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Article history:
Received 7 May 2015
Received in revised form
5 September 2015
Accepted 10 September 2015
Available online 23 October 2015
Background: Depression is a prevalent psychiatric disorder with high personal and public health consequences, partly due to a high risk of recurrence. This longitudinal study examines personality traits,
structural and subjective social support dimensions as predictors of rst and recurrent episodes of depression in initially non-depressed subjects.
Methods: Data were obtained from the Netherlands Study of Depression and Anxiety (NESDA). 1085
respondents without a current depression or anxiety diagnosis were included. 437 respondents had a
prior history of depression, 648 did not. Personality dimensions were measured with the NEO-FFI, network
size, partner-status, negative and positive emotional support were measured with the Close Person
Questionnaire. Logistic regression analyses (unadjusted and adjusted for clinical variables and sociodemographic variables) examined whether these psychosocial variables predict a new episode of depression at two year follow up and whether this differed among persons with or without a history of
depression.
Results: In the unadjusted analyses high extraversion (OR:.93, 95% CI (.91.96), P o.001), agreeableness
(OR:.94, 95% CI (.90.97), Po .001), conscientiousness (OR:.93, 95% CI (.90.96), P o.001) and a larger
network size (OR:.76, 95% CI (.64.90), P .001) signicantly reduced the risk of a new episode of depression. Only neuroticism predicted a new episode of depression in both the unadjusted (OR:1.13, 95% CI
(1.101.15), P o.001) and adjusted analyses (OR:1.06, 95% CI (1.031.10), Po .001). None of the predictors
predicted rst or recurrent episodes of depression differently.
Limitations: we used a relatively short follow up period and broad personality dimensions.
Conclusions: Neuroticism seems to predict both rst and recurrent episodes of depression and may be
suitable for screening for preventive interventions.
& 2015 Elsevier B.V. All rights reserved.
Keywords:
Depression
Personality
Social support
1. Introduction
Depression is one of the most prevalent psychiatric disorders.
In a World Mental Health survey initiative in 18 countries Bromet
et al. (2011) found that the average lifetime prevalence of depression ranged from 11.1% to 14.6% and the twelve month prevalence ranged from 5.5% to 5.9%. Depression is highly recurrent:
at least 50% of those who recover from a rst episode of depression have one or more episodes in their lifetime and approximately 80% of those with a history of two episodes have another
recurrence (American Psychiatric Association, 2000). Depression
has major personal and public health consequences (Judd et al.,
n
Correspondence to: GGZinGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The
Netherlands.
E-mail address: a.noteboom@ggzingeest.nl (A. Noteboom).
http://dx.doi.org/10.1016/j.jad.2015.09.020
0165-0327/& 2015 Elsevier B.V. All rights reserved.
2. Methods
2.1. Sample
Data for the present study were obtained from the Netherlands
Study of Depression and Anxiety (NESDA), an ongoing naturalistic
longitudinal cohort study examining the long-term course of depressive and anxiety disorders. NESDA has been designed to be
representative of those with depressive and anxiety disorders in
different health care settings and stages of the developmental
history. A total of 2981 respondents were recruited from different
157
3. Measurements
3.1. Depressive disorder diagnosis
Diagnoses of depressive disorders (dysthymia and major depressive disorder) were assessed at baseline and two-year follow
up and were dened according to the DSM-IV criteria. Depressive
disorder diagnoses were established by specially trained clinical
research staff with the Composite International Diagnostic Interview (CIDI, WHO version 2.1. Dutch version, ter Smitten et al.,
1997).The CIDI is a structured diagnostic interview with a high
inter-rater reliability (Wittchen et al., 1991), high testretest reliability (Wacker et al., 2006) and high validity for depressive and
anxiety disorders (Wittchen, 1994). The primary outcome variable
was the occurrence of an episode of depression between baseline
and the two-year follow-up. Based on the baseline CIDI interview
persons were categorized as those with or without a prior history
of depression.
3.2. Personality dimensions
We used the Dutch 60-item self-report NEO ve-factor inventory (NEO-FFI) to measure the ve personality dimensions,
neuroticism, extraversion, openness to experience, agreeableness
and conscientiousness, of the Five Factor Model (Hoekstra et al.,
1996). The NEO-FFI is a short version of the Revised NEO Personality Inventory (NEOPI-R, Costa and McCrae, 1995). The reliability,
internal structure and construct validity of the NEO-FFI are satisfactory (Hoekstra et al., 1996). The Cronbach's alpha for the
different subscales was good (N:.95; E:.87; O:.78; A:.87; C:.83). The
dimension sum score of each subscale was used for the statistical
analyses.
3.3. Social support
We used the Close Person Questionnaire (CPQ, Stansfeld and
Marmot, 1992) as a measure for two types of perceived support:
conding/emotional support and negative aspects of support. The
CPQ has been positively validated using the Self Evaluation and
158
two-tailed Po .05 was considered statistically signicant The statistical software used was SPSS 18.0.
4. Results
4.1. General characteristics at baseline
Our total study sample (N 1085) contained 704 women
(64.9%), and the mean age was 42.4 years (SD 13.9). Most of our
respondents were married or had somebody they considered a
partner (N 804, 74.1%). 299 respondents reported a lifetime diagnosis of an anxiety disorder (27.6%) and 437 reported a lifetime
depression diagnosis (40.3%). Table 1 lists the baseline characteristics for the group of respondents with and without a prior history of depression at baseline. The group with a prior history
contained more women (P .001) and was signicantly older
(P .005). As expected, this group also reported more severe depressive symptoms (Po .001) and had more frequently a history of
anxiety disorders (P o.001). Persons with a depression history also
were more neurotic (P o.001), more introvert (P o.001), more
open to new experiences (P .002), less agreeable (P .015) and
less conscientious (P o.001). No difference was found between the
groups in the percentage of respondents with a partner (P .19).
Persons with a prior history of depression did have a smaller
network size (P o.001), reported less perceived emotional support
(P .043) and more negative aspects of support (P .001).
4.2. Predicting a (new) episode of depression at two year follow up
We used logistic regression analysis in the whole sample to
examine which predictors could signicantly predict a (new)
episode of depression at follow up (Table 2). In the univariable
uncontrolled analyses high neuroticism (OR: 1.13, 95% CI (1.10
1.15), P o.001) signicantly predicted a new episode of depression
Table 1
Baseline characteristics of the group with and the group without a lifetime depression diagnosis.
Demographics
Age (M,SD)
Gender female (N,%)
Years education (M,SD)
Clinical Characteristics
Severity of depressive
symptoms (M,SD)
Presence of lifetime anxiety diagnosis Yes (N,%)
Personality
Neuroticism (M,SD)
Extraversion (M,SD)
Openness (M,SD)
Agreeableness (M,SD)
Conscientiousness (M,SD)
Social support
Having a partner Yes (N,%)
Network size (N,%)
01
25
6 or more
Percieved emotional support (M,SD)
Percieved negative support (M,SD)
P-value
Group without
lifetime diagnosis
of depression
(N 648)
41.4 (14.7)
396 (61.1)
12.9 (3.2)
43.8 (12.6)
308 (70.5)
12.6 (3.2)
8.5 (7.1)
14.3 (8.9)
o .001
96 (14.8)
203 (46.5)
o .001
21.1
26.8
27.3
32.6
31.6
o .001
o .001
.002
.015
o .001
15.4
29.9
26.2
33.3
33.2
(7.4)
(6.2)
(5.7)
(4.7)
(5.0)
487 (75.2)
9
198
441
15.6
(1.4)
(30.6)
(60.0)
(3.5)
7.9 (2.8)
(7.5)
(6.4)
(5.7)
(4.8)
(5.1)
317 (72.5)
19
172
246
15.2
(4.3)
(39.4)
(56.3)
(3.7)
8.5 (3.1)
.005
.001
.07
.19
o .001
.043
.001
159
Table 2
Logistic regression analyses predicting a new episode of depression at 2 year follow up.
N 1085
Demographics
Gender
Age
Education
Clinical Characteristics
Symptom severity
Lifetime anxiety diagnosis
Personality
Neuroticism
Extraversion
Openness
Agreeableness
Conscientiousness
Social Support
Having a partner
Network size
Percieved emotional support
Negative aspects of support
Univariable (a)
Odds ratio (95% CI), P-value
Univariable (b)
Odds ratio (95% CI), P-value
Multivariable (c)
Odds ratio (95% CI), P-value
(1.101.15), o .001
(.91.96), o .001
(1.001.06), .09
(.90.97), o.001
(.90.96), o .001
.75
.76
.96
1.03
(.521.10), .14
(.64.90), .001
(.921.00), .06
(.971.09), .35
1.06
.98
1.02
.98
.99
.90
.90
.99
.97
(1.031.10), o .001
(.951.01), .20
(.991.06), .17
(.941.02), .36
(.951.02), .45
(.591.37), .62
(.761.07), .24
(.951.04), .79
(.911.03), .31
.92
1.02
1.01
.95
(.771.10), .34
(.641.63), .92
(.961.07), .61
(.881.02), .16
5. Discussion
In this study we examined the relationship between the personality dimensions of the Five Factor Model, several social
160
smaller network size and less perceived support could be manifestations of an underlying vulnerability that also predisposes to
depression. More research is necessary to examine the possible
complex dynamic interplay between depression, social support
and neuroticism.
The results from this study have important clinical implications. Neuroticism can be regarded as a risk factor for both rst
and recurrent episodes of depression. In the diagnostic phase of
treatment of patients with a history of depression or even just
subclinical depressive symptoms the level of neuroticism should
be assessed. Patients with a high level of neuroticism can be regarded as a high-risk group for developing a new episode of depression and might prot from preventive interventions. Metaanalytic evidence indicates that preventive interventions can reduce the incidence of depressive disorders by 25% (Cuijpers et al.,
2008). Cuijpers et al. (2010) also advise to develop interventions
focusing on neuroticism itself instead of its specic negative
outcomes (like depression).
There are also several limitations in our study. We examined a
relatively short follow-up period of two years and possibly as a
result the absolute number of rst episodes and recurrences in the
follow-up period per group was relatively low. On the other hand,
Gopinath et al. (2007) had a shorter follow up period and found a
slightly higher recurrence rate in primary care (31%). Our study
group was selected from both primary care and community which
might explain the difference. A longer follow-up period could
probably provide more information. It is possible that more specic associations between personality traits and depression were
not evident because we focused on the broad personality dimensions of the Five Factor Model instead of on the facet-level traits
that comprise these broad dimensions. Another limitation is that
we did not include the age of onset of the depressive disorder in the
analysis. There is evidence that early onset depression is more frequently associated with personality disorders compared to late onset
depression (Fava et al., 1996). Our study also has some important
strengths. The longitudinal design allowed for an examination of
the predictive value of our main predictors. The study population
is large, including respondents who develop a rst episode of
depression and respondents with recurrent depression. We only
included respondents without a current diagnosis (dened as having
no depressive or anxiety disorder diagnosis in the prior six months)
and controlled for symptom severity at baseline to reduce the risk of
earlier described confounding of the personality measurements by the
presence of depressive symptoms (Fava et al., 1994,, 2002). Also, we
included all dimensions of the ve factor model.
In summary, our data indicate that neuroticism is possibly an
important predictor of both rst and recurrent episodes of depression. Neither structural or perceived social support dimensions nor the other personality dimensions of the ve factor model
predicted depression at follow up. Neuroticism can be assessed
relatively easily and efciently and thus is suitable for screening
for individuals who can benet from preventive interventions.
Contributors
Annemieke Noteboom formulated the hypothesis of this study,
analyzed and interpreted the data and wrote the report.
Brenda Penninx is a principal investigator of the NESDA study.
She supervised the rst author in the analysis and interpretation
of the data and in writing the report .
Nicole Vogelzangs supervised the rst author in SPSS usage and
participated in writing the report.
Aartjan Beekman is a principal investigator of the NESDA study.
He also supervised the rst author in the analysis and interpretation of the data and writing the report.
Acknowledgements
We thank all mental health care organizations who supported the NESDA study
for their assistance in the data collection and all patients fort heir participation in
this study.
References
American Psychiatric Association, 2000. Diagnostic and Statistical Manual of Mental
Disorders Text Revision-Fourth. American Psychiatric Association, Washington DC.
Andrade, L., Caraveo-Anduaga, J.J., Berglund, P., Bijl, R.V., Dragomericka, E., Kohn, R.,
Keller, M.B., Kessler, R.C., Kawakami, N., Kilic, C.O.D., Ustun, T.B., Vicente, B.,
Wittchen, H., 2003. The epidemiology of major depressive episodes: results from the
International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int. J. Methods
Psychiatr. Res. 21 (1), 321.
Bagdy, R.M., Quilty, L.C., Ryder, A.C., 2008. Personality and depression. La. Rev. De. Psychiatr. 53 (1), 1425.
Birmaher, B., Williamson, D.A., Dahl, R.E., Axelson, D.A., Kaufman, J., Dorn, L.D., Ryan, N.
D., 2004. Clinical presentation and course of depression in youth: does onset in
childhood differ from onset in adolescence? J. Am. Acad. Child. Adolesc. Psychiatry
43 (1), 6370.
Bromet, E., Andrade, H.L., Hwang, I., Sampson, N.A., Alonso, J., de Girolamo, G., de Graaf,
R., Demyttenaere, K., Hu, C., Iwata, N., Karam, N., Kaur, J., Kostyuchenko, S., Lepine, L.
P., Levinson, D., Matschinger, H., Mora, M.E.M., Oakley Brown, M., Posada-Villa, J.,
Viana, M.C., Williams, D.R., Kessler, R.C., 2011. Cross-National epidemiology of DSMIV depressive episode. BioMedCentral Med. 9, 90.
Burcusa, S.L., Lacono, W.G., 2007. Risk for recurrence in depression. Clin. Psychol. Rev. 27
(8), 959985.
Burton, E., Stice, E., Seeley, J.R., 2004. A prospective test of the stress-buffering model of
depression in adolescent girls: no support once again. J. Consult. Clin. Psychol. 72,
689697.
Costa, P.T., McCrae, R.R., 1995. Domains and facets: hierarchical personality assessment
using the revised NEO personality inventory. J. Pers. Assessment 64, 2150.
Coyne, J.C., 1976. Depression and the response of others. J. Abnorm. Psychol. 85, 186193.
Cuijpers, P., van Straten, A., Smit, F., Mihalopoulos, C., Beekman, A., 2008. Preventing the
onset of depressive disorders: a meta-analytic review of psychological interventions.
Am. J. Psychiatry 165, 12721280.
Cuijpers, P., Smit, F., Penninx, B.W.J.H., de Graaf, R., ten Have, M., Beekman, A.T.F., 2010.
Economic Costs of neuroticism: a population-based study. Arch. Gen. Psychiatry 67,
10861093.
Cukrowicz, K.C., Franzese, A.T., Thorp, S.R., Cheavens, J.S., Lynch, T.R., 2008. Personality
traits and perceived support among depressed older adults. Aging Ment. Health 12
(5), 662669.
Fanous, A.H., Neale, M.C., Aggen, S.H., Kendler, K.S., 2007. A longitudinal study of personality and major depression in a population-based sample of male twins. Psychol.
Med. 37, 11631172.
Fava, M., Boufdes, E., Pava, J.A., McCarthy, M.K., Steingard, R.J., Rosenbaum, J.F., 1994.
Personality disorder comorbidity with major depression and response to uoxetine
treatment. Psychother. Psychosom. 62, 160167.
Fava, M., Alpert, J.E., Borus, J.S., Andrew, B.A., Nierenberg, A.A., Pava, J.A., Rosenbaum, J.F.,
1996. Patterns of personality disorder comorbidity in early-onset versus late-onset
major depression. Am. J. Psychiatry 153, 13081312.
Fava, M., Farabaugh, A.H., Sickinger, A.H., Wright, E., Alpert, S., Sonawalla, S., Nierenberg,
A.A., Worthington, J.J., 2002. Personality disorders and depression. Psychol. Med. 32
(6), 10491057.
Finch, J.F., Okun, M.A., Pool, G.J., Ruehlman, L.S., 1999. A comparison of the inuence of
conictual and supportive social interactions on psychological distress. J. Pers. 67 (4),
581621.
Gopinath, S., Katon, W.J., Russo, J.E., Ludman, E.J., 2007. Clinical factors associated with
relapse in primary care patients with chronic or recurrent depression. J. Affect.
Disord. 101, 5763.
Greden, F.J., 2001. The burden of recurrent depression: causes, consequences and future
prospects. J. Clin. Psychiatry 62 (22), 59.
Grifth, J.W., Zinbarg, R.E., Craske, M.G., Mineka, S., Rose, R.D., Waters, A.M., Sutton, J.M.,
2010. Neuroticism as a common dimension in the internalizing disorders. Psychol.
Med. 40 (7), 11251136.
Haber, M.G., Cohen, E.J.L., Lucas, E.T., Baltes, B.B., 2007. The relationship between selfreported received and perceived social support: a meta-analytic review. Am. J.
community Psychol. 39, 133144.
Hammen, C., 1991. Generation of stress in the course of unipolar depression. J. Abnorm.
Psychol. 100, 555561.
Hardeveld, F., Spijker, J., de Graaf, R., Nolen, W.A., Beekman, A.T.F., 2010. Prevalence and
predictors of recurrence of major depressive disorder in the adult population. Acta
Psychiatr. Scand. 122, 184191.
Hill, J., Holcombe, C., Clark, L., Boothby, M.R., Hincks, A., Fisher, J., Tufail, S., Salmon, P.,
2011. Predictors of onset of depression and anxiety in the year after diagnosis of
161