Sex differences in Cloninger's temperament dimensions--a meta-analysis

There have been many comparisons between men and women on psychological characteristics and personality. The Tridimensional Personality Questionnaire and Temperament and Character Inventory developed by Cloninger are used to measure the following temperament dimensions: novelty seeking, harm avoidance, reward dependence, and persistence. Studies using these scales in healthy (nonclinical) populations have reported varying results on sex differences, but there is no meta-analysis of the topic. In this study, meta-analytic methods were used to estimate sex differences in these temperament dimensions and to study the effect of mean age of the sample and location of the study (Asia/other) on possible differences. Studies on healthy populations were systematically collected; the required minimum sample size was 100. The search resulted in 32 eligible studies. Consequently, women scored higher in reward dependence (pooled effect size; Cohen's d = -0.63; z test, P value < .001) and harm avoidance (d = -0.33; P < .001). There were no differences in novelty seeking (d = -0.04; P = .29) or in persistence (d = -0.02; P = .62). The sex difference in reward dependence was significantly smaller in Asian studies. This study was the first one to pool studies on sex differences in Cloninger's temperament dimensions. Women scored consistently higher in harm avoidance in the studies included. Together with similar sex difference found in related traits (eg, depression), this finding supports the validity of this temperament dimension. The given data on sex differences should be taken into account in future studies using these instruments.

Age is strongly associated with alexithymia in the general population

OBJECTIVE

We studied the prevalence of alexithymia, its distribution in different age groups in a wide age range, its association with sociodemographic and health-related variables, and its co-occurrence with depression.

METHODS

The study forms part of the Health 2000 Study. The original sample comprised 8028 subjects representing the general adult population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), and depression was measured with the 21-item Beck Depression Inventory. Altogether, 5454 participants filled in TAS-20 in their mother tongue.

RESULTS

The prevalence of alexithymia was 9.9%. Men (11.9%) were more commonly alexithymic than women (8.1%). Alexithymia was associated with male gender, increasing age, low educational level, poor perceived health, and depression.

CONCLUSIONS

The findings were in line with earlier population studies. For the first time, it was possible to analyze the prevalence of alexithymia in a wide age range (30-97 years). International comparative studies are needed.

Somatization symptoms in young adult Finnish population--associations with sex, educational level and mental health

We assessed somatization symptoms and their associations among a 31-year-old Finnish population sample (n=1598). Data on somatization symptoms were gathered from a review of all medical public outpatient records. Subjects with four or more somatization symptoms according to the DSM-III-R criteria were classified as somatizers. Ninety-seven (83 females) DSM-III-R somatizers (6.1%) were found. Somatization associated with female sex, lower educational level and increased psychiatric morbidity. Roughly half of the somatizers had a comorbid psychiatric disorder. Mood disorders did not associate specifically with somatization--in fact, after adjusting for sex and educational level only anxiety disorders and personality disorders associated with somatization. It may be concluded that it is important to recognize psychiatric disorders in subjects with somatization symptoms, especially as these symptoms have been shown to be treatable with both psychotherapy and psychiatric medication.

Temperament profiles and somatization--an epidemiological study of young adult people

OBJECTIVE

We assessed the temperament profiles of young adult somatizers in an epidemiological setting. We hypothesized that somatizers would have a characteristic temperament profile.

METHODS

The sample consisted of 984 subjects at the age of 31 years. Data on somatization were gathered from a review of all public health outpatient records. Subjects with four or more somatization symptoms according to the DSM-III-R criteria were classified as somatizers. Temperament profiles were assessed using the Temperament and Character Inventory (TCI).

RESULTS

Six males (1.3%) and 61 females (11.5%) met our criteria for somatization. Harm avoidance and reward dependence of the TCI profiles were associated with somatization symptoms in the whole sample. In logistic regression analysis, sex and psychological distress were associated with somatization but not with temperament profiles.

CONCLUSION

We did not find a characteristic temperament profile for somatizers. This finding is in contrast to suggestions that somatization is associated with temperament profiles.

Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study

OBJECTIVE

To examine the association between body size and depression in a longitudinal setting and to explore the connection between obesity and depression in young adults at the age of 31 years.

DESIGN

This study forms part of the longitudinal Northern Finland 1966 Birth Cohort Study (N = 12,058). The follow-up studies were performed at 14 and 31 years. Data were collected by postal inquiry at 14 years and by postal inquiry and clinical examination at 31 years.

SUBJECTS

A total of 8,451 subjects (4,029 men and 4,422 women) who gave a written informed consent and information on depression by three depression indicators at 31 years.

MEASUREMENTS

Body size at 14 (body mass index (BMI) and 31 (BMI and waist-to-hip ratio (WHR)) years and depression at 31 years by three different ways: depressive symptoms by the HSCL-25-depression questionnaire (HSCL-25), the use of antidepressants and self-reported physician-diagnosed depression.

RESULTS

Obesity at 14 years associated with depressive symptoms at 31 years; among male subjects using the cutoff point 2.01 in the HSCL-25 (adjusted odds ratio (OR) 1.97, 95% CI 1.06-3.68), among female subjects using the cutoff point 1.75 (adjusted OR 1.64, 95% CI 1.16-2.32). Female subjects who were obese both at baseline and follow-up had depressive symptoms relatively commonly (adjusted OR 1.40, 95% CI 1.06-1.85 at cutoff point 1.75); a similar association was not found among male subjects. The proportion of those who used antidepressants was 2.17-fold higher among female subjects who had gained weight compared to female subjects who had stayed normal-weighted (adjusted OR 2.17, 95% CI 1.28-3.68). In the cross-sectional analyses male subjects with abdominal obesity (WHR >or=85th percentile) had a 1.76-fold risk of depressive symptoms using the cutoff 2.01 in the HSCL-25 (adjusted OR 1.76, 95% CI 1.08-2.88). Abdominally obese male subjects had a 2.07-fold risk for physician-diagnosed depression (adjusted OR 2.07, 95% CI 1.23-3.47) and the proportion of those who used antidepressants was 2.63-fold higher among obese male subjects than among male subjects without abdominal obesity (adjusted OR 2.63, 95% CI 1.33-5.21). Abdominal obesity did not associate with depression in female subjects.

CONCLUSION

Obesity in adolescence may be associated with later depression in young adulthood, abdominal obesity among male subjects may be closely related to concomitant depression, and being overweight/obese both in adolescence and adulthood may be a risk for depression among female subjects.

Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need

The purpose of this study was to investigate the dental health behavior and self-perceived dental treatment need, in relation to depressive symptoms and symptoms of anxiety, among a general population drawn from a sample of 31-yr-old-men and women born in Northern Finland in 1966 (n = 8463). The dental health behavior included toothbrushing frequency and the frequency of dental check-ups. Depressive symptoms, as well as symptoms of anxiety, were determined on the basis of the Symptom Checklist-25 (SCL-25). The participants were also asked about their education and family income. Subjects with a high number of depressive symptoms had lower toothbrushing frequency as well as a lower frequency of dental visits than subjects with no or only a few depressive symptoms. Morover, the self-perceived dental treatment need was more common among those with a high number of depressive symptoms. Symptoms of anxiety were significantly associated with lower toothbrushing frequency. The results support the view that there is an increased risk for impaired dental health among subjects with depressive symptoms or symptoms of anxiety.

Co-occurrence of Metabolic Syndrome With Depression and Anxiety in Young Adults: The Northern Finland 1966 Birth Cohort Study

OBJECTIVE

Only a few studies have dealt with the association of metabolic syndrome with depression and anxiety. We studied whether metabolic syndrome and its components are associated with depressive and anxiety symptoms in a young adult population cohort.

METHODS

This study forms part of the Northern Finland 1966 Birth Cohort Study. The study sample consists of 5,698 members of the cohort who participated in the field study in 1997 to 1998. Metabolic syndrome was defined according to the five criteria of the National Cholesterol Education Program. Depressive and anxiety symptoms were defined by the Hopkins Symptom Checklist-25 questionnaire.

RESULTS

Metabolic syndrome was not associated with depression or anxiety. The correlations between the components of the metabolic syndrome and psychological distress as continuous measures were low. High waist circumference (>102 cm in males and >88 cm in females) associated with depression (odds ratio, 1.30; 95% confidence interval, 1.05-1.61), but this association vanished when adjusted for gender, smoking, alcohol consumption, marital status, level of education, and physical activity.

CONCLUSION

No clear association was found between the metabolic syndrome and psychological distress.

Schizophrenia, neuroleptic medication and mortality

BACKGROUND

There is an excess of death from natural causes among people with schizophrenia.

AIMS

Schizophrenia and its treatment with neuroleptics were studied for their prediction of mortality in a representative population sample of 7217 Finns aged >/= 30 years.

METHOD

A comprehensive health examination was carried out at baseline. Schizophrenia was determined using the Present State Examination and previous medical records.

RESULTS

During a 17-year follow-up, 39 of the 99 people with schizophrenia died. Adjusted for age and gender, the relative mortality risk between those with schizophrenia and others was 2.84 (95% CI 2.06-3.90), and was 2.25 (95% CI1.61-3.15) after further adjusting for somatic diseases, bloodpressure, cholesterol, body mass index, smoking, exercise, alcohol intake and education. The number of neuroleptics used at the time of the baseline survey showed a graded relation to mortality. Adjusted for age, gender, somatic diseases and other potential risk factors for premature death, the relative risk was 2.50 (95% CI1.46-4.30) per increment of one neuroleptic.

CONCLUSIONS

There is an urgent need to ascertain whether the high mortality in schizophrenia is attributable to the disorder itself or the antipsychotic medication.

Co-occurrence of personality disorders with mood, anxiety, and substance use disorders in a young adult population

The purpose of this study was to determine the co-occurrence of DSM- III-R personality disorders (PDs) with mood, anxiety, and substance use disorders in a young adult population. The members of the Northern Finland 1966 Birth Cohort Project, living in the city of Oulu with an age of 31 years (N = 1,609) were invited to participate in a two-phase field study. The SCID I and II were used as diagnostic instruments. One hundred and seventy-seven out of 321 interviewed subjects met the criteria for mood, anxiety, or substance use disorders. Altogether 72 (41%) of the subjects with an Axis I disorder met the criteria for at least one PD. The weighted co-occurrence rate of any PD varied from 28% for mood disorders to 47% for anxiety disorders. PDs, especially those in Cluster C, are highly associated with Axis I psychiatric disorders in population.

Comorbidity between facial pain, widespread pain, and depressive symptoms in young adults

AIMS

To assess, firstly, the prevalence of facial pain associated with widespread pain and the prevalence of high levels of depressive symptoms (ie, "depressiveness") among subjects with this pain condition, and secondly, the association between depressiveness and a facial pain condition.

METHODS

This study forms part of the Northern Finland Birth Cohort study. The original material consisted of all people whose expected birthdate was in 1966 in Northern Finland. Of these, 5,696 participated in a follow-up study at the age of 31. As part of it, data on facial pain, pain in other areas of the body, depressiveness (measured using the Symptom Checklist-25 depression subscale) and sociodemographic background data were gathered using questionnaires. Prevalence proportion ratios were estimated using log-binomial regression models.

RESULTS

Facial pain and simultaneous widespread pain were reported by 8.3% of the subjects (6.6% of men and 9.9% of women), and 27.4% of those with widespread pain were depressive. Comorbidity between facial pain, widespread pain, and depressiveness was found to be particularly prevalent among women.

CONCLUSION

Comorbidity should be taken into account in clinical practice. A multidisciplinary approach is needed, especially for patients with complex pain conditions.

Alexithymia after traumatic brain injury: its relation to magnetic resonance imaging findings and psychiatric disorders

OBJECTIVE

People with traumatic brain injury (TBI) were studied to assess the prevalence of alexithymia and its relationship to magnetic resonance imaging (MRI) findings and psychiatric disorders.

METHODS

Fifty-four participants, 67% men, were evaluated after a median of 30 years since TBI. A control group was matched for age, gender, and severity of depression. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). In patients with TBI, axis I psychiatric disorders were assessed with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN, version 2.1), and axis II disorders with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). MRI examinations were carried out with a 1.5 T MRI scanner.

RESULTS

Alexithymia was significantly more common in patients with TBI than in controls (31.5% versus 14.8%; odds ratio 2.64, 95% confidence interval 1.03-6.80). None of the variables representing TBI, ie, severity of TBI or the presence, laterality, or location of contusions on MRI, was associated with the TAS-20 total scores. Several current axis I and II psychiatric disorders, particularly organic personality syndrome, were connected to higher TAS-20 scores.

CONCLUSION

Alexithymia is common, along with psychiatric disorders, in patients with TBI. Both of them may reflect dysfunction of the injured brain. In clinical practice, alexithymic features should be taken into consideration in psychosocial rehabilitation after TBI.

Somatization and alexithymia in young adult Finnish population

BACKGROUND

We assessed alexithymia and alexithymic features among young adult subjects with and without somatization symptoms in an epidemiological setting with a sample of young adults.

METHODS

The sample consisted of urban 31-year-old subjects (N=1002). Data on somatization were gathered from a review of all public health outpatient records. Subjects with four or more somatization symptoms according to the DSM-III-R criteria were considered somatizers. The 20-item version of the Toronto Alexithymia Scale (TAS-20) was used to measure alexithymia. Subjects with a total TAS score over 60 were considered as being alexithymic, and those with a score under 52 were considered nonalexithymic. Subjects with a total TAS score from 52 to 60 were considered as having alexithymic features.

RESULTS

The prevalence of alexithymia was 6.0% among somatizers and 4.8% among subjects without somatization symptoms, and the prevalence of alexithymic features was 7.5% and 12.6%, respectively.

CONCLUSIONS

No association was found between alexithymia and somatization in young adult general population. The earlier theory of the association between alexithymia and somatization may be questionable.

DSM-IV mood-, anxiety- and alcohol use disorders and their comorbidity in the Finnish general population--results from the Health 2000 Study

BACKGROUND

Information on prevalence, accumulation and variation of common mental disorders is essential for both etiological research and development of mental health service systems.

METHODS

A representative sample (6005) of Finland's general adult (> or = 30 years) population was interviewed in the period 2000-2001 with the CIDI for presence of DSM-IV mental disorders during the last 12 months in the comprehensive, multidisciplinary Health 2000 project.

RESULTS

Depressive-, alcohol use- and anxiety disorders were found in 6.5%, 4.5 % and 4.1% of the subjects, respectively. A comorbid disorder was present in 19% of those with any disorder. Males had more alcohol use disorders (7.3 % vs. 1.4 %) and females more depressive disorders (8.3 % vs. 4.6 %). Older age, marriage and employment predicted lower prevalence of mental disorders and their comorbidity. Prevalences of alcohol use- and comorbid disorders were higher in the Helsinki metropolitan area, and depressive disorders in northern Finland.

CONCLUSIONS

Mental disorders and their comorbidities are distributed unevenly between sexes and age groups, are particularly associated with marital and employment status, and vary by region. There appears to be no single population subgroup at high risk for all mental disorders, but rather several different subgroups at risk for particular disorders or comorbidity patterns.

Observing relationships in Finnish adoptive families: Oulu Family Rating Scale

Adoption studies were intended to separate genetic from environmental "causal" factors. In earlier adoption studies, psychiatric diagnostic labels for the adoptive parents were used as a proxy for the multiple dimensions of the family rearing environment. In the Finnish Adoption Study, research design provided the opportunity to study directly the adoptive family rearing environment. For this purpose 33 sub-scales were selected creating what we call Oulu Family Rating Scale (OPAS, Oulun PerheArviointiSkaala). In this paper, the manual for scoring of these sub-scales is presented.

Age at menarche and depression at the age of 31 years: findings from the Northern Finland 1966 Birth Cohort Study

OBJECTIVE

Early age at menarche has been found to be associated with higher oestrogen levels among girls around the onset of puberty and in early adulthood. The role of oestrogen in depression is not clear, although it affects serotonergic functions in the central nervous system (CNS). We wanted to test the hypothesis that age at menarche is associated with depression in young adulthood.

METHODS

The material consisted of 3952 women born in 1966 in Northern Finland. Depression was defined by the Hopkins Symptom Checklist-25 (HSCL-25), the use of antidepressants and by self-reported lifetime depression diagnosed by physician. Menarcheal age was divided as 9-11, 12-15 and 16 years or over.

RESULTS

The prevalence of depression was 1.8-fold in current depression, 2.8-fold in the use of antidepressants and 2.1-fold in self-reported physician-diagnosed depression in women with menarche at the age of 16 years or later. After adjusting for confounders, the significant positive association between current depression and late menarche remained, but the use of antidepressants and depression diagnosed by physician had not statistically significant association with the age of menarche.

CONCLUSION

A possible explanation for the result may be oestrogen as a protective factor against depression.

A large population cohort provides normative data for investigation of temperament

OBJECTIVE

We evaluated the psychometric properties of widely used scales for assessing temperament in a large birth cohort. We simultaneously compared the properties of the temperament dimensions of the Tridimensional Personality Questionnaire (TPQ) and of the Temperament and Character Inventory (TCI).

METHOD

As part of the 31-year follow-up survey of the prospective Northern Finland 1966 Birth Cohort, the TPQ and TCI temperament questions were filled in by 4349 subjects (1974 males, 2375 males). Factor analysis and Cronbach's alpha were used to explore the psychometric properties of the scales.

RESULTS

Of the three higher-order dimensions the reward dependence (RD) was the only one performing poorly in our study sample. Cronbach's alpha was higher in the TCI than in the TPQ.

CONCLUSION

The results indicate good performance of the TCI and TPQ. Factor analysis support adoption of four temperament dimensions and suggest that developmental work is still needed in the RD dimension.

Asperger syndrome, alexithymia and perception of sleep

Two research traditions, the one on Asperger syndrome (AS) and the other on alexithymia, have produced similar findings independently of each other indicating a possible association between these two phenomena. Both conditions are also associated with impaired initiation and continuity of sleep. Twenty AS adults were compared with 10 healthy controls using the Toronto Alexithymia Scale and the Basic Nordic Sleep Questionnaire. AS subjects were significantly more alexithymic and reported lower sleep quality as compared with controls. AS and alexithymia are associated although the mediating factors are unknown. It is possible that alexithymic traits predispose to anxiety, which in turn lowers the sleep quality in AS adults. Alternatively, low sleep quality might be due to AS itself.

Parental separation at birth and depression in adulthood: a long-term follow-up of the Finnish Christmas Seal Home Children

BACKGROUND

Early separation of a child from the mother has been considered a risk factor for later depression. We investigated the association between very early separation and depression in adulthood in a unique dataset.

METHOD

The index cohort consisted of 3020 subjects born in 1945-1965 in Finland, isolated from their family due to tuberculosis in the family and placed in special nurseries, immediately after birth, for an average time of 7 months. Those subjects alive at 1 January, 1971 were identified. For every index subject two reference subjects were chosen, the matching criteria being sex, year of birth and place of birth. Data on depression were obtained from the Finnish Hospital Discharge Register by the end of year 1998.

RESULTS

In males, 4.2% of the index subjects and 2.6% (Adjusted Rate Ratio RR 1.7, 95% CI 1.3-2.3) of the reference subjects had been treated in hospital due to a depressive episode. In females the respective figures were 3.9% for index subjects and 3.6% (RR 1.1, 95% CI 0.8-1.5) for reference subjects.

CONCLUSIONS

The index subjects had an elevated risk for hospital treated depression in adulthood. One explanation may be that the very early temporal separation from the mother at birth may have unfavourable effects on later psychological development. On the other hand, separation from the parents at birth was not found to be strongly associated with severe adulthood depression.

Comparison of hospital-treated personality disorders and personality disorders in a general population sample

The distribution of personality disorders (PDs) was explored in hospital-treated subjects and in a population subsample. This study forms a part of the Northern Finland 1966 Birth Cohort study. Hospital case records of psychiatric treatment periods of all cohort members (n=11,017) were reviewed and re-checked against DSM-III-R criteria. A subsample of the cohort members living in Oulu (n=1609) were invited to a two-stage psychiatric field survey with Structured Clinical Interview for DSM-III-R (SCID) as a diagnostic method. The most common PDs in hospital-treated sample were cluster B PDs (erratic). In the population subsample, cluster C PDs (anxious) formed the majority.

Somatization disorder in young adult population

Somatization is a widespread problem in health care. We estimated the occurrence of Somatization Disorder (SD) using three different case-finding methods in a general population cohort. The sample consists of 1,598 subjects born in 1966. The case-finding methods according to the DSM-III-R criteria for SD were: 1) Finnish Hospital Discharge Register (FHDR) data, 2) analysis of the patient records in public outpatient care 1982-1997, and 3) Structured Clinical Interview for DSM-III-R (SCID) for 321 selected cases. The prevalence of SD was 1.1% (N = 18), giving a female-to-male ratio of 5:1. All cases were found among the public outpatient care records. No cases appeared in the FHDR or were recognized in the psychiatric interview. The lifetime prevalence of SD was comparable with previous western population studies. Methodologically, information from outpatient records may be more sensitive in detecting SD than hospital diagnosis or even psychiatric interview. Clinically we stress the importance of recognizing these cases by liaison psychiatrists especially because SD has been recognized as being difficult to treat among somatic and primary health service providers and because some promising treatment alternatives such as cognitive-behavioral therapy and antidepressants have emerged for SD patients.

Inpatient treatment of mood disorders in the era of de-institutionalisation, depression awareness campaigns and development of new antidepressants

OBJECTIVE

To analyse changes in inpatient treatment for mood disorders during the period of de-institutionalisation, de-centralisation of service planning, economic recession, attempts to increase depression awareness and increasing biological treatment possibilities. A special interest is paid to whether de-institutionalisation at specialist level psychiatric care results in transfer of inpatient care into non-specialised institutions.

METHOD

A register study of all inpatient treatment due to psychiatric disorders from four health care districts in Northern Finland, with a population of more than 600,000. Treatment undertaken by psychiatric hospitals and wards, primary care wards and medical and surgical wards in general hospitals are distinguished.

RESULTS

Inpatient treatment for mood disorders increased vastly in all kinds of health care institutions. The increase was due to growing inpatient treatment of depression.

LIMITATIONS

The National Discharge Register does not include treatment episodes in private nursing homes or details about the contents of the treatment.

CONCLUSION

Even during explicit active de-institutionalisation, other policies may have a greater impact on hospital use, resulting in unexpected changes in patient populations and service utilisation. In Finland, de-institutionalisation failed concerning mood disorders. The depression awareness policies during the 1990s increased inpatient use of depression across institutions.

Parental separation at birth and criminal behaviour in adulthood--a long-term follow-up of the Finnish Christmas Seal Home children

BACKGROUND

Parental absence has been connected with later criminality. We studied the association between very early separation and criminality in a unique data set.

METHODS

The index cohort consisted of 2,906 subjects born between 1945 and 1965 in Finland who were temporarily isolated from their family immediately after birth and sent to adequate nursing homes due to tuberculosis in the family. The average separation time was 7 months. For every index subject, two reference subjects (matched for sex, year of birth and place of birth) were gathered. Data on criminal offences were obtained from Statistics Finland arising from adolescence to middle age, between January 1, 1977 and December 31, 1998. The association between parental separation and subcategories of non-violent and violent criminality and violent recidivism, respectively, in male and female offspring was analysed. Subjects who had committed at least two violent crimes were defined as violent recidivists.

RESULTS

Of the male index subjects, 12.1% as compared with 7.1% of the reference cohort (estimated relative risk RR 1.73; 95% CI 1.42-2.11) had committed violent offences. Of the male index subjects 5.2% and of the male reference subjects 3.6% were violent recidivists (RR 1.47; 1.10-1.98). Of the male index subjects 26.3% and of the reference cohort 23.4% had committed nonviolent crimes (RR 1.14; 1.01-1.29). Among females, non-violent crimes were committed by 7.9% of the index subjects and by 5.0% of the reference subjects, respectively (RR 1.54; 1.18-2.00). Violent crimes were rare among female subjects.

CONCLUSION

Criminal behaviour was more prevalent among both male and female subjects separated at birth from their families because of tuberculosis in the family than in the reference cohort. Especially violent crimes were prevalent in the male index cohort. Even so, the differences between the index and reference cohorts were rather modest. Very early separation may have some, although limited, influence on later criminality in the offspring.