The novel frontal alpha asymmetry factor and its association with depression, anxiety, and personality traits.

Frontal alpha asymmetry (FAA) is widely examined in EEG research, yet a procedural consensus on its assessment is lacking. In this study, we tested a latent factorial approach to measure FAA. We assessed resting-state FAA at broad, low, and high alpha bands (8-13; 8-10.5; and 11-13 Hz) using mastoids as reference electrodes and Current Source Density (CSD) transformation (N = 139 non-clinical participants). From mastoid-referenced data, we extracted a frontal alpha asymmetry factor (FAAf) and a parietal factor (PAAf) subjecting all asymmetry indices to a varimax-rotated, principal component analysis. We explored split-half reliability and discriminant validity of the mastoid factors and the mastoid and CSD raw asymmetry indices (F3/4, F7/8, P3/4, and P7/8). Both factor and raw scores reached an excellent split-half reliability (>.99), but only the FAAf reached the maximum discriminant validity from parietal scores. Next, we explored the correlations of latent factor and raw FAA scores with symptoms of depression, anxiety, and personality traits to determine which associations were driven by FAA after variance from parietal activity was removed. After correcting for false discovery rate, only FAAf at the low alpha band was negatively associated with depression symptoms (a latent CES-D factor) and significantly diverged from PAAf's association with depression symptoms. With respect to personality traits, only CSD-transformed F7/8 was positively correlated with Conscientiousness and significantly diverged from the correlations between Conscientiousness and P3/4 and P7/8. Overall, the latent factor approach shows promise for isolating functionally distinct resting-state EEG signatures, although further research is needed to examine construct validity.

Does Machiavellianism meaningfully differ from psychopathy? It depends.

Machiavellianism is a personality construct characterized by cynicism, callousness, and skillful manipulation of others to achieve personal gains. We review the Machiavellianism literature with a particular focus on its measurement alongside narcissism and psychopathy in the so-called "Dark Triad" (DT). We discuss criticisms of Machiavellianism on the grounds of insufficient construct validity as well as its virtual indistinguishability from psychopathy when assessed by commonly used instruments. As a response to these criticisms, we offer the super-short form of the Five Factor Machiavellianism Inventory (FFMI-SSF) as an alternative. The goal of the present study was to evaluate the FFMI-SSF in relation to psychopathy and basic personality traits (i.e., the Five Factor Model) and to compare it to widely used measures of the DT and psychopathy in a large undergraduate sample (n = 1004).

Personality disorders as predictors of intimate partner violence: A meta-analysis.

Despite years of research demonstrating a relation between personality pathology and intimate partner violence (IPV), no meta-analysis has been published examining how well, or poorly, all ten personality disorders (PDs) predict IPV perpetration or victimization, nor has any meta-analysis examined these relations across types of IPV. Therefore, the present study was undertaken to synthesize existing research on the effects of all ten PDs, as well as psychopathy and global PD symptoms, on physical, psychological, and sexual IPV perpetration and victimization. An initial search in PsycINFO, PubMed, and Sociological Abstracts yielded 3988 results. After duplicate and irrelevant articles were removed, 163 studies were included in the analysis, representing 189 individual samples. Analysis was conducted in R using the metafor package. Main effects analyses indicate that PDs were significantly and positively related to IPV perpetration. Results were more mixed for IPV victimization. Antisocial and borderline PDs demonstrated the most robust effect sizes across both perpetration and victimization. Moderator analyses suggested that with few exceptions, main effects were consistent across a number of sample and study characteristics. Findings may help to inform prevention and intervention efforts in clinical settings.

Development and Validation of the Super-Short Form of the Five Factor Machiavellianism Inventory (FFMI-SSF).

Previous findings have showed that existing measures of Machiavellianism often fail to distinguish Machiavellianism from another construct in the Dark Triad (i.e., psychopathy) and do not align with theoretical descriptions. To rectify this, a 52-item measure (i.e., FFMI) was developed to measure traits that are the most theoretically relevant to Machiavellianism using the Five-Factor model of personality. The aim of the current study is to develop a briefer version of the FFMI that can be used in situations in which efficiency is critical. Using data collected from three samples (total N = 1,945), we developed a 15-item measure of Machiavellianism (i.e., FFMI-SSF) that was shown to be similarly effective as the FFMI in capturing core personality traits relevant to Machiavellianism and distinguishing Machiavellianism from psychopathy and narcissism.

Examining the factor structure and validity of the Triarchic Model of Psychopathy across measures.

The triarchic model of psychopathy proposes 3 distinct trait domains underlying psychopathy: boldness, meanness, and disinhibition. The original (and most widely used) measure developed from this model is the Triarchic Psychopathy Measure (TriPM), which yields a total psychopathy score as well as scores on each of the 3 domains. Recently, researchers have derived several alternative measures from other inventories to assess these 3 domains; however, the purported underlying 3-factor structure of the alternative scales has been relatively untested. In the present study, 431 participants completed the TriPM and its alternative measures via Amazon Mechanical Turk, and items within the scales were subjected to a series of factor analyses. For all measures, fit indices for a 3-factor solution showed poor fit and indicated that the optimal factor solutions ranged between 5 and 7 factors. In addition, although some of the factor scores from the 3-factor solutions appeared to map onto the a priori domains of boldness, meanness, and disinhibition, others were equally correlated with meanness and disinhibition. The current results demonstrate the factor structures of the TriPM and its alternative measures are more complex than the proffered 3-factor solution, which calls into question the extent to which these adequately represent the underlying triarchic model. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Exploring Gender Differences in Machiavellianism Using a Measurement Invariance Approach.

Research suggests that men and women differ on mean levels of Dark Triad personality constructs such as Machiavellianism, but few studies have investigated whether or not these differences are due to actual latent trait differences or bias in measurement. Further, recent research suggests important challenges associated with existing measures of MACH in terms of overlap with psychopathy and matching expert descriptions. The present study took a recently developed measure of Machiavellianism (the Five Factor Machiavellianism Inventory; FFMI), based on the five-factor model, and examined its invariance across gender. Strong (or scalar) factorial invariance was established, indicating that latent factor means can be compared between men and women using this measure. Mean-level differences showed that men had higher levels of latent factors related to antagonism and social dominance. In terms of total score, men reported significantly higher mean levels of Machiavellianism. The findings of the present study lend support to the notion that mean level differences in Machiavellianism across gender are not artifacts of measurement bias.

Untangling the Relation Between Narcissistic Traits and Behavioral Aggression Following Provocation Using an FFM Framework.

Work on narcissism has identified two variants: grandiose and vulnerable. The variants share an antagonistic core, but differ in neuroticism and extraversion. The current study explored how the variants relate to behavioral aggression following provocation. Results showed an interaction between grandiose narcissism and condition, such that grandiose narcissism was positively related to aggression only among those who were provoked, though the magnitude of this interaction was dependent on which measure of grandiose narcissism was used. A similar effect for vulnerable narcissism was not found. Moderated mediation analyses showed that antagonism-related traits were responsible for this relation. For vulnerable narcissism, moderated mediation results showed competing relations among vulnerable narcissism components-neuroticism-related traits were negatively related while antagonism-related traits were positively related. Results are discussed in the context of previous work. Antagonism-related traits, as opposed to traits related to extraversion and neuroticism, are most important in explaining narcissistic aggression.

The Importance of Antagonism: Explaining Similarities and Differences in Psychopathy and Narcissism's Relations With Aggression and Externalizing Outcomes.

Psychopathy and narcissism are multidimensional constructs with substantial overlap. Low agreeableness (i.e., antagonism) features prominently in clinical and theoretical descriptions of both disorders. The authors examined whether antagonism components of their assessments accounted for the overlap between narcissism and psychopathy. Next, they tested whether the antagonism components were responsible for the relations that narcissism and psychopathy bore to aggression outcomes. Using multiple regression, the authors found that the low agreeableness component accounted for the majority of overlap between psychopathy and narcissism, nearly all of the variance in narcissism's relations with aggression outcomes, and the majority of variance in psychopathy's relations with aggression outcomes. Disinhibitory traits, which serve to distinguish psychopathy from narcissism, accounted for incremental variance in aggression outcomes for psychopathy. Results are discussed in the context of the overlap between narcissism and psychopathy. The authors argue that low agreeableness is largely responsible for the maladaptive outcomes associated with grandiose narcissism and psychopathy.

Using item-level analyses to better understand the consequences of partialing procedures: An example using the Dark Triad.

OBJECTIVE: Partialing procedures are frequently used in psychological research. The present study sought to further explore the consequences of partialing, focusing on the replicability of partialing-based results. METHOD: We used popular measures of the Dark Triad (DT; Machiavellianism, narcissism, and psychopathy) to explore the replicability of partialing procedures. We examined whether the residual content of popular DT scales is similar to the residual content of DT scales derived from separate samples based on relations with individual items from the IPIP-NEO-120, allowing for a finer-grained analysis of residual variable content. RESULTS: Profiles were compared using three sample sizes (Small N = 156-157, Moderate N = 313-314, Large N = 627-628) randomly drawn from a large MTurk sample (N = 1,255). There was low convergence between original and residual DT scales within samples. Additionally, results showed that the content of residual Dirty Dozen scales was not similar across samples. Comparable results were found for short Dark Triad-Machiavellianism, but only in the moderate and small samples. CONCLUSION: The results indicate that there are important issues that arise when using partialing procedures, including replicability issues surrounding residual variables. Reasons for the observed results are discussed and further research examining the replicability of residual-based results is recommended.

The "core" of the dark triad: A test of competing hypotheses.

As research on the dark triad (DT; the interrelated constructs of Machiavellianism, narcissism, and psychopathy) has accumulated, a subset of this research has focused on explicating what traits may account for the overlap among the DT members. Various candidate traits have been investigated, with evidence supporting several of them, including antagonism (vs. agreeableness), honesty-humility, and callousness and interpersonal manipulation (the latter 2 as a set). The present study sought to test the leading candidates against one another in their ability to account for the shared variance among the DT members. Using a preregistered analytical plan, we found that agreeableness (as measured by the International Personality Item Pool-NEO-120), honesty-humility (H/H) from the HEXACO-Personality Inventory, and the Self-Report Psychopathy Scale subscales of Callous Affect and Interpersonal Manipulation accounted for all or nearly all of the shared variance among the DT members. Big Five Inventory (BFI)-based measures of Agreeableness (BFI and BFI-2) accounted for notably less variance in most cases. The results were consistent across 2 large samples (Ns of 627 and 628) and across various DT measurement approaches. We argue that the most parsimonious explanation for findings on the core of the DT is that such traits all fall under the umbrella of antagonism. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Using Dominance Analysis to Decompose Narcissism and Its Relation to Aggression and Externalizing Outcomes.

Research on narcissism has shown it to be multidimensional construct. As such, the relations the larger construct bear with certain outcomes may mask heterogeneity apparent at the more basic trait level. This article used the Five Factor Narcissism Inventory, a Five-Factor Model-based measure of narcissism that allows for multiple levels of analysis, to examine the relative importance of narcissistic traits in relation to aggression, externalizing behavior, and self-esteem outcomes in two independent samples. The relative importance of the narcissism factors was determined through the use of dominance analysis-a relatively underused method for determining relative importance among a set of related predictors. The results showed that antagonism, compared with agentic extraversion and neuroticism, was the dominant predictor across all forms of aggressive behavior. Additional analyses showed that subscales within the broader factor of antagonism also showed differential importance relative to one another for certain aggression outcomes. The results are discussed in the context of the relation between narcissism and aggression and highlight the utility of using extensions of regression-based analyses to explore the heterogeneity within personality constructs.

Using Bayesian methods to update and expand the meta-analytic evidence of the five-factor model's relation to antisocial behavior.

The Five Factor Model (FFM) of personality is the dominant hierarchical model of personality. Previous work has demonstrated the importance of the FFM domains and facets in understanding a variety of antisocial behaviors ranging from non-violent antisocial behavior to a variety of aggression outcomes. The aim of the present meta-analysis was to quantitatively summarize the empirical work that has examined these relations, as well as update and expand previous work in this area using Bayesian meta-analytic methods. A comprehensive search of available literature on the FFM and antisocial behavior was conducted and posterior distributions of effect sizes were computed for the FFM domains (across 12 antisocial outcomes). The meta-analytic results supported the primary importance of (low) Agreeableness and (low) Conscientiousness in predicting antisocial behavior across antisocial outcomes, with the exception of the outcome related to child molestation. The importance of Neuroticism was more dependent on the specific antisocial outcome under examination. The results are discussed in the context of the descriptive research on the FFM and antisocial behavior, and how Bayesian methods provide additional utility in estimation and prediction compared to more common frequentist methods. Furthermore, we recommend that future work on the FFM and antisocial behavior move towards process-level analyses to further examine how traits are implicated in different forms of antisocial behavior.

Development and preliminary validation of a five factor model measure of Machiavellianism.

Machiavellianism is characterized by planfulness, the ability to delay gratification, and interpersonal antagonism (i.e., manipulativeness and callousness). Although its theoretically positive relations with facets of Conscientiousness should help distinguish Machiavellianism from psychopathy, current measurements of Machiavellianism are indistinguishable from those of psychopathy in large part because of their assessment of low Conscientiousness. The goal of the present study was to create a measure of Machiavellianism that is more in line with theory using an expert-derived profile based on the 30 facets of the five-factor model (FFM) and then test the validity of that measure by comparing it with relevant constructs. Previously collected expert ratings of the prototypical Machiavellian individual on FFM facets yielded a profile of 13 facets including low Agreeableness and high Conscientiousness. Items were written to represent each facet, resulting in a 201-item Five Factor Machiavellianism Inventory (FFMI). Across 2 studies, with a total of 710 participants recruited via Mechanical Turk, the FFMI was reduced to its final 52-item form and was shown to relate as expected to measures of Big Five personality traits, current Machiavellianism measures, psychopathy, narcissism, ambition, and impulsivity. The FFMI is a promising alternative Machiavellianism measure. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Differences among dark triad components: A meta-analytic investigation.

Since its emergence 14 years ago the dark triad (DT), composed of narcissism, psychopathy, and Machiavellianism, has become an increasingly popular research focus. Yet questions remain over whether the DT components are sufficiently distinct from another. We examined the nomological networks of each DT component through a meta-analysis of the available literature on the DT. We conducted 3 separate analyses-an examination of the average intercorrelations among the DT components (k = 156), an examination of similarities in each DT component's nomological network (k = 159), and an examination of the effect sizes between DT components and 15 outcome categories (k range = 7 to 42). Our results indicate that the nomological networks of psychopathy and Machiavellianism overlap substantially while narcissism demonstrated differential relations compared with psychopathy and Machiavellianism. These results remained relatively constant after controlling for DT assessment approach. We argue that the current literature on Machiavellianism may be better understood as a secondary psychopathy literature. Future directions for DT research are discussed in light of our meta-analytic results. (PsycINFO Database Record

Screening for depression in hospitalized medical patients.

Depression among hospitalized patients is often unrecognized, undiagnosed, and therefore untreated. Little is known about the feasibility of screening for depression during hospitalization, or whether depression is associated with poorer outcomes, longer hospital stays, and higher readmission rates. We searched PubMed and PsycINFO for published, peer-reviewed articles in English (1990-2016) using search terms designed to capture studies that tested the performance of depression screening tools in inpatient settings and studies that examined associations between depression detected during hospitalization and clinical or utilization outcomes. Two investigators reviewed each full-text article and extracted data. The prevalence of depression ranged from 5% to 60%, with a median of 33%, among hospitalized patients. Several screening tools identified showed high sensitivity and specificity, even when self-administered by patients or when abbreviated versions were administered by individuals without formal training. With regard to outcomes, studies from several individual hospitals found depression to be associated with poorer functional outcomes, worse physical health, and returns to the hospital after discharge. These findings suggest that depression screening may be feasible in the inpatient setting, and that more research is warranted to determine whether screening for and treating depression during hospitalization can improve patient outcomes. Journal of Hospital Medicine 2017;12:118-125.

Analysis of Patient-reported Outcomes of Quality of Life and Functioning Before and After Treatment of Major Depressive Disorder Comorbid With Alcohol Use Disorders.

OBJECTIVE: Alcohol use disorders (AUDs) are common among persons with major depressive disorder (MDD) and have an adverse impact on course of illness and patient outcomes. The aim of this study was to examine whether AUD adversely impacted patient-centered outcomes in a sample of research subjects evaluated as part of a large clinical trial for depression. The outcomes of interest to this post hoc analysis are quality of life (QOL), functioning, and depressive symptom severity. METHODS: We analyzed 2280 adult MDD outpatient research subjects using data from the Sequenced Treatment Alternatives to Relieve Depression trial. We compared entry and post-selective serotonin reuptake inhibitors (SSRI) treatment QOL, functioning, and depressive symptom severity scores between 121comorbid MDD with AUD (MDD + AUD) subjects and 2159 MDD-no-AUD subjects, and also differences between subjects categorized as remitters versus nonremitters within each group at exit. RESULTS: At entry, MDD + AUD subjects reported similar QOL, functioning, and depressive symptom severity compared with the MDD-no-AUD subjects. After treatment with citalopram, both groups showed significant improvements throughout treatment; however, 36% to 55% of subjects still suffered from severely impaired QOL and functioning at exit. CONCLUSIONS: The overall study population demonstrated a significant response to treatment with large effect sizes in depressive symptom reduction, but to a lesser extent in QOL and functioning. Findings suggest that subjects with MDD + AUD benefited equally as MDD-no-AUD from treatment with selective serotonin reuptake inhibitors (SSRI) medication, yet both groups continue to experience reduced QOL and functioning after treatment. Monitoring QOL and functioning is critical to determine whether interventions that improve clinical outcomes also impact patient-centered outcomes, and our analysis suggests that there is a pressing need for innovative interventions that effectively improve these outcomes.

Quality of Life and Functioning in Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder After Treatment With Citalopram Monotherapy.

OBJECTIVES: Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) often have high comorbidity, consequently influencing patient-reported outcomes of depressive symptom severity, quality of life (QOL), and functioning. We hypothesized that the combined effects of concurrent PTSD and MDD would result in worse treatment outcomes, whereas individuals who achieved MDD remission would have better treatment outcomes. METHODS: We analyzed 2280 adult participants who received level 1 treatment (citalopram monotherapy) in the Sequenced Treatment Alternatives to Relieve Depression study, including 2158 participants with MDD without comorbid PTSD and 122 participants with MDD with comorbid PTSD (MDD + PTSD). Post hoc analysis examined the proportion of participants whose scores were within normal or severely impaired for functioning and QOL. Remission status at exit from MDD was also determined. RESULTS: At entry, participants with MDD + PTSD experienced significantly worse QOL, functioning, and depressive symptom severity compared with participants with MDD without comorbid PTSD. Although both groups had significant improvements in functioning and QOL posttreatment, the participants with MDD + PTSD were less likely to achieve remission from MDD. CONCLUSIONS: Findings suggested that participants with MDD + PTSD are at a greater risk for severe impairment across all domains and less likely to achieve remission from MDD after treatment with citalopram monotherapy. As such, the use of patient-reported measures of QOL and functioning may inform practicing clinicians' and clinical trial researchers' abilities to develop appropriate interventions and monitor treatment efficacy. More importantly, we encourage clinicians and health care providers to routinely screen for PTSD in patients with MDD because this at-risk group requires tailored and specific pharmacotherapy and psychotherapy interventions beyond traditionally standard treatments for depression.

The recovery index: A novel approach to measuring recovery and predicting remission in major depressive disorder.

BACKGROUND: Clinicians view "recovery" as the reduction in severity of symptoms over time, whereas patients view it as the restoration of premorbid functioning level and quality of life (QOL). The main purpose of this study is to incorporate patient-reported measures of functioning and QOL into the assessment of patient outcomes in MDD and to use this data to define recovery. METHOD: Using the STAR*D study of patients diagnosed with MDD, this present analysis grades patients' MDD severity, functioning level, and QOL at exit from each level of the study, as well as at follow-up. Using Item Response Theory, we combined patient data from functioning and QOL measures (WSAS, Q-LES-Q) in order to form a single latent dimension named the Recovery Index. RESULTS: Recovery Index - a latent measure assessing impact of illness on functioning and QOL - is able to predict remission of MDD in patients who participated in the STAR*D study. CONCLUSIONS: By incorporating functioning and quality of life, the Recovery index creates a new dimension towards measuring restoration of health, in order to move beyond basic symptom measurement.

Examining the Impact of Patient-Reported Hope for Improvement and Patient Satisfaction with Clinician/Treatment on the Outcome of Major Depressive Disorder Treatment.

AIMS: This analysis aims at examining if patient-reported variables such as hope for improvement and patient satisfaction with clinician/treatment could influence the outcome major depressive disorder (MDD) treatment, namely depression remission, in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. STUDY DESIGN: Retrospective cohort study. PLACE AND DURATION OF STUDY: The STAR*D study was conducted at 18 primary care and 23 psychiatric care settings in the United States from 2001-2007 and was funded by the National Institute of Mental health (NIMH). The analysis contained in this manuscript was conceptualized at the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences and performed at the UCLA School of Public Health. METHODOLOGY: Using data from STAR*D, the current study used logistic regression and survival analyses to examine the relationship between depressive symptoms remission and two sets of self-reported factors: Hope for improvement and, Patient satisfaction with treatment/clinician. RESULTS: First, more than 90% of STAR*D patients reported having high hope for improvement (agree or strongly agree) and more than 66% endorsed high satisfaction with clinicians and more than 50% expressed high satisfaction with treatments (very or mostly satisfied). Second, hope for improvement was predictive of depression remission (p<0.05). Third, satisfaction with clinician/treatment, did not predict remission. CONCLUSION: This study shows the impact that patients' subjective hope for improvement can have on predicting depression remission in contrast to satisfaction with clinician/treatment. Future studies should prospectively incorporate patients' subjective attitudes regarding hope for improvement and satisfaction with clinicians and treatments as mediators and moderators of MDD treatment success.

Patient-reported functioning in major depressive disorder.

OBJECTIVES: Compared with the general population, patients with major depressive disorder (MDD) report substantial deficits in their functioning that often go beyond the clinical resolution of depressive symptoms. This study examines the impact of MDD and its treatment on functioning. METHODS: From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, we analyzed complete data of 2280 adult outpatients with MDD at entry and exit points of each level of antidepressant treatment and again 12 months post treatment. Functioning was measured using the Work and Social Adjustment Scale (WSAS). RESULTS: The results show that only 7% of patients with MDD reported within-normal functioning before treatment. The proportion of patients achieving within-normal functioning (WSAS) scores significantly increased after treatment. However, the majority of patients (>60%) were still in the abnormal range on functioning at exit. Although remitted patients had greater improvements compared with nonremitters, a moderate proportion of remitted patients continued to experience ongoing deficits in functioning after treatment (20-40%). Follow-up data show that the proportions of patients experiencing normal scores for functioning after 12 months significantly decreased from the end of treatment to the follow-up phase, from 60.1% to 49% (p < 0.0001), a finding that was particularly significant in nonremitters. Limitations of this study include the reliance on self-report of functioning and the lack of information on patients who dropped out. CONCLUSION: This study points to the importance of functional outcomes of MDD treatment as well as the need to develop personalized interventions to improve functioning in MDD.