Having Lower Personal Reserve Predicts Sustained Remission of Major Depression

Decreased levels of the personality trait of personal reserve foretold a higher probability of sustained remission (SR) in major depression, according to a prospective study.

About 40% of patients in this study reached SR, and they had a lesser duration of their present depressive episode. In addition, baseline depression was less severe.

This study aimed to analyze the connection between 8 constructs of measured personality traits on the Temperament and Personality Questionnaire (T&P) and SR in patients with major depression due to lack of information in these areas. Measured personality traits included anxious worrying, self-criticism, rejection sensitivity, irritability, self-focused, perfectionism, personal reserve, and social avoidance across the T&P scale.

The personal reserve trait on the T&P scale proved to be the only trait independently connected with SR after the duration of the present depressive episode and depression intensity were ruled out in the adjusted multivariable analysis.

The cohort consisted of 77 patients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) studied over the course of 12 months across 3 hospitals in the Greater Tokyo Area. Patients had clinical consultations and medication management by psychiatrists.

The 77 patients received a complete assessment consisting of baseline measurements of the T&P and severity of depression at 6 months and again at 12 months. In this study, SR was outlined as remission as shown by the GRID-Hamilton Depression Rating Scale (GRID-HAMD) with a score of £ 7 also at 6 and 12 months. The 8 T&P construct scores were compared at baseline between the SR and non-SR groups, and multivariable logistic regression analyses were carried out to see how T&P personality traits associated with SR.

The measures used included the T&P; the Dysfunctional Attitudes Scale (DAS-24) to evaluate personality traits and dysfunctional schema degree; a Structured Clinical Interview using the DSM-IV-TR Axis I Disorders-Patient Edition to confirm depression diagnosis; the GRID-HAMD; and the Beck Depression Inventory- Second Edition (BDI-II) to evaluate severity of depression.

Lower T&P personal reserve and lower T&P rejection sensitivity were held in common by patients who reached SR. Lower T&P personal reserve trait scores in patients with major depression had an independent association with increased rates of SR.

Rejection sensitivity and personal reserve scores on the T&P were significantly lower in the SR group compared with the non-SR group (T&P rejection sensitivity: P = .007; T&P personal reserve: P = .013).

SR was reached by 40.3% of patients and characterized by a significantly low value of depression severity as compared with the non-SR group (GRID-HAMD17 : P = .012; BDI-II: P = .001). The existing depressive episode of the SR group consisted of a median duration that was significantly briefer than the episode length of the non-SR group (P = .029). No significant distinctions were found for other personality characteristics.

Some limitations were noted, including: there might be limited generalizability of patient characteristics because only 3 medical institutions were included; the total number of participating patients was small and restricts the statistical influence of the results; and outcomes were followed up for only 12 months. In addition, personality traits were self-reported, and treatment could not be controlled since it was a naturalistic study.

The authors recommended that more studies in naturalistic treatment settings with larger sample sizes and a wider range of demographic characteristics would be helpful in deepening understanding of personality traits’ effects on depression treatment.

“An approach that provides psychoeducation to help patients reflect on personal reserve trait and encourages them to disclose and discuss their problems related to their depressive symptoms may be helpful in treating depression which ultimately may lead to SR,” the authors suggest.

Reference

Nogami W, Nakagawa A, Katayama N, et al. Effect of personality traits on sustained remission among patients with major depression: a 12-month prospective study. Neuropsychiatr Dis Treat. 2022;18:2771-2781. Published online November 28, 2022. doi:10.2147/NDT.S384705