Resumen

MINAYA, Omar; FRESAN, Ana  y  LOYZAGA, Cristina. Temperament and character dimensions in first-episode depressed patients. Salud Ment [online]. 2009, vol.32, n.4, pp.309-315. ISSN 0185-3325.

Unipolar depression is considered as one of the main psychiatric diagnosis related to psychosocial functioning impairment. It has been documented that personality features exert a direct influence on how people with depression cope and adapt to the disorder. The relationship between personality traits and depression has been studied in several models. As depressed patients usually exhibit several personality features of more than one personality disorder, a multidimensional theoretical perspective may increase the clinical description of prototypical diagnosis provided by current categorical criteria. The psychobiological model of personality proposed by Cloninger takes into account the respective contribution of neurobiologically-based mechanisms related to adaptative behaviors in response to danger, avoidance and reward, formulating four main temperamental dimensions and three characterological dimensions centered in conscious learning about self-concepts. The four temperament dimensions are: Novelty Seeking (NS) is thought to be related to the behavioral activation system; Harm Avoidance (HA) to the behavioral inhibition system; Reward Dependence (RD) is defined as a bias toward the maintenance of ongoing behaviors; and Persistence (PE) is defined as a tendency to perseverance despite frustration and fatigue. The character dimensions are: Self-directedness (SD) refers to the ability of an individual to control, regulate and adapt behavior to fit the situation in accordance with personal goals and values; Cooperativeness (CO), account for individual differences in identification with and acceptance of other people; and Self-transcendence (ST) refers to spiritual maturity, transpersonal identification and creativity. Several studies that used the psychobiological model or personality reported that personality differences are detectable among persons with a current major depressive disorder when compared to non-depressed. The most frequent finding reported is the association between higher scores in harm avoidance (HA) and depression. Nevertheless, other studies have found that depression is also related with high scores in the temperamental dimension: reward dependence (RD). In terms of character dimensions, it has been reported that depressed patients exhibit low self-directedness (SD) and low cooperativeness (CO). Objetive The aims of the present study were to determine the reliability of the Temperament and Character Inventory (TCI) in a sample of Mexican depressed patients and healthy controls and to compare TCI dimensions between both groups. Method A total of 40 first-episode depressed patients and 40 healthy controls matched by gender, age and length of education were recruited. All patients were recruited from the outpatient service at the Instituto Nacional de Psiquiatría Ramón de la Fuente. Patients were excluded if they had received any psychotropic medication for the treatment of depression, if they had concomitant medical or neurological illness, current substance abuse or a history of substance dependence, history of bipolar disorder; high risk for suicide or were agitated. Healthy controls were recruited from a public university and were not enrolled if they presented any psychiatric disorder or scored ≥ 2 points in any SCL-90 subscale, or verbally reported any aggressive behavior in the week prior to the assessment. Diagnosis of depression was done according to DSM-IV criteria and confirmed by clinical consensus. The Montgomery & Asberg Depression Rating Scale (MADRS) was used to measure depressive symptom severity. Personality dimensions were assessed using the Temperament and Character Inventory (TCI). Results Personality dimensions of the TCI showed moderate to high reliability. Internal consistency was higher for the character dimensions than for the temperament dimensions in both groups. Patients with major depression showed higher scores in the temperament dimension harm avoidance when compared to healthy controls. No significant differences emerged between groups in the dimensions: novelty seeking, reward dependence and persistence. Significant differences emerged between groups in terms of character dimensions. Depressed patients exhibit: lower self-directedness, lower cooperativeness and lower self-transcendence when compared to healthy controls. Discussion Personality assessment in patients with their first depressive episode offers the advantage of reducing biases secondary to the falsification of retrospective report, the effects of illness chronicity and pharmacological treatment on personality. Our results support the idea that the temperament dimension harm avoidance can be consider as an intermediate phenotype for major depression, as it can be a risk factor or may have a direct influence in the way depression is manifest. In terms of character dimensions, lower scores of self-direct edness may be reflected in patients lack of control responses in situations where mature and effectives responses are required. In this way, patients with low self-direct edness may exhibit irresponsible behaviors and a poor impulse control. Low cooperativeness in patients with depression may represent a state characterized by a limited empathy and can be reflected as social intolerance or social isolation. These behavioural changes are frequent depressive symptoms that can be observed by persons that share the environment with the patient. The result of a low self-transcendence in patients with depression raises the possibility that certain beliefs can modify patients' behavior when they cannot conceive their existence as a part of a unified whole. This, in conjunction with lack of transpersonal identification may explain the presence of self-destructive thoughts and behaviors, such as suicide ideation, frequent symptoms observed in patients with depression. In conclusion, our results show that the temperament dimension HA can be associated with vulnerability to depression, while severity of depression may lay in the interaction between constitutional factors and the subjectivity of illness experience conferred by character.

Palabras llave : Temperament; character; depression; first-episode.