Temperament and Character Domains of Personality and Depression

Depression Research and Treatment has issued a second compendium of papers focused on temperament, character, and depression. The psychobiology theory of personality proposed by Cloninger is a currently prevailing theory of personality that has been extensively investigated in the context of many different types of mental and personality disorders. This special issue reports up-to-date research findings on the psychobiology theory and depression from different countries. 
 
The current issue consists of six reports. Miettunen and colleagues in Finland present findings from a longitudinal birth cohort study (N = 4941). Participants with depression at 31 years of followup had higher rates of harm avoidance (HA) than participants without any psychiatric disorders. Participants without any psychiatric history were followed for another 12 years. Those who subsequently developed depression had high HA in 1997. The authors hypothesize that high HA is a potential indicator for subsequent depression. This study only used temperament scales and thus no information was available on the association between character and depression. 
 
Students in senior high schools (N = 1234) who were invited to participate in an internet-based intervention program for depression were studied by Christian and colleagues in Norway. High HA and low self-directedness (SD) emerged as strong predictors of adolescent depression. Interestingly, use of the internet intervention program was associated with low reward dependence (RD) in addition to depression severity. 
 
Garcia and colleagues studied an adolescent population (N = 304) in Sweden. Based on positive affect (PA) and negative affect (NA) scores derived from the Positive Affect and Negative Affect Schedule, the participants were categorized into four groups: self-fulfilling (high PA and low NA), high affective (high PA and high NA), low affective (low PA and low NA), and self-destructive (low PA and high NA). The self-fulfilling group was characterized by higher persistence (PS), SD, and cooperativeness (CO) than the three other groups. The self-destructive group was characterized by high HA and RD. The authors claim character maturity (expressed as high SD and CO) is important for psychological well-being. 
 
In Japan, Lu and colleagues followed graduate students (N = 184) on two occasions separated by a five-month interval. In a structural regression model, they posited that trait anxiety and depression constructs were linked to high HA and low SD. Although trait anxiety and depression scores were moderately correlated with each other, these two constructs showed different associations with Temperament and Character Inventory (TCI) subscale scores. Thus, trait depression was linked to high self-transcendence (ST) whereas trait anxiety was linked to low RD, PS, and CO. The authors claim that character maturity is linked to trait rather than state aspects of depression and anxiety. 
 
Directly exposed survivors of the Oklahoma City bombing randomly selected from a bombing survivor registry (N = 151) were examined by North and colleagues in the USA. Posttraumatic stress disorder (PTSD) after the bombing was associated with low SD and CO together with high ST and HA. Postdisaster major depression (MD) was more prevalent among those with PTSD than those without it, but low SD and CO could not be predicted by post-disaster MD. The authors emphasized the importance of developing and validating measures of resilience. 
 
A unique measure of temperament, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS), was used by Tei-Tominaga and colleagues to study job stress among employees in one Japanese company (N = 728). Depression was predicted by high levels of cyclothymic and anxious temperament traits even after controlling for the effects of work-related stressors such as demanding work conditions and overcommitment. 
 
These articles all indicate the importance of temperament and character traits in the development of depression among a variety of populations across different countries. Despite some differences between the studies, a common theme may be that low SD and high HA are predictors of depression either directly or being mediated by third variables. 
 
 
Toshinori Kitamura 
 
C. Robert Cloninger 
 
Andrea Fossati 
 
Jorg Richter

The link between personality and depression has long intrigued researchers and clinicians alike. Personality has been viewed as contributing to the onset and course of depression as well as influencing therapeutic choices for depression. Two major current personality theories are the "Big Five," in which the NEO-PI is used as a measuring instrument, and the Psychobiology Theory of Personality, which uses the Temperament and Character Inventory (TCI) as a measuring instrument. This special issue deals with the latter theory in terms of its interrelations with depression and related conditions.
The last couple of decades have witnessed a great number of research reports on this topic. The association of TCI dimension with diverse types of health problems, and depression in particular, has been reported in the literature. The TCI has also been studied in terms of predicting treatment responses of depressed patients. Genetic and environmental correlates of TCI dimensions are a hot topic among researchers. Hence we believe that the present special issue is very timely.
This issue consists of six reports. K. Josefsson and colleagues, in Finland, present results from a longitudinal study of young Finns. Based on TCI scores at Time 1, the group tried to predict levels of depression 10 years later. They found that both high harm avoidance (HA) and low self-directedness (SD) independently predicted later depression severity. Thus, a prospective population-based design yielded findings that echoed the results of past cross-sectional and clinical treatment studies.
In a two-year follow-up study of a clinical population of depression, J. G. Goekoop and colleagues in the Netherland reported that only the increase in SD (in this two-year period) was related to the decrease in emotional dysregulation symptoms, while the increase in SD was associated with the decrease in HA. This suggests that symptomatic recovery follows reversibility of lowered SD.
People with current depression may be diagnosed with bipolar disorder if they have a lifelong history of manic or hypomanic episodes. Hence the association of TCI profiles with depression should be examined in terms of previous diagnoses of mood disorders. J. A. Harley and colleagues, in New Zealand, relate the results of their South Island Bipolar Study, namely, that high HA scores differentiated people with major depressive disorder (MDD) and those with bipolar disorder (BD) from unaffected relatives of bipolar probands after controlling for the current severity of depression. HA, however, failed to differentiate those with MDD from those with BD. On the other hand, high self-transcendence (ST) differentiated people with bipolar I (major depression with manic episodes) from those with MDD and unaffected relatives, confirming other reports of the importance of selftranscendence in the creativity of people with bipolar disorders.
People with depression are diagnosed with psychotic depression if they show positive symptoms simultaneously. J. G. Goekoop and colleagues in the Netherland in a followup study of clinical samples of depression reported that whereas patients with depression as a whole were characterized by higher HA and lower SD than healthy controls during the acute episode and higher HA after full remission, patients with psychotic depression were characterized by lower cooperativeness and lower reward dependence (RD) in the acute episode and lower RD after full remission. Hence it may be that people with psychotic depression share the same personality traits of low RD with people with schizophrenia although the latter may be differentiated by high self-transcendence.
Z. Chen and colleagues in China, in their cross-sectional nonclinical population study, conducted a unique examination of TCI subscale score associations not with the total score of Zung's Self-rating Depression Scale but with the scores of its subscales. Unexpectedly, it was not the negative subscale score but the positive subscale score (consisting of items such as "enjoy things" (reverse) and "feel useful and needed" (reverse)) that was predicted by low SD, cooperativeness, RD, and persistence. This observation shows the importance of the absence of positive emotions in addition to the presence of negative emotions in mood disorders.
Depression is often observed among pregnant women. E. Andriola and colleagues, in Italy, present unique preliminary findings on TCI patterns among expectant mothers and their partners. Both groups were characterized by low SD, whereas only expectant mothers were demonstrated to have high HA.
Eating disorders (ED) are often comorbid with depression, and individuals with both conditions are known to be resistant to treatment. A. D. Giovanni and colleagues, in Italy, report a high prevalence of major depression (MD) in outpatients with ED. Compared to patients with ED only, those with ED and MD demonstrated higher anger and eating disorder pathology scores. They were also characterized by high HA and low SD.
C. R. Cloninger hypothesized dopamine, serotonin, and noradrenaline to be biological substrates of novelty seeking (NS), HA, and RD, respectively. Hence it may be of research interest to investigate the temperaments of patients suffering from conditions characterized primarily by deficiencies of these neurotransmitters. Parkinson's disease (PD) is such an example. PD is known to be caused by dopamine deficiency in cells of the substantia nigra. Pluck and Brown, in the UK, studied PD patients and controls. They found that NS scores correlated with a reaction time measure of attentional orientation to visual novelty, whereas HA scores correlated with anxiety scores. These observations confirm Cloninger's original hypotheses about attention and learning in NS and HA. Now that we have identified links between temperament and character domain patterns and depression, we must further investigate what mediates these effects. One possible mediator is coping style. M. Fushimi, in Japan, provides a hint that external locus of control is linked to psychological maladaptive patterns. Such coping styles may be based on personality traits. Other promising candidate mediators include self-esteem and self-efficacy, depressogenic dysfunctional attitudes and thinking errors, lack of social supports and social networks, poor coping reaction (rather than perceived coping styles), and stressful life events induced by specific personal traits.
Deeper insight into the association between personality and depression may contribute to the more efficacious treatment of depression.