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

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exploration of their environment and novel stimuli,
poorer organizational capabilities, and less
soothability relative to infants of nondepressed
mothers. Mechanisms to explain such associations
would primarily be heritability but could also
include effects of prenatal exposures to maternal
depression and correlated stress.
Temperament may also be an early sign of
vulnerability to the later development of depre-
ssion6. Children of depressed mothers may inherit
a tendency to experience and express negative
emotions7 .
The following study is the study of measure-
ment of temperament and comparison with normal
controls in children of patients suffering from
depression.
Material and Methods
Experimental Group:
Subjects included in the study were the children
(male/female) of patients with depression utilizing
the services of the Department of Psychiatry and
Drug De-Addiction Centre, Lady Hardinge Medical
College and Associated hospitals, New Delhi.
Control Group:
Subjects of the control (normal healthy) group
were recruited from the children of the attendants
of the patients utilizing services of departments
other than psychiatry. After careful matching for
age, sex, socioeconomic status all the consenting
subjects in this group were enrolled into the study
subject to meeting the inclusion and exclusion
criteria.
Total 50 index cases of depression in the study
group and 50 normal persons in control group were
recruited by using the above inclusion and exclusion
criteria
Inclusion criteria for cases
1. Children between 4-16 years of age.
2. The diagnosis of depression in the affected
parent by using ICD-10 DCR criteria.
3. No history of depression in other parent.
4. No other psychiatric disorder in either of
the parents.
Exclusion criteria for cases
1. Any chronic medical, surgical illness or
mental retardation in the parent or child.
Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society
DELHI PSYCHIATRY JOURNAL Vol. 15 No.1
2. Person who do not give consent to partici-
pate due to any reason.
Inclusion criteria for control subjects
1. Children between 4-16 years of age.
2. No other medical or psychiatric illness in
either parent.
Exclusion criteria for control subjects
Any chronic medical or surgical illness or
mental retardation in the parents or in the child
Instruments used
International Statistical Classification of
Diseases and Related Health Problems- Tenth
Revision (ICD-10) Classification of mental and
Behavioral disorders: Diagnostic criteria for
research8
Temperament Measurement Schedule9
This scale measures nine temperamental
variables described by Thomas and chess, with 45
items (5 each for 9 variables) to be rated on a 5
point scale. Two extreme scores of 1 and 5 are
provided with definitions with a midpoint score of
3, scores less than 3 are in a positive direction for
intensity and frequency of the behavior measured
by each item. Mean score for each of the variables
are computed by dividing the total score by 5. This
scale has test-retest reliability of 0.61- 0.85 and the
Inter- rater reliability of 0.61- 0.83.
The scale comprised of the following:
Factor-1: Sociability
Approach withdrawal
Adaptability
Threshold of responsiveness
Factor-2: Emotionality
Mood
Persistence
Factor-3: Energy
Activity level
Intensity
Factor-4: Distractibility
Distractibility
Factor-5: Rythmicity
Rythmicity
Hamilton Rating Scale for Depression
(HAM-D)10-12
Procedure
This study included 50 experimental subjects
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DELHI PSYCHIATRY JOURNAL Vol. 15 No.1 APRIL 2012

(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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Comparison of TMS scores between
experimental group and control group:
Factor-1: Sociability
Approach-withdrawal: Subjects in the
experimental group had significantly lower scores
on the variable- Approach-withdrawal than the
subjects in the control group (p= 0.001).
Adaptability: Subjects in the experimental
group had lower scores on the variable- Persistence
but the difference was not found to be statistically
significant (p = 0.575).
Overall, subjects in the experimental group had
significant lower scores on the factor- Emotionality
than the subjects in the control group (p= 0.013).
Factor-3: Energy
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
but the difference was not found to be statistically
significant (p= 0.199).
Threshold of responsiveness: Subjects in the
experimental group had significantly lower scores
(p = 0.001).
Over all, the exper imental group had
significantly lower scores on the factor-Sociability
than the subjects in the control group (p < 0.001).
Factor-2: Emotionality
Mood: Subjects in the experimental group had
significantly lower scores on the variable-mood
than the subjects in the control group (p < 0.001).
Persistence: Subjects in the experimental
Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society
group had significant lower scores on the variable-
activity level than the subjects in the control group
(p = 0.032).
Intensity: Subjects in the experimental group
had significantly lower scores (p= 0.002).
Overall, subjects in the experimental group had
significantly lower scores on the factor-Energy than
the subjects in the control group (p = 0.001).
Factor-4: Distractibility
Subjects in the experimental group had signifi-
cant lower scores on the factor-Distractibility than
the subjects in the control group (p= 0.029).
Factor-5: Rhythmicity
Subjects in the experimental group had lower
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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,
68 Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society
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persistence and on factor emotionality in subjects
is consistent with those of previous studies.
Low mood of the children and adolescents
whose mothers/ fathers were depressed, can be
explained in a pure behavioural basis the mother
psychologically and functionally absent for them,
in terms of care, provoke protest and withdrawal
from the part of the child. Psychoanalytically, the
mother becomes less attractive to the male child
and emotionally based interactions and exchanges
can less and less take place between them, thus the
childs investment in the object and object
relations can suffer.
Factor-3: Energy
Lower scores on the variable- activity level,
persistence and overall energy levels may go well
with the low mood; and at the same time , the excited
condition of some children , will also have to be
explained by way of their tendency again to activate
their mothers, and / or their own unconscious
mechanism of defending against their own anxiety-
depressive position by exhibiting excitement
defense maniaque
From social learning point of view, the child
can model after the parent who is depressed, and
thus becoming a copy of the withdrawn parent,
especially if the parent is depressed for a longer
duration.
Factor-4: Distractibility
Subjects in the experimental group had signifi-
cant lower scores on the factor-Distractibility.
Distractibility can be considered as larval stage of
attention deficit, but not amounting to psycho-
pathology, but at the same time giving the therapists
an opportunity to precociously therapeutically
intervene so that the future possibilities for disorders
of attention and concentration can be reduced, or
even nullified.
Factor-5: Rhythmicity
Subjects in the experimental group had lower
scores on the factor-Rhythmicity.Lack of rhythm is
of particular importance, as the mother and child
are in mutually well tuned well adjusted rhythm, in
the normal course. Any out of rhythm behaviour or
gesture or expression can upset the mother-child /
parent-child unit.
Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society
DELHI PSYCHIATRY JOURNAL Vol. 15 No.1
The results are comparable to studies in past.
It was noted that children of patients with affective
illness showed low sociability i.e. were withdrawing
and less adaptable; lower emotionality (persistently
negative mood); lower energy i.e. less activity and
less intensity of emotions; low distractibility and
less regular biological rhythms25.
The goodness of fit model developed by
Thomas and Chess26 predicts that the concordance,
or the agreement in the temperament as reflected
by the characteristic ways of responding to the
environment between the child and the caregiver
(the parent or teacher) would result in a tendency
for positive relations and outcomes. The nature of
the environmental demands or expectancies (such
as the teaching and parenting styles, and the
organization of the learning environment) and
childrens capacities (such as temperament) may
influence activity, sociability, rhythmicity and
attentiveness levels. This illustrates how the
inappropriate parenting styles in families of parents
suffering from depression probably can have
adverse effects on temperamental characteristics of
children living in such families.
In our country there is a paucity of studies on
mother-baby interactions, normal and abnormal, as
Child and Adolescent Psychiatry as a discipline is
still yet to develop; our study may be fitting in as a
small attempt to fill such lacunae.
Conclusions
Depression of any family member has impact
on whole family because of its serious negative
consequences especially on the children.
The children of patients suffering from depre-
ssion had more difficult temperament as compared
to the children of non-depressed parents.
Limitations of our study
Interpretation of the findings in study is limited
by small sample size.
It was a cross-sectional study.
There was no pilot study.
There was exclusive reliance on parents as a
source of data.
Data from other sources such as teachers and
bigger sample size might have improved the validity
of these assessments.
Results obtained are of limited clinical signifi-
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cance due to cross sectional design of study. By
following up the study subjects longitudinally with
serial assessments the results can be evaluated for
consistency which can be a more meaningful
finding.
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