NESDA ANALYSIS PLAN 1

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1 NESDA ANALYSIS PLAN 1 Please fax, send or completed form to Marissa Kok, NESDA study, A.J. Ernststraat 887, 1081 HL Amsterdam. Fax: NESDA is supported by the ZonMW Geestkracht program, which is intended to promote collaboration between disciplines and institutes. 1. First author information: Name of first author: Annemieke Noteboom Telephone: / Site: UL/LUMC UMCG/RUG VU/VUMC Trimbos WOK NIVEL Other:_GGZinGeest If proposer is not a NESDA senior investigator, which NESDA senior investigator will supervise?: Aartjan Beekman and Brenda Penninx 2. Working title of plan: Social support, personality traits and mood and anxiety disorders 3. Give a brief summary of your analysis plan that includes the following: a. Research question and/or hypothesis The purpose of this cross sectional study is to examine how social support dimensions (perceived social support, negative interactions and support satisfaction) are associated with mood and anxiety disorders. We also want to examine the influence of personality traits on social support dimensions. We expect that personality plays an important role in the way patients establish and perceive social support. We hypothesize that next to the independent effect of both personality and social support there is a moderating effect on the severity of symptoms. First, we want to examine if there are differences in the social support dimensions between the study groups of patients with a mood disorder, an anxiety disorder or both compared to a control group without any current or lifetime mood or anxiety disorders. We hypothesize that all three study groups have a smaller social network, more negative interactions and perceive less social support and have a lower level of support satisfaction compared to the control group. We hypothesize that patients with both an anxiety and a mood disorder experience less social support, less support satisfaction and more negative interactions compared to patients with a mood disorder or an anxiety disorder. We also hypothesize that patients with a mood disorder experience less social support, less support satisfaction and more negative interactions compared to patients with an anxiety disorder. In the group of patients with an anxiety disorder we hypothesize that patients suffering from a social phobia experience less

2 social support and satisfaction from this support and more negative interactions compared to patients with other anxiety disorders. Next, we want to examine whether there are differences in the five factor profile between the study groups and the control group. We expect that all groups are characterized by high neuroticism, low conscientiousness, low agreeableness and low extraversion compared to a control group without any lifetime or current mood or anxiety disorder. We expect that patients with a mood disorder and patients with a mood and anxiety disorder are characterized by a significantly higher level of neuroticism and a significantly lower level of extraversion compared to patients with an anxiety disorder. We also expect that patients with an anxiety disorder are characterized by a significantly higher level of agreeableness compared to patients with a mood disorder and patients with a mood and anxiety disorder. Finally, we want to examine the influence of the big five personality traits and the social support dimensions on the severity of symptoms in the group of patients with a mood disorder, an anxiety disorder and in the group of patients with co-morbidity of a mood and anxiety disorder. We expect that both personality and social support influence the severity of symptoms and that there is an moderating effect between personality traits and the social support dimensions. We hypothesize that within each group patients with an outgoing, friendly and reliable personality style (characterized by at least one standard deviation above the mean on Extraversion, Conscientiousness and Agreeableness) will have a larger social network and experience more social support, support satisfaction and less negative interactions resulting in less severe symptoms than patients with more neurotic, anxious, hostile or rigid personality traits (characterized by scores at least one standard deviation above the mean on neuroticism and one standard deviation below the mean on openness). We expect that the adaptive personality style is more frequent in the group with patients with an anxiety disorder compared to both the group with a mood disorder and the group with a mood and anxiety disorder. Openness Neuroticism Extraversion Agreeableness Social support Negative interactions Severity of symptoms in mood and/or anxiety disorders Conscientious -ness Satisfaction

3 Theoretical model of the direct and moderating effects of personality and social support dimensions on severity of mood and anxiety disorders b. Brief background and rationale for addressing the research question in NESDA The five factor model is among the most popular models of personality. It states that five personality dimensions (neuroticism, extraversion, openness to experience, agreeableness and conscientiousness) lie at the top of the hierarchy of human functioning (mccrae & Costa, 1999). These personality dimensions represent stable dispositions and patterns of thoughts, feelings and behaviors which influence relationships, social roles and perceptions of individuals of themselves and others (mccrae & Costa, 1996). Over the years numerous studies have found systematic links between the domains of Five Factor Model (FFM) of personality and mood and anxiety disorders. For example, direct links have been found between mood disorders and a high level of neuroticism/negative emotionality and a low level of extraversion. Neuroticism is considered to be a risk factor for the development of mood disorders (Fanous et al, 2007; Kendler et al 2002, 2006a en 2006b). A low level of extraversion has been suggested to be a vulnerability factor for depression (Hirschfeld et al, 1983, Kendler et al, 2006b), but doesn t seem to be a risk factor (Angst & Clayton, 1986; Kendler et al, 1993; Boyce et al, 1991 and Hirschfeld et al, 1989). A high level of extraversion may have a protective effect on depression (Farmer et al, 2002). Anxiety disorders seem to be characterized by a high level of neuroticism and a high level of agreeableness (Maalouff e.a., 2004). There is evidence that the genetic markers of neuroticism and affective disorders are closely related (Hettema et al, 2006). Neuroticism may account for the onset, overlap and course of depression and anxiety (Weinstock and Whisan, 2006). In a meta-analysis of 33 studies Malouff e.a. (2004) examined the relationship between the FFM traits and symptoms of clinical disorders. They found the typical pattern of a high level of neuroticism and low levels of conscientiousness, agreeableness and extraversion associated with clinical disorders in general. The effect size of Openness was small and only in some samples significant. Mood disorders were associated with a significantly lower level of extraversion compared to the other disorders. Anxiety disorders were associated with a significantly higher level of agreeableness than other clinical disorders. Research also consistently links social support to mental health. An inverse relationship was found between social support and psychological distress and supportive relationships seem to have stress-buffering effect (Cohen en Wills, 1985). House e.a. (1988) summarize evidence showing that social relationships as a risk factor for mental health is comparable to factors such as smoking, blood pressure and physical activity as risk factors for physical health. Miller (2004) showed that low levels of social support was the most important risk factor for depression in African Americans. Where high levels of social support seems to have a protective influence on mental health, negative interactions seem to be an important risk factor (Lincoln e.a., 2003, 2005, 2007). Personality traits appear to impact the availability and the effectiveness of social support (Cutrona, Hessling & Suhr, 1997; Dolan, van Amelingen & Arsenault, 1992; Kraus, Davis, Bazzini, Church & Kirchman, 1993). Finch and Graziano (2001) found that personality traits influence depression indirectly through positive and negative social exchanges. They found that there is an inverse relationship between agreeableness and depression. Low agreeable persons probably use strategies that enhance the chance of conflict with others leading to a higher risk of depression. Lincoln (2008) states that neuroticism and extraversion are both important correlates of social relations, although neuroticism seems to be stronger related to social relations than extraversion. Extraversion and Conscientiousness seem to be positively

4 related to social support (Cutrona & Russel, 1987; Kitamura et al, 2002, Marks & Lutgendorf, 1999). Those with a Conscientious or extraverted personality style are more likely to show prosocial behaviour. They are more social active and maintain relationships, even when they are depressed. This has a positive effect on the perceived social support and may also influence the severity of depression through the behavioural activation due to social activities (Cukrowicz et al, 2008). Neuroticism and Openness seem to be negatively related to social support (Cutrona & Russell, 1987; Kitamura, et al, 2002). The purpose of this study is to examine the relationship between personality traits, social support, negative interactions and support satisfaction and mood and anxiety disorders. We want to compare a group of patients with mood disorders, a group of patients with anxiety disorders and a group of patients with both a mood and anxiety disorder recruited from community and primary care with a group of patients without a mood or anxiety disorder (current or life time) from the same settings and with each other. We want to compare these groups on the FFM traits and social support variables to examine their direct and indirect associations with severity of mood and anxiety disorders. c. Variables to be used in main analysis (the main predictor and outcome variables must be identified) Dependent variable: presence or absence and severity of anxiety and/or mood disorder (based on CIDI) Predictors: personality traits (based on NEOFFI), Social support, negative interactions and support satisfaction (based on the Close Person Inventory) and social network. Covariates: demographics (age, gender, education level), socioeconomic status, daily hassles and negative life events. d. Outline of analyses This is a cross sectional study based on the baseline measurements of the NESDA study. First, we examine with ANOVA or chi-square analysis if there are differences between the study groups (group with mood disorders, group with anxiety disorders and a group with both an anxiety and mood disorder) compared each other and to a control group without a lifetime or current mood or anxiety disorder concerning demographic variables, personality traits and social support characteristics. Second we examine with Pearson correlation calculations to what extent the personality traits, social support characteristics and the interaction variables are related to severity of symptoms in the three study groups. Next, we examine in a multivariate model of lineair regression which personality and support variables and their interactions have the highest associations with the dependent variable of presence or absence and severity of symptoms. 4. Proposed authors: Annemieke Noteboom, Aartjan Beekman, Carmilla Licht, Brenda Penninx 5. Timeline for completion and submission of manuscript A year after submission of the analysis plan (2010).

5 I hereby state that I will use the data only for addressing the research question described in point 3, and not for other purposes, unless I submit a new analysis plan. Signed Date References Cutrona, C.E., Hessling, R.M. & Suhr, J.A. (1997). The influence of husband and wife personality on marital social support interactions. Personality Relationships, 4, Dolan, S.L., van Ameringen, M.R., & Arsenault, A (1992). Personality, social support and workers stress. Industrial relations, 47, Hays, J.C., Steffens, D.C., Flint, E.P., Bosworth, H.B. & George, L.K. (2001). Does social support buffer functional decline in elderly patients with unipolar depression. American journal of psychiatry, 158, Kraus, L.A., Davis, M.H., Bazzini, D., Chruch, M & Krichman, C.M. (1993). Personal and social influences on loneliness: the mediating effect of social provisions. Social psychology Quarterly, 56,

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