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Keywords:

  • depression;
  • German sample;
  • Kasahara's scale;
  • reliability;
  • Typus melancholicus;
  • validity

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SUBJECTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENT
  8. REFERENCES
  9. Appendix

Abstract We explored the reliability and validity of Kasahara's scale of melancholic type of personality (KMT) in a German sample population. Subjects comprised 66 patients diagnosed with an affective disorder (F3, ICD-10) and 94 controls. Concerning reliability, KMT scores showed internal consistency with Cronbach's alpha coefficients of 0.65 for patients and 0.67 for controls. The KMT items, except for number 13 in controls, showed significant item–total correlations. In a test–retest procedure, the KMT total score and individual item scores were statistically similar and correlated. These results indicate reliability of the KMT. Concerning validity, KMT scores were significantly higher in patients than in controls. By controlling the effects of age and sex, partial correlation coefficients in a comparison of KMT and Zerssen's F-List (F-List) scores were 0.40 in patients and 0.53 in controls. These results show both the constructive and concurrent validity of the KMT. Sufficient reliability and validity of the KMT were shown in this German sample population to encourage cross-cultural investigation of Typus melancholicus.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SUBJECTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENT
  8. REFERENCES
  9. Appendix

Particular personality patterns have been associated with specific mood disorders. Tellenbach's Typus melancholicus1 is a typological characterization of a premorbid personality type recognized in Germany and Japan and associated with depression. Persons in Japan diagnosed with this personality type are generally respected and socially well integrated because it involves such culturally esteemed characteristics as orderliness and consideration of others.

Typus melancholicus has been noted by very few Anglo-American investigators.2–4 Review articles have defined it as a variation of obsessive type personality. Wittenborn and Maurer.2 concluded that the tendency toward obsessional brooding and moodiness is state dependent in some patients and may temporarily persist as an interepisodic manifestation of depressive illness. They speculated that at the onset of a depressive episode, the combination of intensified obsessions and suppressed anger serves as a defense in a person overwhelmed by stress and preoccupied with fear of losing control.

Empirical study is needed to establish the validity of Typus melancholicus as a premorbid personality associated with depression. von Zerssen et al.5–7 approached Typus melancholicus with psychological test methods and developed two assessment questionnaires: Zerssen's F-List (F-List),5,6 and the Munich Personality Test (MPT).7 They also examined the relation between interview-determined and questionnaire-determined diagnoses of Typus melancholicus.8,9 Using the F-List and MPT, which are widely used in Germany, investigators have studied Typus melancholicus in sample Japanese populations.10–14 Some Japanese investigators have compared these questionnaires with Kasahara's scale of melancholic type of personality (KMT).10,11,14,15 The KMT questionnaire (Appendix 1) is considered a reliable and valid assessment tool for Typus melancholicus in the Japanese. 10,11,16–18

We explored the reliability and validity of Typus melancholicus from a transcultural viewpoint by assessing the reliability and validity of the KMT in a German sample.

SUBJECTS AND METHODS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SUBJECTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENT
  8. REFERENCES
  9. Appendix

We studied 66 patients diagnosed as having F3 (affective disorders) according to the ICD-10 (World Health Organization 1993) who were in- or outpatients in either Münster University Hospital or Rochus Hospital, and 94 control subjects. Patient diagnoses were made by experienced psychiatrists based on non-structured clinical interviews. Control data were obtained from staff members of both hospitals and university students. We briefly interviewed them as to whether they had a past history of any mental disorder or psychiatric treatment and excluded from the study any who responded positively. Informed consent was obtained from all subjects prior to participation.

Kasahara's 15-item questionnaire15 is coded on a four-point scale (0 = Not true, 1 = Somewhat true, 2 = Mostly true, and 3 = Completely true). The original Japanese version of the KMT was translated into German with the author's permission. This German version was translated back into Japanese by bilingual German specialists who were blinded to the original version. The content-equivalence of both versions was thus confirmed. The F-List is recognized in Germany as valid for evaluating Typus melancholicus and is used in a variety of personality studies. Subjects completed the KMT and F-List questionnaires.

To control for the effect of depression, we administered the questionnaire to patients during a period of remission, when symptoms scored less than seven points on Hamilton's 17-item depression scale.19,20 To assess reliability of the KMT, we calculated the Cronbach's alpha coefficient and the item-total correlation. In addition, we made two personality assessments with the KMT, during remission and again at 1-month follow up. Fifty-two of the 66 patients completed both questionnaires. We studied the correlation between scores using this test–retest procedure.

To evaluate the construct validity of the KMT, we compared scores between patients and control subjects. To evaluate the concurrent validity of the KMT, we compared KMT scores with F-List scores. We studied the partial correlation coefficients between KMT and F-List scores for the patient and control groups, controlling for the effects of age and sex.

Values are shown as mean (SD). Score of the two groups was compared with Student's t-test or Student's paired t-test for continuous variables. Pearson's correlation coefficient was used to explore the relation between continuous variables. A P value ≤ 0.05 (two-tailed) indicated a statistically significant difference. Statistical calculations were performed with SPSS for Windows, Version 10.0 (SPSS Japan Inc., Tokyo, Japan).

RESULTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SUBJECTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENT
  8. REFERENCES
  9. Appendix

The mean age of patients was 50.2 (14.8) years. Of the 66 patients 24 were men at 49.0 (12.6) years and 42 were women at 51.0 (16.0) years. Forty-seven of the 66 (71.2%) patients had a depressive episode with somatic symptoms. The mean age of controls was 37.0 (12.8) years. Of the 94 controls, 51 were men at 38.9 (14.0) years and 43 were women at 36.2 (11.2) years.

The Cronbach's alpha coefficient for patient KMT scores was 0.65 and that of controls was 0.67. Pearson's correlation coefficients between the total KMT score and each test item are shown in Table 1. Item 13 was statistically unrelated to KMT total scores in controls.

Table 1.  Item-total correlation of KMT in patients and controls
 PatientsControls
Item numberPearson's coefficientItem numberPearson's coefficient
  • * 

    P < 0.05;

  • ** 

    P < 0.01;

  • *** 

    P < 0.005;

  • **** 

    P < 0.001; n.s., not significant.

  • KMT, Kasahara's scale of melancholic type of personality.

10.395***10.399****
20.342**20.412****
30.321**30.362****
40.400***40.452****
50.667****50.495****
60.579****60.569****
70.513****70.448****
80.297*80.246*
90.252*90.392****
100.530****100.529****
110.531****110.608****
120.358***120.266*
130.260*130.083 n.s.
140.349***140.537****
150.375***150.532****

Overall total KMT score was 31.3 (5.2) in the first analysis and 30.4 (5.2) in the second analysis, with no statistically significant difference between them. Pearson's correlation coefficient for overall total KMT scores between the two tests was 0.71, with the individual items being statistically similar (Table 2).

Table 2.  Scores on KMT in test–retest procedure
 1st KTM2nd KTM
 (Mean ± SD)(Mean ± SD)Paired t-testPearson's coefficient
  • * 

    P < 0.005;

  • ** 

    P < 0.001; n.s., not significant.

  • KMT, Kasahara's scale of melancholic type of personality.

Total31.3 ± 5.230.4 ± 5.2n.s.0.71**
Item
12.4 ± 0.72.4 ± 0.6n.s.0.72**
22.6 ± 0.62.5 ± 0.6n.s.0.40*
32.6 ± 0.52.6 ± 0.6n.s.0.59**
42.5 ± 0.62.5 ± 0.5n.s.0.52**
52.2 ± 0.82.1 ± 0.8n.s.0.91**
62.1 ± 1.12.1 ± 0.9n.s.0.71**
71.5 ± 1.11.6 ± 1.0n.s.0.77**
81.6 ± 1.01.6 ± 1.0n.s.0.52**
92.3 ± 0.72.1 ± 0.7n.s.0.77**
102.0 ± 1.11.9 ± 0.9n.s.0.43*
112.1 ± 0.92.1 ± 1.0n.s.0.71**
121.7 ± 0.91.6 ± 0.9n.s.0.60**
131.6 ± 0.91.7 ± 0.9n.s.0.53**
141.8 ± 0.91.7 ± 0.8n.s.0.63**
152.3 ± 0.82.3 ± 0.7n.s.0.68**

There was a statistical difference in mean KMT scores between patients and control subjects [31.4 (5.2) vs 27.1 (5.1), P < 0.001], between female patients and female controls [32.2 (5.0) vs 27.5 (5.0), P < 0.001], and between male patients and male controls [30.1 (5.5) vs 26.7 (5.2), P < 0.05]. There was a statistical difference in mean F-List scores between patients and control subjects [139.5 (16.5) vs 122.8 (17.2), P < 0.001], between female patients and female controls [142.3 (13.5) vs 127.0 (17.2), P < 0.001], and between male patients and male controls [134.5 (20.2) vs 119.2 (16.6), P < 0.005].

The partial correlation coefficients between the KMT and F-List scores for the patient and control groups were 0.40 (P < 0.005; 95% confidence interval 0.16–0.59) in patients and 0.53 (P < 0.001; 95% confidence interval 0.35–0.67) in controls.

DISCUSSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SUBJECTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENT
  8. REFERENCES
  9. Appendix

The items on Kasahara's KMT concern Tellenbach's Typus melancholicus,1 Kretschmer's cyclothymia,21 and Shimoda's immobilithymia.22 Kasahara15 developed this inventory based on clinical experience without empirical study. Sato et al.10,11,18 established both the reliability and validity of the KMT test for determining Typus melancholicus in the Japanese.

Our study is the first to explore the reliability and validity of the KMT in a country other than Japan. The Cronbach's alpha coefficient we obtained demonstrated the internal consistency of the test in our sample population. Among patients every KMT item showed a significant item-total correlation, consistent with the findings of Sato et al.18 Among our control subjects, however, Item 13 showed no significant item-total correlation. It could be that Item 13, ‘I am rather cheerful’, was considered by some control subjects as to describe hyperthymia, a component of manic patients and contradictory to Typus melancholicus. Indeed, Item 13 is similar to the Item 30 of the MPT, ‘Other people consider me lively’, which is characteristic of ‘Extraversion’ and contradictory to ‘Rigidity’ so far as factorial structure is concerned. ‘Rigidity’ is considered to be equivalent to Typus melancholicus. Kasahara15 originally intended Item 13 to identify Kretschmer's cyclothymia, syntonia, and slight optimism and to provide one item describing Typus melancholicus. The relatively homogeneous patient group of patients, as compared to the more disparate group of control subjects, might have answered Item 13 as Kasahara had originally intended. Further study is needed to investigate whether these divergent results are based upon differences between patients and controls or between the cultures of Germany and Japan. Re-evaluation is needed to make this KMT item significant in the German. The KMT was replicable in the test–retest procedure.

The KMT and F-List scores in patients were significantly higher than those in controls. Adjusted for sex and age, significant correlation existed between the KMT and F-List in patients and in controls, providing evidence that the KMT has both constructive validity and concurrent validity. We consider the KMT to have sufficient reliability and validity in German populations for cross-cultural explorations of Typus melancholicus.

Given the wide use of KMT in different countries, it is important to explore its validity through investigations of differences in KMT scores between depressive patients and normal subjects sharing various cultural backgrounds. There is one non-empirical study that treats this matter. Ogawa and Koide23 explored the personality of depressive patients by clinical interviews based on the KMT and concluded that in France, considered an ‘individualistic’ society, there are large variations in premorbid personality traits and a high frequency of neurotic tendencies. This indicates cultural difference in the premorbid personality of depressed patients. Further study is needed to explore whether Typus melancholicus is associated with depression worldwide.

ACKNOWLEDGMENT

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SUBJECTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENT
  8. REFERENCES
  9. Appendix

This study was supported in part by Research Grant B 42, no. 11/96 from the Heinrich Hertz Foundation, Germany.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SUBJECTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENT
  8. REFERENCES
  9. Appendix
  • 1
    Tellenbach H. Melancholie. Problemgeschichte, Endogenität, Typologie, Pathogenese, Klinik. Springer, Berlin, 1961 (in German).
  • 2
    Wittenborn RJ & Maurer SH. Persisting personalities among depressed women. Arch. Gen. Psychiatry 1977; 34: 968971.
  • 3
    Akiskal HS, Hirschfeld MA & Yerevanian BI. The relationship of personality to affective disorders. Arch. Gen. Psychiatry 1983; 40: 801810.
  • 4
    Phillips KA, Gunderson JG & Hirschfeld RMA et al. A review of the depressive personality. Am. J. Psychiatry 1990; 147: 830837.
  • 5
    Von Zerssen D. Objektivierende Untersuchungen zur prämorbiden Persönlichkeit endogen depressiver (Methodik und vorläufige Ergebnisse). In: Hippius H, Selbach H (eds). Das Depressive Syndrome. Urban and Schwarzenverg, München, 1969; 183205 (in German).
  • 6
    Von Zerssen D, Koeller D-M & Rey E-R. Die prämorbide Persönlichkeit von endogen Depressiven. Eine Kreuzvalidierung früherer Untersuchungsergebnisse. Confin. Psychiat. 1970; 13: 156179 (in German).
  • 7
    Von Zerssen D, Pfister H & Koeller D-M. The Munich Personality Test (MPT)—a short questionnaire for self-rating and relatives' rating of personality traits: formal properties and clinical potential. Eur. Arch. Psychiatr. Neurol. Sci. 1988; 238: 7393.
  • 8
    Von Zerssen D. ‘Melancholic’ and ‘manic’ type of personality as premorbid structures in affective disorders. In: Mundt C, Goldstein MJ, Hahlweg K, Fiedler P (eds). Interpersonal Factors in the Origin and Course of Affective Disorders. Gaskel, London, 1996; 6585.
  • 9
    Hecht H, Van Calker D & Spraul G et al. Premorbid personality in patients with uni- and bipolar affective disorders and controls: assessment by the Biographical Personality Interview (BPI). Eur. Arch. Psychiatry Clin. Neurosci. 1997; 247: 2330.
  • 10
    Sato T, Sakado K & Sato S. Differences between two questionnaires for assessment of Typus melancholicus, Zerssen's F-list and Kasahara's scale: the validity and relationship to DSM-III-R personality disorders. Jpn. J. Psychiatry Neurol. 1992; 46: 603608.
  • 11
    Sato T, Sakado K & Kobayashi S. The measurement of Typus melancholicus using questionnaires; reliability and validity of Zerssen's F-List. Seishin Igaku (Clin. Psychiatry) 1992; 34: 139146 (in Japanese).
  • 12
    Nakanishi T, Isobe F & Ogawa Y. Chronic depression of monopolar, endogenous type: With special reference to the premorbid personality, ‘Typus melancholicus’. Jpn. J. Psychiatry Neurol. 1993; 47: 495504.
  • 13
    Sakado K, Sato T, Uehara T, Sato S & Sakado M. The Japanese version of the Munich Personality Test (MPT): its reliability and validity. Arch. Psychiatr. Diagn. Clin. Eval. 1996; 7: 123132 (in Japanese).
  • 14
    Furukawa T, Nakanishi M & Hamanaka T. Typus melancholicus is not the premorbid personality trait of unipolar (endogenous) depression. Psychiatry Clin. Neurosci. 1997; 51: 197202.
  • 15
    Kasahara Y. Depression seen in general medical clinics. Shinshin Igaku (Psychosom. Med.) 1984; 24: 614 (in Japanese).
  • 16
    Sato T, Sakado K & Sato S. Typus melancholicus measured by a questionnaire in unipolar depressive patients: age- and sex-distribution, and relationship to clinical characteristics of depression. Jpn. J. Psychiatry Neurol. 1993; 47: 111.
  • 17
    Sato T, Sakado K, Uehara T & Sato S. Age distribution of the melancholic type of personality (Typus melancholicus) in outpatients with major depression: a comparison with a population without a history of depression. Psychopathology 1994; 27: 4347.
  • 18
    Sato T, Sakado K, Nishioka K & Kasahara Y. Reliability of Kasahara's scale for assessment of the melancholic type of personality (Typus melancholicus). Seishin Igaku (Clin. Psychiatry) 1996; 38: 157162 (in Japanese).
  • 19
    Prien RF, Carpenter LL & Kupfer DL. The definition and operational criteria for treatment outcome of major depressive disorder. A review of the current research literature. Arch. Gen. Psychiatry 1991; 48: 796800.
  • 20
    Frank E, Prien RF & Jarret RB et al. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, recurrence. Arch. Gen. Psychiatry 1991; 48: 851855.
  • 21
    Kretschmer E. Körperbau und Charakter. Springer, Berlin, 1921 (in German).
  • 22
    Shinfuku N & Ihda S. Über den prämorbiden Charakter der endogenen Depression-Immodithymie-(später Immobilithymie) von Shimoda. Fortschr. Neurol. Psychiatr. Grenzgeb. 1969; 37: 545552 (in German).
  • 23
    Ogawa T & Koide H. Cultural variations of premorbid personality of endogenous depression: a transcultural study. Jpn. J. Psychiatry Neurol. 1992; 46: 831839.

Appendix

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SUBJECTS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. ACKNOWLEDGMENT
  8. REFERENCES
  9. Appendix

Appendix 1. Kasahara's scale of melancholic type personality15,16

1. I like to work.

2. When I start something, I always finish it thoroughly.

3. I have a strong sense of responsibility.

4. I give importance to my social duty.

5. I cannot say no when someone asks me to do something.

6. I would rather avoid confrontation with somebody.

7. I am rather timid.

8. I am nervous about what other people think of me.

9. I give importance to common sense.

10. I would not do something extreme.

11. I do not like to be conspicuous.

12. I sometimes get excited easily.

13. I am rather cheerful.

14. I like to arrange my belongings.

15. I am neat.