Laboratory of Personality Development Researchers in the Laboratory of Personality and Development are interested in the contributions of personality to mental and physical health outcomes across the life span. LPD researchers are committed to risk factor research, intervention research, and integrating the two. With respect to risk factors, LPD researchers are interested in discovering how personality may amplify or diminish risk for adverse health outcomes, and how the relationships between personality and health may change with age. With respect to interventions, LPD researchers are interested in how personality and age moderate the effectiveness of psychosocial and pharmacological interventions for mental disorders and physical illness. The LPD serves as a vibrant intellectual forum for undergraduate and graduate students, psychology interns, medical students, postdoctoral fellows and faculty. Funding is often available for summer internships (undergraduates, medical students), graduate students in clinical psychology, and postdoctoral fellows. Trainees in the LPD have been supported by a variety of grant mechanisms, including T32s, Minority Supplements, and START-MH. Ongoing LPD projects involve new data collection and secondary analyses of public domain dataset. There are ongoing collaborations with University of Rochester faculty in the Departments of Psychiatry, Clinical and Social Sciences in Psychology, Family Medicine, Public Health Sciences, and in the Cancer Center. LPD researchers are actively involved in two trans-departmental Centers, the Center for the Study and Prevention of Suicide and the Rochester Center for Mind Body Research. LPD research has also been enriched by collaborations with investigators at the National Institute on Aging and Buffalo State University, as well as with researchers in Canada, China, Germany, Iceland, New Zealand, and Sweden. Faculty & Staff Director: Paul Duberstein, Ph.D. Silvia Sörensen, Ph.D. Lab Coordinator: Nathan Franus, M.S. Investigators: Kathryn Castle, Ph.D. Benjamin Chapman, Ph.D. Kenneth Conner, Psy.D., M.P.H. Stephanie Gamble, Ph.D. Marnin Heisel, Ph.D. Jameson Hirsch, Ph.D. Joanne McGriff, M.D., M.P.H. Wendy Nilsen, Ph.D. Jenny Speice, Ph.D. J. David Useda, Ph.D. Elizabeth Wahlig, Ph.D. Angela Williams, Ph.D. Research Staff: Anthony Beckman, B.A. Mary Harper, B.S. Lucinda Hutton, M.S., NCCP Kendra Marinucci, M.S.W., C.S.W. Patrick Walsh, B.A. Department of Psychiatry Collaborators: Eric D. Caine, M.D. Yeates Conwell, M.D. Deborah King, Ph.D. Jeffrey Lyness, M.D. Jan Moynihan, Ph.D. Nancy Talbot, Ph.D. Other Rochester-Based Collaborators: Bruce Friedman, Ph.D., M.P.H. Department of Public Health Sciences Ronald Epstein, M.D. Department of Family Medicine Ronald Rogge, Ph.D. Clinical and Social Sciences in Psychology Richard Ryan, Ph.D. Clinical and Social Sciences in Psychology Projects Research on Risk Factors Adult Depression, Suicidal Ideation, and Personality (P.R. Duberstein, PI). We have reported data suggesting that depressed older adults who are low in the personality trait Openness to Experience (OTE) are at increased risk for completed suicide. We then developed a model that integrates this finding with other research on depression and suicide: Low OTE mutes symptom-reporting, obscuring symptom-recognition, and increasing suicide risk. We are in the midst of testing aspects of this model in a sample of 350 depressed psychiatric inpatients 50 years of age and older. Data are collected from patients as well as from their family members and friends who are asked about their perceptions of the patients’ symptoms. Depression Outcome in Older Primary Care Patients (J.M. Lyness, PI). This study examines the 3-4 year course of depression in over 900 older primary care patients, including psychiatric, medical, functional, and psychosocial variables as both predictors and outcomes. The focus is on major, minor, and subsyndromal depressions in these patients, to test theoretical models (e.g., the cerebrovascular model just described) by a risk factor approach as well as to identify those most at risk for chronicity. LPD researchers are particularly interested in the contribution of Neuroticism and other personality traits to risk for incident and recurrent depression in older adults. Findings have implications for theories of etiology as well as for the development and implementation of future intervention efforts. Detecting Depression In Older Adults (P.R. Duberstein, PI). Numerous factors are thought to undermine the detection, diagnosis, and treatment of depression in older adults. We aim to examine whether friends and relatives are able to detect depressive disorders and symptoms of depression and anxiety in 900 older primary care patients. We hypothesize the detection will be poorer for: disorders that are less severe and first episode (vs. recurrent); patients with certain personality traits (e.g., low extraversion; low openness to experience) or in poor physical health and men and unmarried participants Detection will also be poorer when friends and relatives of probands have no history of depression or are in poor physical health (Aim 4). Findings could help guide the development of screening instruments, educational and clinical interventions, and surveillance strategies to lessen the public health impact of unrecognized and untreated depression. Validation of a Preparation for Future Care Measure with Older African Americans (S. Sörensen, PI). Preparation for Future Care (PFC) is defined as thoughts or actions aimed at optimizing the care received in late adulthood, for example, by identifying sources of aid and arranging coverage of long-term care. The purpose of this project is to validate a measure of PFC in a sample of older African-Americans and to develop a short form of this measure. Cross-validation against measures of cognitive functioning is a secondary goal. Effective assessment of PFC is important because it may buffer the adverse effects of chronic, progressive illnesses and functional limitations. PFC is important because it may buffer the adverse effects of chronic, progressive illnesses and functional limitations. Data will be collected from 200 African-American and 200 White older adults in the Rochester area. Participants will be asked to complete a 47-item PFC survey and a 21-item short form within 2-4 weeks. They will also complete measures of everyday cognition, basic cognitive functioning, and emotional and attitudinal measures. The information gained will contribute to the development of a screening tool for practitioners assisting older adults with care plans. Preparation for Future Care in Older Adults (S. Sörensen, PI). As part of her Career Development Award (K01 AG022072-01), Dr. Sörensen is currently conducting two ancillary studies aimed at (1) describing the natural course of PFC, (2) investigating four antecedents of PFC: Personality, Cognitive Functioning and Impairment, Depression, and Medical Illness, and (3) examining the consequences of PFC over time with regard to Subjective Well-being, Functional Status, and Health Care Utilization. Data are being collected as part of an ancillary study to a NIA-funded longitudinal investigation of first-degree relatives of Alzheimer’s patients (ADAPT, Pierre Tariot, MD, PI). In addition, secondary data analyses will be performed on an ongoing NIH-funded study of depression in primary care patients (DOS; J. Lyness, PI) in order to assess the antecedents and consequences of PFC. Risk and Protective Factors in Black Adolescents (K. Castle, PI). One of the most urgent areas of concern in minority mental health is suicidal behavior in Black adolescents. The overall rate of adolescent completed suicide increased by 19% from 1980 to 1997, but the rate for Black adolescents increased 126%. We will develop and test an innovative, multivariate model of psychosocial factors that may buffer risk for depression and suicidal behavior in role in Black adolescents. Central constructs in the model are perceived discrimination, alienation, and ethnic identity. The proposal has the following Specific Aims: 1. To examine the relationship between self-reported ethnic identity, alienation, and perceived discrimination, and a) depression, and b) suicidal ideation in Black adolescents. 2. To test and refine an Ethnic Identity Protection model of mental health outcomes in Black adolescents. Participants in the cross-sectional study will be recruited from The Pediatric Practice at Strong Memorial Hospital. The subjects will complete self-report measures assessing ethnic identity, perceived discrimination, alienation, depressive symptoms, suicidal ideation, alcohol use, aggression, impulsivity, and personality. Data will be collected following their primary care visit. The central hypothesis is that ethnic identity moderates the effects of perceived discrimination and alienation on depression and suicidal ideation. Multiple regression analyses will be conducted. By focusing on ethnic identity, perceived discrimination, and alienation, this pilot study will spear-head new and productive research questions on depression and suicide that will aid in better serving Black adolescents. Anxiety and the Delayed-Type Hypersensitivity Response (M. Larson, PI). Immunologic changes appear to be potentiated in individuals who are strong cardiovascular reactors to stress, but it is unclear if such alterations are related to heightened levels of either state or trait anxiety. Moreover, neither anxiety nor stress responses have yet been correlated significantly with clinically relevant shifts in the cell-mediated immune response. These are the primary objectives of the proposed research project, which would be undertaken using the delayed-type hypersensitivity (DTH) response as a clinically relevant model of cell-mediated immunity. Subjects would be required to complete two separate experimental sessions (baseline vs. acute stress), spaced two weeks apart, which would be counterbalanced. Injection of tetanus toxoid at the end of each session would serve to initiate the DTH response, and subjects would be required to return 48 hours after each of the experimental sessions so that the magnitude of these DTH responses could be assessed. It is hypothesized that DTH response magnitude will be positively correlated with anxiety level, that DTH responses that are initiated immediately following the stressful task will be significantly larger in magnitude than DTH responses initiated during the baseline condition, and that these exaggerated DTH responses will be mirrored by exaggerated cardiovascular responses to the same task. Patient Centered Care and Healthcare Costs (R. Epstein, PI). Preliminary studies indicate that patient-centered care may reduce health care utilization while improving health status and satisfaction. This study examined the relationship between measures of physicians' patient-centeredness and health care costs and patients’ health status and satisfaction with treatment. One hundred primary care physicians stratified by case-mix-adjusted total health care costs were sampled. LPD researchers are particularly interested in the relationship between physicians’ self-reported personality traits and indicators of patient-centered care. The associations between physician personality and health care costs are also of interest. The study will help identify modifiable factors in physician interaction style that can lead to decreased utilization, decreased costs, and recognition of emotional distress Treatment-based Research Treating Depressed Women with Sexual Abuse Histories (N. Talbot, PI) Depression is a debilitating and common psychiatric disorder; more than 1 in 5 women will suffer major depression during her lifetime. Although proven psychotherapies for depression exist, their applicability to women who report childhood sexual abuse histories has been rarely examined. Childhood sexual abuse confers increased risk for depression and is associated with more severe, chronic, and recurrent depression, complicating comorbidities, and poor outcomes in multiple domains. The research plan is designed to initiate a program of systematic research into treatments for this high-risk subgroup of women by comparing interpersonal psychotherapy (IPT), an established treatment for depression, to usual care provided in a community mental health center. The study will use a 2 (treatment) X4 (pretest, 8-week, posttest, 3-month follow-up) repeated measures design. Seventy women with major depression (DSM-IV) will be randomly assigned to IPT or usual care. IPT is hypothesized to lead to greater improvements in depressive symptoms, and psychological and social functioning. Key patient-level variables that predict good and poor outcomes will be identified. LPD researchers are particularly interested in whether treatment response is moderated by personality traits. The acceptability of IPT will also be examined. Results will guide the next stage of research, which is to refine treatment strategies to improve health outcomes. A Pilot Study of IPT-G for Depressed Seniors in Public Housing Settings (M Heisel, PI). Aggressive identification and treatment of depression may reduce associated morbidity and mortality and mitigate suicide risk. The proposed research is designed to test the feasibility of providing group-based psychotherapy on-site in community housing settings for multiply disadvantaged seniors (i.e., with financial, educational, and/or social disadvantage, and/or with physical, mental, or functional impairment). We will coordinate and facilitate two courses of Interpersonal Psychotherapy for Group (IPT-G), co-facilitated by an on-site social worker coordinating supportive services for older adults living in public-housing high-rise buildings. Service coordinators working for Eldersource, an aging services organization in Rochester, currently provide mental health support for adults living in Rochester Housing Authority (RHA) public housing settings, and report that residents have a need for mental health intervention. Demographic, cognitive, and personality moderators of treatment response will be explored.