Demographic, psychosocial, health and personality predictors of depression and quality of life: importance of an integrative framework

L'étude transversale investigue l'influence des cinq dimensions de personnalité (selon Costa & McCrae, 1992) sur le lien entre dépression majeure et qualité de vie. Adoptant une approche intégrative, elle compare 79 patients ambulatoires et 102 sujets non-dépressifs, en tenant compte de covariées démographiques, psychosociales, et de leur santé physique. Trois dimensions de personnalité, à savoir l'Ouverture à l'expérience, la Conscience et le Névrosisme influencent directement la qualité de vie après avoir contrôlé pour la sévérité de la dépression. De plus, le Névrosisme et la Conscience augmentent indirectement la qualité de vie en modérant l'effet de la dépression sur celle-ci. Un accent particulier est mis sur la dépression dans deux groupes d'âge. La qualité de vie des adultes jeunes est déterminée uniquement par la sévérité de la dépression, alors que celle des adultes âgés est de nature multi-déterminée : sévérité symptômes, risque suicidaire, comorbidités physiques et dimensions de personnalité

Personality traits in late-life depression: from group comparison to individual trajectories

The concept of personality is gradually shifting from the stability of a categorical model of personality disorders towards a dimensional model (DSM-V). Personality traits, as defined by the Five-Factor Model (FFM, Costa & McCrae, 1992), impact on the clinical expression and outcome of late-life depression. They predict remission of depressive symptoms, clinical progress and improved quality of life in old age. Neuroticism is a predictor of depression, even after adjusting for physical burden and subjective impact of life stressors. Personality dimensions are associated with quality of life in old age, but not in young age, after controlling for acute depression features, physical health and psychosocial variables. FFM dimensions influence the poor recognition of late-life depression in old age patients by general hospital physicians. The dimensional FFM of personality offers a promising theoretical framework for clinicians who wish to adopt a person-centred approach that takes into account the patients’ individual differences

Exploring the impact of personality dimensions in late-life depression: from group comparisons to individual trajectories

In last years, the concept of personality moved from the stability of categorical models over the lifespan to the complex interactions between gene, environment, and clinical expression according to the dimensional approaches. Within this framework, studies start to explore the impact of personality on the evolution and treatment of depression in old age.(Figure is included in full-text article.

The Function of Personality in Suicidal Ideation from the Perspective of the Interpersonal-Psychological Theory of Suicide

The Interpersonal-Psychological Theory of Suicide (IPTS) has been increasingly studied over the last years, responding to the demand for a valid framework addressing suicidality. Yet, only a few studies have explored the function of personality in the IPTS and none with clinical patients. We aimed to contribute to fill this gap in investigating the relationship between personality as conceptualized by the Five-Factor Model, the IPTS constructs, and a dimensional measure of current suicidal ideation. We conducted correlation, multiple linear regression, and path analyses based on a trait-interpersonal framework in a sample of 201 individuals visiting the psychiatric emergency room of a general hospital with current suicidal ideation. Neuroticism (positively) and openness (negatively) predicted perceived burdensomeness, while neuroticism (positively) and extraversion (negatively) predicted thwarted belongingness. Higher conscientiousness and lower extraversion were both predictors of the acquired capability for suicide. However, none of the models involving path analyses with IPTS variables as mediators of the relationship between personality traits and suicidal ideation was adequately adjusted to the data. Thus, it appears that personality plays a significant albeit modest role in suicidality when considered from an IPTS perspective. As personality is frequently assessed in the clinical routine, health professionals should consider it as complementary to detect individuals at risk of or presenting suicidal ideation

Determinants of clinical outcome and length of stay in acute care forensic psychiatry units

Criminological and sociodemographic variables, such as previous criminal convictions, increased risk of violence, early onset of mental disorder, antisocial personality, psychosis and low social support, have all been related to longer length of stay (LoS) and poorer outcome in long stay forensic services. The factors impacting on LoS and clinical response in acute care specialized units are poorly documented. To address this issue, we examined the psychiatric records of all cases admitted between January 1st and December 31th 2020 in the sole acute ward for detained persons located in the central prison of the Geneva County, Switzerland. Information on judicial status included pre-trial versus sentence execution, previous incarcerations, and age of the first incarceration. Sociodemographic data included age, gender, marital status, and education attainment. Previous inpatient stays prior to incarceration were recorded. All of the ICD-10 clinical diagnoses were made by two independent, board-certified psychiatrists blind to the scope of the study. The standardized assessment was based on the HoNOS (Health of Nation Outcome Scales) at admission and discharge, HONOS-secure at admission, HCR-20 (Historical Clinical Risk 20) version 2, PCL-R (Psychopathy Checklist Revised), and SAPROF (Structured Assessment of Protective Factors). Stepwise forward multiple linear regression models predicting the LoS and delta HONOS respectively were built with the above mentioned parameters. The selected variables were then used in univariate and multivariable regression models. Higher HCR-scores (mainly on clinical items), and longer LoS were related to higher delta HONOS scores. In contrast, cases in pre-trial detention showed a worst clinical outcome. In multivariable models, all three variables remained independent predictors of the clinical outcome and explained 30.7% of its variance. Only education and diagnosis of borderline personality were related to the LoS and explained 12.6% of its variance in multivariable models. Our results suggest that the use of acute wards specialized in forensic psychiatry are mainly useful for patients with prior inpatient care experience, and higher violence risk during sentence execution. In contrast, they seem to be less performant for persons in pre-trial detention that could benefit from less restrictive clinical settings

The dimensionality of suicidal ideation and its clinical implications

No consensus has been reached regarding the theoretical dimensions underlying the Scale for Suicide Ideation (SSI) and Beck's Scale for Suicide Ideation (BSI), widely used in research and clinical practice. This undermines the understanding and management of suicidal behavior

Big five personality traits and disabling chronic low back pain: association with fear-avoidance, anxious and depressive moods

Physical dysfunction in chronic low back pain patients is influenced by psychological variables rather than by pain severity. Assessing personality traits may help clinicians address the complexity of patients' experiences and design treatments that target these vulnerabilities. This study aimed to identify the distinguishing personality traits of a cohort of patients with disabling chronic low back pain and to determine associations between those traits and fear-avoidance beliefs, depressive, and anxious moods

Recovering the capability to work among patients with chronic low Back pain after a four-week, multidisciplinary biopsychosocial rehabilitation program: 18-month follow-up study

Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability

Agreement between physicians and liaison psychiatrists on depression in old age patients of a general hospital: influence of symptom severity, age and personality

OBJECTIVE: Comorbid depressive episodes are common among general hospital inpatients. However, existing evidence shows that depression is often poorly recognized in patients aged over 60 years. The aim of the study was first to determine the degree of agreement between primary care physicians' and liaison psychiatrists' evaluation of depression, and second, to analyze how patients' clinical presentation and personality traits influence this degree of agreement. METHODS: Agreement was defined as the matching of the physicians' initial referral for depressive mood and the actual diagnosis of a major depressive disorder evaluated by the consultation-liaison service in 148 inpatients aged 60+ years. Nature and severity of psychiatric symptoms were rated on the HoNOS65+ scale and patients' personality traits were assessed with the Big Five Inventory. RESULTS: Forty percent of the patients referred for depressive mood were indeed diagnosed with major depression. Agreement between physicians and psychiatrists was most likely in patients with more severe depressive symptoms and younger age. In contrast, risk for non-agreement was increased for patients with more open personalities, yet lower levels of neuroticism, who were referred for depressive mood even though they presented another or even no psychiatric disorder. CONCLUSION: These data reveal that the detection of late-life depression in general hospitals may be critically influenced by age, symptoms severity and personality traits

Longitudinal assessment of psychotherapeutic day hospital treatment for neuropsychiatric symptoms in dementia

OBJECTIVE: Behavioral and psychological symptoms (BPSD) of dementia are associated with more rapid cognitive deterioration as well as increased caregiver stress. The effectiveness of psychiatric day hospital care for this condition remains disputed. We report here the assessment of a psychotherapeutic day hospital program in a series of elderly people with dementia and concomitant BPSD. METHODS: Treatment setting: The day hospital program combined music, movement, psychodynamic group therapies, sociotherapy as well as individual interviews and family interventions. Participants: 76 individuals with mild to moderate dementia. Outcome measures: The Neuropsychiatric Inventory (NPI), Therapeutic Community Assessment scale including staff (SAS) and client assessments (CAS) and a Group Evaluation Scale (GES) were administrated at admission, 3, 6 and 12 months and discharge. RESULTS: Linear regression analysis showed that SAS (but not CAS) and GES scores significantly increased while the NPI total scores decreased across the different time points. NPI item score modifications were significant for anxiety and apathy. These changes remained significant when demographic variables, drug treatment changes and occurrence of life events were also considered. CONCLUSION: A psychotherapeutic day hospital program designed for older people with dementia and neuropsychiatric symptoms allows for a significant reduction of anxiety and apathy, better adhesion to therapeutic community treatment and clinical progress in group therapy. Controlled interventional studies are needed to further confirm these data