The Cardiff Depression Study: a sib-pair study of dysfunctional attitudes in depressed probands and healthy control subjects

BACKGROUND: Current cognitive theories propose that depression develops as a result of the interaction between dysfunctional cognitive schemata and environmental stressors. There is also consistent evidence of a substantial genetic contribution to depression. This study examines the familiality and stability of dysfunctional attitudes and attempts to distinguish whether they reflect trait vulnerability to depression or the state of being depressed. METHOD: The 24-item Dysfunctional Attitude Scale (DAS-24) was completed by 108 depressed probands and their nearest-aged siblings and 105 healthy control probands and their nearest-age siblings, at the time of a semi-structured clinical interview and 10-12 months later. Subjects also completed self-report measures of depressed mood on both occasions. RESULTS: Measures of clinical depression were significantly correlated with DAS scores. At retest, DAS scores remained elevated despite improvement in mood, giving support for earlier findings, that dysfunctional attitudes remain active following recovery. The dependency subscale (DAS-D) of the DAS showed modest familiality, although there were no significant differences for DAS-D scores between the two groups of siblings. In a multiple regression analysis, current mood-state was the overwhelming predictor of DAS scores. However for DAS-D, gender as well as current mood influenced scores on this subscale. CONCLUSION: Although there was modest evidence for temporal stability and familiality for some DAS-24 subscale scores, dysfunctional attitudes were predominantly influenced by current low mood, and therefore reflect the state of being depressed rather than a familial vulnerability trait underpinning depression.     

The relationship between subjective sleep estimation and objective sleep variables in depressed patients.

INTRODUCTION: To our knowledge there is no evidence in the literature about the relationship between subjective sleep estimation and objective sleep variables in depression. It is not known whether the subjective estimation of sleep quality and sleep duration is directly related to any objective sleep variable in depressed patients. METHODS: Thirty patients with major depression and 10 healthy subjects have been investigated in our sleep laboratory during 1 or 2 consecutive nights after 1 night for adaptation. Every subject, after final awakening in the laboratory, answered questions concerning the subjective feelings about sleep duration, number of awakenings and sleep depth. We compared the sleep estimation in both groups and calculated the correlation between objective and subjective sleep variables in depressed patients. RESULTS: The degree of a wrong sleep estimation in depressed patients is larger than in healthy subjects. Slow wave sleep (SWS) in depressed patients correlates positively with the subjective estimation of sleep duration. Eye movement density in REM sleep correlates with the subjective estimation of the number of awakenings. CONCLUSION: SWS in depression has a positive influence on the subjective feeling of sleep duration while phasic REM sleep activity has a negative influence.     

The relationship of personality style to abstract thinking deficits in schizophrenia.

Hypothesized that the correlation between Inability to Abstract and Autism measures of schizophrenics would be larger after the effects of relevant personality variables were partialed out than before. The multiple correlations of these deficit measures with 15 of the Sixteen Personality Factor scales and a measure of verbosity were determined in a sample of 100 schizophrenics. The correlations between Inability to Abstract and Autism before and after those scales that contributed significantly to the Rs had been partialed out also were calculated. Neither was significant. The results offer no support for the view that observed differences between schizophrenic subgroups in inability to abstract and autism reflect variations in personality style rather than cognitive factors.     

The relationship of aerobic physical fitness to selected personality traits.

The relationships between aerobic physical fitness and selected personality traits measured by the MMPI were investigated for college males engaged in an aerobic conditioning class. Results indicated that physical fitness scores and selected scales on the MMPI are related in college males and that changes in aerobic physical fitness are related to score changes on selected scales of the MMPI for college males who participated in an aerobic exercise program.     

Medical students' attitudes towards science and gross anatomy,and the relationship to personality

Assessment of the personalities of medical students can enable medical educators to formulate strategies for the best development of academic and clinical competencies. Previous research has shown that medical students do not share a common personality profile, there being gender differences. We have also shown that, for French medical students, students with personality traits associated with strong competitiveness are selected for admission to medical school. In this study, we further show that the medical students have different personality profiles compared with other student groups (psychology and business studies). The main purpose of the present investigation was to assess attitudes to science and gross anatomy, and to relate these to the students'' personalities. Questionnaires (including Thurstone and Chave analyses) were employed to measure attitudes, and personality was assessed using the Big Five Inventory (BFI). Data for attitudes were obtained for students at medical schools in Cardiff (UK), Paris, Descartes/Sorbonne (France), St George''s University (Grenada) and Ankara (Turkey). Data obtained from personality tests were available for analysis from the Parisian cohort of students. Although the medical students were found to have strongly supportive views concerning the importance of science in medicine, their knowledge of the scientific method/philosophy of science was poor. Following analyses of the BFI in the French students, ‘openness’ and ‘conscientiousness’ were linked statistically with a positive attitude towards science. For anatomy, again strongly supportive views concerning the subject''s importance in medicine were discerned. Analyses of the BFI in the French students did not show links statistically between personality profiles and attitudes towards gross anatomy, except male students with ‘negative affectivity’ showed less appreciation of the importance of anatomy. This contrasts with our earlier studies that showed that there is a relationship between the BF dimensions of personality traits and anxiety towards the dissection room experience (at the start of the course, ‘negative emotionality’ was related to an increased level of anxiety). We conclude that medical students agree on the importance to their studies of both science in general and gross anatomy in particular, and that some personality traits relate to their attitudes that could affect clinical competence.     

The relationship between personality, dysfunctional parenting in childhood, and lifetime depression in a sample of employed Japanese adults

BACKGROUND: Few studies have explored the relationship between personality, dysfunctional parenting in childhood, and adult depression. METHODS: Parental rearing styles and personality scores as measured by the Parental Bonding Instrument (PBI) and the Interpersonal Sensitivity Measure (IPSM) were compared in a group of employed Japanese adults with and without a lifetime history of depression. The diagnosis was provided by the Inventory to Diagnose Depression, Lifetime version (IDDL). To estimate the effects of the PBI and the IPSM scores on lifetime depression, a multiple logistic regression analysis was performed. RESULTS: Subjects with lifetime depression were seen to have significantly lower scores on the PBI 'care' and higher scores on the IPSM than the subjects without lifetime depression. Lower levels of maternal care and higher levels of 'interpersonal sensitivity' each independently increased the risk for lifetime depression. LIMITATIONS: The findings of the present study may not be conclusive since the data were retrospectively obtained. CONCLUSION: Dysfunctional parenting and personality seem to be correlated by lifetime depression, but it is uncertain whether they are independent risk factors     

The temporal relationship between hostility and depressed mood.

Nineteen depressed in-patients were studied in a follow-up design for 8 weeks or until discharge, using three depression scales and a hostility questionnaire. It was hypothesized within a cognitive theory of depression that, self-rated hostility being a measure of negative thoughts and attitudes, changes in hostility would precede mood changes. Analysis was by contemporaneous and cross-correlations between mood and hostility measures. High intercorrelations were obtained among the mood ratings which decreased significantly over time, as did two of the four hostility measures. The hypothesis was confirmed by the cross-correlations between nurses' mood ratings and intropunitiveness and direction of hostility. The cross-correlations with Beck and Hamilton scales supported the hypothesis at a non-significant level.     

The big five factors of personality and their relationship to personality disorders

Articles examining the relationship between the Big Five factors of personality and personality disorders (PDs) are reviewed. A survey of these studies indicates that there is some agreement regarding the relationship between the Big Five and PDs. However, the level of agreement varies and may be a function of instrumentation, the method of report, or how data have been analyzed. Future research should consider the role of peer-ratings, examine the relationship between PDs and the first-order factors of the Big Five, consider dimensions over and above the Big Five as predictors of PDs. © 1997 John Wiley & Sons, Inc. J Clin Psychol 53 : 587–593, 1997.     

Indirect measurement of dysfunctional attitudes in bipolar affective disorder

Objective. The present study uses an indirect measure to explore whether dysfunctional attitudes are characteristic of all phases of bipolar disorder. Previous studies with bipolar patients using indirect measurements have uncovered depression‐like responses that were otherwise undetected. Design. A cross‐sectional study design was adopted to explore the presence of dysfunctional attitudes within each phase of the illness. Method. Manic patients, depressed bipolar patients, remitted bipolar patients, and healthy controls were compared on a sentence stem completion task designed to implicitly assess dysfunctional attitudes. Results. The manic, depressed, and remitted patients all exceeded the controls on implicit measures of dysfunctional attitudes. Conclusions. The findings are consistent with the hypothesis that all phases of bipolar disorder are associated with depressogenic dysfunctional attitudes.     

The relationship of psychological well-being to distress and personality

BACKGROUND: The concept of psychological well-being has been neglected for a long time in scientific literature. Over the last decades, however, many psychometric instruments have been developed to measure it. The aim of the present study was to analyze the concept of psychological well-being and its relationship to distress and personality traits. It is clinically and empirically important to establish where the measures of well-being are located in relation to symptomatology indices and personality traits. METHODS: A sample of 450 subjects in the general population completed three self-rating scales for the assessment of symptomatology (Kellner's Symptom Questionnaire), psychological well-being (Ryff's Psychological Well-Being Scales, PWB), and personality traits (Cloninger's Tridimensional Personality Questionnaire). The assessment was repeated after 1 month. Pearson's coefficient was used to analyze PWB test-retest reliability and correlations between well-being, distress and personality indicators. Exploratory factor analysis was performed for both assessments. RESULTS: Test-retest Pearson's coefficients were satisfactory for all six PWB scales. Exploratory factor analyses showed a 4- or 5-factor structure, where well-being, distress and personality remained separated. PWB scales were negatively and significantly correlated with all symptom scales, but only with one personality dimension, TPQ Harm Avoidance. Mean-level differences by gender showed that in general women significantly presented with lower levels of well-being (except in Positive Relations) and higher levels of distress and personality disturbances. CONCLUSIONS: The results suggest that the relationship of well-being to distress and personality is complex. Psychological well-being could not be equated with the absence of symptomatology or with personality traits. PWB scales measure an attitude toward optimal functioning that is crucial for a comprehensive consideration of individuals in clinical settings.     

Mood state dependency of dysfunctional attitudes in bipolar affective disorder

Introduction. Studies of cognitive styles among euthymic people with bipolar affective disorder (BAD) without use of mood induction techniques to access those cognitive styles give misleading impressions of normality of those cognitions. The aim of this study was to assess dysfunctional attitudes of participants with BAD, and control participants with no previous psychiatric histories, after mood inductions. Methods. Sad and happy moods were induced within 49 BAD and 37 controls. Dysfunctional attitudes were measured following mood inductions using the Dysfunctional Attitude Scale-short form (DAS-24), which has three subscales of achievement, interpersonal, and goal attainment. Results. It was hypothesised that within BAD the sad mood induction would help in accessing dysfunctional attitudes in all three domains relative to the happy mood induction. This was supported. It was also hypothesised that the mood inductions would not affect dysfunctional attitudes within controls. This was supported. When diagnosis was entered as a between group variable, achievement dysfunctional attitudes were significantly higher in BAD compared to controls after a happy induction. Conclusions Both sad and happy moods provoked higher levels of dysfunctional attitudes within BAD. Euphoria may be related to elevated achievement dysfunctional attitudes, raising risk for mania.     

Mood state dependency of dysfunctional attitudes in bipolar affective disorder

Introduction. Studies of cognitive styles among euthymic people with bipolar affective disorder (BAD) without use of mood induction techniques to access those cognitive styles give misleading impressions of normality of those cognitions. The aim of this study was to assess dysfunctional attitudes of participants with BAD, and control participants with no previous psychiatric histories, after mood inductions.

Methods. Sad and happy moods were induced within 49 BAD and 37 controls. Dysfunctional attitudes were measured following mood inductions using the Dysfunctional Attitude Scale—short form (DAS-24), which has three subscales of achievement, interpersonal, and goal attainment.

Results. It was hypothesised that within BAD the sad mood induction would help in accessing dysfunctional attitudes in all three domains relative to the happy mood induction. This was supported. It was also hypothesised that the mood inductions would not affect dysfunctional attitudes within controls. This was supported. When diagnosis was entered as a between group variable, achievement dysfunctional attitudes were significantly higher in BAD compared to controls after a happy induction.

Conclusions Both sad and happy moods provoked higher levels of dysfunctional attitudes within BAD. Euphoria may be related to elevated achievement dysfunctional attitudes, raising risk for mania.     

The relationship of self-disclosure to personality,adjustment and self-actualization

This study tested the hypothesis that a high level of self-disclosure is indicative of psychological adjustment and self-actualization. The self-disclosure scale. Social Avoidance and Distress, Fear of Negative Evaluation, Alienation and Repression-Sensitization scales were administered to 60 Ss. The results for all scales indicated that a high level of disclosure was associated with adjustment as measured by these scales. A second group of 94 Ss completed the self-disclosure scale and the Personal Orientation Inventory, a measure of self-actualization. The results indicated that high disclosers compared to low disclosers had achieved a higher level of self-actualization. That is, there were significant correlations between self-disclosure and measures of self-actualization such as Time Competence, Internal Support, Existentiality, Self-Acceptance and Capacity for Intimate Contact.     

A neuroendocrine study of serotonin function in depressed stroke patients compared to non depressed stroke patients and healthy controls.

OBJECTIVES: We employed a neuroendocrine challenge paradigm to study serotonergic abnormalities associated with poststroke depression. METHOD: Twelve depressed stroke patients (major depression N= 5, minor depression N = 7), 8 nondepressed stroke patients and 12 healthy volunteers completed a single-blind, placebo-controlled, challenge tests. Baseline cortisol (CORT) and prolactin (PRL) values, and these hormonal responses to 30 mg of oral d-FEN and placebo over a 4 hour period were measured in the three groups. RESULTS: There were intergroup differences for baseline adjusted PRL responses (change scores from baseline) to d-FEN (group effect F = 4.38, df = 2,29, p = 0.02) while these responses to placebo were comparable between groups (group effect F = 1.82, df = 2,29, p = 0.18). Peak PRL responses (post d-FEN maximal PRL change from baseline scores) in depressed stroke patients were significantly greater than in nondepressed patients (p = 0.005) but comparable to healthy normals (p = 0.47). However, these responses between major and minor depression were not significant (p = 0.34). There was a trend suggesting a negative correlation between peak PRL response and severity of depression (p = 0.056). Depressed patients were younger than the controls (p = 0.054). Also, the depressed group was more functionally impaired (p = 0.04) and more likely to have right-sided lesions (p = 0.009) compared with the nondepressed group. Differences in baseline adjusted PRL changes between depressed and nondepressed groups became non significant when the influence of laterality of lesions was covaried, whereas covariation of functional scores and age did not alter the significance. CORT responses did not show intergroup differences. LIMITATIONS: The study group was small and was heterogenous in lesion characteristics, time since stroke and type of depression. A fixed-order design was used in the challenge test paradigm. CONCLUSIONS: When laterality of stroke lesion was taken into account, depressed and nondepressed stroke patients did not differ in PRL responses to d-FEN.     

A dopamine transporter polymorphism is a risk factor for borderline personality disorder in depressed patients

BACKGROUND: Borderline personality disorder (BPD) is often co-morbid with major depression and may complicate its treatment. We were interested in differences in genetic and developmental risk factors between depressed patients with or without a co-morbid BPD. METHOD: Out-patients with major depressive disorder were recruited for two treatment trials. Assessment of depressed patients included the assessment of personality disorders, developmental risk factors and DNA samples for genetic analyses. RESULTS: In each study there was a significant association between the 9-repeat allele of the dopamine transporter (DAT1) and BPD, with odds ratios (OR) > 3 and p < or = 0.02. This association remained significant when developmental risk factors for BPD (childhood abuse and neglect and borderline temperament) were also included in the analyses. The OR was even larger in the depressed patients aged > or = 35 years (OR 9.31, p = 0.005). CONCLUSION: This replicated association in depressed patients between the 9-repeat allele of DAT1 and BPD may provide clues to understanding the neurobiology of BPD. The finding that the association is larger in the older depressed patients, suggests that the 9-repeat allele may be associated with a poorer prognosis BPD, rather than a young adult limited variant of BPD.