Stability of the harm avoidance personality trait in late-life depression

Harm avoidance is one of the four temperament dimensions in Cloninger’s psychobiological model of personality (Cloninger et al., 1993). In this model, personality is conceptualized as having four temperament dimensions (novelty seeking, harm avoidance, reward dependence, persistence) and three character dimensions (self-directedness, cooperativeness, self-transcendence). Individuals high in harm avoidance (HA) tend to be described as “worrying and pessimistic; fearful and doubtful; shy; and fatigable.” Those with low HA scores are “relaxed and optimistic; bold and confident; outgoing; and vigorous.” HA was initially proposed as a personality trait that is independent of the state of depression. However, other reports have found HA to be positively correlated with the severity of depression (Hansenne et al., 1999; Hirano et al., 2002). Repeated within-subject measures have been used to explore the stability of HA in major depression. However, conflicting results are reported in the literature and research in HA is largely with adults (Chien and Dunner, 1996; Marijnissen et al., 2002). The aim of this study is to investigate whether the personality trait of HA is stable over a 12-month period in a group of older people with a history of depression. This is a first report on the stability of HA in an exclusive elderly sample. The subjects in this study were community patients of the Mental Health Service for Older People in Hamilton, New Zealand. This is a secondary specialist referral service with a catchment population of 40,760 people aged 65 years and over (12% of the total population). The inclusion criteria for the study were (1) age 65 years or more; (2) a diagnosis of major depressive disorder according to the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in the past two years; (3) a Standardized Mini-mental Status Examination (MMSE) score of more than 24; (4) living at home; and (5) fluency in English. 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 in the service met the above inclusion criteria. Approximately half (24 females and 13 males) consented. The mean age was 74.8 (SD = 5.6; range 66–92) years. The mean standardized MMSE score was 28.3 (SD = 1.8; range 24–30). Seventeen patients (46%) were married; eleven (30%) were widowed; and six (24%) were divorced or separated. All participants were of European descent.