16-year-olds with asthma completed questionnaires on personality, coping, symptom reporting, and QOL (overall QOL and positive effects QOL). The direct relations between personality traits and QOL, as well as mediation pathways were tested with structural equation modeling.

RESULTS

Adolescents high on extraversion and low on neuroticism had better overall QOL, while adolescents high on agreeableness had better positive-effects QOL. The coping strategy restricted lifestyle fully mediated the relation between extraversion and overall QOL, the relation between neuroticism and overall QOL was fully mediated by symptom reporting and the coping strategy worrying about asthma. The coping strategies positive reappraisal and hiding asthma fully mediated the relation between agreeableness and positive-effects QOL.

CONCLUSION

The results show that personality is related to QOL in adolescents with asthma. These relations were fully mediated by coping and symptom reporting. This study sheds light on the underlying mechanism why personality is associated with QOL. The results of this study will help to understand what determines QOL in patients with chronic illness in general and adolescents with asthma specifically. Furthermore, the results will help to design interventions that could facilitate minimizing the negative effects of having asthma on the QOL of these adolescents.

Effect of temperaments on quality of life and social adaptation in depressive patients with mood disorder

AIMS

The aim of this study was to investigate the effects of temperament on quality of life and social adaptation in depressive patients with mood disorder.

METHODS

Forty-six consecutive depressive outpatients were investigated by using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version, the Munich Personality Test, the World Health Organization Quality of Life 26 (WHO QOL 26), and the Social Adaptation Self-evaluation Scale (SASS). The unpaired t-test, Pearson's r and multiple regression analysis were used to assess three variables (age, the number of temperaments and/or personality types, and Hamilton Depression Rating Scale scores) as independent variables with the scores of WHO QOL 26 and SASS as the dependent variables.

RESULTS

The number of temperaments and/or personalities and Hamilton Depression Rating Scale scores were significantly and negatively associated with WHO QOL 26 scores while only the number of temperaments and/or personalities was significantly and negatively associated with SASS scores.

CONCLUSIONS

The findings suggest that the combination of temperaments and/or personality types assessed with the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version and the Munich Personality Test may worsen both quality of life and social adaptation and that some temperaments and/or personality types in combination may be subclinical manifestations of mood disorders.

Psychosocial factors and health as determinants of quality of life in community-dwelling older adults

PURPOSE

It is important to understand the determinants of differences in quality of life in old age and to include a wide range of possible predictors. The present study investigated the determinants of quality of life in two groups of older adults for whom there was an unusually informative set of possible predictor variables.

METHOD

Participants were members of the Lothian Birth Cohorts of 1921 (n = 550) or 1936 (n = 1,091). Four facets of quality of life (QoL) and general QoL were measured using the WHOQOL-BREF. Possible determinants included personality traits, measured with the International Personality Item Pool (IPIP) scales; childhood and old age general cognitive ability, measured with the Moray House Test; minor psychological symptoms, measured with the Hospital Anxiety and Depression Scale (HADS); physical health, assessed by grip strength and cardiovascular disease history; and sociodemographic factors, assessed by interview.

RESULTS

Linear regression analyses revealed that HADS depression had the greatest influence on quality of life. Personality traits, most notably Emotional Stability, also predicted quality of life to varying degrees, along with factors reflecting current life circumstances. There were differences between the two cohorts in the variables which predicted quality of life. There were different, conceptually relevant, contributions to the different QoL facets.

CONCLUSIONS

Personality traits and minor depressive symptoms have an important influence on self-reported quality of life in old age. Quality of life may be influenced more by current than past circumstances, and this relationship may change with age.

Relations of internalized stigma with temperament and character in patients with schizophrenia

OBJECTIVE

The aim of the study was to assess the associations between self-stigma and temperament and character dimensions.

METHODS

One hundred twenty outpatients with diagnosis of schizophrenia, established with Mini International Neuropsychiatric Interview were consecutively included in the study. Self-stigma was assessed with Internalized Stigma of Mental Illness (ISMI), personality dimensions with Temperament and Character Inventory, and psychopathology with Positive and Negative Symptom Scale.

RESULTS

The results showed that higher level of harm avoidance, lower self-directedness, and persistence correlated with ISMI and all its subscales. Self-transcendence correlated with ISMI subscales alienation, discrimination, and stigma resistance. Regression analyses controlling for psychopathology, age, length of illness, and number of hospitalizations revealed that higher level of harm avoidance and low self-directedness predicted internalized stigma.

CONCLUSION

The finding suggests that the experience of self-stigma is related to personality dimensions. Interpretations of these findings include the possibility that, irrespective of patients' psychopathology or functional characteristics, experience of self-stigma and its consequences might depend on personality dimensions. Further studies are needed.

Temperament and character personality profile in relation to suicidal ideation and suicide attempts in major depressed patients

To prevent suicidal behaviour, it is important to better understand those personality traits associated with suicidal ideation and suicide attempts. A sample of 394 consecutive major depressed outpatients admitted to Bonn University Hospital was subdivided into three groups: Lifetime suicide attempters (N=32; 8.1%), suicide ideators (N=133) and patients without suicide ideation (N=229). Psychodiagnostic measures embraced the Temperament and Character Inventory (TCI), the Symptom Checklist-90-R and the Hamilton Depression Rating Scale. Suicide attempters and ideators showed higher scores on emotional distress and depression. Analysis of covariance (covariates: age, gender, depression) revealed that suicide attempters score higher on the temperament dimension harm avoidance compared with non-attempters. Suicide ideators could be distinguished from non-ideators by character dimensions in terms of lower self-directedness and higher self-transcendence. Our findings suggest that high harm avoidance is a personality trait associated with suicide attempt in major depression, whereas low self-directedness and high self-transcendence are related to suicidal ideation. As temperament dimensions represent the "emotional core" and character dimensions the "cognitive core" of personality, we discuss whether Cloninger's psychobiological model might be helpful to distinguish between non-suicide ideators, patients who do think about suicide, and patients initiating suicidal behaviour.

Temperament and character in subjects with obsessive-compulsive disorder

BACKGROUND

The aims of this study were to evaluate the differences between personality traits of patients with obsessive-compulsive disorder (OCD) and normal controls using the Temperament and Character Inventory (TCI) and to examine the relationship of personality traits and the severity of obsessive-compulsive (OC) symptoms. We also aimed to examine the influence a particular personality trait might have on the 5 factor-analyzed symptom dimension scores of OCD.

METHOD

We recruited 130 patients with OCD and 185 age- and sex-matched normal controls. All subjects completed the TCI. Patients with OCD were assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale, and the factor-analyzed symptom dimension scores from the Y-BOCS checklist.

RESULTS

Patients with OCD had higher harm avoidance scores and lower self-directedness (SD), reward dependence (RD), and cooperativeness (C) scores than the controls. Lower SD scores and lower C scores were associated with OC symptom severity measured by the Y-BOCS after adjusting for age and depression severity. Hoarding dimension of OC symptoms was associated with lower SD scores and higher persistence (P) scores after adjusting for age, OC symptom severity, and depression severity.

CONCLUSIONS

There were significant differences in TCI subscales between patients with OCD and controls. Particular personality traits may have an influence on the severity and the dimensions of OC symptoms.

The consequences of anxious temperament for disease detection, self-management behavior, and quality of life in Type 2 diabetes mellitus

OBJECTIVE

The purpose of this study is to examine the consequences of anxious temperament for disease detection, self-management behavior, and quality of life in Type 2 diabetes mellitus (T2DM).

METHOD

A sample of 204 individuals newly diagnosed with T2DM completed measures of anxious temperament, self-management behavior, and quality of life; participants also supplied a blood sample for glycated hemoglobin (A1C) analysis at initial diagnosis (baseline) and at 6-month follow-up (as indicators of disease progression at diagnosis and achieved glycemic control, respectively).

RESULTS

Anxious temperament was inversely associated with A1C at both baseline and at 6-month follow-up. However, the association between anxious temperament and A1C at follow-up was mostly accounted for by the association between anxious temperament and baseline A1C and not by the uptake of self-management behaviors after diagnosis. Higher levels of anxious temperament were also associated with an increased likelihood of having been diagnosed with a prediabetic condition but were associated with poorer quality of life at both time points.

CONCLUSION

Anxious temperament appears to be a double-edged sword that may facilitate early detection but not subsequent behavioral or emotional adjustment to T2DM.

Personality, adherence, asthma control and health-related quality of life in young adult asthmatics

BACKGROUND

Striving for improved adherence and asthma control is of vital concern in today's asthma management. Several influential factors have been identified, but the importance of personality traits has been insufficiently explored. The aim was first to determine whether personality traits in young adult asthmatics are related to asthma control and health-related quality of life (HRQL), and second to examine the influences of personality traits on adherence to regular asthma medication treatment.

METHODS

Young adult asthmatics, 22 years of age (n=268) completed questionnaires. Statistical analyses were performed.

RESULTS

The personality traits Negative Affectivity and Impulsivity correlated negatively with asthma control, whereas in women Hedonic Capacity correlated positively with asthma control. Negative Affectivity, Impulsivity, Hedonic Capacity, Alexithymia and asthma control predicted the mental dimension of HRQL. Asthma control and physical activity predicted the physical dimension of HRQL. Among respondents with regular asthma medication (n=109), Impulsivity correlated negatively with adherence. In men, Antagonism and Alexithymia were associated with low adherence. Additionally, Alexithymia, Hedonic Capacity and Negative Affectivity showed non-linear relationships with adherence, meaning that initially increased scores on these personality traits scales were associated with increased adherence but higher scores did not increase adherence. Respondents who were prescribed a single inhaler combining ICS and LABA reported higher adherence than those with monotherapies.

CONCLUSION

These data suggest that personality can influence how asthma patients adhere to asthma medication treatment, and report their control and HRQL. Tools determining personality traits may be useful in the future in individualizing management of asthma patients.

Alexithymia, temperament and character as predictors of psychopathology in patients with major depression

The study investigated the capacity of alexithymic personality features, in combination with temperament and character traits, age and gender, to predict psychopathological symptoms in patients with major depression. Consecutive patients (n=339) were investigated using the Toronto Alexithymia Scale-20 (TAS-20), the Temperament and Character Inventory (TCI), the Symptom Checklist-90-R (SCL-90-R), and the Hamilton Depression and Anxiety Rating Scales (HDRS, HARS). The amount of variance in SCL-90-R subscales and Hamilton scales predicted by TAS-20, TCI, age and gender was calculated by linear regression analyses. The 'difficulties identifying feeling' facet of alexithymia appeared to be a significant predictor of all dimensions of psychopathology. Among TCI scales harm avoidance was the strongest predictor for somatization, phobic anxiety, and anxiety (SCL-90-R, HARS); low self-directedness was the strongest predictor for obsessionality, depression (SCL-90-R, HDRS), interpersonal sensitivity and psychoticism; and low cooperativeness was the strongest predictor for hostility and paranoia. In conclusion, many psychopathological symptoms in major depression are associated with difficulties in the identification of emotions. Relative to alexithymia, Cloninger's psychobiological model of personality could predict psychopathological symptoms in a distinct and meaningful manner. The TAS-20 and the TCI are useful questionnaires for a better understanding of the relationship between psychopathology and personality in major depression.

Quality of life in patients with chronic idiopathic urticaria: the impact of Axis I and Axis II psychiatric disorders

OBJECTIVE

Chronic idiopathic urticaria (CIU) associated with lower quality of life (QoL) levels. Psychiatric disturbances are frequently present in patients with CIU. This study examined the impact of Axis I and Axis II psychiatric disorders on the QoL of patients with CIU.

METHOD

The study sample consisted of 100 subjects including CIU patients with only Axis I psychiatric diagnoses (n=25), CIU patients with only Axis II diagnoses (n=25), CIU patients with both Axis I and Axis II diagnoses (n=25), CIU patients without any Axis I and Axis II diagnosis (n=25), and healthy control subjects with respect to urticaria and psychiatric disorders (n=25). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-1) and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders (SCID-II) was used to determine Axis I and Axis II psychiatric disorders, respectively. QoL levels were assessed by means of the World Health Organization QoL Assessment-Brief (WHOWOL-BREF).

RESULTS

There were significant differences among the groups with respect to all WHOQOL-BREF subscale scores. The QoL levels were similar among CIU patients with only Axis I psychiatric diagnoses, CIU patients with only Axis II diagnoses and CIU patients with both Axis I and Axis II diagnoses, and between CIU patients without any Axis I and Axis II diagnosis, and healthy control subjects. When compared with those of CIU patients without any Axis I and Axis II diagnosis, CIU patients without concurrent psychiatric diagnoses had significantly lower scores in most domains of the QoL scale.

CONCLUSIONS

Axis I and Axis II psychiatric disorders seem to be considerable factors influencing the QoL in CIU patients.

Psychometric characteristic of the Italian version of the Temperament and Character Inventory--revised, personality, psychopathology, and attachment styles

In this article, we described the psychometric characteristics of the revised version of the Cloninger's personality Temperament and Character Inventory (TCI-R), Italian translation. Two independent samples, which were composed of 355 and 385 nonclinical mother-language Italian subjects, respectively, completed the TCI-R. A further sample of psychiatric outpatients was compared with community samples. We analyzed the internal consistency of each dimension, the test-retest reliability and the factorial structure of the questionnaire. Furthermore, we explored the potential association between personality, psychopathologic indicators (evaluated by the Symptom Checklist-90), behavior dyscontrol measures, and adaptive and maladaptive interpersonal styles. As a whole, the internal consistency of the TCI-R scales was adequate, although some differences in Cronbach alpha values were observed between the 2 samples in some TCI-R subfacets. The factorial structure was consistent with the original hypothesis of Cloninger and test-retest showed a good stability of the scores over the time. Normal data for the Italian population were also calculated. Furthermore, the character dimensions of self-directedness and cooperativeness were related with some psychopathologic domains in our sample and negatively with impulsiveness, anger, and hostility. Novelty seeking was associated with impulsiveness, whereas harm avoidance was associated with anger and hostility. On the contrary, persistence and reward dependence were inversely correlated with such traits. Harm avoidance, reward dependence, self-directedness, and cooperativeness were strongly related with measures of attachment. Finally, significant differences were observed in both temperament and character traits between community subjects and psychiatric outpatients. In the present study, the validity of the Italian translation of the TCI-R is therefore supported. Personality features are also confirmed as risk factors for specific psychopathologic domains, impulsivity, anger, and hostility. Furthermore, we found attachment styles of nonclinical subjects correlated with personality features.

Estimating relative risks from significant family-based association studies

Two approaches are described to estimate relative risks from significant family-based association studies. They can be used to obtain either point estimates or confidence regions. The approaches are evaluated by a simulation study and illustrated by application to a real data set. It is shown that both approaches largely reduce the bias in the relative risk estimates which can occur in case that the significant outcome of the study from which the relative risks are estimated is ignored.