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DELHI PSYCHIATRY JOURNAL Vol. 15 No.

1 APRIL 2012

Original Article
A Comparative Study of Temperament in
Children of Patients Suffering from Depression
in Comparison to Normal Controls
Indiver Kalra1, Anurag Jhanjee2, KES Unni3, MS Bhatia4
1,2,3,
Department of Psychiatry, Lady Hardinge Medical College & associated
S.S.K. Hospital, New Delhi-110001
4
Department of Psychiatry, UCMS and G.T.B. Hospital, Dilshad Garden, Delhi-110095

Abstract
Temperament is a very important aspect of functioning that needs to be understood in children
of patients suffering from depression. It may be an early sign of vulnerability to the later
development of depression. Early detection and early intervention in children of patients with
depression are in premature state in India. The present study aimed to study the temperament
characteristics in children of patients suffering from depression as compared to age and sex
matched control sample. A case control study was conducted on children aged 4-16 years of
patients with depression who presented to indoor and outdoor services of department of
psychiatry in Lady Hardinge Medical College evaluating them on Temperament Measurement
Schedule and comparing the outcome with children of healthy parents matched for age, sex,
education, and socioeconomic status with the children of patients suffering from depression
were found to show significantly lower threshold of responsiveness, lower approach withdrawal;
they were low on sociability, low on mood, low on emotionality and lower activity ,intensity,
energy and distractibility as compared to control. These children had lower mean score on the
variable- Adaptability, Persistence and Rhythmicity although the difference was not found to
be statistically significant.
Keywords: Temperament, parental depression, children

Introduction depression-related outcomes in their children


Researchers have studied a range of aspects of however some researchers have broadened the
child psychological problems and well-being in construct to internalizing disorders or problems in
children of patients with depression. Much attention children, given that anxiety disorders are the most
has focused on the likelihood of children of frequent co-occurring disorders in both clinical3 and
depressed parents becoming depressed themselves. community samples4. Other than this researchers
Both theory about the mechanisms whereby have also been interested in externalizing disorders,
maternal depression might contribute to depression since elevated rates of conduct problems have been
in children1 and about the developmental pathways noted since the earliest studies of children of
to the emergence of depression in children2 point depressed parents5.
to the impor tance of knowing more about Other important aspect of functioning that
associations between maternal depression and the needs attention in children of depressed parents is
emergence of depression in children and temperament. Difficulties in temperament
adolescents. Many of the studies of children of associated with depression in parents could be
depr essed parents have therefor e examined observed, for example, through infants behavioral
associations between depression in parents and tendencies toward less interest in and active

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APRIL 2012 DELHI PSYCHIATRY JOURNAL Vol. 15 No.1

exploration of their environment and novel stimuli, 2. Person who do not give consent to partici-
poorer organizational capabilities, and less pate due to any reason.
soothability relative to infants of nondepressed Inclusion criteria for control subjects
mothers. Mechanisms to explain such associations
1. Children between 4-16 years of age.
would primarily be heritability but could also
2. No other medical or psychiatric illness in
include effects of prenatal exposures to maternal
either parent.
depression and correlated stress.
Temperament may also be an early sign of Exclusion criteria for control subjects
vulnerability to the later development of depre- Any chronic medical or surgical illness or
ssion6. Children of depressed mothers may inherit mental retardation in the parents or in the child
a tendency to experience and express negative Instruments used
emotions7 .
The following study is the study of measure- International Statistical Classification of
ment of temperament and comparison with normal Diseases and Related Health Problems- Tenth
controls in children of patients suffering from Revision (ICD-10) Classification of mental and
depression. Behavioral disorders: Diagnostic criteria for
research8
Material and Methods
Temperament Measurement Schedule9
Experimental Group:
This scale measures nine temperamental
Subjects included in the study were the children variables described by Thomas and chess, with 45
(male/female) of patients with depression utilizing items (5 each for 9 variables) to be rated on a 5
the services of the Department of Psychiatry and point scale. Two extreme scores of 1 and 5 are
Drug De-Addiction Centre, Lady Hardinge Medical provided with definitions with a midpoint score of
College and Associated hospitals, New Delhi. 3, scores less than 3 are in a positive direction for
Control Group: intensity and frequency of the behavior measured
Subjects of the control (normal healthy) group by each item. Mean score for each of the variables
were recruited from the children of the attendants are computed by dividing the total score by 5. This
of the patients utilizing services of departments scale has test-retest reliability of 0.61- 0.85 and the
other than psychiatry. After careful matching for Inter- rater reliability of 0.61- 0.83.
age, sex, socioeconomic status all the consenting The scale comprised of the following:
subjects in this group were enrolled into the study Factor-1: Sociability
subject to meeting the inclusion and exclusion Approach withdrawal
criteria. Adaptability
Total 50 index cases of depression in the study Threshold of responsiveness
group and 50 normal persons in control group were Factor-2: Emotionality
recruited by using the above inclusion and exclusion Mood
criteria Persistence
Factor-3: Energy
Inclusion criteria for cases
Activity level
1. Children between 4-16 years of age. Intensity
2. The diagnosis of depression in the affected Factor-4: Distractibility
parent by using ICD-10 DCR criteria. Distractibility
3. No history of depression in other parent. Factor-5: Rythmicity
4. No other psychiatric disorder in either of Rythmicity
the parents.
Hamilton Rating Scale for Depression
Exclusion criteria for cases (HAM-D)10-12
1. Any chronic medical, surgical illness or Procedure
mental retardation in the parent or child.
This study included 50 experimental subjects
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(children of patients suffering from depression), in administration of any one of the above mentioned
accordance with the inclusion and exclusion criteria scales.
for the study. For this purpose the absence of any
Statistical Methods
psychiatric disorder in the proband and controls
were confirmed by the trainee and supervising Data from the entire study was collected and
psychiatrist. Before the interview each of the analyzed. As most of the data did not show normal
participant parents was explained and assured about distribution and there were two main groups to be
the confidentiality of the information obtained from compared, Mann-Whitney test was used to compare
him/her and an Informed Consent was obtained for the means of two groups.
each subject for completion of the convention Results
regarding the ethicality. A self designed Proforma
was used to obtain historical data about depressive Subject charcteristics:
illness from the patients. The Proforma also had a One hundred subjects including 50 cases and
standard physical and mental status examination to 50 controls were taken.
be filled in at the time of initial assessment and These two groups were matched for age, sex,
finally using the ICD-10: Diagnostic criteria for socioeconomic status and finally fifty subjects in
research the diagnosis of depression was arrived at each group, were tested and compared.
and from the list of diagnosed depressive patients,
Socio-demographic variables
a sample of 50 patients with children in age group
4- 16 years was obtained using the table of random Age distribution
numbers. Hence the 50 experimental subjects Age matching of test and control groups was
(children of parents with diagnosis of drug considered, to avoid confounding effect, if any, of
dependence) were obtained. age on the ratings of the two scales used in this
In the case of control group, subjects were study
recruited from the children of the attendants of the Table 1: Age distribution in years
patients utilizing services of any department other Age group in years Test Group Control group
than psychiatry, after careful matching for the
controlled parameters. 4-8 29 25
9-12 9 14
The parents of the subjects were asked to 13-16 12 11
present on their allotted days of assessment. A
written informed consent was obtained for each Table 2: Comparison of age of subjects in
subject (both test and control). two groups
The subjects were then assessed based on the
response given by their parents for each of the Group Mean (years) Standard deviation ()
individual items of the Temperament Measurement Test 9.16 3.37
Schedule (TMS). TMS is based on situations that Control 8.7 3.57
are applicable to Indian settings.9 During interview
Sex distribution
the questions were thoroughly explained uniformly
to all the participants in Hindi so as to minimise There were 24 females and 26 males in cases.
any bias due to not understanding the nature and Control group included 22 females and 28 males.
meaning of questions by the participants. During Socioeconomic status
interviewing of the cases, the parent who is not The groups under study were matched for
having any psychiatric illness (other than the socioeconomic status. The maximum number of
depressed parent) was taken as informant as subjects from test and control groups was from the
information given by the depressed parent may be lower socioeconomic status.
influenced by his/her own depressive symptoms. The temperament measurement schedule was
The entire assessment takes about 1.5 to 2 hours. administered to the test and the control group and
Also the parents of the subjects were allowed one comparison was done between two groups by
break in the entire session after completing the applying Mann- Whitney Test.
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APRIL 2012 DELHI PSYCHIATRY JOURNAL Vol. 15 No.1

Comparison of TMS scores between group had lower scores on the variable- Persistence
experimental group and control group: but the difference was not found to be statistically
Factor-1: Sociability significant (p = 0.575).
Overall, subjects in the experimental group had
Approach-withdrawal: Subjects in the
significant lower scores on the factor- Emotionality
experimental group had significantly lower scores
than the subjects in the control group (p= 0.013).
on the variable- Approach-withdrawal than the
subjects in the control group (p= 0.001). Factor-3: Energy
Adaptability: Subjects in the experimental Activity level: Subjects in the experimental

Table 3: Descriptive Statistics of experimental group


N Minimum Maximum Mean Std. Deviation

Approach withdrawal 50 17.00 21.00 19.16 1.037


Adaptability 50 14.00 20.00 16.84 1.283
Threshold of responsiveness 50 18.00 22.00 20.18 1.101
Mood 50 16.00 24.00 20.54 1.631
Persistence 50 13.00 23.00 17.50 2.197
Activity level 50 11.00 18.00 12.92 1.259
Intensity 50 16.00 21.00 18.88 1.573
Distractibility 50 13.00 19.00 16.46 1.388
Rhythmicity 50 10.00 15.00 12.26 1.065
Valid N (list wise) 50

Table 4: Descriptive Statistics of Control group


N Minimum Maximum Mean Std. Deviation

Approach withdrawal 50 18 23 19.94 1.077


Adaptability 50 15 20 17.20 1.143
Threshold of responsiveness 50 19 24 21.08 1.085
Mood 50 16 24 21.84 1.517
Persistence 50 14 23 17.78 2.384
Activity level 50 11 18 13.34 1.189
Intensity 100 17 22 19.80 1.385
Distractibility I 100 14 20 17.08 1.226
Rhythmicity 100 10 16 12.66 1.303
Valid N (list wise) 50

group had lower scores on the variable- Adaptability group had significant lower scores on the variable-
but the difference was not found to be statistically activity level than the subjects in the control group
significant (p= 0.199). (p = 0.032).
Threshold of responsiveness: Subjects in the Intensity: Subjects in the experimental group
experimental group had significantly lower scores had significantly lower scores (p= 0.002).
(p = 0.001). Overall, subjects in the experimental group had
Over all, the exper imental group had significantly lower scores on the factor-Energy than
significantly lower scores on the factor-Sociability the subjects in the control group (p = 0.001).
than the subjects in the control group (p < 0.001).
Factor-4: Distractibility
Factor-2: Emotionality Subjects in the experimental group had signifi-
Mood: Subjects in the experimental group had cant lower scores on the factor-Distractibility than
significantly lower scores on the variable-mood the subjects in the control group (p= 0.029).
than the subjects in the control group (p < 0.001).
Factor-5: Rhythmicity
Persistence: Subjects in the experimental
Subjects in the experimental group had lower
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DELHI PSYCHIATRY JOURNAL Vol. 15 No.1 APRIL 2012

scores on the factor-Rhythmicity than the subjects


in the control group but the difference was not found
to be statistically significant (p = 0.090).

patients with depression as compared to normal


controls. The results have been found to be
consistent with previous studies (discussed ahead)
apart from few new findings.
Factor-1: Sociability:
The findings of lower threshold of responsive-
ness, lower approach withdrawal; and low
sociability have been consistent with the findings
in previous studies. Deficits in interpersonal
functioning are at the core of several theories of
depression emerging in childhood13-15. Behavioral
models of depression also suggest the importance
of these social skills, traits, or tendencies, in that
they could be associated with childrens lower
likelihood of being reinforced if they lack certain
skills or express other behaviors that result in a lack
of rewarding relationships16,17.
Murray has studied infants, toddlers, and
preschool-age children interacting with their
depressed mothers. She found that the depression
in mothers still accounted for the childrens quality
of interaction18-20. Adolescent children of depressed
mothers have poorer peer relationships and less
adequate social skills than teens of nondepressed
control mothers21-24.
Discussion
Factor-2: Emotionality
The present study tried to compare the measure
of different temperament factors in children of Finding of lower scores on the variable- mood,
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persistence and on factor emotionality in subjects The results are comparable to studies in past.
is consistent with those of previous studies. It was noted that children of patients with affective
Low mood of the children and adolescents illness showed low sociability i.e. were withdrawing
whose mothers/ fathers were depressed, can be and less adaptable; lower emotionality (persistently
explained in a pure behavioural basis the mother negative mood); lower energy i.e. less activity and
psychologically and functionally absent for them, less intensity of emotions; low distractibility and
in terms of care, provoke protest and withdrawal less regular biological rhythms25.
from the part of the child. Psychoanalytically, the The goodness of fit model developed by
mother becomes less attractive to the male child Thomas and Chess26 predicts that the concordance,
and emotionally based interactions and exchanges or the agreement in the temperament as reflected
can less and less take place between them, thus the by the characteristic ways of responding to the
childs investment in the object and object environment between the child and the caregiver
relations can suffer. (the parent or teacher) would result in a tendency
for positive relations and outcomes. The nature of
Factor-3: Energy
the environmental demands or expectancies (such
Lower scores on the variable- activity level, as the teaching and parenting styles, and the
persistence and overall energy levels may go well organization of the learning environment) and
with the low mood; and at the same time , the excited childrens capacities (such as temperament) may
condition of some children , will also have to be influence activity, sociability, rhythmicity and
explained by way of their tendency again to activate attentiveness levels. This illustrates how the
their mothers, and / or their own unconscious inappropriate parenting styles in families of parents
mechanism of defending against their own anxiety- suffering from depression probably can have
depressive position by exhibiting excitement adverse effects on temperamental characteristics of
defense maniaque children living in such families.
From social learning point of view, the child In our country there is a paucity of studies on
can model after the parent who is depressed, and mother-baby interactions, normal and abnormal, as
thus becoming a copy of the withdrawn parent, Child and Adolescent Psychiatry as a discipline is
especially if the parent is depressed for a longer still yet to develop; our study may be fitting in as a
duration. small attempt to fill such lacunae.
Factor-4: Distractibility Conclusions
Subjects in the experimental group had signifi- Depression of any family member has impact
cant lower scores on the factor-Distractibility. on whole family because of its serious negative
Distractibility can be considered as larval stage of consequences especially on the children.
attention deficit, but not amounting to psycho- The children of patients suffering from depre-
pathology, but at the same time giving the therapists ssion had more difficult temperament as compared
an opportunity to precociously therapeutically to the children of non-depressed parents.
intervene so that the future possibilities for disorders Limitations of our study
of attention and concentration can be reduced, or
Interpretation of the findings in study is limited
even nullified.
by small sample size.
Factor-5: Rhythmicity It was a cross-sectional study.
Subjects in the experimental group had lower There was no pilot study.
scores on the factor-Rhythmicity.Lack of rhythm is There was exclusive reliance on parents as a
of particular importance, as the mother and child source of data.
are in mutually well tuned well adjusted rhythm, in Data from other sources such as teachers and
the normal course. Any out of rhythm behaviour or bigger sample size might have improved the validity
gesture or expression can upset the mother-child / of these assessments.
parent-child unit. Results obtained are of limited clinical signifi-
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cance due to cross sectional design of study. By 210.


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