Parental care and personality in melancholic and nonmelancholic depression

Impact of dysfunctional parenting, affective temperaments, and stressful life events on the development of melancholic and non-melancholic depression: A path analysis study

BACKGROUND

The influence of psychosocial factors on differentiating between melancholic depression (MEL) and non-melancholic depression (NMEL) remains unclear. In this study, we aimed to investigate the interrelationship between dysfunctional parenting, personality traits, stressful life events, and the diagnosis of MEL and NMEL among patients with major depressive disorder (MDD).

METHODS

Ninety-eight patients with MDD completed the following self-administered questionnaires: the Parental Bonding Instrument (PBI) for dysfunctional parenting, the short version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) for affective temperaments, and the Life Experiences Survey (LES) for stressful life events. The data were analyzed using single and multiple regression analyses and path analysis.

RESULTS

Dysfunctional parenting did not have a significant direct effect on MEL. However, paternal care had a significant indirect effect on MEL through depressive temperament. The total indirect effect of paternal care on MEL was significant (indirect path coefficient = 0.161, p <0.05). In other words, low levels of paternal care were associated with the development of NMEL via increased depressive temperament. None of the paths from paternal care to MEL via negative change scores of the LES were significant.

LIMITATIONS

This study used cross-sectional data, so the possibility that current depressive status may affect the assessment of LES and TEMPS-A cannot be ruled out.

CONCLUSIONS

We found that low levels of paternal care did not directly affect the development of NMEL, but affected the development of NMEL through the mediation of depressive temperament rather than stressful life events.

Affective Temperaments in Differentiation Between Melancholic and Nonmelancholic Depression: A Case-Control Study

ABSTRACT

The association between major depressive disorder (MDD) and personality traits has been extensively studied. However, differences in personality traits between patients with melancholic MDD (MEL) and nonmelancholic MDD (NMEL) remain unclear. In this study, we aimed to determine whether neuroticism, which has been associated with MDD, and the five affective temperament subtypes assessed by the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) can be used to distinguish MEL and NMEL. A total of 106 patients with MDD (MEL, n = 52; NMEL, n = 54) and 212 age- and sex-matched healthy controls answered the Eysenck Personality Questionnaire-revised and the short version of TEMPS-A. In hierarchical logistic regression analysis, only depressive temperament scores were identified as a statistically significant feature distinguishing NMEL from MEL. Depressive temperament scores assessed by the short version of TEMPS-A were found to be significantly higher in NMEL patients than in MEL patients.

Maladaptive personality traits may link childhood trauma history to current internalizing symptoms

Research supports a strong relationship between childhood maltreatment and internalizing psychopathology (e.g., anxiety and depression), and features of personality are assumed to explain some of this relationship. In this study, we proposed a model in which maladaptive traits mediate the effect of childhood trauma history on internalizing symptoms in adult individuals. A mixed sample (N = 462) composed of 142 psychiatric patients and 320 community-dwelling individuals completed the Childhood Trauma Questionnaire (CTQ), the Personality Inventory for DSM-5 (PID-5), and the Symptom Checklist (SCL-27) for internalizing psychopathology. The effect of childhood traumas explained 34% of the variance in internalizing symptoms while controlling for the influence of age and gender. The traits accounted for 78% of this effect, which was predominantly exerted through the domains of Negative Affectivity, Detachment, and Psychoticism, and specifically through the facets of Depressivity, Suspiciousness, Anxiousness, Perceptual Dysregulation, and Distractibility. This finding provides preliminary support for the proposed model indicating that the aforementioned maladaptive trait domains potentially function as mediating links by which childhood traumas are translated into internalizing symptoms in adulthood. However, these findings must be interpreted with caution due to the cross-sectional and retrospective mono-method design of this study. Clinical implications are discussed in relation to transdiagnostic treatment and the potential value of specifying trait domain specifiers in ICD-11 and DSM-5 models of personality disorders.

Subtypes of depression and their overlap in a naturalistic inpatient sample of major depressive disorder

Subtyping depression is important in order to further delineate biological causes of depressive syndromes. The aim of this study was to evaluate clinical and outcome characteristics of distinct subtypes of depression and to assess proportion and features of patients fulfilling criteria for more than one subtype. Melancholic, atypical and anxious subtypes of depression were assessed in a naturalistic sample of 833 inpatients using DSM-IV specifiers based on operationalized criteria. Baseline characteristics and outcome criteria at discharge were compared between distinct subtypes and their overlap. A substantial proportion of patients (16%) were classified with more than one subtype of depression, 28% were of the distinct anxious, 7% of the distinct atypical and 5% of the distinct melancholic subtype. Distinct melancholic patients had shortest duration of episode, highest baseline depression severity, but were more often early improvers; distinct anxious patients had higher NEO-Five Factor Inventory (NEO-FFI) neuroticism scores compared with patients with unspecific subtype. Melancholic patients with overlap of anxious features had worse treatment outcome compared to distinct melancholic and distinct anxious subtype. Distinct subtypes differed in only few variables and patients with overlap of depression subtypes may have independent clinical and outcome characteristics. Studies investigating biological causes of subtypes of depression should take influence of features of other subtypes into account.

The role of DSM-5 borderline personality symptomatology and traits in the link between childhood trauma and suicidal risk in psychiatric patients

BACKGROUND

Childhood traumas appear to be linked to suicidal behavior. However, the factors that mediate between these two phenomena are not sufficiently understood. Recent findings suggest that borderline personality disorder (BPD) may explain some of the association.

METHOD

The present study investigated the potential mediating role of BPD symptomatology and traits between reported childhood trauma and suicidal risk in adult psychiatric outpatients (N = 124). BPD symptomatology was measured with DSM-5 Section II criterion-counts (SCID-II; Structured Clinical Interview for DSM-IV Axis II), whereas BPD traits were measured with specified DSM-5 Section III traits (PID-5; Personality Inventory for DSM-5). Childhood traumas were self-reported (CTQ; Childhood Trauma Questionnaire), whereas level of suicidal risk was measured with a structured interview (MINI Suicidality Module; Mini International Neuropsychiatric Interview). Mediation effects were tested by bias-corrected (10.000 boot-strapped samples) confidence intervals.

RESULTS

BPD features account for a considerable part of the cross-sectional association between childhood trauma and level of suicidal risk, even when controlling for the influence of gender, age, and educational level. This finding remained stable when testing the model without the suicidality-related BPD criterion and PID-5 items. DSM-5 Section II BPD criterion-counts explained 67% of the total effect, whereas DSM-5 Section III BPD traits accounted for 82% of the total effect. The specific DSM-5 Section III trait facets of "Depressivity" (52%) and "Perceptual Dysregulation" (37%) accounted for most of this effect.

CONCLUSIONS

The findings provide preliminary support for the proposed mediation model indicating that BPD features may help explain relations between childhood trauma and elevated suicidal risk in adult life, in particular for DSM-5 Section III personality traits of depressivity (e.g., pessimism, guilt, and shame) and perceptual dysregulation (e.g., dissociation). To reduce the suicidal risk among those with a history of childhood trauma, BPD features (including "Depressivity" and "Perceptual Dysregulation") might be an important target of assessment, risk management, and treatment. However, other factors are likely to be involved, and a longitudinal and more large-scale design is warranted for a conclusive test of mediation.

Clinical differences between melancholic and nonmelancholic depression as defined by the CORE system

BACKGROUND

The definition and delineation of melancholia have remained elusive for an extended period. A longstanding signal of psychomotor disturbance has been operationalized via the observer-rated CORE measure and with CORE-assigned melancholic and nonmelancholic compared in several Australian studies. Replication studies in other regions have not previously been reported. This study compares Brazilian patients with melancholic and nonmelancholic depression according to the CORE measure of psychomotor disturbance in terms of clinical characteristics, suicide ideation, stressful life events, quality of life, parental care, and personality styles.

METHODS

A total of 181 patients with unipolar major depression attending a tertiary care outpatient service in Brazil were evaluated in relation to melancholic status and study variables.

RESULTS

The CORE-assigned melancholic patients presented higher symptom severity, greater prevalence of suicide ideation, and Axis I comorbidities than nonmelancholics. Scores of dysfunctional personality styles and dysfunctional parental care measures were also higher among melancholics. Quality-of-life scores were low in both groups.

LIMITATIONS

The absence of a criterion standard for the diagnosis of melancholia and the use of medication can be potential limitations of the study.

CONCLUSION

Differences suggest that CORE-assigned melancholia defines a distinct group of patients and probably a disorder distinct from nonmelancholic depression not only in quantitative but also in qualitative aspects.

Personality differences between depressed melancholic and non-melancholic inpatients

OBJECTIVE

The aim of the present study was to confirm that non-melancholic depression corresponds to a higher degree of personality dysfunction compared to melancholia.

METHOD

A total of 188 inpatients, with a main DSM-IV diagnosis of major depressive disorder, were classified as melancholic and non-melancholic according to CORE system, DSM-IV, Research Diagnostic Criteria (RDC) Retarded Depression, and RDC Agitated Depression. Personality was assessed by means of the Temperament and Personality Questionnaire (T&P). Only patients at the nadir of their episode were included.

RESULTS

Compared to non-melancholic depressives, patients with CORE melancholia scored lower on social avoidance and higher on effectiveness and cooperativeness; patients with RDC Retarded Depression scored lower on Anxious-Worrying and Cooperativeness; patients with RDC Agitated Depression scored lower on Social Avoidance, Rejection Sensitivity and Anxious-Worrying, and higher on Effectiveness; while patients with DSM-IV melancholia scored higher on Irritability and lower on Cooperativeness. Both CORE and RDC Agitated Depression were associated with higher scores of Perfectionism.

CONCLUSIONS

The hypothesis of an association of melancholic depression with less marked personality dysfunction was confirmed for CORE melancholia and RDC Agitated Depression, and not supported for DSM-IV melancholia. Mixed evidence was obtained for RDC Retarded Depression. Personality of melancholic depressives seems to be characterized not only by less dysfunction but also by perfectionism, akin to the features of Tellenbach's typus melancholicus.

Two behavioural indicators of dependency and the Five-Factor Model of personality

Residence with parents and unemployment during studies were chosen as the two behavioural indicators of dependency among 601 undergraduate students. Students completed a demographic questionnaire, Costa and McCrae's (1992) NEO-FFI and Beck, Davis, and Freeman's (1990) Typical Beliefs of DPD. Unemployed students, living with their parents, were found to be significantly more dependent, neurotic and agreeable and less extraverted, conscientious and open than employed students who did not reside with their parents. Residing with parents during one's studies was the strongest predictor of dependency and neuroticism, followed by unemployment. Unemployed male students, who resided with their parents, were the most dependent, neurotic and agreeable and the least open, extraverted and conscientious group. The relationship between dependency and the Big Five is also discussed.

Parental lack of care and overprotection. Longitudinal associations with DSM-III-R disorders

BACKGROUND

This study served to replicate and extend the findings from the National Comorbidity Survey [Enns MW, Cox BJ, Clara I (2002) Psychol Med 32:997-1008], in examining associations between recalled parental bonding and the prevalence and incidence of mental disorders in adulthood.

METHODS

Data were used from 4,796 adults aged 18-64, who had participated in three waves (i.e., 1996, 1997, and 1999) of a large-scale Dutch epidemiological study.

RESULTS

Parental lack of care and overprotection were significantly associated with both prevalence and incidence of DSM-III-R disorders. However, the impact of parental bonding was modest, explaining only 1-5% of the variance in the occurrence and onset of psychopathology. Chi-square tests demonstrated there were no differences between the impact of paternal and maternal rearing behaviors on mental disorders, or between lack of care and overprotection in the prediction of mental disorders.

CONCLUSIONS

Overall, individuals' recollections of parental lack of care and overprotection appear to be non-specifically, modestly related to the prevalence and incidence of DSM-III-R disorders in adults from the general population. Future research may examine indirect or mediated links between parental bonding and (clinical diagnoses of) mental health problems.

Prevalence of typus melancholicus in healthy germans

BACKGROUND

There have been few studies concerning the prevalence of Typus melancholicus (TM) in healthy volunteers based on age or sex. To our knowledge, no such studies have been performed in healthy Germans, but several in healthy Japanese people. Therefore, it is necessary to also determine the prevalence of TM in healthy Germans, in order to know whether the prevalence of TM is cross-culturally constant.

SUBJECTS AND METHODS

We examined the prevalence of TM in 121 healthy German volunteers (62 men and 59 women with a mean age +/- SD of 43.9 +/- 16.8 years and 47.4 +/- 15.9 years, respectively). Kasahara's Inventory for the Melancholic Type Personality (KIMTP) and von Zerssen's F-List (F-List) were used to identify TM. The subjects were divided by age into three groups: those aged 40 years or less (group A), those aged 41-60 years (group B), and those aged 61 years or more (group C). Mean total KIMTP and F-List scores were calculated. In addition, we also calculated mean scores of the two KIMTP TM factors ['harmony in personal relationships' (factor 1) and 'social norms' (factor 2)]. Differences in scores between men and women were analyzed by Student's t test. Differences in scores between the three age groups were evaluated by one-way analysis of variance and Scheffé's test.

RESULTS

The KIMTP and F-List scores increased with age in both men and women. In the women, the KIMTP and F-List scores were significantly higher in groups B and C than in group A. In the women, the group C KIMTP factor 1 score was significantly higher than the group A KIMTP factor 1 score. The KIMTP and F-List scores tended to be higher for the women than for the men. Within groups B and C, the KIMTP and F-List scores and the KIMTP factor 1 score were significantly higher for the women than for the men.

CONCLUSION

Overall, the sex and age distributions of scores for both questionnaires were similar to those obtained in previous studies in Japanese people. It is of note that our German subjects and previous Japanese subjects were not demographically controlled and, clearly, cultural backgrounds differed. Thus, KIMTP and the F-List may discriminate the TM personality with some degree of universality despite cultural differences and might be useful in cross-cultural comparisons of TM.