validation of the temperament evaluation of memphis, pisa, paris and san diego...

Journal of Affective Disorders 111 (2008) 193–203www.elsevier.com/locate/jad

Research report

Validation of the Temperament Evaluation of Memphis, Pisa, Parisand San Diego (TEMPS-A): Portuguese-Lisbon version

M. Luisa Figueira a, Lara Caeiro b,⁎, Ana Ferro a, Lara Severino a, Pedro M. Duarte c,Manuela Abreu a, Hagop S. Akiskal d,e, Kareen K. Akiskal e

a Department of Psychiatry, Faculty of Medicine, University of Lisbon, Santa Maria Hospital, Lisbon, Portugalb Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal

c Manic Depressive Association, Lisbon, Portugald International Mood Centre, University of California at San Diego, La Jolla, CA, USA

e French Union of Depressive and Manic-Depressive Association, France

Received 27 December 2007; received in revised form 3 March 2008; accepted 3 March 2008Available online 28 April 2008

Abstract

Background: The TEMPS-A has been validated in 8 languages, the original being American English, and includes among otherssuch Latin languages as Italian, French, and Spanish-Buenos Aires. This is the first Portuguese-Lisbon validation.Methods: The sample included 1173 students from six different universities and representing most disciplines (such as medicine,law, humanities, engineering, etc.), both sexes (67% female), and ages between 17 and 58 (x±SD=21±4). Standard psychometrictests were used for internal consistency, validity, and factor analysis.Results: The study upheld the 5 Factor proposed structure of TEMPS-A. Cronbach α varied from 0.67 for the depressive and 0.83for the anxious, with the others in-between. We could retain all 110 items of the Interview Schedule. The highest mean scores werefound for the hyperthymic, and the lowest for the irritable. As expected, depressive and anxious subscales had strong correlations,followed by the cyclothymic and anxious, and cyclothymic and irritable; in exploratory factor analysis, these subscales constitutedFactor I, contrasted to the depressive and the hyperthymic as a biphasic continuum (Factor II). Females scored higher on thedepressive, cyclothymic and anxious, and the males on hyperthymic and irritable. Overall, however, no temperament was“dominant” in this population, all temperaments z-scores being 3.3–4%!Limitations: Study limited to university students of young age.Conclusions: TEMPS-ALisbon is a reliable and valid instrument. The only relatively weak factor is the depressive, which is similar toother language versions. Gender differences and correlations of temperaments are generally similar to other countries. What appearsrelatively special to the Portuguese is the relatively “balanced” mix of temperaments in this university student population.© 2008 Elsevier B.V. All rights reserved.

Keywords: Temperament; TEMPS-A; Portugal; University students

⁎ Corresponding author. CCEM, Serviço de Neurologia (Piso 6),Hospital de Santa Maria, Av. Prof Egas Moniz, 1649-028 LisboaPortugal.

E-mail address: [email protected] (L. Caeiro).

0165-0327/$ - see front matter © 2008 Elsevier B.V. All rights reserved.doi:10.1016/j.jad.2008.03.001

1. Introduction

TheTEMPS-A (TemperamentEvaluation ofMemphis,Pisa, Paris and San Diego-Autoquestionnaire) is a 110-

mailto:[email protected]

http://dx.doi.org/10.1016/j.jad.2008.03.001

Table 1Description of means and SD in the sub-scales, in each gender

Total frequency % Depressive Cyclothymic Hyperthymic Irritable Anxious

Female 785 66.9%Mean±SD 6.96±2.96 7.26±4.22 10.62±4.31 4.57±3.17 9.68±5.01

Male 388 33.1%Mean±SD 5.7±2.86 6.54±4.28 12.13±4.18 5.07±3.35 6.48±4.46

t-test 6.95⁎ 2.75⁎ 5.68⁎ 2.48⁎ 11.1⁎

*p-valueb0.01.Comparison of means (t-test and p-values) between genders.

194 M.L. Figueira et al. / Journal of Affective Disorders 111 (2008) 193–203

item temperament scale in 5 dimensions (depressive,cyclothymic, hyperthymic, irritable and anxious), whichto-date has been validated in eight languages (Placidi et al.,1998; Akiskal and Akiskal, 2005; Karam et al., 2005;Rozsa et al., 2006). At least twenty other languageversions exist, including two Spanish versions, one fromBarcelona (Sánchez-Moreno et al., 2005), which has notyet been validated, and the other from Buenos Aires(Vázquez et al., 2007), which was just validated.

Although a Portuguese-Rio de Janeiro version exists, ithas neither been validated, nor published. The presentcontribution is on the validation of the Portuguese-Lisbonversion as a collaboration between theUniversity of Lisbonand the University of California, San Diego.

2. Methods

2.1. Measures

The TEMPS-A is a “yes” or “no” type self reportquestionnaire developed by Akiskal and collaborators(Akiskal and Akiskal, 2005; Akiskal et al., 2005c). Thisquestionnaire contains 110 items assessing depressive(items 1–21), cyclothymic (items 22–42), hyperthymic(items 43–63), irritable (items 64–84), and anxious(items 85–110) temperaments.

The original questionnaire was translated intoPortuguese and back-translated into English by apsychiatrist and an English-born bilingual in a blindcondition. The back English translation was then revisedby the Akiskals and the appropriate modifications weremade by the Lisbon team for the final version.

Table 2Scale means, standard deviations, percentage on z-scores, and Cronbach α

Temperaments (items) Mean Median Standard Deviation [−1

Depressive (1–21) 6.55 6.00 2.99 806Cyclothymic (22–42) 7.03 6.00 4.25 817Hyperthymic (43–63) 11.12 11.00 4.33 787Irritable (64–84) 4.75 4.00 3.24 769Anxious (85–110) 8.62 8.00 5.06 764

+/−1SD: number of patients scoring between 1SD and 2SD; +/−2SD: numb

2.2. Subjects

We included 1173 university students from Lisboa–Portugal, in six different universities, of both sexes andaged between 17 and 58 years old (Mean±SD=21±4,Median=20). Subjects were asked to respond to each ofthe 110 questions positively if it was characteristic tothem since at least mid-adolescence.

The protocol was approved by the UniversityHospital of Lisbon Board for the protection of humansubjects and it was in accordance with the Portugueselaws regarding research on human subjects.

2.3. Statistics

The factorial score for each of the five subscales wascalculated by adding one point for the presence (true) ofeach trait. So, the total score of each scale was the resultof the sum of all “true” answers.

Construct validity was performed trough factoranalysis using the principal component analysis withVarimax rotation, eigenvalue N1 and inspection of thescree plot of eigenvalues.

Internal consistency was evaluated using the Cronbachα test. The correlations between the five subscales wereperformed using the Pearson's bivariate correlation.

Standardization was obtained by Z-scores whichdefined a degree of each temperament, and the conceptof dominant temperament derived from the comparisonof the z-scores attained by each subject on all the 5 typesof temperament. The interval ranging above and belowone z-score of the mean (Z1=mean± 1SD) was

SD;+1SD] (%) +/−1SD (%) +/− 2SD (%) α

68.7 320 27.3 47 4 .6769.7 309 26.3 47 4 .7967.1 348 29.7 38 3.3 .7865.6 360 30.7 44 3.8 .7265.1 364 31.0 45 3.8 .83

er of patients scoring higher than 2SD.

Table 3Factor analysis results eigenvalue in each item and percentage of trueanswer in each item in 1173 subjects

Item Eigenvalue Frequency

i1 .558 5.3i2 .603 14.3i3 .610 16.3i4 .620 13.9i5 .560 10.9i6 .590 6.6i7 .552 24.4i8 .557 18.5i9 .531 34.2i10 .504 42.4i11 .603 12.9i12 .674 45.8i13 .585 50.7i14 .626 93.8i15 .571 41.9i16 .559 70.9i17 .647 24.7i18 .553 59.4i19 .646 32.0i20 .653 7.5i21 .632 29.9i22 .600 29.8i23 .637 42.8i24 .544 25.4i25 .557 23.0i26 .711 28.2i27 .554 25.8i28 .577 27.5i29 .658 28.9i30 .617 32.6i31 .594 44.3i32 .571 20.3i33 .633 21.9i34 .570 38.6i35 .560 38.1i36 .572 68.3i37 .600 36.8i38 .637 46.0i39 .549 40.2i40 .656 45.1i41 .587 15.8i42 .699 23.7i43 .569 86.1i44 .609 48.0i45 .616 39.2i46 .582 66.4i47 .680 54.5i48 .606 56.6i49 .604 65.4i50 .586 48.0i51 .612 51.4i52 .562 71.1i53 .577 62.6i54 .614 35.6i55 .586 56.4i56 .568 13.7

Table 3 (continued)

Item Eigenvalue Frequency

i57 .590 37.4i58 .566 66.5i59 .602 41.7i60 .560 37.7i61 .593 64.3i62 .607 59.2i63 .616 53.5i64 .494 29.3i65 .607 37.6i66 .635 30.8i67 .511 50.5i68 .645 18.1i69 .575 19.8i70 .592 33.6i71 .534 12.7i72 .599 10.7i73 .595 13.2i74 .666 3.3i75 .583 52.3i76 .646 28.9i77 .638 17.6i78 .592 10.9i79 .584 13.1i80 .594 2.9i81 .576 35.8i82 .596 36.4i83 .677 5.1i84 .463 19.1⁎

i85 .577 67.3i86 .694 40.1i87 .638 43.3i88 .653 49.3i89 .667 46.8i90 .590 43.8i91 .619 14.4i92 .570 23.6i93 .569 40.2i94 .567 23.5i95 .680 21.0i96 .571 24.4i97 .670 41.5i98 .635 30.6i99 .665 47.8i100 .635 21.4i101 .635 18.0i102 .704 29.8i103 .576 59.6i104 .572 5.0i105 .567 36.0i106 .510 31.6i107 .648 41.4i108 .591 15.7i109 .568 16.7i110 .545 31.3

⁎Just for women.Extraction method: Principal Component Analysis.

195M.L. Figueira et al. / Journal of Affective Disorders 111 (2008) 193–203

Table 5Rotated factor analysis of the 5 temperament subscales

Temperament subscales Factor I Factor II

Depressive .660Cyclothymic .821Hyperthymic − .898Irritable .828Anxious .701


considered the standard population scores. The z-scoreswere graduated as: mildly positive (Z1 until Z2) ormildly negative (−Z1 until −Z2), and moderatelypositive (NZ2) or moderately negative (b−Z2).

Differences in scores (mean and standard deviation[SD]) between sex and age groups were tested using thet-test independent analysis and differences in frequen-cies were tested with the qui-square.

The overall analysis was performed using the SPSS14 with a 95% confidence interval, and bivariateanalysis. Two-tailed p-value of 0.05 was consideredstatistical significant.

3. Results

3.1. Demographic characteristics by temperament

The mean scores and SD or the mean ranks weredetermined for sexes and age groups, for each temperamentsub-scale, and differences in scores between genders weretested using the independent t-test analysis. The resultsrevealed that females presented higher mean scores in thedepressive, cyclothymic, and anxious subscales, whilemales presented highermean scores in the hyperthymic andirritable subscales (Table 1).

Concerning 3 age groups (≤20, 21 to 25,≥26),we usedtheKruskal–Wallis to compare themand the result revealedthat subjects with 20 years old or less (n=648) had a highermean rank in the depressive, cyclothymic, and anxioussubscales (p-valueb0.01), while subjects with 26 years oldor more presented a higher mean rank in the hyperthymicsub-scale (p-valueb0.01). In the irritable sub-scale therewas no statistical differences (p-valueN0.05).

3.2. Psychometrics

The internal consistency coefficient for each of oneof the five scales was good to moderately, with thepossible exception of the depressive, as shown by theCronbach α (Table 2).

Table 4Pearson's correlation among the 5 temperament subscales in theTEMPS-A Portugal (N=1173)

TemperamentSubscales

Depressive Cyclothymic Hyperthymic Irritable

Cyclothymic(sig.)

.46⁎

Hyperthymic(sig.)

− .38⁎ − .09⁎

Irritable (sig.) .29⁎ .51⁎ .05⁎⁎

Anxious (sig.) .58⁎ .52⁎ −24⁎ .41⁎

*p-valueb0.01; ** p-valueb0.05.

We used the frequencies of distribution of z-scoresobtained in each of the five scales in order to calculatethe expected percentage above and upon 1SD or 2SD.To grade each of the temperaments, one could use theformula “mean+1SD” or “mean–1SD” and evaluateeach temperament as “mildly higher” or “mildly lower”,but if we use the same formula with 2SD than we wouldhave the temperament(s) as “moderately higher orlower”. Interestingly all temperaments had nearly thesame percentages in this population as judged by theirscores above the cut-off of +/−mean+2SD (Table 2):They ranged from 3.3% for the hyperthymic, 3.8% forthe irritable and anxious to 4% for the depressive andcyclothymic.

We calculated the factor analysis in each item(Table 3), and we found that there were only twoitems loading b0.5 (item 84 assessing uncontrollablerage before menstrual period and item 64 assessinggrouchiness or irritable tension) but they were strongenough, loading N0.4, to be retained in the Portugueseversion of the TEMPS-A.

The correlation between the five temperamentssubscales are reported on Table 4. The strongestcorrelation was between depressive and anxious fol-lowed by cyclothymic and anxious and irritable. Therewas a mild negative correlation between depressive andhyperthymic temperaments. There was no correlationbetween hyperthymic and irritable or cyclothymictemperaments.

Exploratory factor analysis with varimax rotation(Table 5) revealed 2 principal components, one includ-ing Cyclothymic, Irritable, and Anxious temperamentsand the other including Depressive and Hyperthymictemperaments.

4. Discussion

The development of a Portuguese version ofTEMPS-A, suitable for clinical use (Appendix A), wasperformed in 1173 university students of both sexes.

The statistical analysis demonstrated that, concerningreliability and validity, this Portuguese version had a


good internal consistency coefficient, which was similarto other language versions such as the American(Akiskal et al., 2005a,b), German (Erfurth et al., 2005;Blöink et al., 2005), Lebanese (Karam et al., 2005),Japanese (Matsumoto et al., 2005), Hungarian (Rozsaet al., 2006), Turkish (Vahip et al., 2005), and BuenosAires (Vázquez et al., 2007) versions.

None of the items needed to be dropped out from the110-item Portuguese-Lisboa version; even though items64 and 84 showed a relatively weaker factor loading≥0.40, they could still be retained. This was similar toprevious versions' validation of the TEMPS.

Exploratory factor analysis showed that the “depres-sive” and “hyperthymic”were distinct from and orthogonalto the cyclothymic, irritable, and anxious types oftemperaments. The difference from the Portuguese, andthe Buenos Aires (Vázquez et al., 2007), and the American(Akiskal et al., 2005a) TEMPS-A, was that in Lisbon thedepressive and the hyperthymic types can be consideredpart of a biphasic continuum; a similar phenomenon hasbeen observed in Italy (Akiskal et al., 1998).

As expected, most temperaments were weakly tomoderately correlated with one another. The highestcorrelations (N0.50 Pearson's) were between the depres-sive and anxious, anxious and cyclothymic, andcyclothymic and irritable, as previously reported in theBuenos Aires (Vázquez et al., 2007), the German (Blöinket al., 2005), and in the Lebanese (Karam et al., 2005)

validations. These converging international findings aregenerally in line with Kretschmer's (1936) concepts.

Gender differences, were similar to other nationalstudies (Vázquez et al., 2007; Karam et al., 2005), i.e.females more depressive, cyclothymic and anxious, andmales more hyperthymic and irritable.

It is relevant to point out that, in the Portuguesepopulation the anxious temperament accounted for thelargest variance, followed by the cyclothymic tempera-ment. The Portuguese students presented a relatively higherscore in the hyperthymic and anxious temperaments andlowest scores in the irritable temperament. Nonetheless,judging from the z-scores, no dominant temperamentemerged in Portugal, all subscales had rates of 3.3–4%!This suggests a more “balanced” temperament pool inPortugal, at least among students. In this respect thefindings are different from other nations where studentswere examined, e.g. Placidi et al. (1998) reporting fromItaly and Blöink et al. (2005) reporting from Germany.

Role of funding sourceThere is no role of the funding source.

Conflicts of InterestNo conflicts of interest are need to report.

Acknowledgment

We acknowledge all participants in this study.


Appendix A


References

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Akiskal, H.S., Mendlowicz, M.V., Jean-Louis, G., Rapaport, M.H.,Kelsoe, J.R., Gillin, J.C., Smith, T.L., 2005b. TEMPS-A: validationof a short version of a self-rated instrument designed to measurevariations in temperament. J. Affect. Disord. 85, 45–52.

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Vázquez, G.H., Nasetta, S., Mercado, B., Romero, E., Tifner, S., delL., Ramon, M., Garelli, V., Bonifacio, A., Akiskal, K.K., Akiskal,H.S., 2007. Validation of the TEMPS-A Buenos-Aires: Spanishpsychometric validation of affective temperaments in a populationstudy of Argentina. J. Affect. Disord. 100, 23–29.

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