Stable "trait" variance of temperament as a predictor of the temporal course of depression and social phobia

Examining the Association between Punishment and Reward Sensitivity and Response Inhibition to Previously-Incentivized Cues across Development

Processing and learning from affective cues to guide goal-directed behavior may be particularly important during adolescence; yet the factors that promote and/or disrupt the ability to integrate value in order to guide decision making across development remain unclear. The present study (N = 1046) assessed individual difference factors (self-reported punishment and reward sensitivity) related to whether previously-rewarded and previously-punished cues differentially impact goal-directed behavior (response inhibition) in a large developmental sample. Participants were between the ages of 8-21 years (Mage = 14.29, SD = 3.97, 50.38% female). Previously-rewarded cues improved response inhibition among participants age 14 and older. Further, punishment sensitivity predicted overall improved response inhibition among participants aged 10 to 18. The results highlight two main factors that are associated with improvements in the ability to integrate value to guide goal-directed behaviour - cues in the environment (e.g., reward-laden cues) and individual differences in punishment sensitivity. These findings have implications for both educational and social policies aimed at characterizing the ways in which youth integrate value to guide decision making.

Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.

Developmental pathway for first onset of depressive disorders in females: from adolescence to emerging adulthood

BACKGROUND

Although risk markers for depressive disorders (DD) are dynamic, especially during adolescence, few studies have examined how change in risk levels during adolescence predict DD onset during transition to adulthood. We compared two competing hypotheses of the dynamic effects of risk. The risk escalation hypothesis posits that worsening of risk predicts DD onset beyond risk level. The chronic risk hypothesis posits that persistently elevated risk level, rather than risk change, predicts DD onset.

METHODS

Our sample included 393 girls (baseline age 13.5-15.5 years) from the adolescent development of emotions and personality traits project. Participants underwent five diagnostic interviews and assessments of risk markers for DD at 9-month intervals and were re-interviewed at a 6-year follow-up. We focused on 17 well-established risk markers. For each risk marker, we examined the prospective effects of risk level and change on first DD onset at wave six, estimated by growth curve modeling using data from the first five waves.

RESULTS

For 13 of the 17 depression risk markers, elevated levels of risk during adolescence, but not change in risk, predicted first DD onset during transition to adulthood, supporting the chronic risk hypothesis. Minimal evidence was found for the risk escalation hypothesis.

CONCLUSIONS

Participants who had a first DD onset during transition to adulthood have exhibited elevated levels of risk throughout adolescence. Researchers and practitioners should administer multiple assessments and focus on persistently elevated levels of risk to identify individuals who are most likely to develop DD and to provide targeted DD prevention.

A systematic review of sex/gender differences in the multi-dimensional neurobiological mechanisms in addiction and their relevance to impulsivity

Purpose of Review

Addiction may be characterized along three functional domains: Approach Behavior, Executive Function, and Negative Emotionality. Constructs underlying impulsivity thought to be relevant in addiction map on to these three functional domains. The purpose of the present review was to evaluate the extant research regarding sex/gender differences in the multi-dimensional domains of addiction using human neuroimaging and discuss their relevance to impulsivity.

Recent Findings

Few papers over the past two decades have used human neuroimaging to test sex/gender differences in addiction. There is therefore a significant gap in the literature regarding sex/gender differences in the neurobiological mechanisms driving the multi-dimensionality of addiction and their implications to impulsivity.

Summary

Of the 34 reviewed papers, the orbitofrontal cortex/ventromedial prefrontal cortex (OFC/vmPFC) was the most frequently reported brain region to evidence a sex/gender difference during fMRI tasks probing Approach Behavior and Negative Emotionality. This finding suggests potential sex/gender-specific patterns of subjective valuation in substance misuse, driven by OFC/vmPFC dysregulation.

Longitudinal associations of neuroticism with life satisfaction and social adaptation in a nationally representative adult sample

OBJECTIVE

Correlational studies have frequently linked neuroticism to lower well-being and poorer social adaptation. In this study, we examined the longitudinal associations of neuroticism with life satisfaction and aspects of social adaptation (i.e., loneliness, number of close friends, and interpersonal trust).

METHOD

Cross-lagged panel models (CLPMs) and random intercepts cross-lagged panel models (RI-CLPMs) were used to analyze the prospective associations between variables in a nationally representative adult sample from Germany (N = 5,663 to 11,079 per analysis; 2-4 measurement waves with lags of 4-5 years).

RESULTS

CLPMs indicated that higher neuroticism was related to lower life satisfaction, higher loneliness, fewer friends, and lower interpersonal trust, but not vice versa. At the within-person level, RI-CLPMs revealed similar findings with increased neuroticism predicting decreases in life satisfaction, increases in loneliness, and decreases in interpersonal trust. Indices of social adaptation partially mediated the link between neuroticism and life satisfaction at the between-person but not at the within-person level. Exploratory multigroup analyses support the generalization of the cross-lagged effects of neuroticism on life satisfaction and social adaptation across age, gender, and geographical regions (East versus West Germany).

CONCLUSIONS

These findings highlight the role of neuroticism in shaping psychosocial outcomes over time.

Linking repetitive negative thinking and insomnia symptoms: A longitudinal trait-state model

Sleep disturbance is highly debilitating, and an abundance of research suggests that repetitive negative thinking (i.e., rumination, worry) may contribute to the development and maintenance of maladaptive sleep patterns, such as insomnia symptoms. Although repetitive negative thinking is often conceptualized as a 'trait' risk factor for anxiety-related disorders, it is unclear if it consists of time-varying (TV) or state-like features versus time-invariant (TI) or trait-like characteristics. Furthermore, it is unclear if it is the TV or TI components of repetitive negative thinking that contribute to insomnia symptoms that is commonly observed in anxiety-related disorders. In a 6-wave, 5-month longitudinal study, community participants (N = 1219) completed measures of rumination, worry, transdiagnostic repetitive negative thinking, and insomnia symptoms. A latent variable (trait-state-occasion) model was applied to the measures of repetitive negative thinking. The results showed that although estimates of TI factor variance and TV factor variance were both significant for latent repetitive negative thinking, worry, and rumination, the proportion of TI factor variance (0.82-0.89) was greater than the amount of TV factor variance (0.11-0.19). Although TV factor stability was statistically significant for latent repetitive negative thinking, rumination, and worry, the magnitude of the coefficients was small. Furthermore, regression weights for the latent repetitive negative thinking, rumination, and worry TI factor were significant and larger than those for the TV factor in predicting insomnia symptoms at each of the six time points. These findings suggest that repetitive negative thinking is largely TI, and it is this TI component that contributes to insomnia symptoms. Implications for conceptualizations of repetitive negative thinking as a predisposing and perpetuating factor in insomnia for anxiety and related disorders are discussed.

Developing Transdiagnostic Internalizing Disorder Prognostic Indices for Outpatient Cognitive Behavioral Therapy

A growing literature is devoted to understanding and predicting heterogeneity in response to cognitive behavioral therapy (CBT), including using supervised machine learning to develop prognostic models that could be used to inform treatment planning. The current study developed CBT prognostic models using data from a broad dimensionally oriented pretreatment assessment (324 predictors) of 1,210 outpatients with internalizing psychopathology. Super learning was implemented to develop prognostic indices for three outcomes assessed at 12-month follow-up: principal diagnosis improvement (attained by 65.8% of patients), principal diagnosis remission (56.8%), and transdiagnostic full remission (14.3%). The models for principal diagnosis remission and transdiagnostic remission performed best (AUROCs = 0.71-0.73). Calibration was modest for all three models. Three-quarters (77.3%) of patients in the top tertile of the predicted probability distribution achieved principal diagnosis remission, compared to 35.0% in the bottom tertile. One-third (35.3%) of patients in the top two deciles of predicted probabilities for transdiagnostic complete remission achieved this outcome, compared to 2.7% in the bottom tertile. Key predictors included principal diagnosis severity, social anxiety diagnosis/severity, hopelessness, temperament, and global impairment. While additional work is needed to improve performance, integration of CBT prognostic models ultimately could lead to more effective and efficient treatment of patients with internalizing psychopathology.

Subtypes in addiction and their neurobehavioral profiles across three functional domains

Rates of return to use in addiction treatment remain high. We argue that the development of improved treatment options will require advanced understanding of individual heterogeneity in Substance Use Disorders (SUDs). We hypothesized that considerable individual differences exist in the three functional domains underlying addiction-approach-related behavior, executive function, and negative emotionality. We included N = 593 participants from the enhanced Nathan Kline Institute-Rockland Sample community sample (ages 18-59, 67% female) that included N = 420 Controls and N = 173 with past SUDs [54% female; N = 75 Alcohol Use Disorder (AUD) only, N = 30 Cannabis Use Disorder (CUD) only, and N = 68 Multiple SUDs]. To test our a priori hypothesis that distinct neuro-behavioral subtypes exist within individuals with past SUDs, we conducted a latent profile analysis with all available phenotypic data as input (74 subscales from 18 measures), and then characterized resting-state brain function for each discovered subtype. Three subtypes with distinct neurobehavioral profiles were recovered (p < 0.05, Cohen's D: 0.4-2.8): a "Reward type" with higher approach-related behavior (N = 69); a "Cognitive type" with lower executive function (N = 70); and a "Relief type" with high negative emotionality (N = 34). For those in the Reward type, substance use mapped onto resting-state connectivity in the Value/Reward, Ventral-Frontoparietal and Salience networks; for the Cognitive type in the Auditory, Parietal Association, Frontoparietal and Salience networks; and for the Relief type in the Parietal Association, Higher Visual and Salience networks (pFDR < 0.05). Subtypes were equally distributed amongst individuals with different primary SUDs (χ2 = 4.71, p = 0.32) and gender (χ2 = 3.44, p = 0.18). Results support functionally derived subtypes, demonstrating considerable individual heterogeneity in the multi-dimensional impairments in addiction. This confirms the need for mechanism-based subtyping to inform the development of personalized addiction medicine approaches.

Dynamic risk for first onset of depressive disorders in adolescence: does change matter?

BACKGROUND

Risk factors for depressive disorders (DD) change substantially over time, but the prognostic value of these changes remains unclear. Two basic types of dynamic effects are possible. The 'Risk Escalation hypothesis' posits that worsening of risk levels predicts DD onset above average level of risk factors. Alternatively, the 'Chronic Risk hypothesis' posits that the average level rather than change predicts first-onset DD.

METHODS

We utilized data from the ADEPT project, a cohort of 496 girls (baseline age 13.5-15.5 years) from the community followed for 3 years. Participants underwent five waves of assessments for risk factors and diagnostic interviews for DD. For illustration purposes, we selected 16 well-established dynamic risk factors for adolescent depression, such as depressive and anxiety symptoms, personality traits, clinical traits, and social risk factors. We conducted Cox regression analyses with time-varying covariates to predict first DD onset.

RESULTS

Consistently elevated risk factors (i.e. the mean of multiple waves), but not recent escalation, predicted first-onset DD, consistent with the Chronic Risk hypothesis. This hypothesis was supported across all 16 risk factors.

CONCLUSIONS

Across a range of risk factors, girls who had first-onset DD generally did not experience a sharp increase in risk level shortly before the onset of disorder; rather, for years before onset, they exhibited elevated levels of risk. Our findings suggest that chronicity of risk should be a particular focus in screening high-risk populations to prevent the onset of DDs. In particular, regular monitoring of risk factors in school settings is highly informative.

Associations Between Personality and Depressive Symptoms in an Adolescent Clinical Population: Consideration of Personality Stability

The study used trait-state-occasion TSO models to explore longitudinal personality stability in young adolescents with the onset of depressive symptoms and to quantify time-invariant and time-varying personality components in predicting the course of depressive symptoms. A total of 326 young clinical adolescents were recruited from high schools, and only 290 adolescents (112 boys; 178 girls) were followed up for 4 time points. Personality measures were implemented twice each year with an interval of 6 months, providing four assessment waves (T1 to T4); depression measures were administered at the initial stage (T1) and the third wave (T3), respectively. The results showed that five domains of personality in adolescents with depressive symptoms were largely characterized by the stable trait factor (65%-81%). The average autoregressive effects across the four waves were significant for all Big Five personality domains except openness. Moreover, excluding time-varying variance, conscientiousness, extraversion and agreeableness were negatively associated with T1 depressive symptoms; however, only the latter two domains retained significant relationships in the second year of intervention. An elevated level of neuroticism was consistently associated with higher levels of depressive symptoms over interventions. Trait factors of extraversion, agreeableness and neuroticism were associated with depressive symptoms in early adolsecnets, providing some implications for clinical practitioners.

Time-Varying and Time-Invariant Dimensions in Intolerance of Uncertainty: Specificity in the Prediction of Obsessive-Compulsive Symptoms

Intolerance of uncertainty (IU) is the tendency to respond negatively toward uncertain situations. IU consists of a Prospective factor (desire for predictability) and an Inhibitory factor (uncertainty paralysis) and is central to theoretical approaches to obsessive-compulsive disorder (OCD). However, time-invariant (TI) and time-varying (TV) components of IU and their association with OCD symptoms are not yet understood. The present study examined the association between TI and TV components of IU and OCD symptoms in community adults (N = 1,280) over a 5-month period. Latent variable models were fit to the data to examine the relative impact of TI and TV components of IU on OCD symptoms. As a test of specificity, models examining the association between TI and TV components of IU and depressive symptoms were also examined. The results showed that IU consists of significant TI and TV components, although the TI component accounted for most of the variance (76-84%) and was more strongly associated with OCD and depressive symptoms than the TV component. Furthermore, the TI component of IU was strongly associated with OCD symptoms when controlling for depressive symptoms, and the TI component of IU was strongly associated with depressive symptoms when controlling for OCD symptoms. A consistent pattern was observed for both Prospective and Inhibitory IU factors, with stable TI components demonstrating stronger relations with OCD and depressive symptoms than TV components. These findings have implications for conceptualizing the TI component of IU as a risk for OCD and other emotional disorders.

How a transdiagnostic approach can improve the treatment of emotional disorders: Insights from clinical psychology and neuroimaging

Multiple psychological treatments for emotional disorders have been developed and implemented, improving the quality of life of individuals. Nevertheless, relapse and poor response to psychotherapy are common. This article argues that a greater understanding of both the psychological and neurobiological mechanisms of change in psychotherapy is essential to improve treatment for emotional disorders. It aims to demonstrate how an understanding of these mechanisms provides a basis for (i) reconceptualizing some mental disorders, (ii) refining and establishing the evidence for existing therapeutic techniques and (iii) designing new techniques that precisely target the processes that maintain these disorders. Possible future directions for researchers and practitioners working at the intersection of neuropsychology and clinical psychology are discussed.

A longitudinal trait-state model of attentional control: Implications for repetitive negative thinking

BACKGROUND

Attentional control refers to the ability to direct, focus, and shift attention voluntarily, and poor attentional control may confer risk for various affective disorders by increasing repetitive negative thinking. Although attentional control has been described as a trait, it is unclear if it is a time-varying (TV) or state-like factor versus a time-invariant (TI) or trait-like personality characteristic.

METHODS

In a 6-wave, 5-month longitudinal study, community participants (n = 1,251) completed the Attentional Control Scale (Derryberry & Reed, 2002), the most commonly used measure of attentional control that includes two components: Focusing and Shifting. A latent variable (trait-state-occasion) model was applied to the two components.

RESULTS

The results showed that although estimates of TI factor variance and TV factor variance were both significant for Focusing and Shifting, the proportion of TI factor variance (0.81, 0.77) was significantly greater than the amount of TV factor variance (0.18, 0.22). Furthermore, although TV factor stability was statistically significant for Focusing and Shifting, the size of the coefficients was small to moderate in magnitude. In predicting latent repetitive negative thinking at each of the six time points, regression weights for the attentional control TI factor were significant and larger than those for the TV factor (which were generally not significant).

LIMITATIONS

Relatively short timeframe of 5 months and exclusive reliance on self-report measures.

CONCLUSIONS

These findings suggest that self-reported attentional control is largely TI and that it is this TI component that predicts repetitive negative thinking.

Facets of Emotion Regulation and Emotional Disorder Symptom Dimensions: Differential Associations and Incremental Validity in a Large Clinical Sample

A growing literature suggests robust associations between dimensions of emotion regulation and emotional disorder psychopathology. However, limited research has investigated associations of emotion regulation dimensions across several emotional disorders (transdiagnostic associations), or the incremental validity of emotion regulation versus the higher-order construct of neuroticism. The current study used exploratory structural equation modeling and a large clinical sample (N = 1,138) to: (a) develop a multidimensional emotion regulation measurement model, (b) evaluate the differential associations between latent emotion regulation dimensions and five latent emotional disorder symptom dimensions (social anxiety, depression, agoraphobia/panic, obsessions/compulsions, generalized worry), and (c) determine the incremental contribution of emotion regulation in predicting symptom dimensions beyond neuroticism. The best-fitting measurement model of emotion regulation included four dimensions: Problematic Responses, Poor Recognition/Clarity, Negative Thinking, and Emotional Inhibition/Suppression. Although many zero-order associations between the four latent emotion regulation dimensions and five latent symptom dimensions were significant, few associations remained significant in a structural regression model that included neuroticism. Specifically, Negative Thinking and Problematic Responses incrementally predicted depression symptoms, while Emotional Inhibition/Suppression predicted both social anxiety and depression symptoms. Associations between neuroticism and the emotional disorder dimensions were similar regardless of whether the emotion regulation dimensions were held constant. These results suggest that self-reported emotion regulation dimensions are associated with the severity and expression of a range of emotional disorder symptoms, but that some emotion regulation dimensions have limited incremental validity after accounting for general emotional reactivity. Studies of emotion regulation should assess neuroticism as a key covariate.

Stability and Change in Relations Between Personality Traits and the Interpersonal Problems Circumplex During Cognitive Therapy for Recurrent Depression

Both personality impairment and maladaptive-range traits are necessary for diagnosis in the alternative model of personality disorder. We clarified personality impairment-trait connections using measures of the interpersonal problems circumplex and personality traits among adult outpatients (N = 351) with major depressive disorder receiving cognitive therapy (CT). The trait scales' circumplex projections were summarized by elevation (correlations with general interpersonal problems), amplitude (specific relations to the circumplex dimensions of dominance and affiliation), and angle (predominant orientation in the two-dimensional circumplex). Most trait scales showed hypothesized circumplex relations, including substantive elevation (e.g., negative temperament, mistrust), amplitude (e.g., aggression, detachment), and expected angles (e.g., positive temperament and manipulativeness oriented toward overly nurturant/intrusive or domineering/vindictive problems, respectively), that were stable across time during CT. These results revealed meaningful and consistent impairment-trait connections, even during CT when mean depressive affect decreased substantially.

Testing explanatory models of the interplay between depression, neuroticism, and stressful life events: a dynamic trait-stress generation approach

BACKGROUND

Classic conceptual frameworks explaining the relationship of personality traits to depression include the precursor and predisposition models. The former hypothesizes that depression is predicted by traits alone whereas the latter hypothesizes that stress, together with personality, predicts depression. Dynamic vulnerability models (DVM) expand on these perspectives by incorporating fluctuations in personality over time. The stress generation model provides an alternative view, positing that depression generates stress, creating a self-perpetuating cycle. However, these conceptual models are rarely directly compared.

METHOD

We tested these models, focusing on neuroticism and stressful life events that the participant may have contributed to, using path analysis in a sample of 550 never-depressed, adolescent females assessed five times over 3 years.

RESULTS

A dynamic precursor model with stress generation was best supported. For the precursor component, neuroticism predicted subsequent depression across four assessment intervals. For the dynamic trait component, stressful life events predicted subsequent neuroticism at three of four intervals. Finally, in line with stress generation, depression consistently predicted subsequent stressful life events, and life events then predicted depression.

CONCLUSIONS

Finding support for the DVM is noteworthy, as this is the first comprehensive test of this model. Moreover, results supported integrating stress generation with trait vulnerability. Continued use of integrated approaches and refining the statistical implementation of these theories is necessary to advance understanding of the development of depression.

The dual-system theory of bipolar spectrum disorders: A meta-analysis

Bipolar spectrum disorders are characterized by alternating intervals of extreme positive and negative affect. We performed a meta-analysis to test the hypothesis that such disorders would be related to dysregulated reinforcement sensitivity. First, we reviewed 23 studies that reported the correlation between self-report measures of (hypo)manic personality and measures of reinforcement sensitivity. A large relationship was found between (hypo)manic personality and BAS sensitivity (g = .74), but not with BIS sensitivity (g = -.08). This stands in contrast to self-reported depression which has a small, negative relationship with BAS sensitivity and a large positive one with BIS sensitivity (Katz et al., 2020). Next, we reviewed 33 studies that compared reinforcement sensitivity between euthymic, bipolar participants and healthy controls. There, bipolar disorder had a small, positive relationship with BAS sensitivity (g = .20) and a medium, positive relationship with BIS sensitivity (g = .64). These findings support a dualsystem theory of bipolar disorders, wherein BAS sensitivity is more closely related to mania and BIS sensitivity more closely to bipolar depression. Bipolar disorders show diatheses for both states with euthymic participants being BAS- and BIS- hypersensitive. Implications for further theory and research practice are expounded upon in the discussion.

Is personality stable in adolescence? Disentangling time-invariant and time-varying factors of personality in a trait-state-occasion model

This study applied trait-state-occasion (TSO) modelling to investigate the extent to which inter-individual differences in personality were accounted for by time-invariant and time-varying factors during adolescence. The participants were 753 high school students, and only 661 students were followed for 4 years. The mean age in the first year was 15.23 years and 52.8% were females. The results showed that the full TSO model had the best representation of adolescent personality, and the means of the proportions of variance explained by trait factors for the Big Five ranged between 56% and 83%, suggesting that inter-individual differences in personality are mainly accounted for by stable trait variance over the course of adolescence. Furthermore, the five dimensions of personality differed not only in the amounts of trait variance but also in the stability of time-varying factors. These findings have significant implications for personality research.

The longitudinal structure of disgust proneness: Testing a latent trait-state model in relation to obsessive-compulsive symptoms

Although disgust proneness (DP) is increasingly recognized as a personality characteristic that confers risk for psychiatric conditions such as obsessive-compulsive disorder (OCD), the extent to which it reflects a time-varying (TV) or state-like factor versus a time-invariant (TI) or trait-like personality characteristic is unclear. In a 6-wave, 5-month longitudinal study, community participants (n = 982) recruited through ResearchMatch completed the Disgust Propensity and Sensitivity Scale Revised (van Overveld, de Jong, Peters, Cavanagh, & Davey, 2006), a measure of three variants of DP including Somatic Disgust Sensitivity, Ruminative Disgust Sensitivity, and Disgust Propensity. A latent variable (trait-state-occasion) model was applied to all of the DP dimensions. The results showed that although estimates of TI factor variance and TV factor variance were both significant for Somatic Disgust, Ruminative Disgust, and Disgust Propensity, the proportion of TI factor variance (range from .68 to .82) for the DP dimensions was substantially and significantly greater than the amount of TV factor variance (range from .18 to .32). Furthermore, while TV factor stability was statistically significant for the DP dimensions, the size of the coefficients were only moderate in magnitude. Subsequent analysis then examined the extent to which TV or TI components of DP were associated with latent OCD symptoms at each of the six time points. The results showed that estimates of the regression weight for the TI DP factor were significant and larger than those for the TV factor which were often nonsignificant. These findings suggest that DP is largely TI, and it is this TI component that is most strongly associated with OCD symptoms.

Distinct Risk Profiles in Social Anxiety Disorder

Using a factor mixture model (FMM) approach, this study examined if SAD could be subtyped by distinct risk profiles, and whether these subtypes predicted different manifestations of the disorder. We derived risk profiles from neurotic temperament (NT), positive temperament (PT), and autonomic arousability (AA), which are hypothesized to be important in the maintenance of anxiety disorders such as SAD. In our sample of 758 SAD outpatients, a two-class FMM solution fit the data best. Class 1 was characterized by very low PT whereas PT in Class 2 was substantially higher. The two classes differed to a lesser extent on NT, but were virtually equivalent on AA. Class 1 had significantly more males, individuals with depressive disorders, generalized SAD, and higher SAD severity. Class 2 had more individuals with performance subtype SAD. These findings provide initial support for distinct risk profiles within SAD that may be predictive of its clinical expression.

Mid-life predictors of late-life depressive symptoms; determining risk factors spanning two decades in the Women's Heathy Ageing Project

Background

Data available from longitudinal studies of adequate duration to explore midlife risk factors for late life higher depressive symptom scores in women is lacking. This study examines midlife (mean ages 50 years and 60 years) predictors of late life (mean age 70 years) depressive symptom scores to enrich our understanding of the role of changing risk factors across the lifespan.

Methods

This investigation was an assessment of the long-term impact of lifestyle and health variables on depressive symptoms. Data were drawn from an epidemiological prospective study of women's healthy ageing spanning two decades. Variables included assessment of mood, demographics, physical health, smoking status, attitudes towards ageing and menopause, alcohol consumption and employment. Analysis was conducted to determine the set of strongest predictors assessed in 1992 (mean age 50 years) and in 2002 (mean age 60 years) in relation to higher CESD-SF scores measured in 2012 (mean aged 70 years (n = 249)). A cross-sectional analysis determining concurrent associations at mean age 70 years was also conducted.

Results

An increase in positive mood at 50 and 60 years was associated with a 0.3 (95% CI 0.1-0.5) and 0.4 (95%CI 0.1-0.8) point reduction in CESD score at 70 years respectively. An increase in Hassles score at age 50 was associated with a 0.18-point increase in CESD (95% CI 0.01-0.05) 20 years later. However, no relationship was observed between Hassles score at 60 and CESD 10 years later. Analysis of concurrent risk factors demonstrated that bothersome symptom frequency and higher anxiety were associated with higher depressive symptom scores when women were 70 years.

Conclusion

Low levels of positive mood were consistently associated with depressive symptoms scores 10 and 20 years later, suggesting clinical interventions aimed at improving positive affect may be particularly useful across the midlife.

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

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

The contributions of affective traits and emotion regulation to internalizing disorders: Current state of the literature and measurement challenges

Dysfunctional affective processes are central to the experience of internalizing disorders (e.g., depression, anxiety, and related disorders). Specifically, extreme positive affect and elevated negative affect each have unique and robust patterns of associations with internalizing symptoms. This article examines affect as both an individual difference and a within-person dynamic process that unfolds over time. Recent research is reviewed that clarifies the hierarchical structure of affect and facet-level associations with symptoms, affect-laden traits that confer risk for internalizing psychopathology, models of emotion regulation, and how emotion regulation abilities and strategies contribute to or detract from psychological well-being. Several measurement challenges in this literature are identified and discussed, including possible conceptual and content overlap, mood-state distortion, naturalistic assessment in daily life, and the benefits and limitations of self-reported affective experience. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Distress and anhedonia as predictors of depression treatment outcome: A secondary analysis of a randomized clinical trial

Two core features of depression include depressed mood (heightened distress) and anhedonia (reduced pleasure). Despite their centrality to depression, studies have not examined their contribution to treatment outcomes in a randomized clinical trial providing mainstream treatments like antidepressant medications (ADM) and cognitive therapy (CT). We used baseline distress and anhedonia derived from a factor analysis of the Mood and Anxiety Symptom Questionnaire to predict remission and recovery in 433 individuals with recurrent/chronic major depressive disorder. Patients were provided with only ADM or both ADM and CT. Overall, higher baseline distress and anhedonia predicted longer times to remission within one year and recovery within three years. When controlling for treatment condition, distress improved prediction of outcomes over and above anhedonia, while anhedonia did not improve prediction of outcomes over and above distress. Interactions with treatment condition demonstrated that individuals with higher distress and anhedonia benefited from receiving CT in addition to ADM, whereas there was no added benefit of CT for individuals with lower distress and anhedonia. Assessing distress and anhedonia prior to treatment may help select patients who will benefit most from CT in addition to ADM. For the treatments and outcome measures tested, utilizing distress to guide treatment planning may yield the greatest benefit. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00057577.

Bringing light into darkness: A multiple baseline mixed methods case series evaluation of Augmented Depression Therapy (ADepT)

Two core features of depression are elevations in negative valence system (NVS) functioning and reductions in positive valence system (PVS) functioning. Existing psychological treatments have focused on the NVS and neglected the PVS, which may contribute to sub-optimal outcomes. The present mixed methods multiple randomised baseline case series preliminarily evaluates Augmented Depression Therapy (ADepT), a novel depression treatment targeting PVS and NVS disturbance, that aims both to reduce depression and enhance wellbeing. Eleven clinically depressed participants were recruited. Intensive time series analyses showed that 7/11 participants improved on both wellbeing and depression. Reliable and clinically significant improvement was observed for 9/11 participants on at least one of these outcomes (and also across a range of other PVS and NVS outcomes). Group level analyses showed significant pre to post change on all outcomes. Benchmarking analyses indicated these effect sizes were at least comparable (and for some PVS outcomes superior) to existing treatments. Gains were largely sustained over one-year follow-up. Qualitative interviews indicated ADepT was feasible and acceptable. These findings provide preliminary support for ADepT as a novel depression treatment. Further evaluation, directly comparing ADepT to existing treatments using randomised controlled trial designs, is now required.

Neuroticism Level and Life Satisfaction in Women Undergoing Breast Augmentation Surgery (a Preliminary Report)

Background

The aim of the present study was to verify the relationship between the level of neuroticism and selected aspects of life satisfaction in women undergoing breast augmentation surgery.

Methods

The study group included 109 women, aged 18–46 years, who completed the self-developed survey measuring selected psychological traits before and after (1 year) surgery. Four questions in this survey were related to the level of neuroticism and two pertained to the self-assessment of leading character traits and the level of life satisfaction. Three questions made up the lie scale.

Results

The studied women were constant in their truthfulness. No statistically significant difference in the level of neuroticism before and after surgery was noticed. However, an increase in the subjective life satisfaction after surgery was highly significant (p < 0.001). Statistically significant negative correlations of neuroticism level with the self-assessment of positive character traits (r_s = − 0.236; p = 0.013) and life satisfaction (r_s = − 0.277; p = 0.004) were found before surgery. Also, a significant positive correlation was observed between neuroticism and the change in life satisfaction 1 year after surgery (r_s = 0.302; p = 0.001).

Conclusions

Breast augmentation surgery did not affect neuroticism level, which proves that constitutional personality traits in women undergoing such operations are not significantly influenced by a surgical intervention. However, neuroticism may play the role of a modulator of the psychological changes in women after breast augmentation (e.g., an increased postsurgical life satisfaction). The preliminary results obtained in our study should be confirmed on a larger sample size in the future.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Multidimensional Emotional Disorder Inventory (MEDI): Assessing transdiagnostic dimensions to validate a profile approach to emotional disorder classification

There has been limited progress evaluating the validity of dimensional approaches to emotional disorder classification. This has occurred in part because of a lack of standardized assessment tools developed with the specific intent of studying dimensional classification. The goal of the current study was to develop and validate the Multidimensional Emotional Disorder Inventory (MEDI) to efficiently assess nine empirically supported transdiagnostic dimensions proposed in the Brown and Barlow (2009) profile approach to emotional disorder classification: neurotic temperament, positive temperament, depression, autonomic arousal, somatic anxiety, social anxiety, intrusive cognitions, traumatic reexperiencing, and avoidance. The MEDI factor structure, reliability, and convergent/discriminant validity was evaluated in outpatients with emotional disorders (pilot sample = 227; validation sample = 780). The final 9-factor solution fit the data well. Intercorrelations among MEDI factors were consistent with previous research, and all MEDI dimensions had acceptable reliability. Correlations with common self-report questionnaires and DSM-5 diagnoses supported the convergent/discriminant validity of all nine MEDI dimensions. Collectively, these results support the use of 49-item MEDI in clinical research samples. The MEDI should be used in future research to evaluate the validity of the Brown and Barlow (2009) approach to emotional disorder classification. Because it provides an efficient assessment of several well-established emotional disorder traits and phenotypes, the MEDI also may have utility for general research or clinical purposes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Borderline personality disorder is equally trait-like and state-like over ten years in adult psychiatric patients

Borderline personality disorder (PD) has historically been cast as an unabating condition. Longitudinal data, however, support a more variable time course marked by remission and relapse. In the present study, we tested the possibility that borderline PD has both stable (i.e., consistently present across time and situation, as modern diagnostic systems stipulate) and dynamic (i.e., episodic and situational) elements. Participants were 668 patients from the Collaborative Longitudinal Personality Disorders Study who were administered semistructured diagnostic interviews 5 times over a decade. Trait-state-occasion modeling dissected borderline pathology into time-invariant (i.e., trait) and time-varying (i.e., state) components. Contradicting traditional views of PD intransigence, less than half of borderline PD variability (approximately 45%) was time-invariant (i.e., perfectly stable) over the study timeframe. Furthermore, we found that the time-invariant component of borderline pathology, which we termed borderline proneness, was very closely related (r = .81) to a previously validated Five Factor Model trait composite of borderline features. Moreover, the trait versus state components showed a clear pattern of discriminant validity in relation to several putative causal agents for borderline PD (i.e., environmental pathogens, temperament dimensions). We conclude that borderline pathology contains a stable core and sizable situational components, and that both elements relate systematically to normative personality dimensions and known risk factors. These findings have key implications for etiological research, prognosis, and treatment for borderline PD. (PsycINFO Database Record

Positive and Negative Affect as Links Between Social Anxiety and Depression: Predicting Concurrent and Prospective Mood Symptoms in Unipolar and Bipolar Mood Disorders

The co-occurrence of social anxiety and depression is associated with increased functional impairment and a more severe course of illness. Social anxiety disorder is unique among the anxiety disorders in sharing an affective profile with depression, characterized by low levels of positive affect (PA) and high levels of negative affect (NA). Yet it remains unclear how this shared affective profile contributes to the covariation of social anxiety and depressive symptoms. We examined whether self-reported PA and NA accounted for unique variance in the association between social anxiety and depressive symptoms across three groups (individuals with remitted bipolar disorder, type I [BD; n = 32], individuals with remitted major depressive disorder [MDD; n = 31], and nonpsychiatric controls [n = 30]) at baseline and follow-ups of 6 and 12 months. Low levels of PA, but not NA, accounted for unique variance in both concurrent and prospective associations between social anxiety and depression in the BD group; in contrast, high levels of NA, but not PA, accounted for unique variance in concurrent and prospective associations between social anxiety and depression in the MDD group. Limitations include that social anxiety and PA/NA were assessed concurrently and all measurement was self-report. Few individuals with MDD/BD met current diagnostic criteria for social anxiety disorder. There was some attrition at follow-up assessments. Results suggest that affective mechanisms may contribute to the high rates of co-occurrence of social anxiety and depression in both MDD and BD. Implications of the differential role of PA and NA in the relationship between social anxiety and depression in MDD and BD and considerations for treatment are discussed.

Time-varying and time-invariant dimensions of depression in children and adolescents: Implications for cross-informant agreement

The longitudinal structure of depression in children and adolescents was examined by applying a Trait-State-Occasion structural equation model to 4 waves of self, teacher, peer, and parent reports in 2 age groups (9 to 13 and 13 to 16 years old). Analyses revealed that the depression latent variable consisted of 2 longitudinal factors: a time-invariant dimension that was completely stable over time and a time-varying dimension that was not perfectly stable over time. Different sources of information were differentially sensitive to these 2 dimensions. Among adolescents, self- and parent reports better reflected the time-invariant aspects. For children and adolescents, peer and teacher reports better reflected the time-varying aspects. Relatively high cross-informant agreement emerged for the time-invariant dimension in both children and adolescents. Cross-informant agreement for the time-varying dimension was high for adolescents but very low for children. Implications emerge for theoretical models of depression and for its measurement, especially when attempting to predict changes in depression in the context of longitudinal studies. (PsycINFO Database Record

Three-way Interaction of Neuroticism, Extraversion, and Conscientiousness in the Internalizing Disorders: Evidence of Disorder Specificity in a Psychiatric Sample

It is well-established that neuroticism, extraversion, and conscientiousness are individually associated with internalizing disorders, but research suggests that these main effects may be qualified by a three-way interaction when predicting depression. The current study was the first to examine this three-way interaction in a psychiatric sample (N=463) with a range of internalizing symptoms as the outcomes. Using two omnibus personality inventories and a diagnostic interview, the expected three-way interaction emerged most consistently for symptoms of major depression, and there was also evidence of synergistic effects for post-traumatic stress disorder and generalized anxiety disorder. Findings indicate that, even in a clinically-distressed and currently-disordered sample, high levels of extraversion and conscientiousness protect against distress disorders for those with high levels of neuroticism.

Anxiety Disorders and Temperament-an Update Review

PURPOSE OF REVIEW

The review focused on associations between temperament dimensions and clinical features in different anxiety disorders, likewise in obsessive-compulsive disorder in clinical samples of adults. A literature search was conducted in the Medline and PsycINFO databases covering the years 2010-2016. A systematic review and grading of the level of evidence for an association between temperament dimension scores and clinical features in each disorder were performed.

RECENT FINDINGS

Twenty papers reporting 18 different studies were included. Five of the papers focused on panic disorder (PD), five on social anxiety disorder (SAD), three on post-traumatic stress disorder (PTSD), one on generalized anxiety disorder (GAD), three on obsessive-compulsive disorder (OCD), and an additional three papers on several anxiety disorders. The review consolidates the finding that trait anxiety, especially as assessed by Cloninger's model or the five-factor model, is a phenomenon common to all anxiety disorders and OCD. More follow-up studies including large samples are needed to differentiate the dimensional profiles of trait anxiety in specific disorders.

A comparison and integration of structural models of depression and anxiety in a clinical sample: Support for and validation of the tri-level model

Prominent structural models of depression and anxiety arise from 2 traditions: (a) the tripartite/integrative hierarchical model based on symptom dimensions, and (b) the fear/anxious-misery model based on diagnostic comorbidity data. The tri-level model of depression and anxiety was developed to synthesize these structural models, postulating that narrow (disorder-specific), intermediate (fear and anxious-misery), and broad (general distress) structural factors are needed to most fully account for covariation among these symptoms. Although this model has received preliminary support (Prenoveau et al., 2010), the current study compares it with the above established models and seeks to validate the best-fitting structure. We evaluated the tri-level model and alternative structural models in a large clinical sample (N = 1,000) using bifactor analysis. In exploratory and confirmatory subsamples, the tri-level model provided a good fit to the data and each of the 3 levels (narrow, intermediate, and broad) accounted for substantial variance; this model provided a superior fit relative to more parsimonious competing structural models. Furthermore, impairment was independently associated with all 3 levels of the tri-level model, comorbidity was most closely linked to the broad tri-level dimensions, and the factors generally showed the expected convergent/discriminant associations with diagnoses. Results suggested several revisions to prior research: (a) worry may be best modeled at the broadest structural level, rather than as an indicator of anxious-misery or fear; (b) social interaction anxiety may belong with anxious-misery, rather than fear; and (c) obsessive-compulsive disorder is generally associated with fear disorders, but hoarding is associated with both fear and anxious-misery. (PsycINFO Database Record

Is Rumination a Risk and a Protective Factor?

High trait positive affect (PA) protects against depressive symptoms through cognitive responses such as rumination. However, how rumination in response to positive emotions (positive rumination) protects against depressive symptoms while rumination in response to negative emotions (brooding) predicts depressive symptoms is poorly understood. We hypothesized that (a) positive rumination and brooding represent a shared cognitive process of affect amplification on distinct affective content and (b) less brooding and greater positive rumination would distinctly mediate greater trait PA in predicting fewer depressive symptoms. Our prospective design among 321 adults first compared three confirmatory factor analysis models of the relationship between brooding and positive rumination. We then utilized structural equation modeling to examine whether brooding and positive rumination mediated the relationship between trait PA and depressive symptoms, controlling for baseline depressive symptoms, trait negative affect (NA), and the distinct effects of each mediator. Results supported a conceptualization of brooding and positive rumination as distinct but related constructs, represented as a common process of affect amplification to explain how rumination may amplify resilience or risk in predicting depressive symptoms (χ = 195.07, Δχ = 8.78, p < .001, CFI = .91, RMSEA = .07). Furthermore, positive rumination and brooding were distinctly predicted by trait PA, suggesting that trait PA exerts distinct effects on protective and risk forms of rumination. Less brooding mediated the relationship between greater trait PA and fewer depressive symptoms (β = -.04, p = .012), but positive rumination did not (β = .02, p = .517). Rumination may represent a protective and a risk factor, which may better enable individuals who brood to redirect their rumination on positive content and thereby reduce their risk of depressive symptoms.

Exploring Occasion Specificity in the Assessment of DSM-5 Maladaptive Personality Traits

Abstract. The alternative classification system for personality disorders in DSM-5 features a hierarchical model of maladaptive personality traits. This trait model comprises five broad trait domains and 25 specific trait facets that can be reliably assessed using the Personality Inventory for DSM-5 (PID-5). Although there is a steadily growing literature on the validity of the PID-5, issues of temporal stability and situational influences on test scores are currently unexplored. We addressed these issues using a sample of 611 research participants who completed the PID-5 three times, with time intervals of 2 months. Latent state-trait (LST) analyses for each of the 25 PID-5 trait facets showed that, on average, 79.5% of the variance was due to stable traits (i.e., consistency), and 7.7% of the variance was due to situational factors (i.e., occasion specificity). Our findings suggest that the PID-5 trait facets predominantly capture individual differences that are stable across time.

A Study of the Coupling of FET Temperament Traits with Major Depression

Objective: Temperament and mental illness have been linked to the same systems of behavioral regulation. A temperament model, carefully structured to respond to subtle differences within systems of behavior regulation, should exhibit distinct temperament patterns in the presence of mental illness. Previous comparisons of temperament profiles in mental disorders used mostly emotionality-related traits. In contrast, the Functional Ensemble of Temperament (FET) model differentiates not only between emotionality traits, but also between traits related to physical, verbal, and mental aspects of behavior and maps 12 functional aspects of behavior to temperament traits as well as to symptoms of mental illnesses. This article reports on the coupling of sex, age, and temperament traits with Major Depression (MD) using the FET framework. Method: Intake records of 467 subjects, ages 17-24, 25-45, 46-65, 66-84 were examined, with temperament assessed by the Structure of Temperament Questionnaire (based on the FET). Results: The presence of MD was associated with changes in mean temperament scores on 9 of the 12 traits. The results were in line with the DSM-5 criteria of fatigue (patients with MD reported a significant decrease in three types of endurance - motor-physical, social-verbal, and mental), of psychomotor retardation (a significant decrease in physical and social-verbal tempo) and of worthlessness (as low Self-Confidence). The results also showed that three new symptoms, high Impulsivity, high Neuroticism, and diminished Plasticity, should be considered as depressive symptoms in future versions of the DSM. As a significant negative result, no interaction of age or sex (with the exception of the Self-Confidence scale) with MD was found for temperament traits. Conclusion: The value of differentiating between physical, social, and mental aspects of behavior is demonstrated in the differential effects of major depression and gender. The value of differentiating between endurance, dynamical and orientation-related aspects of behavior is also demonstrated. The deleterious impact of MD on temperament scores appeared to be similar across all age groups. The appearance of high impulsivity, neuroticism, and low plasticity deserve further study as associated factors in future versions of the DSM/ICD.

Temperament Distinguishes Persistent/Recurrent from Remitting Anxiety Disorders Across Early Childhood

Up to 20% of preschool-age children meet criteria for anxiety disorders and, for a large subset, anxiety appears to persist throughout early childhood. However, little is known about which factors predict persistence/recurrence of anxiety in young children. Temperament, including behavioral inhibition (BI), negative emotionality (NE), and positive emotionality (PE), predict the onset of anxiety disorders, but to our knowledge no study has examined whether temperament predicts the course of anxiety in young children. From a community sample of 3-year-olds, we identified 89 children (79.8% White, non-Hispanic; 41.6% female) who met criteria for an anxiety disorder and examined whether observed and parent-reported BI, NE, and PE at age 3 distinguished children who continued to meet criteria for an anxiety disorder from those who remitted by age 6. Higher levels of BI and lower levels of PE assessed in the laboratory and higher parent-reported BI and shyness and lower surgency at age 3 significantly predicted persistence/recurrence of anxiety disorders from age 3 to 6. These data are the first to demonstrate the influence of temperament on the course of anxiety disorders in young children. These findings can enhance assessment and treatment of anxiety by focusing intervention efforts on children who are at risk for persistent or recurring anxiety rather than children who are displaying transient, and possibly developmentally normative, anxiety.

Is low positive emotionality a specific risk factor for depression? A meta-analysis of longitudinal studies

Depression is well known to share a negative cross-sectional relationship with personality constructs defined by positive emotion (positive affect, extraversion, behavioral activation). These Positive Emotionality (PE) constructs have been proposed to represent stable temperamental risk factors for depression, not merely current mood state. These constructs have also been proposed to increase risk specifically for depression, relative to anxiety. We performed a meta-analysis of longitudinal studies to examine the relationship of PE to depression (59 effect sizes) and anxiety (26 effect sizes). In cross-sectional analyses, PE constructs were negatively associated with depression (r = -.34) and anxiety (r = -.24). PE constructs also prospectively predicted depression (r = -.26) and anxiety (r = -.19). These relationships remained statistically significant, but were markedly attenuated, when baseline levels of depression (β = -.08) and anxiety (β = -.06) were controlled. Moreover, depression and anxiety were equally strong predictors of subsequent changes in PE (β = -.07 and -.09, respectively). These findings are consistent with theoretical accounts of low PE as a temperamental vulnerability for depression, but suggest that the prospective relationship of PE to depression may be weaker and less specific than previously assumed. (PsycINFO Database Record

Interaction of CD38 Variant and Chronic Interpersonal Stress Prospectively Predicts Social Anxiety and Depression Symptoms Over Six Years

Variation in the CD38 gene, which regulates secretion of the neuropeptide oxytocin, has been associated with several social phenotypes. Specifically, rs3796863 A allele carriers have demonstrated increased social sensitivity. In 400 older adolescents, we used trait-state-occasion modeling to investigate how rs3796863 genotype, baseline ratings of chronic interpersonal stress, and their gene-environment (GxE) interaction predicted trait social anxiety and depression symptoms over six years. We found significant GxE effects for CD38 A-carrier genotypes and chronic interpersonal stress at baseline predicting greater social anxiety and depression symptoms. A significant GxE effect of smaller magnitude was also found for C/C genotype and chronic interpersonal stress predicting greater depression; however, this effect was small compared to the main effect of chronic interpersonal stress. Thus, in the context of chronic interpersonal stress, heightened social sensitivity associated with the rs3796863 A allele may prospectively predict risk for social anxiety and (to a lesser extent) depression.

Chronic environmental stress and the temporal course of depression and panic disorder: A trait-state-occasion modeling approach

Both acute stressful life events and ongoing strains are thought to confer vulnerability to emotional disorders. Unremitting stressful conditions may be particularly pathogenic, but prior research has struggled to delimit chronic versus transient stressful experiences. We aimed to isolate stable stressors-theorized to be indicators of a latent stress proneness trait-and to examine their effects on the temporal course of depression and panic disorder. We recruited 677 patients diagnosed with an emotional disorder and administered interviews for psychopathology and life stress 3 times over 12-month intervals. Trait-state-occasion modeling revealed that 74% of the variance in life stress was stable over the follow-up period. These stable stressors were associated with a more refractory course of depression and, to a smaller degree, panic disorder over time. In addition, neither gender nor participation in cognitive-behavioral therapy affected the persistence of environmental stress over the study time frame. We discuss implications of these findings for explaining depression recurrence, improving psychological interventions for emotional disorders, and the measurement and evaluation of stress proneness.

Prospective associations of low positive emotionality with first onsets of depressive and anxiety disorders: Results from a 10-wave latent trait-state modeling study

Unipolar depressive disorders and anxiety disorders co-occur at high rates and can be difficult to distinguish from one another. Cross-sectional evidence has demonstrated that whereas all these disorders are characterized by high negative emotion, low positive emotion shows specificity in its associations with depressive disorders, social anxiety disorder, and possibly generalized anxiety disorder. However, it remains unknown whether low positive emotionality, a personality trait characterized by the tendency to experience low positive emotion over time, prospectively marks risk for the initial development of these disorders. We aimed to help address this gap. Each year for up to 10 waves, participants (n = 627, mean age = 17 years at baseline) completed self-report measures of mood and personality and a structured clinical interview. A latent trait-state decomposition technique was used to model positive emotionality and related personality traits over the first 3 years of the study. Survival analyses were used to test the prospective associations of low positive emotionality with first onsets of disorders over the subsequent 6-year follow-up among participants with no relevant disorder history. The results showed that low positive emotionality was a risk marker for depressive disorders, social anxiety disorder, and generalized anxiety disorder, although evidence for its specificity to these disorders versus the remaining anxiety disorders was inconclusive. Additional analyses revealed that the risk effects were largely accounted for by the overlap of low positive emotionality with neuroticism. The implications for understanding the role of positive emotionality in depressive disorders and anxiety disorders are discussed.