Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-22T18:34:41.937Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical outcomes of older depressed patients with and without comorbid neuroticism

Published online by Cambridge University Press:  13 August 2013

David C. Steffens ,
Douglas R. McQuoid ,
Moria J. Smoski  and
Guy G. Potter
David C. Steffens*
Affiliation:
Departments of Psychiatry, University of Connecticut Health Center, Connecticut, USA
Douglas R. McQuoid
Affiliation:
Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
Moria J. Smoski
Affiliation:
Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
Guy G. Potter
Affiliation:
Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
*
Correspondence should be addressed to: David C. Steffens, MD, MHS, Professor and Chair, Department of Psychiatry, UCONN Health Center, 263 Farmington Ave, Farmington, CT 06030-1410, USA. Phone: +1-860-679-1587; Fax: +1-860-679-1296. Email: [email protected].
Get access

Abstract

Background:

Neuroticism is a psychological construct that includes tendency to exhibit negative affect (NA), having poor stress tolerance and being at risk for depression and anxiety disorders. The consequences of neuroticism in the elderly adults are understudied. We hypothesized that older depressed patients with comorbid neuroticism at baseline would have worse mood and cognitive outcomes compared with older depressed patients without neuroticism.

Methods:

One hundred and ten older depressed adults completed baseline self-reports of depression and the NEO-Personality Inventory as a measure of neuroticism, were administered a battery of cognitive tests annually and were seen by a study psychiatrist who assessed patients using the Montgomery Åsberg Depression Rating Scale (MADRS) and treated patients with antidepressants using an established treatment guideline. Patients were followed as clinically indicated for up to three years. We measured remission (defined as MADRS score ≤ 6) rates at one year as a categorical outcome. In addition, we used Cox proportional hazard models to examine the relationship between neuroticism and change in MADRS and cognitive score over time.

Results:

Non-remitters (30%) at one year had higher scores in total neuroticism (TN), vulnerability to stress (VS), and NA. Over three years, time to achieve remission was associated with higher TN, higher VS, and greater NA. In analyses controlling for baseline cognitive score, age, sex, and education, VS was associated with baseline to two-year change in cognition.

Conclusions:

Presence of neuroticism in older depressed patients treated with medication is associated with poor mood outcomes and may indicate increased risk of cognitive decline.

Keywords

depressionelderlyneuroticismcognition
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 12 , December 2013 , pp. 1985 - 1990
Copyright
Copyright © International Psychogeriatric Association 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S., Meyers, B. S., Young, R. C., Kakuma, T., Silbersweig, D. and Charlson, M. (1997). Clinically defined vascular depression. American Journal of Psychiatry, 154, 562–565.Google ScholarPubMed
Canuto, A., Giannakopoulos, P., Meiler-Mititelu, C., Delaloye, C., Herrmann, F. R. and Weber, K. (2009). Personality traits influence clinical outcome in day hospital-treated elderly depressed patients. American Journal of Geriatric Psychiatry, 17, 335–343.CrossRefGoogle ScholarPubMed
Chan, S. W., Norbury, R., Goodwin, G. M. and Harmer, C. J. (2009). Risk for depression and neural responses to fearful facial expressions of emotion. British Journal of Psychiatry, 194, 139–45.CrossRefGoogle ScholarPubMed
Chandler, M. J.et al. (2005). A total score for the CERAD neuropsychological battery. Neurology, 65, 102–106.CrossRefGoogle ScholarPubMed
Costa, P. T. JR. and McCrae, R. R. (1985). The NEO Personality Inventory Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Costa, P. T. JR. and McCrae, R. R. (2006). Age changes in personality and their origins: comment on Roberts, Walton, and Viechtbauer (2006). Psychological Bulletin, 132, 26–28.CrossRefGoogle ScholarPubMed
De Beurs, E., Beekman, A., Geerlings, S., Deeg, D., Van Dyck, R. and Van Tilburg, W. (2001). On becoming depressed or anxious in late life: similar vulnerability factors but different effects of stressful life events. British Journal of Psychiatry, 179, 426–431.CrossRefGoogle ScholarPubMed
Enns, M. W. and Cox, B. J. (2005). Psychosocial and clinical predictors of symptom persistence vs remission in major depressive disorder. Canadian Journal of Psychiatry, 50, 769–777.CrossRefGoogle ScholarPubMed
Eysenck, H. J. and Eysenck, S. B. G. (1975). Manual of the Eysenck Personality Questionnaire. London: Hodder and Stoughton.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-Mental state. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Hayward, R. D., Taylor, W. D., Smoski, M. J., Steffens, D. C. and Payne, M. E. (2013). Association of five-factor model personality domains and facets with presence, onset, and treatment outcomes of major depression in older adults. American Journal of Geriatric Psychiatry, 21, 88–96.CrossRefGoogle ScholarPubMed
Jacobs, N., Kenis, G., Peeters, F., Derom, C., Vlietinck, R. and Van Os, J. (2006). Stress-related negative affectivity and genetically altered serotonin transporter function: evidence of synergism in shaping risk of depression. Archives of General Psychiatry, 63, 989–996.CrossRefGoogle ScholarPubMed
Jang, Y., Clay, O. J., Roth, D. L., Haley, W. E. and Mittelman, M. S. (2004). Neuroticism and longitudinal change in caregiver depression: impact of a spouse-caregiver intervention program. Gerontologist, 44, 311–317.CrossRefGoogle ScholarPubMed
Jelicic, M., Bosma, H., Ponds, R. W., Van Boxtel, M. P., Houx, P. J. and Jolles, J. (2003). Neuroticism does not affect cognitive functioning in later life. Experimental Aging Research, 29, 73–78.CrossRefGoogle Scholar
Karp, J. F., Frank, E., Anderson, B., George, C. J., Reynolds, C. F. and Mazumdar, S. (1993). Time to remission in late-life depression: analysis of effects of demographic, treatment, and life-events measures. Depression, 1, 250–256.CrossRefGoogle Scholar
Kendler, K. S., Gatz, M., Gardner, C. O. and Pedersen, N. L. (2006). Personality and major depression: a Swedish longitudinal, population-based twin study. Archives of General Psychiatry, 63, 1113–1120.CrossRefGoogle ScholarPubMed
Lahey, B. B. (2009). Public health significance of neuroticism. American Psychologist, 64, 241–256.CrossRefGoogle ScholarPubMed
Low, L. F., Harrison, F. and Lackersteen, S. M. (2013). Does personality affect risk for dementia? A systematic review and meta-analysis. American Journal of Geriatric Psychiatry, 21, 713–728.CrossRefGoogle ScholarPubMed
Montgomery, S. A. and Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.CrossRefGoogle ScholarPubMed
Morris, J. C.et al. (1989). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology, 39, 1159–1165.Google Scholar
Ormel, J., Oldehinkel, A. J. and Brilman, E. I. (2001). The interplay and etiological continuity of neuroticism, difficulties, and life events in the etiology of major and subsyndromal, first and recurrent depressive episodes in later life. American Journal of Psychiatry, 158, 885–891.CrossRefGoogle ScholarPubMed
Petersen, T.et al. (2002). NEO-FFI factor scores as predictors of clinical response to fluoxetine in depressed outpatients. Psychiatry Research, 109, 9–16.CrossRefGoogle ScholarPubMed
Quilty, L. C., De Fruyt, F., Rolland, J. P., Kennedy, S. H., Rouillon, P. F. and Bagby, R. M. (2008). Dimensional personality traits and treatment outcome in patients with major depressive disorder. Journal of Affective Disorders, 108, 241–250.CrossRefGoogle ScholarPubMed
Ramel, W., Goldin, P. R., Eyler, L. T., Brown, G. G., Gotlib, I. H. and McQauid, J. R. (2007). Amygdala reactivity and mood-congruent memory in individuals at risk for depressive relapse. Biological Psychiatry, 61, 231–239.CrossRefGoogle ScholarPubMed
Schmitz, N., Hartkamp, M., Baldini, C., Rollnik, J. and Tress, W. (2002). Psychometric properties of the German version of the NEO-FFI in psychosomatic outpatients. Personality and Individual Differences, 31, 713–722.CrossRefGoogle Scholar
Steffens, D. C., Fisher, G. G., Langa, K. M., Potter, G. G. and Plassman, B. L. (2009). Prevalence of depression among older Americans: the Aging, Demographics and Memory Study. International Psychogeriatrics, 21, 879–888, PMC2875937.CrossRefGoogle ScholarPubMed
Steunenberg, B., Beekman, A. T., Deeg, D. J., Bremner, M. A. and Kerkhof, A. J. (2007). Mastery and neuroticism predict recovery of depression in later life. American Journal of Geriatric Psychiatry, 15, 234–242.CrossRefGoogle ScholarPubMed
Welsh, K. A.et al. (1994). The Consortium to Establish a Registry of Alzheimer's Disease (CERAD) Part V: a normative study of the neuropsychological battery. Neurology, 44, 609–614.CrossRefGoogle Scholar
Wetherell, J. L., Reynolds, C. A., Gatz, M. and Pedersen, N. L. (2002). Anxiety, cognitive performance, and cognitive decline in normal aging. Journal of Gerontology B: Psychological Sciences and Social Sciences, 57, 246–255.CrossRefGoogle ScholarPubMed
Wilson, R. S., Arnold, S. E., Sschneider, J. A., Kelly, J. F., Tang, Y. and Bennett, D. A. (2006). Chronic psychological distress and risk of Alzheimer's disease in old age. Neuroepidemiology, 27, 143–153.CrossRefGoogle ScholarPubMed
Wilson, R. S., Bennett, D. A., Mendes De Leon, C. F., Bienias, J. L., Morris, M. C. and Evans, D. A. (2005). Distress proneness and cognitive decline in a population of older persons. Psychoneuroendocrinology, 30, 11–17.CrossRefGoogle Scholar
Wilson, R. S., Schneider, J. A., Boyle, P. A., Arnold, S. E., Tang, Y. and Bennett, D. A. (2007). Chronic distress and incidence of mild cognitive impairment. Neurology, 68, 2085–2092.CrossRefGoogle ScholarPubMed