The Interaction of Personality and Social Support on Prospective Suicidal Ideation in Men and Women With Late-Life Depression

ObjectiveEvidence suggests a cross-sectional association between personality traits and suicidal ideation in LLD. Yet, it is unclear how personality may influence suicidal ideation over time in LLD, or whether such an association would be moderated by psychosocial and biological individual differences. The present study had three aims: 1) to examine whether personality traits increase suicidal ideation in LLD over time, 2) to understand whether this relationship is influenced by subjective social support, and 3) to determine whether the potential relationship between social support, personality, and suicidal ideation is different for men and women.DesignParticipants were enrolled in the Duke University Neurocognitive Outcomes of Depression in the Elderly (NCODE), a longitudinal investigation of the predictors of poor illness course in LLD. Patients were initially enrolled in the NCODE study between December 1994 and June 2000 and were followed for an average of six years.SettingNCODE operates in a naturalistic treatment milieu.ParticipantsOne hundred twelve participants aged 60 and older with a current diagnosis of major depressive disorder.MeasurementsAnnual assessments of depression, suicidal ideation, and social support (measured with the Duke Social Support Index). Participants also completed the NEO Personality Inventory-Revised (NEO-PI-R) providing measures of the five major personality dimensions (neuroticism, extraversion, openness, conscientiousness, and agreeableness).ResultsUnivariate logistic generalized linear mixed modeling (GLMM) analyses revealed that higher levels of depression at baseline, less subjective social support, higher neuroticism, and lower extraversion were significantly associated with an increased likelihood of suicidal ideation over time. While the relationship between these dimensions and suicidal ideation were no longer significant in multivariate analyses, there was a significant moderating effect of social support on the association between suicidal ideation and certain neuroticism and extraversion personality facets. Decreased subjective social support was associated with an increased likelihood of suicidal ideation in LLD patients with high (but not low) impulsiveness and low (but not high) gregariousness and positive emotions. Across all models, social support was beneficial to women, but not men, in decreasing the likelihood of future suicidal ideation.ConclusionChanges in social support may contribute to suicidal ideation in older depressed adults with certain personality traits. Irrespective of personality traits, changes in social support had a significant effect on the suicidal ideation of women but not men. These relationships were apparent even when controlling for depression severity, age, and history of suicide attempt.     

Adult attention-deficit/hyperactivity disorder in major depressed and bipolar subjects: role of personality traits and clinical implications

A significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and affective disorders has been consistently reported in adults. Less data regarding the role of personality traits and the influence of ADHD co-occurrence on clinical characteristics and outcome of mood disorders are currently available. One hundred and six remitted major depressed, 102 euthymic bipolar subjects, and 120 healthy controls, homogeneous with respect to demographic characteristics, were included in the study. ADHD diagnosis was based on DSM-IV-TR criteria. Childhood and adult ADHD features were measured with the Wender Utah Rating Scale, the Adult ADHD Self-rating Scale, and the Brown Attention-Deficit Disorder Scale. The Revised NEO Personality Inventory was also administered to the clinical groups, in order to investigate personality dimensions. The occurrence of adult ADHD in subjects with bipolar disorders (BD) or major depressive disorder (MDD) was 15.7 and 7.5 %, respectively, compared to 3.3 % in healthy controls (HC). Significant associations (p < .001) between personality traits (neuroticism, conscientiousness, and extraversion) and ADHD features were observed. Logistic regression analysis of all clinical subjects (n = 208) showed that those with lower levels of neuroticism (OR = 1.031; p = .025) had a lower frequency of ADHD comorbidity. The present study emphasizes the close relationship between affective disorders, especially BD, and ADHD in adults. Our findings support the need to assess subjects with mood disorders in the clinical setting for possible coexisting ADHD and to further investigate personality traits to better understand the etiology of affective disorders and ADHD co-occurrence.     

Selective alteration of personality in response to noradrenergic and serotonergic antidepressant medication in depressed sample: evidence of non-specificity.

Recent investigations suggest that serotonergic mechanisms modulate dimensions of personality, in particular decreases in Anger-Hostility and increases in Affiliation. None of these studies, however, demonstrated a specific serotonergic effect on personality, as other neurotransmitter systems have not been assessed for their impact on these personality dimensions. In this study, 76 depressed outpatients were treated with either the noradrenergic antidepressant desipramine (n = 38) or a selective serotonin re-uptake inhibitor (paroxetine or sertraline) (n = 38) over a period of 8-14 weeks. Personality scores were measured pre- and post-treatment using the revised NEO Personality Inventory, which measures five basic dimensions of personality, with subscales assessing Anger-Hostility and Affiliation (Gregariousness). There was a significant decrease in Neuroticism and Anger-Hostility, and a significant increase in Extraversion and Gregariousness following antidepressant treatment. Although changes in neuroticism and extraversion were significantly correlated with change in depression severity, Anger-Hostility and Gregariousness personality scores were not. Therefore, changes in these personality traits were not attributable to a non-specific effect of medication on changes in depression severity. There were no significant differences in personality change scores between the antidepressant treatment groups. Thus, while antidepressants may have a direct effect on neurochemical pathways relevant to personality, independent of changes in depression severity, these effects cannot be directly or specifically attributed to a serotonergic mechanism.     

Personality characteristics and affective status related to cognitive test performance and gender in patients with memory complaints.

The aims are to study personality characteristics of patients with memory complaints and to assess the presence of objective (OMI) versus subjective (SMI) memory impairment, the affective status, as well as potential gender differences. The patients were assessed by means of a neuropsychiatric examination and a neuropsychological test-battery. The Swedish version of the revised NEO Personality Inventory (NEO PI-R) and the Hospital Anxiety and Depression Scale (HADS) were used. The 57 patients (38 women, 19 men, mean age 56.9) differed from the Swedish normative group in three of the five personality factors: neuroticism, extraversion and agreeableness. This was mainly because of the scores of the female patients. Approximately half of the patients had OMI. No differences regarding personality factors or affective status were found between OMI and SMI patients. The female patients scored significantly higher than the male patients on symptoms of anxiety and depression. Neuroticism and symptoms of depression interacted with memory performance and gender. Our findings demonstrate the importance of applying an objective assessment of memory functions and a gender perspective when studying patients with memory complaints.     

The impact of personality on symptom expression in obsessive-compulsive disorder

Previous research conducted on the five-factor model of personality (FFM) in obsessive-compulsive disorder (OCD) has demonstrated that community and clinical participants score significantly higher than controls on the domains and facets of neuroticism and extraversion and selective facets of agreeableness and conscientiousness. However, studies have yet to examine the extent to which personality traits, as assessed by the FFM, are associated with the specific symptoms of OCD. The purpose of this study was to examine further the personality predictors of obsessive-compulsive symptoms in clinical participants using the facets of the FFM. Patients with a DSM-IV diagnosis of OCD (N = 56) completed the Revised NEO Personality Inventory, the Yale Brown Obsession Compulsion Scale, and the Beck Depression Inventory. Lower scores on openness to ideas were uniquely associated with greater obsession severity, whereas lower openness to actions was uniquely associated with greater compulsive severity. In contrast with past research that has emphasized the association between neuroticism and extraversion and dimensionally rated obsessive-compulsive symptoms, this study demonstrates the specific associations between selective facet traits of openness and clinical obsessions and compulsions. Whereas tendencies toward negative affectivity may confer a nonspecific vulnerability to the development of OCD, facets of openness may impact on the particular expression and severity of obsessive-compulsive symptoms.     

Do clinical evaluations in a psychiatry clerkship favor students with positive personality characteristics?

OBJECTIVE: The authors examine associations of personality characteristics, National Board of Medical Examiners subject examination performance, and Objective Structured Clinical Examination performance with clinical evaluations of third-year medical students in a psychiatry clerkship. METHODS: Students completed the Revised NEO Personality Inventory, which measures personality domains of neuroticism, extraversion, openness, agreeableness, and conscientiousness and associated personality traits. At clerkship completion, students completed the National Board of Medical Examiners subject examination and a psychiatry Objective Structured Clinical Examination, and were evaluated by attending physicians (using a standardized evaluation form) regarding their clinical "knowledge and skill" and "interpersonal behavior." Data were analyzed using Pearson correlation and canonical correlation. RESULTS: National Board of Medical Examiners subject examination and Objective Structured Clinical Examination scores were uncorrelated with clinical evaluations of "knowledge and skill" and "interpersonal behavior." Personality variables explained a moderate amount of variance in clinical evaluations. "Knowledge and skill" was positively associated with the domain of conscientiousness, the extraversion trait of warmth, and the conscientiousness traits of competence and achievement striving. "Interpersonal behavior" was negatively associated with the neuroticism trait of angry hostility and positively associated with the domain of agreeableness; the extraversion traits of warmth, gregariousness, and positive emotions; and the agreeableness traits of trust, altruism, compliance, and tender-mindedness. CONCLUSION: Clinical evaluations of medical students may favor personality styles that reflect positive elements of extraversion, agreeableness, and conscientiousness. The present findings raise questions regarding the validity of clinical evaluation elements in clerkship performance appraisal.     

Lack of association between conversation partners' nonverbal behavior predicts recurrence of depression, independently of personality

High neuroticism and low extraversion are related to depression and its recurrence. We investigated whether nonverbal involvement behavior during social interaction is one of the factors via which these relations are effectuated. We measured nonverbal expressions of involvement from videotaped behavior of remitted depressed outpatients (n=101) and their conversation partners, and assessed self-reported neuroticism and extraversion scores. During a 2-year follow-up, we assessed the recurrence of depression. Twenty-eight participants (27.7%) experienced a recurrent episode. Time to recurrence was predicted by neuroticism and extraversion, and also by the degree of association between levels of nonverbal involvement behavior of conversation partners. The behavioral effect did not explain the personality effect. Neuroticism moderated the behavioral effect. The results point to the independent relevance of personality and nonverbal behavior in the long-term course of depressive disorder.     

Neuroticism may be associated with history of depression in the elderly

The relationships between geriatric depression and various personality traits have never been fully clarified, and their clinical significance is uncertain. Depression in geriatric patients may differ from the disorder found in younger individuals, and may also have distinctive personality antecedents or consequences. In this study 16 elderly subjects who had recovered from depression and 14 elderly control completed the Eysenck Personality Inventory (EPI) and the Personality Disorder Examination (PDE). On the EPI, neuroticism subscale scores were significantly higher for patients than controls, while mean extraversion scores were not significantly different. On the PDE, recovered depressives had higher dimensional scores than controls in each DSM-III-R personality disorder except antisocial. Neuroticism scores correlated significantly with PDE dimensional scores for all but two of the DSM-III-R personality disorders, while extraversion scores correlated significantly with only two PDE categories. Together, these findings suggest that neuroticism and criteria for most DSM-III-R personality disorders may be associated with history of depression in a geriatric population.     

The effects of neuroticism, extraversion, and positive and negative life events on a one-year course of depressive symptoms in euthymic previously depressed patients versus healthy controls

We investigated a) the concurrent impact of positive and negative life events on the course of depressive symptoms in persons remitted from depression and healthy controls, b) whether the impact of life events on symptom course is moderated by the history of depression and the personality traits of neuroticism and extraversion, and c) whether life events mediate possible relationships of history of depression and personality traits with symptom course. Using data from the Netherlands Study of Depression and Anxiety, we examined 239 euthymic participants with a previous depressive disorder based on DSM-IV and 450 healthy controls who completed a) baseline assessments of personality dimensions (NEO Five-Factor Inventory) and depression severity (Inventory of Depressive Symptoms [IDS]) and b) 1-year follow-up assessments of depression severity and the occurrence of positive and negative life events during the follow-up period (List of Threatening Events Questionnaire). Remitted persons reported higher IDS scores at 1-year follow-up than did the controls. Extraversion and positive and negative life events independently predicted the course of depressive symptoms. The impact of life events on symptom course was not moderated by history of depression or personality traits. The effect of extraversion on symptom course was partly caused by differential engagement in positive life events.     

Phobic, panic, and major depressive disorders and the five-factor model of personality

This study investigated five-factor model personality traits in anxiety (simple phobia, social phobia, agoraphobia, and panic disorder) and major depressive disorders in a population-based sample. In the Baltimore Epidemiologic Catchment Area Follow-up Study, psychiatrists administered the Schedules for Clinical Assessment in Neuropsychiatry to 333 adult subjects who also completed the Revised NEO Personality Inventory. All of the disorders except simple phobia were associated with high neuroticism. Social phobia and agoraphobia were associated with low extraversion. In addition, lower-order facets of extraversion, agreeableness, and conscientiousness were associated with certain disorders (i.e., low positive emotions in panic disorder; low trust and compliance in certain phobias; and low competence, achievement striving, and self-discipline in several disorders). This study emphasizes the utility of lower-order personality assessments and underscores the need for further research on personality/psychopathology etiologic relationships.     

Positive and negative life events and personality traits in predicting course of depression and anxiety

Spinhoven P, Elzinga BM, Hovens JGFM, Roelofs K, van Oppen P, Zitman FG, Penninx BWJH. Positive and negative life events and personality traits in predicting course of depression and anxiety. Objective: To examine the prognostic value of personality dimensions and negative and positive life events for diagnostic and symptom course trajectories in depressive and anxiety disorder. Method: A total of 1209 subjects (18–65 years) with depressive and/or anxiety disorder were recruited in primary and specialized mental health care. Personality dimensions at baseline were assessed with the NEO‐FFI and incidence and date of life events retrospectively with a structured interview at 2‐year follow‐up. DSM‐IV‐based diagnostic interviews as well as life chart assessments allowed course assessment at both the diagnostic and symptom trajectory level over 2 years. Results: Life events were significantly related to diagnostic and symptom course trajectories of depression and anxiety also after correcting for sociodemographic and clinical characteristics. Only negative life events prospectively predicted longer time to remission of depressive disorder. Prospective associations of neuroticism and extraversion with prognosis of anxiety and depression were greatly reduced after correcting for baseline severity and duration of index disorder. Personality traits did not moderate the effect of life events on 2‐year course indicators. Conclusions: Negative life events have an independent effect on diagnostic and symptom course trajectories of depression and to a lesser extent anxiety unconfounded by sociodemographic, clinical, and personality characteristics.     

Impact of personality on termination of short-term group psychotherapy in depressed elderly outpatients

OBJECTIVE: Termination in group psychotherapy is an essential phase of the psychotherapeutic process, yet its clinical determinants remain largely unknown, especially in elderly patients. The aim of this study was to assess how patients' personality traits influence their way of leaving a short-term psychotherapy group as well as a larger therapeutic community program. METHOD: Personality traits were assessed with the NEO Five-Factor Inventory in 24 elderly depressed outpatients. Patients' terminations from the group as well as from the community were ranked into four classes according to their appropriateness (completeness of experience and ability to deal with feelings of separation). RESULTS: Neuroticism was not related to the quality of termination. In contrast, agreeableness and openness to experience were strongly associated with successful termination. Conscientiousness and extraversion may have a differential impact depending on the type of group (group psychotherapy versus therapeutic community). CONCLUSION: Personality traits may be important clinical determinants of the quality of termination process in both group psychotherapy and therapeutic community settings for elderly depressed patients.     

Alexithymia and the five-factor model of personality.

The relationship between alexithymia assessed by the Toronto Alexithymia Scale (TAS) and the five-factor model of personality measured by the NEO Five-Factor Inventory (FFI) was investigated in a group of psychiatric outpatients (n = 114) and normal volunteers (n = 71). When controlling for depression, the domains of neuroticism, introversion, and low openness predicted alexithymia. These three dimensions accounted for 57.1% of the explained variance in the patient cohort and 38.1% in the volunteer group. In the patient cohort, neuroticism contributed the majority of explained variance, which may reflect the state effect of distress that elevates neuroticism. Introversion was the most significant predictor in the volunteer group. These data suggest alexithymia is a unique personality trait that is not fully explained by the five-factor model of personality.     

Patient-informant agreement on personality ratings and self-awareness after head injury

To address concerns about self-awareness deficits and the validity of self-ratings by patients with head injury (HI), the current study examines mean differences and correlations between self-ratings from 52 patients with HI and ratings of the patient by informants using the revised NEO Personality Inventory (NEO-PI-R). Patient self-ratings were significantly lower than informant ratings on neuroticism and extraversion and significantly higher on conscientiousness. Patient-informant correlations ranged from .42 for conscientiousness to .67 for agreeableness, and these agreement correlations compare favorably with those obtained from normal adult samples. Hierarchical multiple regression equations for each of the five NEO-PI-R trait domains showed that more severe injuries were associated with higher agreement for extraversion. For all five traits, the strongest predictors of informant personality ratings were the patients' self-ratings. The implications of these findings for clinical assessment and improved research on self-awareness deficits after HI are discussed.     

Patient-Informant Agreement on Personality Ratings and Self-Awareness after Head Injury

To address concerns about self-awareness deficits and the validity of self-ratings by patients with head injury (HI), the current study examines mean differences and correlations between self-ratings from 52 patients with HI and ratings of the patient by informants using the revised NEO Personality Inventory (NEO-PI-R). Patient self-ratings were significantly lower than informant ratings on neuroticism and extraversion and significantly higher on conscientiousness. Patient-informant correlations ranged from .42 for conscientiousness to .67 for agreeableness, and these agreement correlations compare favorably with those obtained from normal adult samples. Hierarchical multiple regression equations for each of the five NEO-PI-R trait domains showed that more severe injuries were associated with higher agreement for extraversion. For all five traits, the strongest predictors of informant personality ratings were the patients' self-ratings. The implications of these findings for clinical assessment and improved research on self-awareness deficits after HI are discussed.     

Can personality traits help us explain disability in chronic schizophrenia?

Psychotic features have been considered the main determinant of psychosocial function in schizophrenia. However, other variables are likely to affect dysfunction in these patients. The authors' hypothesis is that personality traits in outpatients with chronic schizophrenia differ from traits found in the healthy population and may be associated with disability in this disorder. A total of 62 patients with schizophrenia were evaluated with the Eysenck Personality Questionnaire (EPQ) and the Tridimensional Personality Questionnaire (TPQ). Psychotic features were measured with the help of the Positive and Negative Syndrome Scale (PANSS). Disability was assessed with the Disability Assessment Schedule (DAS). A total of 43 healthy subjects were used as controls for personality measurements. Normative data for the study population was also used to evaluate results in patients. Patients with schizophrenia had higher levels of neuroticism (median in percentile 65) and lower levels of extraversion (median in percentile 25) than the healthy population. Results of the TPQ showed higher harm avoidance and lower reward dependence levels compared to the healthy population. After multiple regression tests, negative symptoms were the strongest predictor of disability in patients with schizophrenia. Neuroticism contributed independently to the DAS overall behavior and global judgement subscales scores (more negative symptoms and higher neuroticism resulted in worse functioning), but not to the social role subscale. Outpatients with chronic schizophrenia showed high levels of neuroticism, harm avoidance, and introversion. Neuroticism significantly contributes to the long-term deficits found in patients with schizophrenia.     

Amygdala gray matter concentration is associated with extraversion and neuroticism

Using high-resolution magnetic resonance imaging and voxel-based morphometry in 41 healthy individuals, this study evaluated the association between the personality traits of extraversion and neuroticism, on the one hand, and individual differences in localized brain volume and gray matter concentration, on the other, with a special focus on the amygdala. Extraversion was positively correlated with gray matter concentration in the left amygdala, whereas neuroticism was negatively correlated with gray matter concentration in the right amygdala. Given that neuroticism is a risk factor for depression, our finding offers one explanation as to why prior structural imaging studies of depressed patients (which did not control for personality) produced conflicting findings. Furthermore, our data are consistent with the view that amygdala reduction seen in depressed patients precedes the onset of the disease, rather than being a consequence of the illness.     

Normal personality traits and comorbidity among phobic, panic and major depressive disorders

High comorbidity among anxiety and depressive conditions is a consistent but not well-understood finding. The current study examines how normal personality traits relate to this comorbidity. In the Baltimore Epidemiologic Catchment Area Follow-up Study, psychiatrists administered the full Schedules for Clinical Assessment in Neuropsychiatry to 320 subjects, all of whom completed the Revised NEO Personality Inventory. The disorders of interest were simple phobia, social phobia, agoraphobia, panic disorder, and major depression. Analyses were carried out with second-order generalized estimating equations. The unadjusted summary odds ratio (SOR - or weighted mean odds ratio) for all five disorders was 1.72 (95% confidence interval=1.21-2.46). Neuroticism, introversion, younger age, and female gender were all significant predictors of prevalence of disorders. After adjustment for the relationships between these personality and demographic predictors and prevalence, the association among disorders was much weaker (SOR=1.11, 95% CI=0.79-1.56). However, subjects with high extraversion had a SOR 213% as high (95% CI=102-444%) as those with low extraversion (1.60 vs. 0.75). Therefore, neuroticism and introversion are associated with increased comorbidity due to relationships in common with the prevalence of the different disorders. In contrast, extraversion is associated with increased comorbidity per se.     

Personality disorders and traits in patients with body dysmorphic disorder

Individuals with body dysmorphic disorder (BDD) have been postulated to have schizoid, narcissistic, and obsessional personality traits and to be sensitive, introverted, perfectionistic, and insecure. However, data on personality traits and disorders in BDD are limited. This study assessed 148 subjects with BDD, 26 of whom participated in a fluvoxamine treatment study; 74 subjects were assessed for personality disorders with the Structured Clinical Interview for DSMIII-R Personality Disorders (SCID-II), 100 subjects completed the NEO-Five Factor Inventory (NEO-FFI), and 51 subjects completed the Rathus Assertiveness Scale. Forty-two subjects (57%) had one or more personality disorders, with avoidant personality disorder (43%) being most common, followed by dependent (15%), obsessive-compulsive (14%), and paranoid (14%) personality disorders. On the NEO-FFI, the mean scores were in the very high range for neuroticism, the low range for extraversion and conscientiousness, the low-average range for agreeableness, and the average range for openness to experience. On the Rathus Assertiveness Scale, the mean score was -17.1 +/- 32.0 for women and -17.0 +/- 32.3 for men. Among fluvoxamine responders, the number of personality disorders significantly decreased between the study baseline and endpoint. These findings suggest that the rate of personality disorders in BDD is relatively high, with avoidant personality disorder being most common. The high neuroticism scores and low extraversion scores are consistent with this finding.     

La théorie des cinq facteurs. Profils de personnalité selon la théorie des cinq facteurs et troubles de la personnalité chez des patients déprimés

ObjectivesThe aim of this study was to investigate in a clinical sample the relationships between the specific personality disorders (PD) and the personality traits as defined by the Big Five Model.Patients and methodsFifty-eight patients with major depressive disorder without psychotic symptoms were administered the NEO Personality Inventory Revised and the Structured Interview for DSM-IV Personality Disorders.ResultsAbout the two thirds of them presented at last one PD, the most frequent being obsessive-compulsive, avoidant, paranoid and borderline PDs. These four PDs exhibited a common Five Factor profile characterized by high neuroticism (domain and four facets), and low warmth, positive emotions, openness to values and trust. Three of them showed specific traits in addition: low extraversion and especially gregariousness and activity among paranoid, and low extraversion (especially gregariousness, assertiveness, and activity), openness to actions, competence, achievement striving and self-discipline but high straightforwardness among avoidant, and low extraversion (gregariousness and activity), openness to actions, and self-discipline among obsessive-compulsive patients.ConclusionsThese findings are fundamentally similar to the literature, with the exception of the relatively low conscientiousness among obsessive-compulsive patients. This discrepancy might be due to the fact that our patients were clinically depressed, while most previous research paradoxically studied the PD/FFM relationships among healthy non-consulting participants.