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Karppanen AK, Miettunen J, Hurtig T, Nordström T, Tammelin T, Korpelainen R. Temperament and longitudinal changes in physical activity - the Northern Finland Birth Cohort 1966 Study. BMC Public Health 2023; 23:426. [PMID: 36869293 PMCID: PMC9985204 DOI: 10.1186/s12889-023-15303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Insufficient physical activity is risk factor for morbidity and premature mortality. This population-based birth cohort study investigated the cross-sectional and longitudinal associations between self-reported temperament at age 31 and self-reported leisure-time moderate to vigorous physical activity (MVPA) levels and changes thereof from the age of 31 to the age of 46 years. METHODS The study population comprised 3,084 subjects (1,359 male and 1,725 female) from the Northern Finland Birth Cohort 1966. MVPA was self-reported at ages 31 and 46 years. Novelty seeking, harm avoidance, reward dependence, and persistence and their subscales were measured using Cloninger's Temperament and Character Inventory at age 31. Four temperament clusters were used in the analyses: persistent, overactive, dependent, and passive. Logistic regression was used to evaluate the relationship between temperament and MVPA. RESULTS The persistent and overactive temperament profiles at age 31 were positively associated with higher MVPA levels both in young adulthood and in midlife, while the passive and dependent temperament profiles were associated with lower MVPA levels. The overactive temperament profile was associated with a decrease in MVPA levels from young adulthood to midlife among males. CONCLUSION A passive temperament profile characterized by high harm avoidance is associated with a higher risk of low MVPA level than other temperament profiles over the life cycle in females. The results suggest that temperament may play a role in determining the level and sustainability of MVPA. Individual targeting and intervention tailoring for promoting physical activity should consider temperament traits.
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Affiliation(s)
- Anna-Kaisa Karppanen
- Research Unit of Population Health, University of Oulu, PO Box 5000, 90014, Oulu, Finland. .,Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland.
| | - Jouko Miettunen
- Research Unit of Population Health, University of Oulu, PO Box 5000, 90014, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tuula Hurtig
- Research Unit of Clinical Neuroscience, Psychiatry, University of Oulu, Oulu, Finland.,PEDEGO Research Unit, Child Psychiatry, University of Oulu, Oulu, Finland.,Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Tanja Nordström
- Research Unit of Population Health, University of Oulu, PO Box 5000, 90014, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, Northern Finland Birth Cohorts, University of Oulu, Oulu, Finland
| | - Tuija Tammelin
- LIKES, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Raija Korpelainen
- Research Unit of Population Health, University of Oulu, PO Box 5000, 90014, Oulu, Finland.,Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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Ahola A, Rautio N, Timonen M, Nordström T, Jääskeläinen E, Miettunen J. Premorbid temperament as predictor of onset of depression: 23-year follow-up. Compr Psychiatry 2023; 121:152359. [PMID: 36495692 DOI: 10.1016/j.comppsych.2022.152359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND Previously Cloninger's temperament traits have been researched as a risk factor for depression mostly in cross-sectional studies. In these studies, especially high harm avoidance has been associated with an increased risk of depression. The main objective of this study was to investigate how temperament traits affect the risk of the onset of depression in a previously mentally healthy adult population. METHODS This study includes a follow-up period of 23 years from the age of 31 until 54 in the Northern Finland Birth Cohort 1966 Study. Temperament was measured at the 31-year follow-up using Temperament and Character Inventory (TCI). The outcome of the study was depressive disorder diagnosis during the follow-up in both sexes. To be able to take correlations between temperament traits we also did an analysis using temperament clusters. RESULTS Our sample size was 3999 individuals, out of which 240 were diagnosed with depression. For women an increase in the TCI score for novelty seeking (NS), harm avoidance (HA) or persistence (P) increased the risk of depression during the follow-up. For men only HA was a significant predictor of depression. An increase in reward dependence (RD) was found to reduce the risk of psychotic depression. In the analysis using the temperament clusters, the cluster including shy and pessimistic individuals was associated with risk for depression diagnosis in men. CONCLUSIONS This prospective general population-based cohort study added to previous knowledge of high HA being a risk factor for depression, but it also found new associations such as higher P and NS.
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Affiliation(s)
- Aleksi Ahola
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland.
| | - Nina Rautio
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Markku Timonen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Tanja Nordström
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Erika Jääskeläinen
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Jouko Miettunen
- Research Unit of Population Health, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Frank GKW, Shott ME, Sternheim LC, Swindle S, Pryor TL. Persistence, Reward Dependence, and Sensitivity to Reward Are Associated With Unexpected Salience Response in Girls but Not in Adult Women: Implications for Psychiatric Vulnerabilities. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1170-1182. [PMID: 33872764 DOI: 10.1016/j.bpsc.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adolescence is a critical period for the development of not only personality but also psychopathology. These processes may be specific to sex, and brain reward circuits may have a role. Here, we studied how reward processing and temperament associations differ across adolescent and adult females. METHODS A total of 29 adolescent girls and 41 adult women completed temperament assessments and performed a classical taste conditioning paradigm during brain imaging. Data were analyzed for the dopamine-related prediction error response. In addition, unexpected stimulus receipt or omission and expected receipt response were also analyzed. Heat maps identified cortical-subcortical brain response associations. RESULTS Adolescents showed stronger prediction error and unexpected receipt and omission responses (partial η2 = 0.063 to 0.166; p = .001 to .043) in insula, orbitofrontal cortex (OFC), and striatum than adults. Expected stimulus receipt response was similar between groups. In adolescents versus adults, persistence was more strongly positively related to prediction error (OFC, insula, striatum; Fisher's z = 1.704 to 3.008; p = .001 to .044) and unexpected stimulus receipt (OFC, insula; Fisher's z = 1.843 to 2.051; p = .014 to .033) and negatively with omission (OFC, insula, striatum; Fisher's z = -1.905 to -3.069; p = .001 to .028). Reward sensitivity and reward dependence correlated more positively with unexpected stimulus receipt and more negatively with stimulus omission response in adolescents. Adolescents showed significant correlations between the striatum and FC for unexpected stimulus receipt and omission that correlated with persistence but were absent in adults. CONCLUSIONS Associations between temperamental traits and brain reward response may provide neurotypical markers that contribute to developing adaptive or maladaptive behavior patterns when transitioning from adolescence to adulthood.
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Affiliation(s)
- Guido K W Frank
- Department of Psychiatry, University of California San Diego, San Diego, California; Eating Disorders Center for Treatment and Research, UC San Diego Health, San Diego, California.
| | - Megan E Shott
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Skylar Swindle
- Department of Psychiatry, University of California San Diego, San Diego, California
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Koski TPK, Hintsanen M, Miettunen J, Ek E, Salo H, Jääskeläinen E, Ala-Mursula L. Temperament and Early Intentions to Retire: A Northern Finland Birth Cohort 1966 Study. J Occup Environ Med 2020; 61:136-143. [PMID: 30475312 DOI: 10.1097/jom.0000000000001501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine associations between temperament traits and early retirement intentions. METHODS In the Northern Finland Birth Cohort 1966, we analyzed early retirement intentions at the age 46 according to Cloninger temperament traits at the age 46 (n = 4409) and at the age 31 (n = 3226). Ordinal logistic regression analyses were used. Adjustments were made for marital status, education, work type, job satisfaction, perceived health, and mental health problems. RESULTS 11% of men and 9% of women had strong retirement intentions. Especially higher harm avoidance was associated with higher early retirement intentions in both sexes at the age of 46. A similar pattern of results, although with weaker associations, was found for temperament assessed at the age of 31. CONCLUSIONS Temperament and especially harm avoidance is related to early retirement intentions.
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Affiliation(s)
- Tomi P K Koski
- Center for Life Course Health Research, University of Oulu (Drs Koski, Miettunen, Jääskeläinen, Ek, Mr Salo, Dr Ala-Mursula); Medical Research Center Oulu, Oulu University Hospital and University of Oulu (Drs Koski, Miettunen, Jääskeläinen); Unit of Psychology, Faculty of Education (Dr Hintsanen), University of Oulu, Oulu; Department of Psychology, University of Jyväskylä, Jyväskylä (Dr Ek), Finland
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Choi JY, Gim MS, Lee JY. Predictability of temperaments and negative experiences on higher-order symptom-based subtypes of depression. J Affect Disord 2020; 265:18-25. [PMID: 31957688 DOI: 10.1016/j.jad.2020.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 11/18/2019] [Accepted: 01/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The identification of subtypes of depression based on higher-order symptoms of emotional, thought, and behavioral dysfunction will broaden understanding of the heterogeneity in depression. Furthermore, exploring the ability of temperaments and negative experiences to predict each subtype is an effective way of facilitating treatment decisions. METHODS Participants were 417 patients diagnosed with depressive disorder at the psychiatry department of a major medical hospital in Seoul, Korea. A latent profile analysis was performed based on three higher-order scales of the MMPI-2-RF: Emotional/Internalizing Dysfunction, Thought Dysfunction, and Behavioral/Externalizing Dysfunction. Four temperament dimensions were assessed by the Temperament and Character Inventory-Revised-Short, and negative experiences including recent negative life events, number of lifetime traumatic events, and severity of maltreatment, were used as covariates in a multinomial regression analysis. RESULTS Four classes were obtained from the latent profile analysis: a "severe mood class" (39.8%), a "moderate mood class" (37.4%), a "mild mood class" (11.3%), and a "severe mood/thought class" (11.5%). Among temperament dimensions, high harm avoidance and low persistence significantly predicted more severe mood classes. Low reward dependence, number of lifetime traumatic events, and severity of maltreatment in negative experiences were significant predictors of the severe mood/thought class. LIMITATIONS This study could not explain the more detailed heterogeneity within depression because of over-inclusiveness of the higher-order scales. CONCLUSIONS This study identified three latent classes that differed in emotional severity and one other class with thought problems. The distinct dimensions of temperament and different types of negative experiences predicted the identified subtypes.
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Affiliation(s)
- Ji Young Choi
- Department of Child Studies, Inha University, Incheon, Republic of Korea
| | - Min Sook Gim
- Department of Psychiatry, Sanggye Baik Hospital, Inje University
| | - Joo Young Lee
- Department of Child Development and Education, Dongduk Women's University, Seoul, Republic of Korea.
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Similar but different: Profiling secondary school students based on their perceived motivational climate and psychological need-based experiences in physical education. PLoS One 2020; 15:e0228859. [PMID: 32040543 PMCID: PMC7010287 DOI: 10.1371/journal.pone.0228859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/25/2020] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to provide more insight into how the physical education (PE) context can be better tailored to the diverse motivational demands of secondary school students. Therefore, we examined how different constructs of student motivation in the context of PE combine into distinct motivational profiles, aiming to unveil motivational similarities and differences between students' PE experiences. Participants were 2,562 Dutch secondary school students, aged 12-18, from 24 different schools. Students responded to questionnaires assessing their perception of psychological need satisfaction and frustration, and perceived mastery and performance climate in PE. In order to interpret the emerging profiles additional variables were assessed (i.e. demographic, motivational and PE-related variables). Two-step cluster analysis identified three meaningful profiles labelled as negative perceivers, moderate perceivers and positive perceivers. These three profiles differed significantly with regard to perceived psychological need satisfaction and frustration and their perception of the motivational climate. This study demonstrates that students can be grouped in distinct profiles based on their perceptions of the motivational PE environment. Consequently, the insights obtained could assist PE teachers in designing instructional strategies that target students' differential motivational needs.
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Saarinen AIL, Keltikangas-Järvinen L, Lehtimäki T, Jula A, Cloninger CR, Hintsanen M. Somatic complaints in early adulthood predict the developmental course of compassion into middle age. J Psychosom Res 2020; 131:109942. [PMID: 32014638 DOI: 10.1016/j.jpsychores.2020.109942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate (i) whether somatic complaints predict the developmental course of compassion in adulthood, and (ii) whether this association depends on alexithymic features. METHODS The participants came from the population-based Young Finns study (N = 471-1037). Somatic complaints (headache, stomachache, chest pain, backache, fatigue, exhaustion, dizziness, heartburn, heartbeat, and tension) were evaluated with a self-rating questionnaire in 1986 when participants were aged between 18 and 24 years. Compassion was assessed with the Compassion Scale of the Temperament and Character Inventory (TCI) in 1997, 2001, and 2012. The data were analyzed using growth curve models. RESULTS We obtained a significant compassion-age interaction (B = -0.137, p = .02) and a compassion-age squared interaction (B = 0.007, p = .006), when predicting the course of somatic complaints. Specifically, in participants without frequent somatic complaints, compassion steadily increased with age in adulthood. In participants with frequent somatic complaints, however, compassion remained at a lower level until the age of 40 years, then started to increase, and achieved the normal level of compassion approximately at the age of 50 years. The association between somatic complaints and compassion over age was found to be independent of alexithymic features. The analyses were adjusted for a variety of covariates (age, gender, use of health care in childhood, depression in childhood, parental socioeconomic factors, parental care-giving practices, stressful life events, parental alcohol intoxication, and participants' socioeconomic factors in adulthood). CONCLUSION Frequent somatic complaints may predict delayed development of compassion in adulthood. This association was found to be independent of alexithymic features.
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Affiliation(s)
- Aino I L Saarinen
- Research Unit of Psychology, University of Oulu, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
| | | | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center, Tampere University, Tampere, Finland
| | - Antti Jula
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - C Robert Cloninger
- Department of Psychiatry, Washington University, St. Louis, United States of America
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Cloninger CR, Cloninger KM, Zwir I, Keltikangas-Järvinen L. The complex genetics and biology of human temperament: a review of traditional concepts in relation to new molecular findings. Transl Psychiatry 2019; 9:290. [PMID: 31712636 PMCID: PMC6848211 DOI: 10.1038/s41398-019-0621-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/25/2019] [Accepted: 10/18/2019] [Indexed: 12/14/2022] Open
Abstract
Recent genome-wide association studies (GWAS) have shown that temperament is strongly influenced by more than 700 genes that modulate associative conditioning by molecular processes for synaptic plasticity and long-term learning and memory. The results were replicated in three independent samples despite variable cultures and environments. The identified genes were enriched in pathways activated by behavioral conditioning in animals, including the two major molecular pathways for response to extracellular stimuli, the Ras-MEK-ERK and the PI3K-AKT-mTOR cascades. These pathways are activated by a wide variety of physiological and psychosocial stimuli that vary in positive and negative valence and in consequences for health and survival. Changes in these pathways are orchestrated to maintain cellular homeostasis despite changing conditions by modulating temperament and its circadian and seasonal rhythms. In this review we first consider traditional concepts of temperament in relation to the new genetic findings by examining the partial overlap of alternative measures of temperament. Then we propose a definition of temperament as the disposition of a person to learn how to behave, react emotionally, and form attachments automatically by associative conditioning. This definition provides necessary and sufficient criteria to distinguish temperament from other aspects of personality that become integrated with it across the life span. We describe the effects of specific stimuli on the molecular processes underlying temperament from functional, developmental, and evolutionary perspectives. Our new knowledge can improve communication among investigators, increase the power and efficacy of clinical trials, and improve the effectiveness of treatment of personality and its disorders.
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Affiliation(s)
- C Robert Cloninger
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
- School of Arts and Sciences, Department of Psychological and Brain Sciences, and School of Medicine, Department of Genetics, Washington University, St. Louis, MO, USA.
- Anthropedia Foundation, St. Louis, MO, USA.
| | | | - Igor Zwir
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Computer Science, University of Granada, Granada, Spain
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Willoughby MT, Stifter CA, Gottfredson NC. The epidemiology of observed temperament: Factor structure and demographic group differences. Infant Behav Dev 2015; 39:21-34. [PMID: 25733489 PMCID: PMC4417459 DOI: 10.1016/j.infbeh.2015.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 12/29/2014] [Accepted: 02/10/2015] [Indexed: 01/18/2023]
Abstract
This study investigated the factor structure of observational indicators of children's temperament that were collected across the first three years of life in the Family Life Project (N=1205) sample. A four-factor model (activity level, fear, anger, regulation), which corresponded broadly to Rothbart's distinction between reactivity and regulation, provided an acceptable fit the observed data. Tests of measurement invariance demonstrated that a majority of the observational indicators exhibited comparable measurement properties for male vs. female, black vs. white, and poor vs. not-poor children, which improved the generalizability of these results. Unadjusted demographic group comparisons revealed small to moderate sized differences (Cohen ds=|.23-.42|) in temperamental reactivity and moderate to large sized differences (Cohen ds=-.64--.97) in regulation. Collectively, demographic variables explained more of the variation in regulation (R(2)=.25) than in reactivity (R(2)=.02-.06). Follow-up analyses demonstrated that race differences were substantially diminished in magnitude and better accounted for by poverty. These results help to validate the distinction between temperamental reactivity and regulation using observational indicators.
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Affiliation(s)
| | - Cynthia A Stifter
- Human Development & Family Studies, Pennsylvania State University, United States
| | - Nisha C Gottfredson
- Center for Developmental Science, University of North Carolina at Chapel Hill, United States
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Brents LK, Tripathi SP, Young J, James GA, Kilts CD. The role of childhood maltreatment in the altered trait and global expression of personality in cocaine addiction. J Psychiatr Res 2015; 64:23-31. [PMID: 25805246 PMCID: PMC4404225 DOI: 10.1016/j.jpsychires.2015.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/10/2015] [Accepted: 02/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Drug addictions are debilitating disorders that are highly associated with personality abnormalities. Early life stress (ELS) is a common risk factor for addiction and personality disturbances, but the relationships between ELS, addiction, and personality are poorly understood. METHODS Ninety-five research participants were assessed for and grouped by ELS history and cocaine dependence. NEO-FFI personality measures were compared between the groups to define ELS- and addiction-related differences in personality traits. ELS and cocaine dependence were then examined as predictors of personality trait scores. Finally, k-means clustering was used to uncover clusters of personality trait configurations within the sample. Odds of cluster membership across subject groups was then determined. RESULTS Trait expression differed significantly across subject groups. Cocaine-dependent subjects with a history of ELS (cocaine+/ELS+) displayed the greatest deviations in normative personality. Cocaine dependence significantly predicted four traits, while ELS predicted neuroticism and agreeableness; there was no interaction effect between ELS and cocaine dependence. The cluster analysis identified four distinct personality profiles: Open, Gregarious, Dysphoric, and Closed. Distribution of these profiles across subject groups differed significantly. Inclusion in cocaine+/ELS+, cocaine-/ELS+, and cocaine-/ELS- groups significantly increased the odds of expressing the Dysphoric, Open and Gregarious profiles, respectively. CONCLUSIONS Cocaine dependence and early life stress were significantly and differentially associated with altered expression of individual personality traits and their aggregation as personality profiles, suggesting that individuals who are at-risk for developing addictions due to ELS exposure may benefit from personality centered approaches as an early intervention and prevention.
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Affiliation(s)
| | | | | | | | - Clinton D Kilts
- Brain Imaging Research Center, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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