Journal of Affective Disorders 111 (2008) 193 203 www.elsevier.

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Research report

Validation of the Temperament Evaluation of Memphis, Pisa, Paris and 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, Portugal b Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal c Manic Depressive Association, Lisbon, Portugal d 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 2008 Available online 28 April 2008

Abstract Background: The TEMPS-A has been validated in 8 languages, the original being American English, and includes among others such 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 psychometric tests were used for internal consistency, validity, and factor analysis. Results: The study upheld the 5 Factor proposed structure of TEMPS-A. Cronbach varied from 0.67 for the depressive and 0.83 for the anxious, with the others in-between. We could retain all 110 items of the Interview Schedule. The highest mean scores were found 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 constituted Factor I, contrasted to the depressive and the hyperthymic as a biphasic continuum (Factor II). Females scored higher on the depressive, cyclothymic and anxious, and the males on hyperthymic and irritable. Overall, however, no temperament was dominant in this population, all temperaments z-scores being 3.34%! Limitations: Study limited to university students of young age. Conclusions: TEMPS-A Lisbon is a reliable and valid instrument. The only relatively weak factor is the depressive, which is similar to other language versions. Gender differences and correlations of temperaments are generally similar to other countries. What appears relatively 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, Servio de Neurologia (Piso 6), Hospital de Santa Maria, Av. Prof Egas Moniz, 1649-028 Lisboa Portugal. E-mail address: laracaeiro@fm.ul.pt (L. Caeiro). 0165-0327/$ - see front matter 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2008.03.001

1. Introduction The TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire) is a 110-

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Table 1 Description of means and SD in the sub-scales, in each gender Total frequency Female Mean SD Male Mean SD t-test 785 388 % 66.9% 6.96 2.96 33.1% 5.7 2.86 6.95 6.54 4.28 2.75 12.13 4.18 5.68 5.07 3.35 2.48 6.48 4.46 11.1 7.26 4.22 10.62 4.31 4.57 3.17 9.68 5.01 Depressive Cyclothymic Hyperthymic Irritable Anxious

*p-value b 0.01. Comparison of means (t-test and p-values) between genders.

item temperament scale in 5 dimensions (depressive, cyclothymic, hyperthymic, irritable and anxious), which to-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 language versions exist, including two Spanish versions, one from Barcelona (Snchez-Moreno et al., 2005), which has not yet been validated, and the other from Buenos Aires (Vzquez et al., 2007), which was just validated. Although a Portuguese-Rio de Janeiro version exists, it has neither been validated, nor published. The present contribution is on the validation of the Portuguese-Lisbon version as a collaboration between the University of Lisbon and the University of California, San Diego. 2. Methods 2.1. Measures The TEMPS-A is a yes or no type self report questionnaire developed by Akiskal and collaborators (Akiskal and Akiskal, 2005; Akiskal et al., 2005c). This questionnaire contains 110 items assessing depressive (items 121), cyclothymic (items 2242), hyperthymic (items 4363), irritable (items 6484), and anxious (items 85110) temperaments. The original questionnaire was translated into Portuguese and back-translated into English by a psychiatrist and an English-born bilingual in a blind condition. The back English translation was then revised by the Akiskals and the appropriate modifications were made by the Lisbon team for the final version.
Table 2 Scale means, standard deviations, percentage on z-scores, and Cronbach Temperaments (items) Depressive (121) Cyclothymic (2242) Hyperthymic (4363) Irritable (6484) Anxious (85110) Mean 6.55 7.03 11.12 4.75 8.62 Median 6.00 6.00 11.00 4.00 8.00 Standard Deviation 2.99 4.25 4.33 3.24 5.06

2.2. Subjects We included 1173 university students from Lisboa Portugal, in six different universities, of both sexes and aged between 17 and 58 years old (Mean SD = 21 4, Median = 20). Subjects were asked to respond to each of the 110 questions positively if it was characteristic to them since at least mid-adolescence. The protocol was approved by the University Hospital of Lisbon Board for the protection of human subjects and it was in accordance with the Portuguese laws regarding research on human subjects. 2.3. Statistics The factorial score for each of the five subscales was calculated by adding one point for the presence (true) of each trait. So, the total score of each scale was the result of the sum of all true answers. Construct validity was performed trough factor analysis using the principal component analysis with Varimax rotation, eigenvalue N1 and inspection of the scree plot of eigenvalues. Internal consistency was evaluated using the Cronbach test. The correlations between the five subscales were performed using the Pearson's bivariate correlation. Standardization was obtained by Z-scores which defined a degree of each temperament, and the concept of dominant temperament derived from the comparison of the z-scores attained by each subject on all the 5 types of temperament. The interval ranging above and below one z-score of the mean (Z1 = mean 1SD) was

[ 1SD; + 1SD] 806 817 787 769 764

(%) 68.7 69.7 67.1 65.6 65.1

+/1SD 320 309 348 360 364

(%) 27.3 26.3 29.7 30.7 31.0

+/ 2SD 47 47 38 44 45

(%) 4 4 3.3 3.8 3.8

.67 .79 .78 .72 .83

+/1SD: number of patients scoring between 1SD and 2SD; +/2SD: number of patients scoring higher than 2SD.

M.L. Figueira et al. / Journal of Affective Disorders 111 (2008) 193203 Table 3 Factor analysis results eigenvalue in each item and percentage of true answer in each item in 1173 subjects Item i1 i2 i3 i4 i5 i6 i7 i8 i9 i10 i11 i12 i13 i14 i15 i16 i17 i18 i19 i20 i21 i22 i23 i24 i25 i26 i27 i28 i29 i30 i31 i32 i33 i34 i35 i36 i37 i38 i39 i40 i41 i42 i43 i44 i45 i46 i47 i48 i49 i50 i51 i52 i53 i54 i55 i56 Eigenvalue .558 .603 .610 .620 .560 .590 .552 .557 .531 .504 .603 .674 .585 .626 .571 .559 .647 .553 .646 .653 .632 .600 .637 .544 .557 .711 .554 .577 .658 .617 .594 .571 .633 .570 .560 .572 .600 .637 .549 .656 .587 .699 .569 .609 .616 .582 .680 .606 .604 .586 .612 .562 .577 .614 .586 .568 Frequency 5.3 14.3 16.3 13.9 10.9 6.6 24.4 18.5 34.2 42.4 12.9 45.8 50.7 93.8 41.9 70.9 24.7 59.4 32.0 7.5 29.9 29.8 42.8 25.4 23.0 28.2 25.8 27.5 28.9 32.6 44.3 20.3 21.9 38.6 38.1 68.3 36.8 46.0 40.2 45.1 15.8 23.7 86.1 48.0 39.2 66.4 54.5 56.6 65.4 48.0 51.4 71.1 62.6 35.6 56.4 13.7 Table 3 (continued) Item i57 i58 i59 i60 i61 i62 i63 i64 i65 i66 i67 i68 i69 i70 i71 i72 i73 i74 i75 i76 i77 i78 i79 i80 i81 i82 i83 i84 i85 i86 i87 i88 i89 i90 i91 i92 i93 i94 i95 i96 i97 i98 i99 i100 i101 i102 i103 i104 i105 i106 i107 i108 i109 i110 Eigenvalue .590 .566 .602 .560 .593 .607 .616 .494 .607 .635 .511 .645 .575 .592 .534 .599 .595 .666 .583 .646 .638 .592 .584 .594 .576 .596 .677 .463 .577 .694 .638 .653 .667 .590 .619 .570 .569 .567 .680 .571 .670 .635 .665 .635 .635 .704 .576 .572 .567 .510 .648 .591 .568 .545

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Frequency 37.4 66.5 41.7 37.7 64.3 59.2 53.5 29.3 37.6 30.8 50.5 18.1 19.8 33.6 12.7 10.7 13.2 3.3 52.3 28.9 17.6 10.9 13.1 2.9 35.8 36.4 5.1 19.1 67.3 40.1 43.3 49.3 46.8 43.8 14.4 23.6 40.2 23.5 21.0 24.4 41.5 30.6 47.8 21.4 18.0 29.8 59.6 5.0 36.0 31.6 41.4 15.7 16.7 31.3

Just for women. Extraction method: Principal Component Analysis.

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M.L. Figueira et al. / Journal of Affective Disorders 111 (2008) 193203 Table 5 Rotated factor analysis of the 5 temperament subscales Temperament subscales Depressive Cyclothymic Hyperthymic Irritable Anxious Factor I .821 .898 .828 .701 Factor II .660

considered the standard population scores. The z-scores were graduated as: mildly positive (Z1 until Z2) or mildly negative ( Z1 until Z2), and moderately positive (N Z2) or moderately negative (bZ2). Differences in scores (mean and standard deviation [SD]) between sex and age groups were tested using the t-test independent analysis and differences in frequencies were tested with the qui-square. The overall analysis was performed using the SPSS 14 with a 95% confidence interval, and bivariate analysis. Two-tailed p-value of 0.05 was considered statistical significant. 3. Results 3.1. Demographic characteristics by temperament The mean scores and SD or the mean ranks were determined for sexes and age groups, for each temperament sub-scale, and differences in scores between genders were tested using the independent t-test analysis. The results revealed that females presented higher mean scores in the depressive, cyclothymic, and anxious subscales, while males presented higher mean scores in the hyperthymic and irritable subscales (Table 1). Concerning 3 age groups (20, 21 to 25, 26), we used the KruskalWallis to compare them and the result revealed that subjects with 20 years old or less (n =648) had a higher mean rank in the depressive, cyclothymic, and anxious subscales (p-valueb 0.01), while subjects with 26 years old or more presented a higher mean rank in the hyperthymic sub-scale (p-valueb 0.01). In the irritable sub-scale there was no statistical differences (p-value N 0.05). 3.2. Psychometrics The internal consistency coefficient for each of one of the five scales was good to moderately, with the possible exception of the depressive, as shown by the Cronbach (Table 2).
Table 4 Pearson's correlation among the 5 temperament subscales in the TEMPS-A Portugal (N = 1173) Temperament Subscales Cyclothymic (sig.) Hyperthymic (sig.) Irritable (sig.) Anxious (sig.) Depressive Cyclothymic Hyperthymic Irritable .46 .38 .29 .58 .09 .51 .52 .05 24 .41

We used the frequencies of distribution of z-scores obtained in each of the five scales in order to calculate the expected percentage above and upon 1SD or 2SD. To grade each of the temperaments, one could use the formula mean + 1SD or mean1SD and evaluate each temperament as mildly higher or mildly lower, but if we use the same formula with 2SD than we would have the temperament(s) as moderately higher or lower. Interestingly all temperaments had nearly the same percentages in this population as judged by their scores above the cut-off of +/mean + 2SD (Table 2): They ranged from 3.3% for the hyperthymic, 3.8% for the irritable and anxious to 4% for the depressive and cyclothymic. We calculated the factor analysis in each item (Table 3), and we found that there were only two items loading b 0.5 (item 84 assessing uncontrollable rage before menstrual period and item 64 assessing grouchiness or irritable tension) but they were strong enough, loading N 0.4, to be retained in the Portuguese version of the TEMPS-A. The correlation between the five temperaments subscales are reported on Table 4. The strongest correlation was between depressive and anxious followed by cyclothymic and anxious and irritable. There was a mild negative correlation between depressive and hyperthymic temperaments. There was no correlation between hyperthymic and irritable or cyclothymic temperaments. Exploratory factor analysis with varimax rotation (Table 5) revealed 2 principal components, one including Cyclothymic, Irritable, and Anxious temperaments and the other including Depressive and Hyperthymic temperaments. 4. Discussion The development of a Portuguese version of TEMPS-A, suitable for clinical use (Appendix A), was performed in 1173 university students of both sexes. The statistical analysis demonstrated that, concerning reliability and validity, this Portuguese version had a

*p-value b 0.01; ** p-value b 0.05.

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good internal consistency coefficient, which was similar to other language versions such as the American (Akiskal et al., 2005a,b), German (Erfurth et al., 2005; Blink et al., 2005), Lebanese (Karam et al., 2005), Japanese (Matsumoto et al., 2005), Hungarian (Rozsa et al., 2006), Turkish (Vahip et al., 2005), and Buenos Aires (Vzquez et al., 2007) versions. None of the items needed to be dropped out from the 110-item Portuguese-Lisboa version; even though items 64 and 84 showed a relatively weaker factor loading 0.40, they could still be retained. This was similar to previous versions' validation of the TEMPS. Exploratory factor analysis showed that the depressive and hyperthymic were distinct from and orthogonal to the cyclothymic, irritable, and anxious types of temperaments. The difference from the Portuguese, and the Buenos Aires (Vzquez et al., 2007), and the American (Akiskal et al., 2005a) TEMPS-A, was that in Lisbon the depressive and the hyperthymic types can be considered part of a biphasic continuum; a similar phenomenon has been observed in Italy (Akiskal et al., 1998). As expected, most temperaments were weakly to moderately correlated with one another. The highest correlations (N0.50 Pearson's) were between the depressive and anxious, anxious and cyclothymic, and cyclothymic and irritable, as previously reported in the Buenos Aires (Vzquez et al., 2007), the German (Blink et al., 2005), and in the Lebanese (Karam et al., 2005)

validations. These converging international findings are generally in line with Kretschmer's (1936) concepts. Gender differences, were similar to other national studies (Vzquez et al., 2007; Karam et al., 2005), i.e. females more depressive, cyclothymic and anxious, and males more hyperthymic and irritable. It is relevant to point out that, in the Portuguese population the anxious temperament accounted for the largest variance, followed by the cyclothymic temperament. The Portuguese students presented a relatively higher score in the hyperthymic and anxious temperaments and lowest scores in the irritable temperament. Nonetheless, judging from the z-scores, no dominant temperament emerged in Portugal, all subscales had rates of 3.34%! This suggests a more balanced temperament pool in Portugal, at least among students. In this respect the findings are different from other nations where students were examined, e.g. Placidi et al. (1998) reporting from Italy and Blink et al. (2005) reporting from Germany.
Role of funding source There is no role of the funding source. Conflicts of Interest No conflicts of interest are need to report.

Acknowledgment We acknowledge all participants in this study.

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Appendix A

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