Psychological Reports: Mental & Physical Health 2015, 116, 3, 855-860. © Psychological Reports 2015

RELATIONSHIP BETWEEN TYPE D PERSONALITY AND ANHEDONIA: A DIMENSIONAL STUDY OF UNIVERSITY STUDENTS1 AXELLE LUSSIER AND GWENOLÉ LOAS

Service de Psychiatrie, Hôpital Erasme, Université Libre de Bruxelles (ULB) Summary.—Type D personality—characterized by negative affectivity and social inhibition—and anhedonia have independently been found to be significantly associated with depression or suicidal ideation in the general population or in psychiatric subjects. The aim of the study was to evaluate the association between Type D personality and anhedonia in a population of 204 university students (102 men, 102 women) after controlling for depression as a confounding variable. Type D personality was evaluated using the Type D scale, anhedonia with the Snaith-Hamilton Pleasure Scale, and depression with the Beck Depression Inventory–II. Significant correlations were found between social inhibition and anhedonia before and after adjustment for depression. In women, a Sobel test indicated significant mediation by social inhibition of the relationship between anhedonia and depression. Results suggested that the social inhibition component of Type D personality could constitute a poor prognosis factor.

Type D Personality (or distressed personality) associates negative affectivity and social inhibition. Individuals with negative emotions such as anxiety, irritability, or dysphoria have a negative view of self and a focalization on the negative characteristics of their environment. Individuals with strong social inhibition feel insecure, inhibited, and display social anxiety (Denollet, 2005). One study has recently reported a significant association between Type D personality and suicidal ideation in the general population (OR = 1.98; Michal, Wiltink, Till, Wild, Münzel, Blankenberg, et al., 2007). Moreover, Type D personality has been associated with depression in community samples, with 42% vs 7% of depressive symptoms in type D and non-type D personality, respectively (Mommersteeg, Denollet, & Martens, 2012), or in student samples, where 36% had type D and depression (Gupta & Basak, 2013). Numerous studies report significant associations between anhedonia, the lowered ability to experience pleasure, and suicidal ideation, notably in various clinical samples (Robbins & Alessi, 1985; Nock & Kazdin, 2002). Anhedonia also constitutes one of the main symptoms of depression. Anhedonia (OR = 2.18) and Type D personality (OR = 3.98) predicted 1 Address correspondence to Gwenolé Loas, Service de Psychiatrie, Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium or e-mail (gwenolé. [email protected]).

DOI 10.2466/09.02.PR0.116k27w2

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ISSN 0033-2941

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poor clinical outcomes in cardiac patients (Denollet, 2005; Leroy, Loas, & Perez-Diaz, 2010). More recently, anhedonia has also been recognized as an outcome of traumatic stress (Frewen, Dean, & Lanius, 2012), and Type D personality is a significant predictor (β = −.18, p < .001) of post-traumatic stress disorder (Rademaker, van Zuiden, Vermetten, & Geuze, 2011). Thus, these patterns of association between Type D personality or anhedonia and depression, risk of suicide, stress, or prognosis in cardiac disease suggest a potential conceptual overlap between the two dimensions. To date, no study has explored the relationship between anhedonia and Type D personality. Hypothesis. Anhedonia and Type D personality will be correlated in a student sample, considering depression as a confounding factor. METHOD Participants All participants, 204 in total (102 men, 102 women), were undergraduate medical students (all academic years) recruited at the Université Libre de Bruxelles (ULB) and the Université de Mons (UMons). The students completed the questionnaires in a classroom setting. The mean age for men was 21.5 yr. (SD = 2.3, range = 18–32), and the mean age for women 21.5 yr. (SD = 1.6, range = 19–29). To take part in the study, the participants had to be French-speaking students, age 18 years and older, and had to agree with the goal and modality of the study that were explained in an information and consent document. No exclusion criteria were defined. This study was approved by the Ethics Committee of the Hôpital Erasme prior to testing. Measures Type D personality.—The Type D personality scale (DS–14) is two sevenitem subscales that have been specifically developed to assess negative affectivity and social inhibition (Denollet, 2005). Each item is rated from 0 to 4 on a 5-point Likert scale. The total score for each subscale ranges from 0 to 28. Satisfactory validity and reliability have been reported. The Negative affectivity and Social inhibition subscales had high internal consistencies and temporal stabilities (Cronbach’s α coefficients were respectively .88 and .86 and the test-retest r over a 3-mo. period was .72 and .82; Denollet, 2005). Anhedonia.—The Snaith-Hamilton Pleasure Scale (SHAPS; Snaith, Hamilton, Morley, Humayan, Hargreaves, & Trigwell, 1995) evaluates an individual’s state of pleasure experienced in recent days (e.g., one item: “I have enjoyed being with my family or close friends”). The scale consists of 14 items rated on a 4-point Likert scale with anchors 1: I strongly agree and 4: I

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strongly disagree. The total score ranges from 14 to 56. Pleasure is inversely related to the score of the scale. The French version of the scale has satisfactory psychometric properties (Loas, Dubal, Perot, Tirel, Nowaczkowski, & Pierson, 1997) with a value of .80 for Cronbach’s α and a test-retest r over a 1-mo. period of .56. Depression.—The Beck Depression Inventory (BDI–II) is a 21-item questionnaire with a total score ranging from 0 to 63 (Beck, Steer, Ball, & Ranieri, 1996). The BDI–II consists of 21 items assessing symptoms of depression experienced during the past 2 wk. Each item contains four statements reflecting varying symptom severity. High internal consistency and temporal stability were reported (Cronbach’s α = .91 and test-retest Pearson r = .93; Beck, et al., 1996). All the descriptive values can be found in Table 1. Cronbach’s α coefficients have been evaluated for the various scales. In men, the Cronbach’s α coefficients were .86 for the DS–14 Negative affectivity, .81 for the DS–14 Social inhibition, .71 for the SHAPS, and .88 for the BDI–II. In women, the values of Cronbach’s α coefficient were .83 for the DS–14 Negative affectivity, .84 for the DS–14 Social inhibition, .72 for the SHAPS, and .93 for the BDI–II. TABLE 1 DESCRIPTIVE STATISTICS Variable Age, yr. DS–14-NA

Men

Women

M

SD

Min.

Max.

M

SD

Min.

Max.

21.48

2.33

18.00

32.00

21.49

1.59

19.00

29.00

8.35

5.60

0.00

25.00

10.17

5.38

1.00

22.00

DS–14-SI

10.57

5.60

0.00

22.00

10.75

5.37

1.00

23.00

SHAPS

23.91

4.40

16.00

35.00

22.18

4.32

14.00

36.00

BDI–II

9.39

7.61

0.00

35.00

10.64

9.53

0.00

50.00

Note.—Min.: minimal value; Max.: maximal value; SD: standard deviation; DS–14-NA: negative affectivity items of the DS–14; DS–14-SI: social inhibition items of the DS–14.

Procedure Three rating scales and an information and consent form were given in closed envelopes (identifiable by a unique number) to the participants at the beginning of a lecture given on the university campus. The participants were asked to complete the various questionnaires at home. The envelopes were retrieved the next day, at the end of another lecture given on campus. The study took place over a period of 2 mo. The participants were given the opportunity to be seen by the psychiatrist in charge of the study if needed.

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Statistical Analyses Statistical analyses were completed separately for men and women. Pearson's r correlations were calculated between the total scores of the different scales. Partial correlations were also calculated with the BDI–II score controlled. A formal mediation analysis was carried out separately for men and women, to assess whether social inhibition mediated the relationship between anhedonia and depression. Using the procedure proposed by Baron and Kenny (1986), a series of hierarchical regressions were performed as well as a Sobel test. Values with p ≤ .05 were accepted as statistically significant. RESULTS AND DISCUSSION All correlation coefficients in men are shown in Table 2. In men, a significant correlation was reported between Social inhibition and Anhedonia measured with the SHAPS before and after controlling for depression: Pearson's r = .27 before controlling for depression scores; rp = .25 when controlled for depression. For women, a significant correlation between Social inhibition and Anhedonia was found (r = .35) with a partial coefficient, after controlling for depression, of rp = .26. A significant correlation (r = .21, p ≤ .05) between Negative affectivity and Anhedonia was reported only before controlling for depression. According to Baron and Kenny (1986), mediation is indicated when the following conditions are observed: (1) the independent variable (anhedonia) affects the mediator (social inhibition); (2) the independent variable (anhedonia) affects the dependent variable (depression); (3) the mediator (social inhibition) affects the dependent variable (depression) when TABLE 2 CORRELATION COEFFICIENTS (95%CI) IN MEN (ABOVE DIAGONAL) AND WOMEN (BELOW DIAGONAL), AND PARTIAL CORRELATIONS CONTROLLING FOR DEPRESSION Variable

DS–14-NA

DS–14-SI

SHAPS

r

r

r

DS–14-NA

.28*

95%CI .34*

95%CI

.16, .50

SHAPS

.21*

95%CI

.02, .39

a

.35*

r

.02

.60*

.27* c

.29*

.08, .44

.10, .46

.09, .45

DS–14-SI

BDI–II

.46, .71

.14

b

.17, .51

BDI–II

.64*

.38*

.30*

95%CI

.51, .74

.20, .53

.11, .47

Note.—DS–14-NA: negative affectivity items of the DS–14; DS–14-SI: social inhibition items of the DS–14. *p ≤ .05. a.03 after adjustment for depression. b.26 (p ≤ .05) after adjustment for depression. c.25 (p ≤ .05) after adjustment for depression.

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the independent variable (anhedonia) is controlled; and (4) complete mediation is confirmed when the relationship between the independent variable (anhedonia) and dependent variable (depression) becomes non-significant after the effect of the mediator (social inhibition) is controlled. If conditions 1 to 3 are verified, then there is partial mediation. Several hierarchical linear regression analyses were done. For women anhedonia predicted social inhibition (β = .35, t100 = 3.68, p = .0004), indicating that the first condition for mediation was met. Anhedonia was a significant predictor of depression at Step 1 (β = .31, t100 = 3.2, p = .002), showing that the second condition was met. When social inhibition was entered in the equation at Step 2, it significantly predicted depression (β = .31, t99 = 3.24, p = .002) and reduced the beta weight for anhedonia (β = .20, t99 = 2.02, p < .05). Thus, there was only partial mediation. The Sobel test was significant (z = 2.75, p = .006). For men anhedonia predicted social inhibition (β = .27, t100 = 2.85, p = .005), indicating that the first condition for mediation was met. Anhedonia was not a significant predictor of depression at Step 1 (β = .14, t100 = 1.4, p = .17), so the second condition was not met. Partial mediation was not observed for men. This cross-sectional study exploring the relationship between Type D Personality and anhedonia in 204 healthy students found that social inhibition and anhedonia were positively correlated in men and women, after controlling for depression scores. Thus, social inhibition could be a factor in explaining the relationship between Type D personality or anhedonia and risk of suicide, depression, or stress. Social inhibition or social difficulties have been reported in people with anhedonia. Three studies using college or university students have examined the relationships between anhedonia (Physical Anhedonia or Social Anhedonia Scales) and expressiveness of emotional communication (French & Schuldberg, 1994), social adjustment (Mishlove & Chapman, 1985), or social skills in interpersonal situations (Numbers & Chapman, 1982). Those scoring as anhedonic reported significantly less emotional expressiveness in real-life social situations (French & Schuldberg, 1994), had poorer overall social adjustment (Mishlove & Chapman, 1985), and were more avoidant (Numbers & Chapman, 1982), Cohen’s d effect size for these three studies ranged from 0.54 to 2.02. The study has two major limitations, however. First, the cross-sectional design precludes any statements about causality. Second, the nature of the current sample suggests that the results cannot be generalized to the general population. Social inhibition could be a risk factor for the development of psychiatric disorder, and this hypothesis must be tested by prospective studies.

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BARON, R. M., & KENNY, D. A. (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182. BECK, A. T., STEER, R. A., BALL, R., & RANIERI, W. (1996) Comparison of Beck Depression Inventories–IA and –II in psychiatric outpatients. Journal of Personality Assessment, 67, 588-597. DENOLLET, J. (2005) DS–14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosomatic Medicine, 67, 89-97. FRENCH, C., & SCHULDBERG, D. (1994) Anhedonia and the intentional communication of emotion. Perceptual & Motor Skills, 79, 1075-1088. FREWEN, P. A., DEAN, J. A., & LANIUS, R. A. (2012) Assessment of anhedonia in psychological trauma: development of the Hedonic Deficit and Interference Scale. European Journal of Psychotraumatology, 3, 8585. GUPTA, S., & BASAK, P. (2013) Depression and Type D personality among undergraduate medical students. Indian Journal of Psychiatry, 55, 287-289. LEROY, M., LOAS, G., & PEREZ-DIAZ, F. (2010) Anhedonia as a predictor of clinical events after acute coronary syndromes: a 3-year prospective study. Comprehensive Psychiatry, 51, 8-14. LOAS, G., DUBAL, S., PEROT, P., TIREL, F., NOWACZKOWSKI, P., & PIERSON, A. (1997) Validation of the French version of the Snaith-Hamilton Pleasure Scale (SHAPS, Snaith, et al., 1995): determination of the statistical parameters in 208 normal subjects and 103 hospitalized patients presenting with depression or schizophrenia. Encephale, 23, 454-458. MICHAL, M., WILTINK, J., TILL, Y., WILD, P. S., MÜNZEL, T., BLANKENBERG, S., & BEUTEL, M. E. (2010) Type D personality and depersonalization are associated with suicidal ideation in the German general population aged 35–74: results from the Gutenberg Heart Study. Journal of Affective Disorders, 125, 227-233. MISHLOVE, M., & CHAPMAN, L. J. (1985) Social anhedonia in the prediction of psychosis proneness. Journal of Abnormal Psychology, 94, 384-396. MOMMERSTEEG, P. M., DENOLLET, J., & MARTENS, E. J. (2012) Type D personality, depressive symptoms and work-related health outcomes. Scandinavian Journal of Public Health, 40, 35-42. NOCK, M. K., & KAZDIN, A. E. (2002) Examination of affective, cognitive, and behavioral factors and suicide-related outcomes in children and young adolescents. Journal of Clinical Child & Adolescent Psychology, 31, 48-58. NUMBERS, J. S., & CHAPMAN, L. J. (1982) Social deficits in hypothetically psychosis-prone college women. Journal of Abnormal Psychology, 91, 255-260. RADEMAKER, A. R., VAN ZUIDEN, M., VERMETTEN, E., & GEUZE, E. (2011) Type D personality and the development of PTSD symptoms: a prospective study. Journal of Abnormal Psychology, 120, 299-307. ROBBINS, D. R., & ALESSI, N. E. (1985) Depressive symptoms and suicidal behavior in adolescents. American Journal of Psychiatry, 142, 588-592. SNAITH, R. P., HAMILTON, M., MORLEY, S., HUMAYAN, A., HARGREAVES, D., & TRIGWELL, P. A. (1995) A scale for the assessment of hedonic tone: the Snaith-Hamilton Pleasure Scale. British Journal of Psychiatry, 167, 99-103. Accepted March 30, 2015.

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RELATIONSHIP BETWEEN TYPE D PERSONALITY AND ANHEDONIA: A DIMENSIONAL STUDY OF UNIVERSITY STUDENTS.

Type D personality-characterized by negative affectivity and social inhibition-and anhedonia have independently been found to be significantly associa...
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