Personality Traits as Markers of Psychosis Risk in Kenya: Assessment of Temperament and Character

Abstract

Specific personality traits have been proposed as a schizophrenia-related endophenotype and confirmed in siblings at risk for psychosis. The relationship of temperament and character with psychosis has not been previously investigated in Africa. The study was conducted in Kenya, and involved participants at clinical high-risk (CHR) for psychosis (n = 268) and controls (n = 251), aged 15-25 years. CHR status was estimated using the Structured Interview of Psychosis-Risk Syndromes (SIPS) and the Washington Early Psychosis Center Affectivity and Psychosis (WERCAP) Screen. Student's t-tests were used to assess group differences on the Temperament and Character Inventory (TCI). Neurocognitive functioning, stress severity, and substance use were correlated with the TCI, correcting for psychosis severity. CHR participants were more impulsive (ie, higher novelty seeking [NS]) and asocial (ie, lower reward dependence) than controls. They were also more schizotypal (ie, high self-transcendence [ST] and lower self-directedness [SD] and cooperativeness [CO] than controls). CO was related to logical reasoning, abstraction, and verbal memory. Stress severity correlated with high HA and schizotypal character traits. Lifetime tobacco use was related to NS, and lifetime marijuana use to high NS, low SD and high ST. Temperament and character of Kenyan CHR youth is similar to that observed in schizophrenia. Psychosis risk in Kenya is associated with impulsive, asocial, and schizotypal traits. CHR adolescents and young adults with schizophrenia-specific personality traits may be most at risk for developing a psychotic disorder and to require early intervention to improve outcomes.

Keywords: TCI; character; personality; psychosis; risk; temperament.

Fig. 1.

TCI dimensions in psychosis-risk and control participants. Figures depicts mean percentile scores of participants at clinical high risk (CHR) for developing a psychotic disorder and healthy controls (n = 519). CHR status was assessed using either the psychotic section of the WERCAP Screen (pWERCAP) (A) or the Structured Interview of Psychosis-Risk Syndromes (SIPS) (B). With pWERCAP grouping, there were 251 control and 268 CHR participants. With SIPS grouping, there were 449 control and 70 CHR participants. NS = novelty seeking, HA = harm avoidance, RD = reward dependence, PS = persistence, SD = self-directedness, CO = cooperativeness, ST = self-transcendence. ~P < .05, *P < .007 (corrected for multiple comparisons). **P < .0001.

Fig. 2.

Psychosocial stressors and TCI configurations. Figures show least square mean stress severity of individual items on the WERC Stress Screen, controlled for psychosis severity across all participants (n = 519). (A) Comparison of participants with harm avoidance (HA) scores on the TCI higher or lower than the cohort mean. (B) Comparison of participants with character configurations of high self-directedness, high cooperativeness and low self-transcendence (ie, SCt) with those with low self-directedness, low cooperativness and high self-transcendence (ie, scT). *P < .05. **P < .005.