Change in Self-Reported Personality During Major Depressive Disorder Treatment: A Reanalysis of Treatment Studies From a Demoralization Perspective

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Change in self-reported personality trait scores (especially Neuroticism and Extraversion) over the course of treatment for major depressive disorder (MDD) has been robustly demonstrated. We believe that these observed changes on personality trait scales may reflect reduction in demoralization rather than changes in personality per se. Data were combined from 3 archival samples: a randomized clinical trial and 2 naturalistic follow-up studies. All participants (N = 300) received either psychotherapy or psychopharmacological treatment. Pre- and posttreatment participants were assessed with the revised NEO Personality Inventory (NEO-PI–R), the 17-item Hamilton Rating Scale for Depression (HRSD–I7), and Beck Depression Inventory—II (BDI–II). Comparisons were made between “unadjusted” and “adjusted” NEO-PI–R substantive personality trait scales—in which demoralization-related items were removed from their original trait scale (i.e., adjusted NEO-PI–R scales) and also used to form a separate NEO demoralization scale (NEOdem). The NEOdem scale changed more over the course of treatment (d = .41) compared with the adjusted NEO-PI–R scales, which manifested only small changes (d < |.19|). Moreover, the adjusted NEO-PI–R trait scales revealed much smaller changes compared with their unadjusted counterparts. The study provides further support for the utility of distinguishing between demoralization and NEO-PI–R traits in clinical assessment and research. A substantial part of change in self-reported personality during treatment for depression resulted from a reduction in demoralization.

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