Elsevier

Psychiatry Research

Volume 153, Issue 2, 31 October 2007, Pages 145-151
Psychiatry Research

Temperament among offspring at high and low risk for depression

https://doi.org/10.1016/j.psychres.2007.02.013Get rights and content

Abstract

The purpose of this study was to examine relationships between parental depression, offspring temperament, and offspring major depressive disorder (MDD), and to determine whether difficult temperament, as measured by the Dimensions of Temperament Survey (DOTS), mediates the relation between parental MDD and offspring MDD. Offspring (n = 169) of depressed or never depressed parents were followed over approximately 20 years and were blindly assessed up to 4 times (Waves 1 to 4) using semi-structured interviews. Offspring completed the DOTS at the time of first or second assessment. The results showed: (1) high-risk offspring with one or more depressed parent were significantly more likely than offspring with neither parent depressed to have a difficult temperament; (2) offspring with a difficult temperament were more than twice as likely as those with an easy temperament to develop a MDD; and (3) difficult temperament explained more than 10% of the association between parental depression and new onsets of MDD in offspring. The findings suggest that offspring temperament is associated with development of MDD and that difficult temperament at least partially mediates the relationship between parental depression and offspring depression. When identifying those at greatest risk for MDD, measures of temperament could serve as a useful supplement to family psychiatric history of MDD.

Introduction

Numerous longitudinal and family history studies have demonstrated that the offspring of parents with Major Depressive Disorder (MDD) are at a two- to three-fold increased risk for developing depression as compared to the offspring of parents without a history of this disorder (Weissman et al., 1987, Orvaschel et al., 1988, Puig-Antich et al., 1989). The depression faced by these offspring is impairing; yet few receive any treatment (Weissman et al., 1987). Despite the wealth of evidence demonstrating the increased risk of MDD in the children of depressed parents, the mechanisms behind this risk are not well understood, and early signs of MDD are unclear (Downey and Coyne, 1990, Goodman and Gotlib, 1999).

Temperament in offspring could serve as one early sign of risk for a psychiatric disorder. Temperamental characteristics are evident early in life and stable over time, irregularities in temperament have been shown to predict future psychiatric and behavioral problems, and there is evidence of a relationship between psychiatric disorder in parents and temperament in their children (Maziade et al., 1986, Mufson et al., 1990, Frick, 2004).

Difficult temperament and extreme temperamental traits have been linked to a wide range of psychological and behavioral problems in both adolescence and adulthood — including substance abuse, social phobia, generalized anxiety disorder, depressive symptoms and disorders, delinquency, aggression, and convictions for violent offenses (Kashani et al., 1991, Henry et al., 1996, Merikangas et al., 1999, Sanson and Prior, 1999, Giancola and Mezzich, 2003, Elovainio et al., 2004, Giancola, 2004). Some studies have found associations between specific characteristics of temperament and depression, as well as other mood disorders. Elovainio et al. (2004), for example, demonstrated that impulsiveness, shyness with strangers, fatigability, sentimentality, and persistence increased the risk for depressive symptoms among a sample of men and women aged 20 to 35, and Caspi et al. (1996) found that children who were inhibited — that is shy, fearful, easily upset by strangers, or had difficulty concentrating on tasks at age 3 were twice as likely as other temperament groups to develop a mood disorder by age 21. In general, temperament traits associated with negative emotionality (e.g., irritability, neuroticism, tendency toward discomfort — see Compas et al., 2004, for review) have been shown to correlate positively with depressive symptoms and disorders in adults, whereas those associated with positive emotionality (activity, approach-withdrawal, sociability) are negatively correlated with these symptoms (Enns and Cox, 1997, Klein et al., 2002). Poor attentional-control (ability to concentrate, task persistence) has also been linked with depression in the literature (Rothbart et al., 1995).

There is also evidence linking parental psychopathology with temperament in offspring. In a community sample of 210 children and adolescents, Kashani and colleagues (1991) found that children with a difficult temperament were more likely to have parents with a psychiatric disorder. Durbin et al. (2005) found that low Positive Emotionality (PE) in young children was related to mood disorders in their mothers, though this relationship did not hold for other categories of disorders, or for negative emotionality. Merikangas et al. (1998) found scores on the activity subscale of temperament to be highest among offspring of parents with substance use disorders, and lowest among offspring of parents with anxiety and/or affective disorders. Offspring of the anxiety/affective disorder group also demonstrated less regular sleeping and eating habits. Finally, employing a subset of offspring of the current study participants — those whose temperament was assessed at the initial recruitment and whose diagnoses were assessed 10 years later — Mufson et al. (2002) documented that offspring of parents with comorbid MDD and anxiety disorders had significantly lower levels of adaptability/approachability than those of parents with MDD alone. Children of parents with MDD also showed less regular eating and sleeping habits than children of parents without any history of psychiatric disorder.

Given the observed relationships between parental psychopathology and child temperament, and between temperament and disorders in children, it has been hypothesized that temperament may be a mechanism through which depression is passed from parent to child (Goodman and Gotlib, 1999, Costello et al., 2002). However, parental depression is independently a significant risk factor for disorders among offspring, and previous studies have not addressed how much additional impact measures of child temperament confer on the development of depressive disorders among children who are already exposed to the risk of parental depression. The current report employs a sample of offspring of parents with MDD (“high-risk”) or without MDD (“low risk”), followed over a span of more than 20 years, to examine the relationships between parental MDD, offspring temperament and offspring MDD. We evaluated the hypothesis that difficult temperament, as measured using the Dimensions of Temperament Survey (DOTS; Lerner et al., 1982), mediates the relation between parental MDD and offspring MDD. To test this hypothesis, we addressed four questions: (1) Is parental MDD associated with difficult temperament? (2) Is parental MDD associated with offspring MDD; (3) Is difficult temperament associated with offspring MDD? (4) Is the relation between parental MDD and offspring MDD reduced with temperament in the model? As a secondary purpose, we also examined whether or not parental MDD and difficult temperament interact to determine risk of MDD in offspring.

Section snippets

Subjects

Offspring at high or low risk for depression by virtue of the presence or absence of major depression in their parents were followed into adulthood over a period of 20 years. Depressed parents were originally selected from patients seeking treatment at the Yale University Depression Research Unit. Depression in the parents as assessed by the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L; Mannuzza et al., 1986) was moderate to severe and resulted in significant

Results

Mean scores for each subscale on the DOTS and the total difficult temperament score are given in Table 1 for offspring with or without parental MDD, after adjustment for offspring age. Offspring with one or more depressed parent had significantly greater difficult temperament scores when compared to those with neither parent depressed. There was also a trend for offspring with parental depression to show higher scores on the subscales for Adaptability, Attention, and Irritability, consistent

Discussion

Offspring of parents with a MDD are at increased risk for developing a depressive disorder (Weissman et al., 1987, Orvaschel et al., 1988, Puig-Antich et al., 1989). Four findings of the present study support the conclusion that difficult temperament, as measured by the DOTS (Lerner et al., 1982), partially mediates the relation between parental depression and childhood depression. First, in this subsample of offspring from our longitudinal, high-risk study (Weissman et al., 1987), those with

Acknowledgments

The authors express their gratitude to Min Tang, M.S. for assistance with statistical analyses. This study was supported by NIMH grant R01MH036197 (P.I., Myrna M. Weissman).

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