Personality trait of harm avoidance in late‐life depression

Cloninger (1993) proposed a psychobiological model of personality in which personality is conceptualized as having four temperament dimensions: (1) Novelty seeking; (2) Harm avoidance; (3) Reward dependence; (4) Persistence; and three character dimensions: (1) Self-directedness; (2) Cooperativeness; (3) Self-transcendence. The dimension of Harm Avoidance (HA) consists of four lower order traits: HA1 (anticipatory worry and pessimism vs uninhibited optimism), HA2 (fear of uncertainty), HA3 (shyness with strangers) and HA4 fatigue and asthenia vs vigor). HA was initially proposed to be independent of the state of depression (Cloninger, 1987). However, HA has been reported to be elevated in people with major depression and it is positively correlated with the severity of depression (Abrams et al., 2004). None of the studies today included an exclusive group of older people. The aim of the present study was to investigate whether the level of HA is correlated to the severity of depression and anxiety in a group of people over the age of 65 who had a history of major depression. The subjects in this study were community patients of the Mental Health Service for Older People based in Hamilton, New Zealand. This is a secondary specialist referral service. The inclusion criteria for the study were: (1) a diagnosis of major depressive disorder according to the Diagnostic Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (APA, 1994) in the past 2 years; (2) a Mini-Mental Status Examination (MMSE) of more than 24; and (3) living at home. The exclusion criteria were: (1) the presence of a psychotic, bipolar or dementia disorder; and (2) severe vision or hearing impairment which would impact on completing self-rating scales/inventories. In November 2004, 73 patients met the above inclusion and exclusion criteria. Approximately half (24 females and 13 males) consented to participate in this study. The mean age was 74.8 (SD1⁄4 5.6; range 66–92) years. The mean MMSE score was 28.3 (SD1⁄4 1.8; range 24–30). The subjects completed the 34 items on Harm Avoidance of the Temperament and Character Inventory (Cloninger et al., 1994), the 15-item version of the Geriatric Depression Scale (GDS), the Structured Hamilton Depression Rating Scale (HDRS) and the Beck Anxiety Inventory (BAI). The mean HA score was 17.0 (SD1⁄4 7.4; range 1–35). The mean scores for GDS, HDRS and BAI were 5.3 (SD1⁄4 11.9; range 0–15), 12.0 (SD1⁄4 6.1; range 3–23), and 15.3 (SD1⁄4 11.9; range 0–48) respectively. The Pearson correlations coefficients between the HA scores and the scores of GDS, HDRS and BAI were 0.41 ( p< 0.05), 0.37 ( p< 0.05) and 0.43 ( p< 0.01) respectively. In this clinical sample, a mean HA score of 17.0 was found. It is higher than a mean score of 12.0 which was found in a community based, non-clinical, sample of ages ranged from 50–91 years (Cloninger et al., 1994, Ch. 9) This study has shown HA score is positively correlated with the severity of depressive and anxiety symptoms in late-life depression as has been found in studies of younger adults. The dimension of HA from the TCI needs to be interpreted in conjunction with the level of anxiety and depression. Clinicians should not draw conclusion on this personality trait using the TCI before addressing the severity of depression. An increased HA found in this sample may be nonspecific (Marijnissen et al., 2002) because it has been found in major depression and other psychiatric diagnostic entities in adults including obsessive–compulsive disorder, anxiety disorders, eating disorders and ADHD. This study suggests that an increased HA is associated with late-life depression. The limitations of the present study include the relatively small sample size of clinical subjects in a specialist referral service; and the lack of a control group which could have given information on the level of HA in elderly people with no history of depression. It was a cross-sectional study. Future longitudinal studies would be useful to determine whether HA is a stable trait in older people with depression.