www.elsevier.com/locate/jad

Journal of Affective Disor

Research report

Personality–life event congruence effects in late-life depression

Jennifer Q. Morsea,*, Clive J. Robinsa,b

aDepartment of Psychology, Social and Health Sciences, Duke University, United StatesbDepartment of Psychiatry and Behavioral Sciences, Duke University, United States

Received 10 February 2004; accepted 14 September 2004

Abstract

Background: This study examined whether specific interactions of personality and life events predicted increases in depressive

symptoms over time in a late-life sample.

Method: Participants (n=55) who were in remission from a recent episode of major depression completed a depression symptom

interview and a questionnaire assessing the personality constructs sociotropy and autonomy. Six months later, they completed

the same personality questionnaire and a checklist of life events experienced during the past 6 months.

Results: As predicted, increases in depressive symptoms were significantly predicted by the congruent interaction of sociotropy

with negative interpersonal events and by the congruent interaction of autonomy with negative autonomy events, but not by

either of the non-congruent interactions.

Limitations: A small sample prevented examinations of important depressive subtypes based on age of depression onset and

vascular status.

Conclusions: These findings strongly support the personality–life event congruence model of depression in a late-life sample.

Clinical implications include attending to stressful events that match an older adult’s personality style, to help the older adult

cope with those events that are more likely to increase his or her depression.

D 2004 Elsevier B.V. All rights reserved.

Keywords: Late-life depression; Personality; Life events

Cognitive and psychoanalytic theories have con-

verged on a similar theoretical framework describing

personality characteristics that create vulnerability to

depression following negative life events that are

0165-0327/$ - see front matter D 2004 Elsevier B.V. All rights reserved.

doi:10.1016/j.jad.2004.09.007

* Corresponding author. Now at Personality Studies, Western

Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA

15213, United States. Tel.: +1 412 246 5838; fax: +1 412 246 5840.

E-mail address: MORSEJQ@upmc.edu (J.Q. Morse).

congruent with those characteristics. Empirical studies

of adult samples have supported this congruence

hypothesis. While research on late-life depression has

addressed its association with life events and person-

ality, only one study has examined the role of

interactions between personality characteristics and

life events. Depression in late-life can have unique

features, such as involvement of vascular disease, so

the results with adult samples cannot necessarily be

ders 84 (2005) 25–31

1 Participants who completed the second survey (n=55) did not

differ from those who did not (n=15) except for having lower

MMSE error scores than non-completers (completers: M=1.06,

S.D.=1.33, non-completers: M=1.88, S.D.=1.80, t(67)=�2.02,

p=0.05) at CRC entry.

J.Q. Morse, C.J. Robins / Journal of Affective Disorders 84 (2005) 25–3126

generalized to late-life depression. This paper reports

the results of an empirical test of the personality–life

event congruence effect in a late-life sample.

Theorists have suggested that normal personality

development requires both interpersonal connection

and self-definition (Arieti and Bemporad, 1980; Beck,

1983; Blatt, 1974; Bowlby, 1977) and that over-

emphasis on either theme creates vulnerability to

depression, particularly following matching stressful

life events. Highly sociotropic (Beck, 1983) or depend-

ent (Blatt, 1974) people value close relationships,

which may leave them vulnerable to depression after

negative interpersonal events. Autonomous (Beck,

1983) or self-critical (Blatt, 1974) people value

independence, mastery and control, which may leave

them vulnerable to depression after perceived loss of

control or failure. The interaction between sociotropy

or autonomy and matching events predicts depressive

relapse in adults (Hammen et al., 1989; Segal et al.,

1992). Research on late-life depression has focused on

main effects of life events or personality factors.

There is a positive relation between depressive

symptoms in older adults and negative life events

(Kraaij et al., 1998). Clinically depressed patients

reported both more frequent and more severe life

events than did control groups (Emmerson et al., 1989).

In terms of personality, neuroticism has received the

most attention in late life. Neuroticism is related to

greater depressive symptoms (Abrams et al., 1991) and

predicts increased risk of developing late-life depres-

sion (Oldehinkel et al., 2001). Sociotropy and

autonomy both correlate significantly with depressive

symptoms in older adults (Allen et al., 1997). Thus,

there is evidence linking both life events and person-

ality to late-life depression, but the magnitude of these

effects was modest and it is possible that interactions

between personality and life events account for addi-

tional variance in depression in older adults.

In the lone study investigating the interaction

between personality and life events in late-life depres-

sion, Mazure et al. (2002) compared 42 late-onset

depressed outpatients with 42 non-depressed elderly

matched controls. Depressed group membership was

associated both with the interaction between sociotropy

and negative events and with the interaction between

autonomy and negative events, which was interpreted

as support for the congruence hypothesis. However, the

event measure was nonspecific, rather than differ-

entiated into interpersonal and autonomy events, so it

does not test the congruence hypothesis. And the

study’s cross-sectional case-control design makes it

impossible to infer causal directionality. The current

study, in contrast, is prospective, testing the ability of

the congruence hypothesis to predict the return of

symptoms in a sample of patients who were in

remission from a major depressive episode.

In this study, we assessed sociotropy, autonomy,

and depressive symptoms in a group of older adult

patients who were in remission from a recent episode

of major depressive disorder and reassessed depres-

sive symptoms and recent life events 6 months later.

Our primary hypothesis was that congruent interac-

tions between the two personality variables and types

of events would be associated with increases in

depressive symptoms over the 6-month period.

1. Method

1.1. Participants

Participants were recruited from a longitudinal study

at the NIMH Clinical Research Center (CRC) for the

Study of Depression in Late Life at Duke University.

For inclusion in the CRC study, subjects met criteria for

major depressive episode using the Duke Depression

Evaluation Schedule for the Elderly (George et al.,

1989) and had a Mini-Mental Status Exam (Folstein et

al., 1975) scorez25. For inclusion in the current study,

participants had to be in remission, defined as Mont-

gomery2sberg Depression Rating Scale (Montgomery

and Asberg, 1979) score V10. Patients with recent

MMSE b25, a diagnosis of Alzheimer’s disease, or

receiving electroconvulsive therapy were excluded.

Seventy-two patients who met these criteria completed

the initial assessment; 15 (21%) did not complete the

second assessment and 2 (3%) had invalid data, based

on visual inspection of the questionnaires following

regression diagnostics. The demographics of the final

sample are described in Table 1.1

Table 1

Sample demographics and comparing depressive subgroups

Overall

(n=55)

Late onset

(n=23)

Early

onset (n=32)

v2 (df) Non-vascular

(n=16)aVascular

(n=33)

v2 (df)

%Women 64 69 57 0.87 (1) 63 64 0.01 (1)

%Married 64 66 61 0.13 (1) 69 58 0.57 (1)

%Minority 7 3 13 1.95 (1) 13 6 0.60 (1)

Mean (S.D.) Mean (S.D.) Mean (S.D.) t (df) Mean (S.D.) Mean (S.D.) t (df)

Age 68.09 (6.82) 67.96 (7.05) 68.19 (6.76) �0.12 (53) 66.50 (5.66) 68.39 (7.43) �0.99 (38.11)

Years of education 14.37 (2.27) 14.23 (2.29) 14.47 (2.29) �0.38 (52) 14.38 (1.86) 14.52 (2.36) �0.21 (47)

Age of onset 46.70 (18.76) 65.77 (7.87) 33.59 (11.15) 11.67 (52)**** 44.81 (19.24) 47.85 (19.74) �0.51 (47)

# previous episodes 4.27 (5.04) 2.00 (1.55) 5.96 (6.03) �4.11b **** 5.13 (7.81) 3.93 (3.50) �0.82b

MMSE errors 1.06 (1.33) 1.18 (1.40) 0.97 (1.30) 0.57 (50) 1.13 (1.64) 1.09 (1.28) 0.09 (45)

Deep white matter

hyperintensities

1.53 (1.01) 1.71 (1.19) 1.39 (1.03) 1.01 (47) 0.63 (0.50) 1.97 (1.05) �6.09 (47)****

Subcortical

hyperintensities

1.31 (1.08) 1.62 (1.12) 1.07 (1.02) 1.79 (47) 0.19 (0.40) 1.85 (0.87) �9.13 (46.97)****

Time 1 MADRS 2.60 (3.20) 2.70 (3.65) 2.53 (2.90) 0.19 (53) 2.25 (2.70) 2.88 (3.34) �0.66 (47)

Time 2 MADRS 5.07 (5.30) 4.26 (5.24) 5.66 (5.35) �0.96 (53) 3.81 (4.25) 5.42 (5.61) �1.01 (47)

Time 1 sociotropy 86.00 (14.09) 85.78 (15.21) 86.15 (13.48) �0.10 (53) 84.67 (14.65) 87.25 (14.42) �0.58 (47)

Time 1 autonomy 77.63 (13.71) 78.19 (13.88) 77.23 (13.79) 0.26 (53) 79.69 (10.29) 77.60 (14.99) 0.50 (47)

Time 2 sociotropy 86.63 (15.98) 84.96 (14.66) 87.84 (16.99) �0.66 (53) 85.22 (18.35) 87.04 (16.18) �0.35 (47)

Time 2 autonomy 78.95 (13.89) 80.13 (12.67) 78.07 (14.87) 0.54 (52) 79.19 (8.56) 79.43 (16.57) �0.05 (46)

Negative interpersonal

events

1.93 (2.01) 1.96 (2.34) 1.91 (1.77) 0.09 (53) 2.13 (2.03) 2.00 (2.11) 0.20 (47)

Negative autonomy

events

1.78 (1.54) 1.52 (1.47) 1.97 (1.58) �1.07 (53) 1.69 (1.62) 1.97 (1.49) �0.60 (47)

a MRI data were missing for six participants.b Mann–Whitney U reported.

**** pb0.0001.

J.Q. Morse, C.J. Robins / Journal of Affective Disorders 84 (2005) 25–31 27

1.2. Procedure

At each appointment, a psychiatrist assessed

depressive symptoms by interview. Subjects who

were in remission were mailed the Personal Style

Inventory (PSI, Robins et al., 1994) and received $3

for completing it. After a psychiatrist appointment 6

months later, participants completed the PSI and the

Modified Schedule of Life Events (Bieliauskas et al.,

1995) and received $15. Demographic and clinical

information came from baseline CRC assessments.

1.3. Measures

1.3.1. Personal style inventory (Robins et al., 1994)

This 48-item self-report measure assesses the key

concerns of sociotropy and autonomy. Both scales

have good internal consistency in depressed sam-

ples—sociotropy: a=0.83, autonomy: a=0.79 (Lynch

et al., 2001), but the psychometric properties of the

PSI among older adults are not known.

1.3.2. Schedule of life events—modified

(Bieliauskas et al., 1995)

This inventory of 48 negative and 6 positive life

events was constructed for use with older adults. It has

been modified for the present study. Details regarding

the modification are available from the first author. The

modified measure includes 48 items: 40 stressors, 3

opportunities to identify negative events that were not

asked about, and 5 positive events intended to provide a

slight bupliftQ at the end of the study. Respondents

indicated whether they experienced each event during

the past 6 months.

Three judges rated whether each event was relevant

to sociotropy concerns, autonomy concerns, or nei-

J.Q. Morse, C.J. Robins / Journal of Affective Disorders 84 (2005) 25–3128

ther. Cohen’s kappa, extended to three judges (Fleiss,

1971), was 0.89. When there was not uniform

agreement, the two agreeing judges categorized the

event. Twenty-one stressors and one positive event

were related to sociotropy, eighteen stressors and two

positive events to autonomy, and one stressor and two

positive events to neither. The 53 responses to open-

ended items were similarly coded. Cohen’s kappa was

0.83. There were no open-ended responses or standard

items where all three judges disagreed. Across all

items Cohen’s kappa was 0.87.

1.3.3. Montgomery A sberg Depression Rating Scale

(Montgomery and A sberg, 1979)

This 10-item clinician rating scale assesses depres-

sive symptoms and is sensitive to change. Items are

rated from 0 (none) to 6 (severe). It has good interrater

reliability (ICC=0.89 to 0.97) (Montgomery and

Asberg, 1979) and good internal consistency

(a=0.86) (Maier and Phillipp, 1985).

2. Results

2.1. Reliability of the personal style inventory

The test–retest correlations for both sociotropy and

autonomy were high (r=0.83 and r=0.80, both

pV0.0001). Cronbach’s alpha was 0.85 at time 1 and

Fig. 1. Changes in depression level as a function of the inter

0.90 at time 2 for sociotropy, and 0.85 at both times

for autonomy. Correlations between MADRS changes

and PSI changes examined the effects of depression

on PSI reporting. These correlations were quite low

and not significant.

2.2. Comparison of depression subtypes

Vascular depression was considered present if

either deep white matter hyperintensities or subcort-

ical grey matter hyperintensities were measured at 2 or

greater on the Coffey scale (Krishnan et al., 1998).

The vascular depression group (n=33) did not differ

from the non-vascular group (n=16) (see Table 1).

Depression was considered early onset if the first

episode of depression occurred at or before the age of

50. The late-onset group (n=23) did not differ from

the early-onset group (n=32) (see Table 1).

2.3. Examination of clinical control variables

Time 2 MADRS scores were not correlated with

age, years of education, number of depressive

episodes, or age of onset of first episode. Independent

t-tests revealed no differences in Time 2 MADRS

scores as a function of gender, race, retirement status,

or marital status. Therefore, no covariates beyond

Time 1 MADRS score were entered in the regression

analyses.

action of sociotropy and negative interpersonal events.

J.Q. Morse, C.J. Robins / Journal of Affective Disorders 84 (2005) 25–31 29

2.4. Regressions predicting change in depression

2.4.1. Sociotropy and negative interpersonal events

Initial MADRS score strongly predicted Time 2

MADRS score (b=0.40, sr2=0.16, t=3.15, pV0.001).After controlling for initial MADRS, Time 2 MADRS

score was not related to sociotropy or negative inter-

personal events, but was related to their congruent

interaction (b=0.30, sr2=0.07, t=2.12, p=0.05). Thisinteraction was probed by examining the relation of

events to depression at sociotropy scores one S.D.

above the mean, one S.D. below the mean, and at the

mean. The positive relation between negative inter-

personal events and increase in MADRS scores was

only significant for high sociotropy scores (b=0.37,t=2.24, pV0.05), not low or average scores (see Fig. 1).

2.4.2. Autonomy and negative autonomy events

Time 2 MADRS score was not related to autonomy

or negative autonomy events, but was related to their

congruent interaction (b=0.28, sr2=0.06, t=2.21,

pV0.05). When this interaction was probed, the

positive relation between negative autonomy events

and increase in MADRS scores was significant for

high autonomy scores (b=0.58, t=3.49, pV0.001) andaverage autonomy scores (b=0.30, t=2.55, pV0.05)(see Fig. 2).

Fig. 2. Changes in depression level as a function of the int

2.4.3. Autonomy and negative interpersonal events

and sociotropy and negative autonomy events

The non-congruent interactions were not related to

change in MADRS score.

3. Discussion

This study sought to predict increase in depressive

symptoms from the interaction between personality

characteristics and classes of life events. Supporting

our hypothesis, older adult patients in remission who

experienced life events that matched their personality

experienced greater increases in depressive symptoms

over 6 months, suggesting that the personality–life

event congruence model has value in understanding

late-life depression.

The current findings also provide preliminary

evidence on the reliability and validity of the

Personal Style Inventory in older adults. PSI scores

were stable over 6 months, had good internal

consistency and were relatively unaffected by

changes in depressive symptoms. These findings are

similar to psychometric statistics reported in adult

clinical samples (Bagby et al., 2001) and suggest that

the PSI is a reliable measure of sociotropy and

autonomy in older adults.

eraction of autonomy and negative autonomy events.

J.Q. Morse, C.J. Robins / Journal of Affective Disorders 84 (2005) 25–3130

3.1. Limitations

Research on stressful life events is hampered by

the difficulty of classifying events into meaningful

categories (Kwon and Whisman, 1998). Although the

judges demonstrated high interrater reliability, their

ratings were independent of the context in which the

individual experienced that event. For example,

retiring from work, categorized as related to

autonomy, may be viewed by the individual as

impacting relationships with colleagues, thus related

to sociotropy. However, participant ratings of an

event’s impact confound person and environment

variables, which is problematic when testing for

person–environment interaction effects. Gender is

also a factor to consider as the meaning of retirement

is based more on affinitive loss for women than for

men. Unfortunately, the sample size precluded exam-

ining gender differences. There is no solution other

than to recognize that these findings are based on

independent raters’ judgments of life events that are

separate from the meanings they may have for the

participants.

There are several subtypes of late-life depression—

early onset versus late onset and vascular versus non-

vascular. The personality–life event congruence effect

may apply differently in these groups. Despite having

information about age of onset and vascular status, the

power in the current sample was not sufficient to test

three-way interactions made up by personality style,

life event, and depression subtype. Future research

should investigate the usefulness of the interaction

between personality and life events in predicting

depression in these groups.

3.2. Clinical implications

The personality–life event congruence hypothesis

brings a theoretical framework to understanding late-

life depression. In addition, in adult samples,

autonomy scores have predicted positive response to

antidepressants (Peselow et al., 1992; Scott et al.,

1996). Older adults often have increased risk of drug

interactions because of comorbid medical illnesses; it

may be helpful to predict response to antidepressants

by assessing personality. In terms of psychotherapy,

once assessed, it may be possible to help the patient to

decrease sociotropy or autonomy concerns through

cognitive therapy or other approaches. It may also be

useful to increase a patient’s awareness of the types of

events to which he or she is most vulnerable, as a step

toward decreasing their frequency or developing

coping skills for reducing their negative impact.

Acknowledgement

This paper is based on a doctoral dissertation

submitted to Duke University by Jennifer Morse,

supervised by Clive Robins. Jennifer Morse thanks

the other members of her dissertation committee, John

F. Curry, Thomas R. Lynch, and David C. Steffens for

their support of this project. The research was

supported by a GlaxoWellcome Long Term Care

Career Development Award to Jennifer Morse through

the Leadership in Aging Program at Duke University.

The larger study was supported by NIMH grants P50

MH60451, P30 MH40159, and R01 MH 54846.

Manuscript preparation was supported in part by

NIMH grant T32 MH 18269, Clinical Research

Training for Psychologists (PI: Paul A. Pilkonis).

We thank David Steffens for offering the resources of

the Mental Health Clinical Research Center for the

Study of Depression in Late Life at Duke University

Medical Center and Carrie Dombeck, Ronna Holliday,

Bobby Levy, Stephanie Levy, and Elena Lopez for

their help in collecting data.

References

Abrams, R.C., Young, R.C., Alexopoulos, G.S., Holt, J.H., 1991.

Neuroticism may be associated with history of depression in the

elderly. Int. J. Geriatr. Psychiatry 6, 483–488.

Allen, N.B., Ames, D., Layton, T., Bennetts, K., Kingston, K.,

1997. The relationship between sociotropy/autonomy and

patterns of symptomology in the depressed elderly. J. Clin.

Psychol. 36, 121–132.

Arieti, S., Bemporad, J.R., 1980. The psychological organization of

depression. Am. J. Psychiatry 137, 1360–1365.

Bagby, R.M., Gilchrist, E.J., Rector, N.A., Dickens, S.E., Joffe,

R.T., Levitt, A., Levitan, R.D., Kennedy, S.H., 2001. The

stability and validity of the sociotropy and autonomy personality

dimensions as measured by the Revised Personal Style

Inventory. Cogn. Ther. Res. 25, 765–779.

Beck, A.T., 1983. Cognitive therapy of depression: new perspec-

tives. In: Clayton, P.J., Barrett, J.E. (Eds.), Treatment of

Depression: Old Controversies and New Approaches. Raven

Press, New York, pp. 265–290.

J.Q. Morse, C.J. Robins / Journal of Affective Disorders 84 (2005) 25–31 31

Bieliauskas, L.A., Conte, M.A., Glandon, G.L., 1995. Inventorying

stressing life events as related to health change in the elderly.

Stress Med., 11.

Blatt, S.J., 1974. Levels of object representation in anaclitic and

introjective depression. Psychoanal. Study Child 29, 7–157.

Bowlby, J., 1977. The making and breaking of affectional bonds: I.

Aetiology and psychopathology in the light of attachment

theory. Br. J. Psychiatry 130, 201–210.

Emmerson, J.P., Burvill, P.W., Finlay-Jones, R., Hall, W.D., 1989.

Life events, life difficulties and confiding relationships in the

depressed elderly. Br. J. Psychiatry 155, 787–792.

Fleiss, J.L., 1971. Measuring nominal scale agreement among many

raters. Psychol. Bull. 76, 378–382.

Folstein, M.F., Folstein, S.W., McHugh, P.R., 1975. bMini-mental

stateQ: a practical method for grading the cognitive state of

patients for the clinician. J. Psychiatr. Res. 12, 189–198.

George, L.K., Blazer, D.G., Hughes, D.C., Fowler, N., 1989. Social

support and the outcome of major depression. Br. J. Psychiatry

154, 478–485.

Hammen, C., Ellicott, A., Gitlin, L., Jamison, K.R., 1989. Socio-

tropy/autonomy and vulnerability to specific life events in

patients with unipolar depression and bipolar disorders. J.

Abnorm. Psychol. 98, 145–160.

Kraaij, V., Kremmers, E., Arensman, E., Kerhof, A.J.F.M., 1998.

Life events over the life cycle and depression in late life. In:

Kosky, R.J., Eshkevari, H.S., Goldney, R.D., Hassan, R. (Eds.),

Suicide Prevention: The Global Context. Plenum Press, New

York, pp. 163–166.

Krishnan, K.R.R., Hays, J.C., George, L.K., Blazer, D.G., 1998.

Six-month outcomes for MRI-related vascular depression.

Depress. Anxiety 8, 142–146.

Kwon, P., Whisman, M.A., 1998. Sociotropy and autonomy as

vulnerabilities to specific life events: issues in life event

categorization. Cogn. Ther. Res. 22, 353–362.

Lynch, T.R., Robins, C.J., Morse, J.Q., 2001. Couple functioning in

depression: the roles of sociotropy and autonomy. J. Clin.

Psychol. 57, 93–103.

Maier, W., Phillipp, M., 1985. Comparative analysis of observer

depression scales. Acta Psychiatr. Scand. 72, 239–254.

Mazure, C.M., Maciejewski, P.K., Jacobs, S.C., Bruce, M.L., 2002.

Stressful life events interacting with cognitive/personality styles

to predict late-onset major depression. Am. J. Geriatr. Psychiatry

10, 297–304.

Montgomery, S.A., 2sberg, M., 1979. A new depression scale

designed to be sensitive to change. Br. J. Psychiatry 134,

382–389.

Oldehinkel, A.J., Bouhuys, A.L., Brilman, E.I., Ormel, J., 2001.

Functional disability and neuroticism as predictors of late-life

depression. Am. J. Geriatr. Psychiatry 9, 241–248.

Peselow, D.E., Robins, C.J., Sanfilipo, M.P., Block, P., Fieve, R.R.,

1992. Sociotropy and autonomy: relationship to antidepressant

drug treatment response to endogenous–nonendogenous dichot-

omy. J. Abnorm. Psychol. 101, 479–486.

Robins, C.J., Ladd, J., Welkowitz, J., Blaney, P.H., Diaz, R.,

Kutchner, G., 1994. The personal style inventory: preliminary

validation studies of new measures of sociotropy and autonomy.

J. Psychopathol. Behav. Assess. 16, 277–300.

Scott, J., Harrington, J., House, R., Ferrier, I.N., 1996. A

preliminary study of the relationship among personality,

cognitive vulnerability, symptom profile, and outcome in major

depressive disorder. J. Nerv. Ment. Dis. 184, 503–505.

Segal, Z.V., Shaw, B.F., Vella, D.D., Katz, R., 1992. Cognitive and

life stress predictors of relapse in remitted unipolar depressed

patients: test of the congruency hypothesis. J. Abnorm. Psychol.

101, 26–36.