Posted by jrbecker on March 17, 2005, at 15:17:47
Journal of Affective Disorders
Volume 85, Issue 3 , April 2005, Pages 267-273
doi:10.1016/j.jad.2004.10.005
Copyright © 2004 Elsevier B.V. All rights reserved.
Research reportPersonality of seasonal affective disorder analyzed by Tri-dimensional Personality Questionnaire
Nobuhisa Maenoa, b, , , Kazunori Kusunokib, Tsuyoshi Kitajimab, Nakao Iwatab, Yuichiro Onob, Shuji Hashimotob, Makoto Imaic, Lan Lia, Yuhei Kayukawad, Tatsuro Ohtaa and Norio Ozakia
aDepartment of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
bDepartment of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
cDepartment of Psychiatry, Shiga University of Medical Science, Otsu, Japan
dDepartment of Health Administration Center, Nagoya Institute of Technology, Nagoya, JapanReceived 11 March 2004; accepted 15 October 2004. Available online 26 January 2005.
Abstract
Background
Although there have been numerous reports in personality of mood disorders, there have been few reports in regard with personality of winter seasonal affective disorder (SAD). Furthermore, no reports have been published concerning summer SAD personality characteristics. Thus, this study was conducted to assess the personality of winter and summer SAD using Tri-dimensional Personality Questionnaire (TPQ) that have been used in a variety of mental disorders.Methods
A total of 6135 Japanese were evaluated with TPQ, the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Self-rating Depression Scale (SDS). Winter, summer and non-SAD groups were classified by SPAQ. We compared the difference of personality trait among these three groups in consideration of gender, age and SDS score influence.Results
Winter SAD demonstrated higher “Novelty Seeking” and “Harm Avoidance”; summer SAD showed higher “Harm Avoidance” than the non-SAD group. “Harm Avoidance” in both SAD groups was re-analyzed using SDS score as a covariate, and “Novelty Seeking” in winter SAD using age as a covariate. As a result, the significance of high “Novelty Seeking” and high “Harm Avoidance” in winter SAD was excluded. However, “Harm Avoidance” remained the significant difference between summer and non-SAD.Limitation
SAD was diagnosed only by SPAQ and not by interview. The state-dependency of “Harm Avoidance” was not confirmed in identical patients over lapse of time.Conclusion
Patients with winter SAD have high “Harm Avoidance” dependent on the depressive state that is in accordance with non-seasonal depression. Patients with summer SAD have high “Harm Avoidance” possibly independent from the depressive state.Keywords: Seasonal affective disorder; Personality; Harm avoidance; Depressive state; TPQ
Article Outline
1. Introduction
2. Subjects and methods
3. Results
4. Discussion
5. Conclusions
Acknowledgements
References
1. Introduction
In cases of seasonal affective disorder (SAD), winter SAD is characterized as being accompanied by atypical depressive symptoms, including hypersomnia, hyperphagia and weight gain. Light therapy has been reported to be effective for winter SAD, although antidepressant drugs are not as effective as in general depression (Rosenthal et al., 1984). By comparison, little literature is available regarding the summer SAD, although this condition reported to be substantially influenced by temperature (Wehr et al., 1987). It is required to clarify the differences and similarities between winter and summer SAD, and non-seasonal depression to elucidate the pathophysiology of each mood disorder. For example, it is of interest whether the characteristics of SAD personality traits are similar to the characteristics of typical personality traits in general depression.The Tri-dimensional Personality Questionnaire (TPQ) or Temperament and Character Inventory (TCI) (TCI is a revised variation of TPQ) has frequently been used in the assessment of personality traits for mental disorders including mood disorders. TPQ is an instrument of self-report developed by Cloninger (1987) composed of a hereditary factor, “Temperament” and an environmental factor “Character”. Furthermore, “Temperament” is classified into following the three dimensions of neurotransmitter: “Novelty Seeking” based on dopamine; “Harm Avoidance” based on serotonin; and “Reward Dependence” based on norepinephrine. According to the results of patients with major depressive disorder evaluated by TPQ, the consensus is that there is a high level of “Harm Avoidance” before treatment and a decrease in “Harm Avoidance” associated with the level severity of depressive state by successful treatment (Chien and Dunner, 1996 and Joyce et al., 1994). Moreover, our previous study with TCI is consistent with these results (Hirano et al., 2002).
Reports on the personality traits of SAD are essentially limited to winter SAD, in which conventional reports have mainly been performed with Neuroticism–Extraversion–Openness to discuss Personality Inventory results (NEO-PI-R; Costa and McCrae, 1988). According to the results, winter SAD is reported to demonstrate a significantly elevated level of “Openness” as compared with major depression (Bagby et al., 1996) and bipolar disorder (Jain et al., 1994). In addition, “Conscientiousness” is indicated to be significantly higher while “Extroversion”, “Agreeableness” and “Neuroticism” are significantly lower than in controls (Lingjaerde et al., 2001). Furthermore, it has been reported that the use of light therapy results in decreased “Neuroticism,” elevated “Extroversion” and “Agreeableness”, although no noticeable change in “Openness” can be observed (Sachs et al., 1996 and Jain et al., 1994).
The assessment of SAD personality traits with TPQ or TCI is limited to a report by Reichborn-Kjennerud and Lingjaerde (1996), which assessed the correlation between TPQ and response to light therapy in winter SAD. The report showed that “Harm Avoidance” remained high in the non-responder, although decreasing after light therapy in the responder. However, the assessment exclusively deals with the relationship of TPQ and response to light therapy, without comparison of SAD and control groups. Furthermore, to our knowledge, an assessment of personality traits in summer SAD has not been reported.
Thus, we compared the personality traits of winter and summer SAD patients with those of non-SAD individuals on the basis of TPQ in a population that we performed a SAD epidemiological survey (Imai et al., 2003). Because previous reports showed that “Harm Avoidance” is influenced by depressed state, “Novelty Seeking” is lower among the elderly, and “Reward Dependence” is higher in females, we made a comparative assessment of TPQ in consideration of these reports, namely by factors such as age, depressed state, and gender serving as the covariates.
2. Subjects and methods
The study consisted of the participation of 15,188 subjects from collaborating institutions in twelve locations throughout Japan. Namely, Asahikawa and Sapporo located in the northernmost island of Hokkaido (average latitude 43.27°N); prefectures in the main island of Honshu, including Akita, Kanazawa, Fukui and Tottori, located in along the Sea of Japan (average latitude 36.76°N), Chiba, Yamanashi, Nagoya, Osaka and Kurume, located in Pacific coastal zone (average latitude 36.68°N) and Kagoshima, which is located in South Kyushu (31.36°; the southernmost of the four major islands). The subjects were evaluated with the Japanese versions of TPQ (Cloninger, 1987; 100 items), Seasonal Pattern Assessment Questionnaire (SPAQ; Rosenthal et al., 1984) and the Self-rating Depression Scale (SDS) (Zung et al., 1965), which were completed by the participating subjects. The distribution and collection of questionnaires were conducted in schools, companies and nursing homes by universities and research institutions in the 12 aforementioned locations, during the period of July–October 1997. After collection, 8769 (57.7%) subjects (n=15,188; age range: 18 to 69 years) whose personality traits were considered to be applicable to this research were initially selected. Of these, 6135 (70.0%) were selected for this study (3002 women [48.9%] and 3133 men [51.1%]). The other subjects were excluded from this study due to reasons such as failing to report their age and gender, and/or the TPQ, SDS and SPAQ were incomplete.The diagnosis of SAD was performed according to criterion of Kasper et al. (1989). Specifically:
(1) SAD was defined as seasonality score on SPAQ being greater than or equal to 11 points, and seasonal change in behavior and mood was problematic in their lives at least to a moderate degree.
(2) (a) Sub-syndromal-SAD was defined as seasonality score on SPAQ being 9 or 10 points, and seasonal change in behavior and mood was problematic in their lives at least to a mild degree.
(b) Seasonality score on SPAQ was greater than or equal to 11 points, and seasonal change in behavior and mood was not problematic in their lives or only to a mild degree.
(3) The determination of winter and summer type was defined in the subjects diagnosed as SAD or sub-syndromal-SAD; winter type was defined as those who feel worst in January and/or February, summer type was defined as those who feel worst in July and/or August.
Statistical analyses: Subjects were divided into three groups as follows.
(1) Winter SAD group; a total of winter and sub-syndromal winter SAD.
(2) Summer SAD group; a total of summer and sub-syndromal summer SAD.
(3) Non-SAD group.
First, to compare age difference, SDS score and score of each dimension on TPQ in these three groups, we performed a one-way analysis of variance (ANOVA) that made the diagnosis into an independent variable. Next, we analyzed Pearson's correlation coefficient regarding factors such as age, score of SDS and gender that may influence the score of each dimension on TPQ. Final comparison of the score of each dimension on TPQ was made by one-way analysis of covariance (ANCOVA), in which the diagnosis groups served as the independent variable, and the factors that had significant correlation to each dimension on TPQ served as the covariate. The three groups were compared using the multiple comparison test by Bonferroni's correction in the present study.
3. Results
The data in this study was identical to the data previously published by Imai et al.; therefore, the difference of the prevalence rate of each SAD by age, gender and latitude had been reported already (Imai et al., 2003). Our research identified the following: Of 6135 subjects of aged 18 to 69 who were considered to be pertinent to the purpose of the study, the winter SAD group (winter and sub-syndromal winter SAD) consisted of 117 subjects (1.9%) (winter SAD: 31 (0.5%); sub-syndromal winter SAD: 86 (1.4%)); the summer SAD group (summer and sub-syndromal summer SAD) was comprised of 98 subjects (1.6%) (summer SAD: 38 (0.6%), sub-syndromal summer SAD: 60 (1.0%)); and the non-SAD group totaled 5920 subjects (96.5%), respectively. Table 1 indicates the subjects' attributes, the result of each score on SPAQ, SDS and each dimension on TPQ in both SAD and non-SAD groups. Furthermore, the results of each dimension on TPQ variance and multiple comparisons test analyses using Bonferroni's correction in three groups are as follows:(1) “Novelty Seeking”: winter SAD group>non-SAD group (F=5.8, df=2, p=0.003), winter SAD vs. non-SAD (Bonferroni's correction: p=0.011).
(2) “Harm Avoidance”; winter SAD group=summer SAD group>non-SAD group (F=29.2, df=2, p<0.001), both winter SAD vs. non-SAD and summer SAD vs. non-SAD (Bonferroni's correction: p<0.001).
(3) The other dimension showed no statistically significant difference.
Table 1.
The results of age, sex, latitude, SPAQ, SDS, TPQ in winter SAD group, summer SAD group and non-SAD group Winter SAD group, n=117 Summer SAD group, n=98 Non-SAD group, n=5920
Age (mean±S.D.) 34.4±13.02 35.7±16.15 39.0±14.37
Sex (M/F) 64/53 40/58 3197/2723
Latitude (northern/southern) 82/35 47/51 3004/2916
SPAQ total (mean±S.D.) 12.5±2.55 12.2±2.13 4.2±3.47
SDS (mean±S.D.) 43.1±8.20 43.9±7.72 37.4±8.49
Novelty Seekinga (mean±S.D.) 17.5±4.03 17.1±4.72 16.4±4.11
Harm Avoidanceb (mean±S.D.) 19.8±5.80 21.0±6.13 17.2±5.96
Reward Dependence (mean±S.D.) 19.4±4.60 19.2±3.96 19.6±4.29
a In “Novelty Seeking”, a significant difference disappeared as follows when we added age as covariate in ANCOVA. Winter SAD group=non-SAD group (F=2.602, df=2, p=0.074).
b In “Harm Avoidance”, a significant difference showed results of as follows when we added SDS as covariate in ANCOVA. Summer SAD group>non-SAD group (F=3.7, df=2, p=0.025), summer SAD group vs. non-SAD group (Bonferroni's correction: p=0.032).Next, with regards to the score on “Novelty Seeking” and “Harm Avoidance”, which showed a statistically significant difference between winter and non-SAD groups, and the score on “Harm Avoidance”, which showed a statistically significant difference between summer and non-SAD groups, we compared correlative factors such as age, depressed state (score of SDS), and gender since they may influence these scores (Table 2). As is shown in Table 2, the score on “Novelty Seeking” showed a significant negative correlation with increased age, and the score on “Harm Avoidance” showed a significant positive correlation with SDS. This fact suggests that age is a confounding factor; therefore, we performed analysis of covariance regarding score on “Novelty Seeking” by statistical control of the influence of age. As a result, the statistically significant difference in score on “Novelty Seeking” disappeared (p>0.05). Similarly, SDS was presumed to be a confounding factor, and we performed an analysis of covariance concerning score on “Harm Avoidance” by statistical control of influence of depressed state. As a result, the statistically significant difference in score on “Harm Avoidance” remained between only summer and non-SAD groups (Table 1).
Table 2.
The results of Pearson's correlation coefficient between age and “Novelty Seeking” and, the results of Pearson's correlation coefficient with SDS of “Harm Avoidance” in three groups Winter SAD group, n=117 (r) Summer SAD group, n=98 (r) Non-SAD group, n=5,920 (r)
“Novelty Seeking” and age −0.522 −0.462 −0.293
“Harm Avoidance” and SDS 0.415 0.434 0.532
All the correlation coefficients of each group are p<0.001.
4. Discussion
The present study showed that the winter SAD group had higher scores in “Novelty Seeking” and “Harm Avoidance”, and the summer SAD group demonstrated a higher score of “Harm Avoidance” than the non-SAD group. Furthermore, because “Harm Avoidance” showed positive correlation with depressed state, and “Novelty Seeking” showed negative correlation with increased age, “Harm Avoidance” exhibited depressed state serving as the covariate, and “Novelty Seeking” likewise constituted the covariate for age. As a result, “Novelty Seeking” was excluded as the statistically significant difference between the winter and non-SAD groups. Moreover, “Harm Avoidance” remained the statistically significant difference between only summer and non-SAD groups, and eliminated the statistically significant difference between winter and non-SAD groups.The independence of high “Harm Avoidance” in summer SAD from the influence of depressed state is very peculiar in comparison with previous findings that showed high “Harm Avoidance” being commonly influenced by state in depressive patients as discussed later in this section. There is a clear need for further studies to conclude whether high “Harm Avoidance” in summer SAD is independent from the influence of depressed state, since no report on the personality traits of summer SAD has been published to the knowledge of the authors.
Our study also demonstrated that winter SAD shows that high “Harm Avoidance” depends on depressed state. These results are consistent with the previous report that the assessment of changes of TPQ in pre- and post-light therapy in winter SAD shows that “Harm Avoidance” decreases with the reduction of depressed state, although the study did not compare the outcome with control subjects (Reichborn-Kjennerud and Lingjaerde, 1996). In addition, to date, many reports regarding personality traits of winter SAD patients are assessed by NEO-PI-R. Our results make the assumption that “Novelty Seeking” in TPQ (TCI) and “Extraversion” in NEO-PI-R compare to the respective correlation of “Harm Avoidance” in TPQ (TCI) and “Neuroticism” in NEO-PI-R (Cloninger et al., 1994). The report that “Neuroticism” decreased with reduction of depressed state in pre- and post-light therapy of winter SAD is also consistent with our results (Sachs et al., 1996 and Jain et al., 1994). Conversely, in the only other report that compares personality traits of winter SAD with healthy persons, significantly lower “Extraversion” and “Neuroticism” is reported as compared with the control group, and thereby inconsistent with our results (Lingjaerde et al., 2001). Whether this inconsistency may be attributed to certain differences in Japanese and Norwegian subjects, or difference in diagnosis between groups based on the information extracted by SPAQ and clinical symptoms, is a subject that has yet to be clarified.
High “Harm Avoidance” dependent on the depressive state in winter SAD is also consistent with findings of previous reports in non-seasonal depression. For example, in our previous study, before and after antidepressant treatment in patients with major depression, a high score on “Harm Avoidance” before treatment decreased when treatment had been effective, and the score on “Harm Avoidance” correlated with the score on the Hamilton Rating Scale of Depression (Hirano et al., 2002). Therefore, it is considered that the association between high “Harm Avoidance” and dependence of “Harm Avoidance” on depressed state are not only a peculiar to phenomenon in winter SAD, but also a common phenomenon in depressive state.
High “Harm Avoidance” subjects phenomenally show “anticipatory worry and pessimism” and “fear and fret to uncertainty.” Therefore, depressive patients show high “Harm Avoidance” during depressed state, resembling negative automatic thoughts, a target of cognitive behavior therapy. Actually, according to a comparison dealing with the cognitive profile of winter SAD patients, non-seasonally depressed and normal controls, the SAD group reported significantly more negative automatic thoughts and dysfunctional attitudes than the non-depressed control group, but did not differ from the group with non-seasonal depression (Hodges and Marks, 1998).
Furthermore, it has been reported that negative automatic thoughts of winter SAD patients change seasonally, and become the most remarkable during the course of the transition from autumn to winter (Rohan et al., 2003). According to these facts, it is thought that in general depression and winter SAD, negative automatic thoughts appear when they are accompanied by depressed state, and although negative automatic thoughts contribute to high “Harm Avoidance”, negative automatic thoughts decrease with the reduction of depressed state, thereby “Harm Avoidance” also decreases. In the future, the association between high score on “Harm Avoidance” in depressive episode and negative automatic thoughts should be assessed.
The following points are acknowledged as limitations of the present study. In the present study, SAD subjects were extracted by SPAQ on a large-scale epidemiological survey; thereby we did not perform a psychiatric interview for the diagnosis of SAD, and questions remain as to whether we could correctly identify and extract true clinical SAD. Moreover, SDS was designed to evaluate usual depressive symptoms not atypical depressive symptoms that most SAD patients have. Therefore, the underestimation of the depressive state using SDS might contribute to High “Harm Avoidance” independent from the depressive state in summer SAD. In addition, although high “Harm Avoidance” dependent on depressed state was confirmed, to prove true state dependency, it is necessary to confirm the degree to which a change of depressed state has an influence on “Harm Avoidance” score with the lapse of time in identical patients.
5. Conclusions
We performed an epidemiological survey of 15,188 Japanese and assessed the difference of personality traits of winter SAD, summer SAD and healthy persons with TPQ in consideration of influences such as age and score of SDS. As a result, we confirmed that the winter SAD group showed a high score on “Harm Avoidance” dependent on depressed state, equivalent to an evaluation in patients with general depression. Furthermore, the study revealed that a high score on “Harm Avoidance” in the summer SAD group was influenced less than the depressed state on “Harm Avoidance” in winter SAD.
Acknowledgements
The authors appreciate Dr. Norman Rosenthal's helpful comments to this article. This work was supported in part by research grants from the Ministry of Education, Culture, Sports, Science and Technology, and the Ministry of Health, Labor and Welfare. In addition, we extend our thanks to the teachers of universities and research institutions for their cooperation in the distribution and collection of questionnaires for the present study.
Collaborating research institutions: Matsumoto Miki (Asahikawa Medical University), Honma Hiroshi (Hokkaido University), Kobayashi Riko (Hokkaido University), Shimizu Tetsuo (Akita University), Mishima Kazuo (Akita University), Furuta Hisakazu (Kanazawa University), Nakagawa Hiroki (Fukui Mental Health Center), Ishizuka Yoshikazu (Yamanashi Medical University), Shirakawa Shuichiro (National Center of Neurology and Psychiatry), Inoue Yuichi (Tottori University), Sugita Yoshiro (Osaka University), Sakamoto Tetsuro (Kurume University), Kamei Kenji (Kagoshima University) and Fukusako Hiroshi (Kagoshima University).
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Corresponding author. Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
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