Temperament and major depression: How does difficult temperament affect frequency, severity, and duration of major depressive episodes among offspring of parents with or without depression?

doi:10.1016/j.jad.2016.04.033

Journal of Affective Disorders

Volume 200, August 2016, Pages 82-88

https://doi.org/10.1016/j.jad.2016.04.033 Get rights and content

Highlights

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We assessed the relationship between parental MDD, offspring MDD, and temperament.
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203 offspring of depressed or non-depressed parents were followed over 20-years.
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Greater rhythmicity and adaptability predicted fewer lifetime MDEs.
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Greater inattention/distractibility predicted shorter duration MDEs.
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Differences in clinical presentation of MDD reflect distinct temperamental profiles.

Abstract

Introduction

The current study examined the relationships between parental depression, offspring depression, and offspring temperament among 203 offspring of parents with or without depression. The specific aim was to investigate how parental depression and offspring difficult temperament affect frequency, severity, and duration of offspring major depressive episodes (MDEs).

Methods

As part of an ongoing multigenerational study assessing familial transmission of depression, offspring were assessed over a 20-year study period. Offspring temperament was assessed at baseline using the Dimensions of Temperament Survey and diagnostic interviews were conducted at each of the four waves using best estimate procedures.

Results

Difficult temperament predicted greater frequency of lifetime MDEs. Parental depression moderated the relationship between offspring difficult temperament and severity of MDEs, such that difficult temperament was associated with increased severity ratings among high-risk, but not low-risk offspring. Dimensional analysis revealed that lower rhythmicity and adaptability were associated with greater number of lifetime MDEs, higher inattention/distractibility was associated with shorter duration of MDEs, and greater activity was associated with decreased severity of MDEs.

Discussion

Certain limitations must be noted, namely the self-report nature of temperament data and the relatively small sample size drawn from a clinical and predominantly Caucasian and Christian sample. Notwithstanding these limitations, our results suggest that the clinical presentation of major depression may reflect temperamental profiles and should be considered in diagnostic and treatment settings.

Section snippets

Participants and procedures

The current study utilized a subsample of a longitudinal, multigenerational study of individuals at high- and low-risk for major depression by Weissman and colleagues (2006, 1997, 1987). A full description of the study procedures has been published elsewhere (Weissman et al., 2006, Weissman et al., 1997, Weissman et al., 1987). The original study sample consisted of adults with depression recruited from the Yale University Depression Research Unit, an outpatient specialty clinic for the

Diagnostic assessments

Offspring and parents completed up to four diagnostic assessments (Waves 1–4); adult participants were assessed using the SADS-L (Mannuzza et al., 1986) and children aged 6 through 17 were administered the K-SADS-E (Kaufman et al., 1997). Trained doctoral and master's level mental health professionals conducted all interviews, and all interviewers were blind to lifetime diagnostic status of either parent or child. Best estimate (BE) procedure (Leckman et al., 1982) was used to diagnose MDEs,

Data analysis

Mixed Model procedures were used to examine the impact of difficult temperament and parental depression (i.e., risk status) on features of major depression. MIXED command in SPSS version 20 was used to adjust for nested family effect. Nested family effect suggests non-independence of outcome; having multiple offspring from the same high-risk family artificially increases the chances of finding a significant association between parental depression, offspring depression, and difficult temperament

Participants

The current study sample consists 203 offspring from 80 families, including 138 high-risk offspring (at least one parent with depression) and 65 low-risk offspring (no history of parental depression). All participants were Caucasian and group matched for age and sex and proband groups did not differ on any key demographic variables (see Table 1). Participants completed a diagnostic interview at Wave 1 and/or Wave 2, and subsequently at Wave 3 and/or Wave 4, and an assessment of temperament at

Discussion

The current study examined the relationships between parental depression, offspring depression, and offspring temperament over a 20-year developmental period from adolescence to adulthood. We extended existing findings by examining how offspring difficult temperament and parental depression affect qualitative features of major depression rather than just lifetime incidence. Several important results were found.

Offspring difficult temperament was associated with more frequent MDEs, but not with

Conclusion

The period from adolescence to adulthood is one of increased responsibility and autonomy. Given the onset of depression peaks during this time, it is crucial to understand how an individual's constitutional makeup (i.e., temperament) impacts the onset, course, and prognosis of disorder. The current study examined the relationships between parental depression, offspring depression, and offspring temperament. As far as we know it is the longest multigenerational follow-up study with high- and

References (45)

B. Bruder-Costello et al.
Temperament among offspring at high and low risk for depression
Psychiatry Res.
(2007)
A. Chronis-Tuscano et al.
Stable early maternal report of behavioral inhibition predicts lifetime social anxiety disorder in adolescence
J. Am. Acad. Child Adolesc. Psychiatry
(2009)
M. Elovainio et al.
Temperament and depressive symptoms: what is the direction of the association?
J. Affect. Disord.
(2015)
J. Kaufman et al.
Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data
J. Am. Acad. Child Adolesc. Psychiatry
(1997)
S.A. Lee et al.
Temperament and depressive symptoms in at-risk children: aggression and learning problems as mediating factors
Personal. Individ. Differ.
(2015)
M.C. Lovejoy et al.
Maternal depression and parenting behavior: a meta-analytic review
Clin. Psychol. Rev.
(2000)
S. Mannuzza et al.
Schedule for affective disorders and schizophrenia-lifetime version modified for the study of anxiety disorders (SADS-LA): rationale and conceptual development
J. Psychiatr. Res.
(1986)
B.R. McFarland et al.
Behavioral activation system deficits predict the six-month course of depression
J. Affect. Disord.
(2006)
L. Mufson et al.
The stability of temperament by child and mother reports over two years
J. Am. Acad. Child Adolesc. Psychiatry
(1990)
A. Pinto-Meza et al.
Behavioural inhibition and behavioural activation systems in current and recovered major depression participants
Personal. Individ. Differ.
(2006)

C.E. Schwartz et al.

Adolescent social anxiety as an outcome of inhibited temperament in childhood

J. Am. Acad. Child Adolesc. Psychiatry

(1999)

V. Srinivasan et al.

Pathophysiology of depression: role of sleep and the melatonergic system

Psychiatry Res.

(2009)

D. Watson et al.

Basic dimensions of temperament and their relation to anxiety and depression: a symptom-based perspective

J. Res. Pers.

(2005)

M. Windle et al.

Adolescent temperament and lifetime psychiatric and substance abuse disorders assessed in young adulthood

Personal. Individ. Differ.

(2006)

A.H. Buss et al.

Temperament: early developing personality traits

Psychol. Behav. Sci

(1984)

A. Caspi et al.

Behavioral observations at age 3 years predict adult psychiatric disorders: longitudinal evidence from a birth cohort

Arch. Gen. Psychiatry

(1996)

H.M. Conklin et al.

Working memory performance in typically developing children and adolescents: behavioral evidence of protracted frontal lobe development

Dev. Neuropsychol.

(2007)

Dimidjian, S., Hollon, S.D., Dobson, K.S., Schmaling, K.B., Kohlenberg, R.J., Addis, M.E., Gallop, R., McGlinchey,...

I.M. Goodyer et al.

Temperament and major depression in 11 to 16 year olds

J. Child Psychol. Psychiatry Allied Discip.

(1993)

J. Gray

The neuropsychology of temperament

J. Joormann et al.

Memory accessibility, mood regulation, and dysphoria: difficulties in repairing sad mood with happy memories?

J. Abnorm. Psychol.

(2004)

K.L. Kasch et al.

Behavioral activation and inhibition systems and the severity and course of depression

J. Abnorm. Psychol.

(2002)

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They were thought to be biologically-based and relatively stable predispositions over the lifespan (Elias et al., 2017; Kawamura et al., 2010) and conceptualized as the sub-clinical manifestations of mood disorders (Akiskal et al., 1998; Akiskal and Mallya, 1987; Akiskal and Akiskal, 1992). According to the Akiskal et al. ’s (2005) model, there are five domains of affective temperaments, namely depressive, hyperthymic, cyclothymic, irritable, and anxious, and all of them have been found to increase the risk for the development of depressive and/or bipolar disorders (e.g., Pompili et al., 2013; Rihmer et al., 2010; Sherman et al., 2016; Vázquez et al., 2013; Mechri et al., 2011; Somers et al., 2006). Affective temperaments referred to as “heritable personality factors that establish a person's baseline level of reactivity, mood, and energy” (Greenwood et al., 2012, pp. 303); consequently, their putative role in the etiology of depressive disorders should be understood in the interaction with environmental factors, in particular regarding the quality of primary attachment relationships (Benoit, 2004; Cassidy et al., 2013; Dagan et al., 2018; Fearon and Belsky, 2008; Galbally et al., 2020).
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: A sample of 61 adolescents and young adults outpatients were asked to complete the Temperament Evaluation of Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A) and the Hamilton Rating Scale for Depression (HAM-D). Attachment was assessed through the Adult Attachment Interview (AAI) and employing a dimensional approach to obtain continuous measures. Mediation models were performed with the affective temperaments as predictor, depressive symptoms as the criterion variable, and attachment dimensions as mediators.
: Findings showed significant direct effects between all the affective temperaments and depressive symptoms. Only the cyclothymic (β = 0.22; SE = 0.1; 95% IC = 0.05, 0.42) and irritable (β = 0.21; SE = 0.09; 95% IC = 0.04, 0.4) temperaments showed an indirect effect on depressive symptoms through secure-insecure attachment. Dismissing attachment did not predict either the affective temperaments nor depressive symptoms. Preoccupied attachment significantly predicts depressive symptoms and, when controlling for it, the hyperthymic temperament no longer directly associates with depressive symptoms.
: The cross-sectional study design limit conclusion about causation and directionality.
: Secure attachment could be a protective factor for depressive symptoms for individuals with a cyclothymic or irritable temperament. Differently, the hyperthymic temperament loses its protective role toward depressive symptoms when accounting for preoccupied attachment.
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In the current Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, temperamental traits are considered as correlate factors of a specific psychiatric disorder (American Psychiatric Association 2013). Affective temperaments may influence clinical expression, course, prognosis and treatment of a number of mood disorders, especially depression (Karam, Salamoun et al. 2010, Rihmer, Akiskal et al. 2010, Sherman, Vousoura et al. 2016, Gonda, Eszlári et al. 2020). Although temperament – psychopathology relations are dynamic, it appears unlikely that depressive episodes produce enduring changes in most personality traits (Klein, Kotov et al. 2011) making the last good treatment prognostic factors.
Dominant-submissive relationships depend upon functionality of the neural circuits involving monoaminergic neurotransmission. Behavioral profiles of selectively bred dominant (Dom) and submissive (Sub) mice have been proposed to mimic hyperthymic- or depressive-like temperaments observed in patients with affective disorders. These mice differentially respond to psychotropic agents and stressful stimuli, however, the mechanisms underlying these differences remain unclear. To address these mechanisms, we analyzed the brain monoamine content and responses to paroxetine (PXT) in Dom and Sub mice.
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Compared to Dom, Sub mice had decreased levels of serotonin (5-HT) in the brainstem (BS), reduced levels of norepinephrine (NE) in the prefrontal cortex (PFC), hippocampus (HPC), and striatum (STR) and elevated levels of dopamine (DA) in PFC, HPC, STR and BS. In EPM, PXT administration increased locomotion and exploration in Dom mice, with no effect in Sub mice. In FST, PXT disrupted immobility in Dom mice only. The PXT-produced differences in regional monoamine content were strain-dependent and consistent with the behavioral alterations.
Chronic PXT treatment, in vivo monoamine assays and sex-dependent analysis were out of the scope of this study and will be performed in the future in order to provide an in-depth evaluation of the neurochemical mechanisms underlying temperament-dependent responses to SSRIs.
Our findings suggest neurochemical mechanisms that underlie temperament-based response to antidepressant treatment.
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An active temperament is characterized by high energy levels and movement, excitability and interest in sports (Buss Am, 1984). While infant high active temperament has been found to be associated with externalizing problems in childhood (Mathiesen and Prior, 2006; Abulizi et al., 2017) it has also been found to be associated with fewer peer relation problems (Abulizi et al., 2017) and reduced severity of major depressive episodes (Sherman et al., 2016). Some components of a highly active temperament mimic symptoms of externalizing symptoms such as hyperactivity, although other components surround resilient building factors such as involvement in sports and a high energy level.
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¹: Current address: Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC, 29425, USA.

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Research paperTemperament and major depression: How does difficult temperament affect frequency, severity, and duration of major depressive episodes among offspring of parents with or without depression?

Highlights

Abstract

Introduction

Methods

Results

Discussion

Section snippets

Participants and procedures

Diagnostic assessments

Data analysis

Participants

Discussion

Conclusion

Psychiatry Res.

J. Am. Acad. Child Adolesc. Psychiatry

J. Affect. Disord.

J. Am. Acad. Child Adolesc. Psychiatry

Personal. Individ. Differ.

Clin. Psychol. Rev.

J. Psychiatr. Res.

J. Affect. Disord.

J. Am. Acad. Child Adolesc. Psychiatry

Personal. Individ. Differ.

J. Am. Acad. Child Adolesc. Psychiatry

Psychiatry Res.

J. Res. Pers.

Personal. Individ. Differ.

Temperament: early developing personality traits

Psychol. Behav. Sci

Behavioral observations at age 3 years predict adult psychiatric disorders: longitudinal evidence from a birth cohort

Arch. Gen. Psychiatry

Working memory performance in typically developing children and adolescents: behavioral evidence of protracted frontal lobe development

Dev. Neuropsychol.

Temperament and major depression in 11 to 16 year olds

J. Child Psychol. Psychiatry Allied Discip.

The neuropsychology of temperament

Memory accessibility, mood regulation, and dysphoria: difficulties in repairing sad mood with happy memories?

J. Abnorm. Psychol.

Behavioral activation and inhibition systems and the severity and course of depression

J. Abnorm. Psychol.

Research paper
Temperament and major depression: How does difficult temperament affect frequency, severity, and duration of major depressive episodes among offspring of parents with or without depression?