The Relationship Between Temperament Traits and Post-Traumatic Stress Disorder Symptoms and Its Moderators: Meta-Analysis and Meta-Regression

Abstract

Posttraumatic stress disorder (PTSD) is a chronic and disabling reaction to extreme stress. Because of the strong consequences of long-lasting PTSD symptoms, the research of risk and protective factors is needed. Presented meta-analysis aimed to verify temperament traits according to the Regulative Theory of Temperament as risk/protective factors of PTSD symptoms development. The studies for this meta-analysis were found in four main databases of scientific journals and due to contact with first authors, the unpublished data was accessed as well. The inclusion criteria allowed studies with traumatized adult populations and operationalization of the temperament according to the Regulative Theory of Temperament. Finally, data were included from 19 studies (5971 people: 3443 men and 2528 females, in the age of 13-85) with prospective, longitudinal and cross-sectional study designs, carried out among people exposed to combat trauma, occupational trauma (policemen and fire-fighters), disasters (flood, fire and mining catastrophes), motor vehicle accidents and chronic illnesses. The results show significant moderate and weak relations of all temperament traits to PTSD symptoms regardless of people’s gender, type of study, type of trauma, DSM version and temperament measure as well as the time elapsed after the trauma. Among different moderators, a previously unrecognized effect of gender was revealed as it explained a significant amount of variance in the case of emotional reactivity, endurance, and perseveration - the relationship was significantly stronger among men than women. Methodological conclusions for further research on personality and trauma are drawn.

Keywords

PTSD war mental health and violence vicarious trauma

Posttraumatic stress disorder (PTSD) is a chronic mental disorder, which is diagnosed in people who are exposed to trauma (death, life threat, actual or threatened serious injury, actual or threatened sexual violence). The exposure may be direct (personal, as witness or finding out about loved ones’ trauma exposure) or indirect (being exposed to aversive details of the trauma while performing professional duties). In a period longer than one month after the trauma, people experience intrusive thoughts about the traumatic event, avoid factors reminding about the trauma, feel physiological symptoms of stress as well as high arousal of the autonomic nervous system, and experience changes in mood and cognitions about oneself and the world (APA, 2013). PTSD is defined as a disabling state which frequently lasts for years if untreated (see Bramsen & van der Ploeg, 1999; Goenjian, Stienberg, Najarian, Tashjian & Pynoos, 2000; McCormack, 2009). It has significant health, personal and social negative consequences (see Arcaya, Lowe, Rhodes, Waers & Subramanian, 2017; Davidson, 2000; Rao, Scher, Vieira, Merikangas, Metti & Peterlin, 2015). Studying the risk and protective factors of post-traumatic stress disorder (PTSD) seems to have been of researchers’ interest continually over the years. Existing widespread research apart from peritraumatic and posttraumatic factors (like trauma exposure and social support; see Brewin, Andrews, & Valentine, 2000; Ozer, Best, Lipsey, & Weiss, 2003) exposes a pronounced role of personality, including temperament traits. The practical implications include taking into consideration the personality/temperament protective factors in recruitment processes for occupations under the risk of experiencing trauma as well as in prevention programs applied before or in a very short time elapsed since the trauma. The latter programs are not yet advanced or widely used, the effective ones have been already introduced, for example, among Israeli students (Wolmer, Hamiel, & Laor, 2011) or policemen (Arnetz, Nevedal, Lumley, Backman, & Lublin, 2009; see Skeffington, Rees, & Kane, 2013, for the summary). As temperament traits are considered one of the most important moderators of the relationship between extreme stress and psychopathology (Strelau, 2008) and there are first reports they may also moderate symptom reduction (Popiel & Zawadzki, 2013), the need for further research in the area seems to be incontestable. At the same time, the lack of a meta-analysis of the relationship between personality and temperament traits with PTSD symptoms is apparent.

PTSD and Temperament

Most of the research shows significant relationships between PTSD symptoms and temperament traits related to general emotionality, like neuroticism (Ceobanu & Mairean, 2015; Chung, Berger, & Rudd, 2007; Contractor, Armour, Shea, Mota, & Pietrzak, 2016; Cox, MacPherson, Enns, & McWilliams, 2004; Dorfel, Rabe, & Karl, 2008; Holeva & Tarrier, 2001; Lauterbach & Vrana, 2001; Pedersen, Middel, & Larsen, 2002; Zhang, Liu, Zhu, Shi, & Cheng, 2010, and prospective studies carried out by Engelhard & Hout, 2007; Engelhard, Hout, & Kindt, 2003; Engelhard, Hout, & Lommen, 2009; Engelhard, Hout, & Schoutenb, 2006; Zuiden et al., 2011), negative emotionality (Ledgerwood & Milosevic, 2013; Reis, Carvalho, & Elhai, 2016; Watson, Gamez, & Simms, 2005), harm avoidance (North, Abbacchi, & Cloninger, 2012, and prospective studies done by Gil, 2005a, 2005b), behavioral inhibition (Meyers, VanMeenen, Mcauley, et al., 2012; Meyers, VanMeenen, & Servatius, 2012), and emotional reactivity (Zawadzki, Kaczmarek, & Strelau, 2009, and prospective study done by Glibowska [unpublished; sample see: Zawadzki, Popiel, Cyniak-Cieciura, & Glibowska, 2018], for the summary of pretraumatic predictors of PTSD, see DiGangi et al., 2013).

Since that time different research has been done among flood, fire, and mining disaster victims, motor vehicle accident (MVA) survivors, policemen, soldiers, and firefighters as well as chronic illness sufferers. All the studies operationalized the temperament according to the Regulative Theory of Temperament (RTT), an internationally recognized theory included in the Encyclopedia of Personality and Individual Differences (see Zeigler-Hill & Shackelford, 2018), developed by Jan Strelau.

RTT defines temperament (Strelau, 2008, p. 88) as “basic, relatively stable personality traits expressed mainly in the formal (temporal and energetic) characteristics of reactions and behavior.” These characteristics may be described in terms of temporal and energetic traits that differ among people and are relatively stable for the same person, are present from early infancy, and are common for people and animals. The traits are biologically determined but change during the ontogenesis process. They determine humans’ possibilities of external stimulation processing and preferred ways of stimulus regulation by the physiological mechanisms, and therefore their role is to regulate the relationship between the subject and his or her environment, especially when facing difficult and extreme situations. Consequently, a less adaptive combination of temperament traits may constitute a temperament risk factor (see Strelau, 1998, 2008) for the development of somatic and psychological dysfunctions. This has been already confirmed for heart disease, somatic complaints, anxiety, affective and personality disorders, alcohol abuse, and burnout syndrome (Fruehstorfer, Veronie, Cremeans-Smith, & Newberry, 2012; Hintsa et al., 2016; Rzeszutek, Oniszczenko, Schier, Biernat-Kałuża, & Gasik, 2015; Strelau & Zawadzki, 2005, 2011; Zawadzki & Popiel, 2012). The RTT theory distinguishes six temperament traits (Strelau & Zawadzki, 1993) described below:
Briskness, defined by speed, tempo, and mobility, is a tendency toward quick reaction, keeping a high tempo of activity and shifting easily in response to changing environmental conditions.

Perseveration, defined by recurrence and persistence, is a tendency to continue and/or repeat behavior after cessation of stimuli which evoked this behavior.

Sensory sensitivity, defined as the ability to react to visual, sound, taste, olfactory, and tactile sensory stimuli of low stimulatory value.

Endurance, defined by endurance to distractors and to fatigue, is an ability to maintain adequate reactions in situations demanding long-lasting and high-stimulative activity.

Emotional reactivity, defined by emotional sensitivity and emotional endurance, is a tendency to react intensely to emotion-generating stimuli.

Activity, defined by direct and indirect sources of stimulation, is a tendency to undertake highly stimulative behaviors or to supply external stimulation through one’s behavior.

Temperament traits postulated by RTT show clear moderate to high relationships with other personality traits according to most famous theories like Cattell’s 16 personality factors (Cattell, Eber, & Tatsuoka, 1970), Eysencks’ psychoticism, extraversion and neuroticism (PEN) model (1970), and Costa and McCrae’s (1992) Big Five models of superfactors. They are considered as a temperament basis of personality traits (see Cyniak-Cieciura, Zawadzki, & Strelau, 2018; Strelau & Zawadzki, 1995).

The extensive research confirmed a predictive role of temperament traits according to RTT in PTSD symptoms development in prospective, longitudinal and cross-sectional studies of people exposed to different traumatic events (for the summary of the selected studies see Strelau, 2008), with the use of different PTSD self-assessment measures and definitions (according to DSM-IV and DSM-5 classifications). The results consequently suggest the strongest relationship between PTSD symptoms and emotional reactivity (in both correlational and regression analyses) and a weaker relationship between PTSD and other temperament traits (sometimes statistically significant only in some groups or after particular time since the trauma elapsed). The differences in the results between the studies indicate there are some factors moderating the relationship between PTSD and temperament. These factors may be categorized into three groups: (1) moderators related to subjects—mostly demographic variables; (2) moderators related to the methodology of the study—study design (prospective, longitudinal vs. cross-sectional), PTSD current definition, temperament, and PTSD measures (different self-assessment tools and structured interviews); and (3) moderators related to the trauma—level of the trauma exposure, type of trauma (as different traumas may be connected to different levels of trauma exposure), and time after the trauma (as with elapsing time the complication effect, the reciprocal influence of persistent PTSD symptoms on temperament may strengthen the relation; see Nowocin, 2017; Zawadzki et al., 2009; Zawadzki & Popiel, 2012).

The literature review suggests that RTT provides an empirically verified, consistent, and interdisciplinary (psychological and biological) explanation for the role of temperament in the development of psychopathological symptoms (Strelau, 2006). Despite the fact that the research on the relationships between PTSD symptoms and temperament traits according to RTT was conducted on Polish samples, it is vast and may provide the researchers with valuable clues for further investigation. Therefore, we decided to conduct a robust meta-analysis and include all possible moderators in a meta-regression.

Hypotheses

We decided to conduct a meta-analysis of the relationship between PTSD symptoms and temperament traits according to RTT. We hypothesized that:
Hypothesis 1: PTSD symptoms would be positively related to emotional reactivity and perseveration (both temperament traits responsible for the higher arousal level).

Hypothesis 2: PTSD symptoms would be negatively related to endurance, activity, briskness, and sensory sensitivity (all the traits responsible for the lesser arousal level).

We also assumed that PTSD symptoms will be significantly related to all temperament traits regardless of the moderators; however, they will differ in the effect size (ES) when these moderators are taken into account. The PRISMA guidelines are followed in the description of the conducted meta-analysis reported below (http://www.prisma-statement.org/).

Method

Search Strategy

The four main databases of scientific journals (Academic Search Complete, Science Direct, PsychArticles, and Proquest) were searched with the use of keywords: “PTSD,” “posttraumatic stress disorder,” “PTSD symptoms,” “posttraumatic stress disorder symptoms,” “temperament,” “Regulative Theory of Temperament,” “RTT,” “Formal Characteristic of Behavior–Temperament Inventory,” and “FCB-TI” in different combinations. We found 40 articles describing the research on the relationships between PTSD symptoms and temperament traits operationalized according to RTT. As the research in the area of PTSD and temperament was conducted mostly in Poland, the databases of Polish scientific journals (Psychological Journal, Psychological Studies, Psychological Annals, and Polish Psychological Bulletin) were searched with the result of another four articles. Three more articles were found in a Polish edited book about trauma research. Finally, the bases of master theses of biggest Polish universities (Warsaw University, Jagiellonian University, University of Wroclaw, University of Gdansk, University of Poznan, and the University of the Name of Cardinal Wyszynski) were searched with three master theses found.

Inclusion Criteria

The following inclusion criteria were taken into account: the operationalization of temperament according to RTT, studies carried out among adults and older adolescents (there were only two studies conducted among children, who did not respond themselves—the inventories were filled out by their parents), access to r-Pearson correlations for both genders. From all 50 records found, 31 were excluded as duplicates. Another two children studies were excluded and two master theses were unavailable. Finally, data from 15 studies were included in the meta-analysis. In order to analyze the moderating effect of gender, all the researchers were asked to share the raw scores, which resulted in getting access to all the published data and other four unpublished studies as well. Figure 1 presents the PRISMA flowchart of article selection and data gathering.

Figure 1.
PRISMA flowchart of article selection and data gathering.

Many of the studies examined independently more than one traumatized sample and having access to all the raw data allowed us to distinguish female and male groups. Therefore, we eventually included 30 different traumatized samples with 5,971 people (2,528 women and 3,443 men). Nine samples experienced chronic illness, four—combat trauma, four—occupational trauma, six—a flood, four—MVAs, and one sample for each of the following—a mining disaster, fire, and different traumas. Most of the groups were studied in a cross-sectional study design (with both temperament and PTSD measurements taken at the same time after the trauma), three in a prospective (with a temperament measurement taken before the trauma and PTSD—after the trauma) and eight in a longitudinal study design (with both temperament and PTSD assessments done in different moments after the trauma). Most of the groups (25) were examined with the use of a Formal Characteristic of Behavior–Temperament Inventory as a tool used to assess temperament traits according to RTT, while five groups were examined with the revised version of this tool—FCB-TI(R)—(for the summary of the differences between both versions, see Cyniak-Cieciura et al., 2018). PTSD assessment was done by different self-assessment tools: PTSD–Factorial Version Inventory (Strelau, Zawadzki, Oniszczenko, & Sobolewski, 2002)—15 groups, PTSD–Clinical Version Inventory (Zawadzki, Bieniek, Strelau, Oniszczenko, & Sobolewski, 2002)—7 groups, Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder (Keane, Caddell, & Taylor, 1988) in Polish translation done by Kuczewska (2007)—3 groups, Post-Traumatic Diagnostic Scale (Foa, 1995; Foa, Cashman, Jaycox, & Perry, 1997) in a Polish translation by Dragan, Lis-Turlejska, Popiel, Szumial, and Dragan (2012)—1 group, and Post-traumatic Diagnostic Scale 5 (Foa et al., 2016) in a Polish translation by Zawadzki et al. (2015)—4 groups. Only the latter groups used the definition of PTSD according to DSM-5 (all other PTSD tools operationalized the disorder according to DSM-IV). As there were many studies examining more than one sample independently, we decided to present a short description of each sample included in a meta-analysis (see Table 1).

Table 1.
The Summary Table of the Groups Included Into the Meta-Analysis.

Sample Type of Trauma Authors and Studies Sample Description DSM Version FCB-TI Version N (F, M) Age Year

Soldiers (Iraq) Combat Glibowska (unpublished; sample see Zawadzki, Popiel, Cyniak-Cieciura & Glibowska, 2018) Professional soldiers taking part in a mission in Iraq, assessed before the mission (temperament assessment) and 15 months after the first assessment (both temperament and PTSD assessments) DSM-IV FCB-TI 56 (0, 56) 23–43 No data

Soldiers (Afghanistan) Combat Glibowska (unpublished; sample see Zawadzki, Popiel, Cyniak-Cieciura & Glibowska, 2018) Professional soldiers taking part in a mission in Afghanistan, assessed before the mission (temperament assessment) and 6 months after the first assessment (both temperament and PTSD assessments) DSM-IV FCB-TI 148 (0, 148) 21–44 No data

Soldiers (Kosovo and others) Combat Unpublished master thesis, Karolczyk (2015) Professional soldiers taking part in different missions, mostly in Kosovo and Iraq, assessed once few years after the missions DSM-IV FCB-TI(R) 73 (0, 73) 23–60 2015

Firefighters Occupational Oniszczenko (2014) Firefighters, assessed once DSM-IV FCB-TI 284 (0, 284) 21–55 2009–2012

Policemen Occupational Oniszczenko (2014) Policemen, assessed once DSM-IV FCB-TI 58 (0, 58) 22–45 2009–2012

Soldiers Combat Oniszczenko (2014) Professional soldiers from the mission in Afghanistan, assessed once DSM-IV FCB-TI 75 (0, 75) 21–42 2009–2012

Firefighters Occupational Zawadzki (unpublished; sample see: Cyniak-Cieciura, Staniaszek, Popiel, Pragłowska, and Zawadzki 2017) Firefighters, assessed once DSM-5 FCB-TI(R) 300 (0, 300) 20–52 2015

Firefighters Occupational Popiel, Zawadzki, Praglowska, Habrat, and Gajda (2019) Firefighters assessed twice—before the service and 1 year after the service DSM-5 FCB-TI(R) 184 (0,184) 19–45 2015

MVA survivors MVA Zawadzki and Popiel (2012), Kaczmarek and Zawadzki (2012), and Kaźmierczak, Strelau, and Zawadzki (2012) MVA survivors from Warsaw and surroundings, assessed twice within 12–24 months after the accident DSM-IV FCB-TI 550 (222, 328) 18–66 2008–2010

MVA survivors MVA Zawadzki and Popiel (2012), Kaczmarek and Zawadzki (2012), and Kaźmierczak, Strelau, and Zawadzki (2012) MVA survivors from Warsaw and surroundings, assessed twice within 24–36 months after the accident DSM-IV FCB-TI 329 (109, 220) 19–66 2010–2012

MVA survivors MVA Barańczuk (2014) MVA survivors from Warsaw and surroundings, assessed once within 24 months after the accident DSM-IV FCB-TI 280 (147, 133) 18–80 2013

MVA survivors MVA Zawadzki (unpublished; sample see: Cyniak-Cieciura et al. 2017) MVA survivors from Warsaw and surroundings, assessed once within 24 months after the accident DSM-5 FCB-TI(R) 301 (169, 132) 18–68 2015

Different trauma victims Different traumas Barańczuk and Zawadzki (2013) MVA survivors, victims of natural disasters, physical or sexual assaults, diseases, and so on from Warsaw and surroundings, assessed once DSM-IV FCB-TI 250 (151, 98) 18–30 2013

Coal miners Mining disaster Strelau and Zawadzki (2005) Miners assessed twice within 24 months after the disaster DSM-IV FCB-TI 52 (0, 52) 23–54 No data

Flood victims Flood Strelau and Zawadzki (2005) and Zawadzki, Kaczmarek, and Strelau (2009) Flood victims from Raciborz and surroundings, assessed twice within 3 years after the flood DSM-IV FCB-TI 276 (144, 132) 14–75 2000

Flood victims Flood Strelau and Zawadzki (2005), Zawadzki, Kaczmarek, and Strelau (2009), and Strelau and Zawadzki (2004) Flood victims from Gdansk, assessed 3 times in 3, 15, and 27 months after the flood DSM-IV FCB-TI 267 (158, 109) 14–77 2001–2003

Flood victims Flood Strelau and Zawadzki (2005) and Zawadzki, Kaczmarek, and Strelau (2009) Flood victims from Budzow and Makow Podhalanski, assessed once in 2 years after the flood DSM-IV FCB-TI 214 (117, 97) 27–66 2003

Flood victims Flood Zawadzki, Kaczmarek, and Strelau (2009) Flood victims from Andrychow, Zagorz, Jaslo, and Piechowice, assessed twice in 3 and 15 months after the flood DSM-IV FCB-TI 413 (210, 203) 14–74 2005–2007

Flood victims Flood Strelau, Zawadzki, Oniszczenko, and Sobolewski (2002) and Zawadzki, Bieniek, Strelau, Oniszczenko, and Sobolewski (2002) Flood victims from Klodzko, Kedzierzyn Kozle, and Raciborz, assessed twice within 24 months after the flood DSM-IV FCB-TI 377 (198, 179) 14–85 1999

Flood victims Flood Zawadzki (unpublished; sample see: Cyniak-Cieciura et al. 2017) Flood victims from Sandomierz, assessed once within 5 years after the flood DSM-5 FCB-TI(R) 303 (173, 130) 18–85 2015

Fire victims Fire Zawadzki, Kaczmarek, and Strelau (2008) Fire victims from Slubice and big Polish cities, assessed twice in 12 and 24 months after the fire DSM-IV FCB-TI 321 (178, 143) 13–85 No data

Neurosurgery patients Chronic illness Oniszczenko (unpublished) Patients after neurological surgeries, assessed once DSM-IV FCB-TI 100 (50, 50) 18–82 No data

Oncological patients Chronic illness Oniszczenko and Laskowska (2011) Oncological patients, assessed once DSM-IV FCB-TI 150 (54, 96) 20–79 No data

Surgery patients Chronic illness Oniszczenko (unpublished) Patients after surgeries, assessed once DSM-IV FCB-TI 31 (22, 9) 22–60 No data

Urological patients Chronic illness Oniszczenko (unpublished) Urological patients, assessed once DSM-IV FCB-TI 17 (6, 11) 24–63 No data

Internal patients Chronic illness Oniszczenko (unpublished) Internal patients, assessed once DSM-IV FCB-TI 42 (23, 19) 23–66 No data

Gynecologic patients Chronic illness Oniszczenko, Szulc, Bulsa, and Zebielowicz (2016) Women with gynecologic pathology (uterine disorders, sarcomas and polyps, tubal occlusion, ovarian cysts, endometriosis, and adnexal inflammation), assessed once DSM-IV FCB-TI 136 (136, 0) 18–60 No data

HIV carriers Chronic illness Rzeszutek, Oniszczenko, and Firląg-Burkacka (2012), Rzeszutek, Oniszczenko, Schier, Biernat-Kałuża, and Gasik (2016), and Rzeszutek and Oniszczenko (2013) HIV carriers from Warsaw without an AIDS diagnosis, assessed once DSM-IV FCB-TI 128 (87, 95) 19–62 2013–2015

AIDS sufferers Chronic illness Rzeszutek, Oniszczenko, and Firląg-Burkacka (2012), Rzeszutek et al. (2015), and Rzeszutek and Oniszczenko (2013) HIV carriers from Warsaw in an active phase of AIDS, assessed once DSM-IV FCB-TI 128 (66, 62) 22–68 2013–2015

Rheumatoid arthritis sufferers Chronic illness Rzeszutek et al. (2016) Rheumatoid arthritis sufferers from Warsaw, assessed once DSM-IV FCB-TI 150 (108, 42) 20–84 2013–2015

Note. Authors and studies means the authors of the articles in which the study examining the sample is described. F = female; M = male; MVA = motor vehicle accidents; FCB-TI = Formal Characteristic of Behavior–Temperament Inventory; FCB-TI(R) = Formal Characteristic of Behavior-Temperament Inventory–Revised version; PTSD = posttraumatic stress disorder; RTT = regulative theory of temperament.

Analytic Strategy

The meta-analysis of the relationship between PTSD symptoms and temperament traits according to RTT was conducted with the use of the Comprehensive Meta-Analysis Version 3 program. An r-Pearson correlation coefficient served as the ES index. Due to the high variability of the groups, it was unjustified to assume a common true ES, distorted only by the measurement error. Therefore, all the results were reported with the use of the random-effect model (see Borenstein, Hedges, Higgins, & Rothstein, 2009), and a different study-to-study variance was assumed (see Borenstein et al., 2009). Heterogeneity of the ES was reported with the use of Q and I ² coefficients. A statistically significant Q coefficient informs about the meaningful heterogeneity of the ES between the studies, whereas I ² is the ratio of between-study variance to the total variance and shows how much of the observed variance reflects real differences in the ES.

Due to having more than one result for the groups that participated in prospective and longitudinal studies, including all of them into the meta-analysis as independent results would increase a standard measurement error. At the same time, combining the results would lead to missing the information about possible differences in the ES between different kinds of studies. Therefore only while comparing different types of the studies, two results for longitudinal studies were included as independent results: the longitudinal one and the last cross-sectional measurement. In all other analyses, the mean of the different measurements in longitudinal studies (one result) was included.

In the first step, the basic meta-analysis was conducted using female and male groups as study units and including the moderators (only categorical variables); in the second step, we included gender, type of study (prospective, longitudinal, and cross-sectional), type of trauma (categorized as disaster, MVA, chronic illness, combat and occupational trauma), version of the DSM classification (DSM-IV or DSM-5), and version of the temperament inventory, FCB-TI or FCB-TI(R), as well as the time after the trauma (less and more than 24 months after the trauma). A random-effect model was used to combine studies within each subgroup. A fixed-effect model was used to combine subgroups and yield the overall effect. The study-to-study variance was not assumed to be the same for all subgroups; it was computed within subgroups and not pooled across subgroups.

In order to check the between-study variance explained by age (a continuous variable) and compare the impact of the moderators significantly affecting the relationship between PTSD symptoms and temperament traits in the second step, a meta-regression was conducted. Four different statistics were calculated: a Q coefficient testing the model of moderators (with a significant result informing that the model of covariates makes a significant impact on ES), a Q coefficient testing the heterogeneity (with a significant result informing about the unexplained variance occurrence), I ²—a ratio of between-study variance (unexplained variance) to the total variance, and R ²—the proportion of the originally unexplained variance now explained by the moderators. Finally, publication bias was estimated with the use of the coefficients described below:

fail-safe N (Rosenthal, 1979), informing about the number of studies with nonsignificant results needed to make the general ES nonsignificant;

Egger’s test (Egger, Davey Smith, Schneider, & Minder, 1997)—a test for asymmetry of the funnel plot (a graph showing the spread of the studies on both sides of the average—the studies of higher precision are plotted near the average and its asymmetry suggests a possible bias);

Trimm and fill (Duval & Tweedie, 2000a, 2000b)—informing about the studies missing on the right or left side of the funnel plot and estimating the ES after their inclusion.

Results

Basic Meta-Analysis

In the first step, a basic meta-analysis was conducted. Its results are presented in Table 2. As shown by the results presented in Table 2, all temperament traits were significantly related to PTSD symptoms. Emotional Reactivity showed the strongest relation (.34), followed by Endurance (−.26) and Briskness (−.26), Perseveration (.23), Activity (−.16), and Sensory Sensitivity (−.14). Emotional Reactivity and Perseveration were positively related to PTSD symptoms, whereas Endurance, Briskness, Activity, and Sensory Sensitivity were negatively related to PTSD symptoms. The heterogeneity measures (the significance of all Q coefficients and significant variability of ES between the studies—34–56% for all the traits) suggest there still is some unexplained variance and at least one factor moderating the relationship between different temperament traits and PTSD symptoms in different studies. It was verified in the next step.

Table 2.
The Relationship Between Temperament Traits According to RTT and PTSD Symptoms.

Traits ES [95% CI] Z (p) Q (p) I²

BR –.26 [–.30, –.22] –12.40 (<.01) 114.26 (<.01) 56.24

PE .23 [.20, .26] 12.94 (<.01) 83.42 (<.01) 40.06

SS –.14 [–.17, –.10] –7.13 (<.01) 95.97 (<.01) 47.90

EN –.26 [–.30, –.22] –13.26 (<.01) 102.19 (<.01) 51.07

ER .34 [.31, .37] 18.52 (<.01) 93.22 (<.01) 46.36

AC –.16 [–.19, –.13] −9.36 (<.01) 75.77 (.01) 34.01

Note. 95% CI = 95% confidence interval; ES = effect size; Q = ES heterogeneity coefficient; I ² = a ratio of the between-study variance to the total variance; BR = briskness; PE = perseveration; SS = sensory sensitivity; EN = endurance; ER = emotional reactivity; AC = activity; PTSD = posttraumatic stress disorder; RTT = regulative theory of temperament.

Moderators

Three categories of moderating factors were taken into account:
Moderators related to the subjects: gender (female—21 groups, male—29 groups) and age (as a continuous variable it was included in a meta-regression analysis only).

Moderators related to the methodology of the study: the type of study (prospective—3 groups, longitudinal—16 groups, and cross-sectional—31 groups), version of the DSM classification (DSM-IV—44 groups or DSM-5—6 groups), and version of the temperament inventory (FCB-TI—43 groups or FCB-TI[R]—7 groups).

Moderators related to the trauma: the type of trauma (categorized as a disaster—15 groups, MVA—8 groups, chronic illness—18 groups, combat trauma—4 groups, and occupational trauma—5 groups).

The ES obtained after taking the moderating factors into account are presented in Table 3. The results suggest that, as assumed, most temperament traits are significantly related to PTSD symptoms regardless of the moderating factors. The only insignificant results were obtained for PTSD symptoms and Briskness (in the case of occupational trauma) and Sensory Sensitivity in prospective studies, groups with occupational and combat trauma, and groups using DSM-5 classification and FCB-TI(R) version. At the same time, there were fewer studies using prospective design, and DSM-5 classification and FCB-TI(R) tool comparing to other categories, and Sensory Sensitivity was a scale with meaningful content changes in the revision of FCB-TI (see Cyniak-Cieciura et al., 2018).

Table 3.
The Moderators of the Relationship Between PTSD and Temperament Traits According to RTT.

Trait Gender Study Type Trauma Time After the Trauma DSM Version FCB-TI Version

F M P L CS CI D MVA OC CO <24 >24 IV 5 FCB-TI FCB-TI(R)

BR −.24 −.27 −.15* −.24* −.28* −.30* −.25* −.25* −.09* −.47* −.25 −.23 −.28 −.13 −.28* −.16*

PE .15 .28 .21* .15* .25* .26 .19 .21 .35 .32 .21 .19 .22 .26 .22 .27

SS −.16 −.12 −.07 −.15 −.16 −.23 −.14 −.10 .01 −.24 −.12 −.16 −.16 .00 −.16 −.01

EN −.20 −.30 −.31 −.27 −.26 −.22* −.27* −.26* −.20* −.42* −.28 −.21 −.27 −.22 −.26 −.24

ER .29 .37 .23* .32* .35* .38 .34 .32 .32 .45 .32 .30 .35* .27* .35* .29*

AC −.17 −.15 −.15 −.20 −.15 −.16* −.21* −.10* −.12* −.20* −.16* −.15 −.17 −.10 −.17* −.09*

Note. Significant ES are bold-faced values; significant differences between the groups marked with an asterisk. F = female; M = male; P = prospective; L = longitudinal; CS = cross-sectional; CI = chronic illness; D = disaster; MVA = motor vehicle accidents; OC = occupational trauma; CO = combat trauma; <24 = less than 24 months; >24 = more than 24 months; IV = DSM-IV version; 5 = DSM-5 version; BR = briskness; PE = perseveration; SS = sensory sensitivity; EN = endurance; ER = emotional reactivity; AC = activity; PTSD = posttraumatic stress disorder; RTT = regulative theory of temperament; ES = effect size.

*p < .05. **p < .01.

Some significant differences were found in the ES within the categories. The relationship between PTSD symptoms and Perseveration, Endurance, and Emotional Reactivity was found to be stronger among men than women. Only the relationship between PTSD symptoms and Emotional Reactivity was comparable between different trauma populations. The relationship between PTSD and Briskness, Sensory Sensitivity, and Emotional Reactivity was stronger in studies that used DSM-IV classification and the first version of FCB-TI. In the case of Briskness, Perseveration, and Emotional Reactivity, the relationship between temperament traits and PTSD was stronger among cross-sectional studies than in the studies of longitudinal or prospective design. Age turned out to be an insignificant moderator of the relationship between PTSD and all six temperament traits.

Finally, in order to check the between-study variance explained by the age and the moderators which were proved to significantly impact the ES in the previous step, a meta-regression analysis was applied. Because of the same limitations as described above, one cross-sectional and one longitudinal measurement were included as independent results only when analyzing the impact of the study type. In all other analyses, the mean of different measurements from longitudinal studies was applied. The meta-regression analyses included:

Four moderators in the case of Briskness: type of study, type of trauma, DSM, and FCB-TI version. Because of the high correlation between DSM and FCB-TI version (−.95), it was unjustified to include both covariates into one model. Therefore, two models were compared: (1) the first one with the type of study, the type of trauma, and DSM version and (2) the second one with the type of study, the type of trauma, and FCB-TI version. The models explained a comparable amount of the between-study variance (36% vs. 34%). Only the type of trauma was a significant moderator of the differences in the ES and still, there is a significant variance to be explained by other moderators (I ² = 48.15%).

Three moderators in the case of Perseveration: gender, type of study, and type of trauma. The model explains a meaningful amount of the between-study variance (67%) leaving only 26.08% to be explained by other moderators. Only gender and type of study proved to significantly impact the ES.

Three moderators in the case of Sensory Sensitivity: trauma type and DSM version (Model 1) as well as trauma type and FCB-TI version (Model 2)—because of the high correlation of the DSM classification and FCB-TI version covariates (−.95), they were included into two different models separately. Both models included significant moderators which make a significant impact on the ES and explained a comparable amount of the variance (63% vs. 64%), leaving 23% of the variance still unexplained.

Two moderators in the case of Endurance: gender and trauma type were included in the analysis, both making a significant impact on the ES, explaining 35% of the between-study variance and leaving 37.56% of the variance still unexplained.

Four moderators in the case of Emotional Reactivity: gender, type of study, DSM version, and FCB-TI version. Again, because of a strong correlation between the latter covariates (−.95), two models were compared: (1) including gender, type of study, and DSM version and (2) including gender, type of study, and FCB-TI version. The models explain a comparable amount of the variance (44% vs. 43%), leaving 48.32% of the variance unexplained. All the covariates were significant, however, type of study on a tendency level (p = .08).

Two moderators in the case of Activity: type of trauma and FCB-TI version. The model explained 46% of the variance, leaving only 21.38% of the between-study variance still unexplained. All the covariates proved to impact the ES on a tendency level (p = .09 and p = .07).

Publication Bias

Table 4 shows publication bias coefficients. The results of tests verifying the level of publication bias allow us to accept the credibility of conducted meta-analysis. A fail-safe N coefficient shows that many more studies than the ones that have been conducted until today (1,257–8,449) would be needed to undermine the results of this meta-analysis. The results of the Egger’s test suggest that only the funnel plot for Sensory Sensitivity showed significant asymmetry, meaning that the studies of smaller size gave stronger results in the case of this trait. The ES adjusted with the use of the Trimm and fill procedure (3 studies missing on the right side of the plot in the case of Briskness, 12—Sensory Sensitivity, and 3 on the left side of the plot in the case of Activity and Emotional Reactivity) does not differ significantly from the one obtained in the basic meta-analysis.

Table 4.
Publication Bias Coefficients.

Traits Fail-Safe N Egger’s Test (1997) Trimm and Fill

Intercept (SE) t (p) ES obs./adj.

BR 4,588 −0.79 (.62) 1.28 (.21) −.26/−.24

PE 3,671 0.43 (.54) 0.81 (.43) .23/.23

SS 1,257 −1.35 (.55) 2.47 (.02) −.14/−.10

EN 4,691 −0.53 (.59) 0.90 (.37) −.26/−.26

ER 8,449 0.58 (.56) 1.03 (.31) .34/.32

AC 1,662 −0.24 (.51) 0.46 (.65) −.16/−.17

Note. ES obs./adj. = observed versus adjusted after Trimm and fill procedure effect size value; BR = briskness; PE = perseveration; SS = sensory sensitivity; EN = endurance; ER = emotional reactivity; AC = activity.

p < .05.

Discussion

The aim of this article was to describe the meta-analysis of the research on the relationships between temperament traits defined according to RTT and PTSD symptoms. The general findings and their implications are summarized in Table 5.

Table 5.
A Summary Table.

General Findings

All six temperament traits, defined according to Regulative Theory of Temperament, are significantly related to PTSD symptoms.

The traits responsible for high arousal level (emotional reactivity and perseveration) show positive relation to PTSD symptoms.

The traits responsible for the low arousal level (endurance, briskness, sensory sensitivity, and activity) show negative relation to PTSD symptoms.

Most temperament traits (apart from sensory sensitivity) are related to PTSD symptoms when measured in a pretraumatic period, which suggests their predictive role in determining the vulnerability to PTSD development following a traumatic event.

Among different moderators a previously unrecognized effect of gender is revealed as it explains a significant amount of the variance in the case of emotional reactivity, endurance, and perseveration—the relation is significantly stronger among men than women.

Note. PTSD = posttraumatic stress disorder.

As assumed, the results suggest that all temperament traits are significantly related to PTSD symptoms regardless of the moderating factors such as gender, age, type of study, type of trauma, time elapsed after the trauma, DSM* classification, and temperament questionnaire version. The traits responsible for high arousal level (emotional reactivity and perseveration) are positively related to PTSD symptoms development and/or maintenance. The traits responsible for the low arousal level (endurance, briskness, sensory sensitivity, and activity) are negatively related to PTSD symptoms.

The ES turned out to be insignificant only in the case of sensory sensitivity in prospective studies, groups exposed to occupational and combat trauma, in the studies using DSM-5 classification and FCB-TI(R) version. This result may be related either to changes in DSM definition of PTSD (as new symptoms of rather cognitive than emotional or somatic nature were added—the posttraumatic cognitions) or in FCB-TI version (as Sensory Sensitivity Scale content was significantly changed; see Cyniak-Cieciura et al., 2018; Cyniak-Cieciura et al., 2017). On the other hand, the result may also be related to the small number of studies using a prospective design, DSM-5 and FCB-TI(R) versions, and occupational and combat trauma populations, suggesting we need more studies of these types in order to be allowed to draw more specific conclusions.

The relationship between temperament traits and PTSD symptoms may reflect not only the vulnerability effect (namely the influence of temperament on PTSD development) but also the effect of complication (the influence of PTSD on temperament) or reciprocal effects (a mutual influence of PTSD symptoms and temperament traits). Only prospective studies provide enough evidence for the vulnerability effects but because of the small number of this kind of studies, the conclusions are limited. On the other hand, the results show that most temperament traits (apart from sensory sensitivity) were significantly related to PTSD symptoms when measured in a pretraumatic period, which suggests their predictive role in determining the vulnerability to PTSD development and means that these relationships should not be interpreted only as a complication or reciprocal effects. Consequently, we may conclude that emotional reactivity determines the level of the arousal developed during the traumatic event and is connected to the fear conditioning process. Endurance may be perceived as a temperamental determinant of physical possibilities of stimulation and arousal processing. Perseveration may be responsible for the maintenance of the arousal after the trauma by rumination and intrusion, while activity and briskness—by the avoidant behavior aiming at lowering the arousal. Briskness measured with the original version of FCB-TI included, apart from speed and tempo, a mobility component, responsible for the adjustment to the conditions of the environment. This component was excluded in the revision process of this tool (Cyniak-Cieciura et al., 2018), which probably lowered the relationship between this trait and PTSD symptoms, as we can see in the obtained results. Finally, there is a weak relationship between PTSD and sensory sensitivity. The role of this trait refers only to stimuli of very low stimulative value, while trauma (especially occupational or combat trauma) is a highly stimulative experience. Therefore, it appears that sensory sensitivity may not determine any stress regulation possibilities but may increase with time elapsed after the trauma as the effect of the arousal persistence (especially in the trauma of long duration, like a chronic disease) and lead to a decrease in one’s possibilities of stimulation processing.

The heterogeneity coefficients suggest a moderate impact of included moderators on ES values. It was verified in two ways: calculating the difference between ES in different groups and then in meta-regression analyses. The general conclusion that can be drawn on the basis of conducted calculations is that the included moderators explained the meaningful amount of the between-study variance in the case of all the traits (29–76%). There still are other significant moderating factors not included in this analysis, such as the level of trauma exposure (which was not considered in most of the research). Moreover, the operationalization of the included factors was insufficient to detect their impact on the ES (mostly categorical covariates were gathered).

Considering the moderators associated with subjects, the age turned out not to make any difference in the ES. Gender impacts the relationship between PTSD symptoms and emotional reactivity, perseveration, and endurance, which is significantly stronger in the male population than in the female population. This result may seem surprising, as PTSD symptoms are usually more intensive in women (Tolin & Foa, 2006), which was usually explained by higher levels of emotionality (and so, emotional reactivity and perseveration) found among them (see Cyniak-Cieciura, Zawadzki, & Strelau, 2016; Lilly, Pole, Best, Metzler, & Marmar, 2009). These results suggest that there are some biological or cultural factors connected to gender (Zawadzki & Strelau, 2009) that make men who are characterized by a higher level of emotional reactivity and perseveration and a lower level of endurance more prone to PTSD development than women of the same temperament profile (women are still more prone to PTSD development in general). We believe that this result may be explained mostly by cultural factors (Hofstede, 1980, 2011), with stronger gender differences in PTSD levels found in more traditional societies (Norris, Perilla, Ibanez, & Murphy, 2001), such as Poland.

As far as the moderators associated with trauma are concerned, the time elapsed after the trauma turned out to be an insignificant covariate; however, this result may be limited by the lack of a quantitative measure (the available data were categorized only into two groups—less than 24 months and more than 24 months after the trauma). On the other hand, the type of trauma impacts the ES value in the case of all the traits apart from emotional reactivity, being usually stronger in people exposed to combat trauma. The result probably reveals the special role of stimulation regulation possibilities while dealing with an exposure to the trauma of long duration and high intensity, like war.

Factors connected to the methodology of the studies, especially DSM and FCB-TI versions, modify the ES values in the case of briskness, sensory sensitivity, emotional reactivity, and activity (the latter was influenced only by the version of the temperament measure). The high correlation between these two covariates does not allow us to conclude about the factor determining this difference; however, both briskness and sensory sensitivity are the scales with most significant content change in the revision process of FCB-TI (in the case of briskness, the mobility component was excluded, leaving only two components: speed and tempo; in the case of sensory sensitivity, a new component of sensory sensitiveness was added—an ability to differentiate between stimuli of a very similar stimulative value). As the content of the Emotional Reactivity Scale was not significantly changed in the revision process of FCB-TI, the explanation of the revealed difference may be connected to the changes of DSM classification. The relationship between PTSD symptoms and emotional reactivity may be lower in the studies using DSM-5 classification because of additional criteria of more cognitive than emotional nature—the posttraumatic cognitions. The change in the relationship between PTSD symptoms and activity needs further examination—the scale of Activity was not significantly changed in the revision process of the temperament measure; therefore, the result is inconclusive at the moment.

There are plenty of methodological conclusions that can be drawn based on the obtained results. The first conclusion (and a restriction at the same time) worth commenting on relates to the differences between study types which were significant only in the case of three traits: perseveration, emotional reactivity, and briskness. The cross-sectional measurements usually provide higher correlations than longitudinal (and prospective) ones because of reciprocal effects that occur with the time elapsed after the trauma (Zawadzki et al., 2009; Zawadzki & Popiel, 2012). Unfortunately, the inclusion of all measurements for longitudinal studies as independent results in the meta-analysis increases the error; therefore, obtained results need to be interpreted with caution. On the other hand, the exclusion of cross-sectional data for longitudinal studies impacts the analysis, as it increases the correlation between the type of study and the type of trauma (most longitudinal studies were conducted on groups of disaster victims and MVA survivors, whereas cross-sectional—on chronic illness sufferers; the exclusion of cross-sectional data from longitudinal studies leads to the comparison mostly of chronic disease sufferers with MVA and disaster survivors). Taking into account these obstacles, we decided to include two results for longitudinal studies: the longitudinal one and the last cross-sectional measurement (as it was comparable to other types of trauma). Presented results suggest that in the case of two traits determining the possibilities of stimulation processing (namely, perseveration and emotional reactivity) and one responsible mostly for the regulation of stimulation (briskness), the relationship is stronger while measured at the same time as PTSD symptoms. Taking into consideration the results of meta-regression, we may conclude with more certainty about the significant role of the type of study in modifying only the relationship between PTSD symptoms and perseveration. Because of the limitations described above, this result is not unreservedly conclusive and only further research on diverse trauma populations will help to obtain reliable conclusions.

Another methodological conclusion (and another restriction) refers to the time after the trauma as a moderator of the ES. Most of the included studies lacked detailed information about the mean time elapsed after the trauma when the assessment took place. On the other hand, we still lack the studies conducted in the first few months after the trauma, as most of the data were gathered after 1 year or later. We also lack more prospective studies. These data could help us differentiate between the vulnerability and complication/reciprocal effects in the relationship between temperament traits and PTSD symptoms (however, this conclusion also refers to personality traits in general). The next point refers to the changes introduced to the classifications and temperament/personality measures—although we lack a proper number of studies using DSM-5 and revised version of FCB-TI to draw specific conclusions, the impact of the introduced changes seems obvious and they oblige scientists to repeat their studies, as with different results different recommendations about therapy or recruitment processes may be needed. Placing as much quantitative data in empirical papers as possible would help to conduct robust meta-regression analyses. Finally, the lack of strictly clinical data is apparent.

The importance of the research on the relationship between PTSD and temperament refers mostly to two areas: the recruitment of people with a high risk of trauma exposure (soldiers, policemen, firefighters, and medical services) and the adjustment of therapy process for those exposed to the trauma. Basing the recruitment decisions on temperament profiles which are less prone to develop PTSD symptoms may result in fewer psychological and psychiatric problems among people at a higher risk of trauma exposure. Popiel and Zawadzki (2013) also revealed that prolonged-exposure trauma-focused psychotherapy (one of the most effective therapies of PTSD; see the last comparison done by Haagen, Smid, Knipscheer, & Kleber, 2015) is less effective among people high on emotional reactivity when they are provided with the therapy after more than 1 year since trauma exposure. More research may provide us with valuable information which would help to provide people with a therapy best adjusted to their possibilities. Last but not least, as temperament traits constitute the temperamental basis of personality traits, the presented results provide strong evidence for the significant relationship between PTSD symptoms and personality in general. They also suggest a rather small role of moderating factors, apart from gender which seems to be of great importance. Replicating the analysis including Eysenck’s and Big Five models of personality may be the next step for researchers examining the role of personality in PTSD development.

Although the results of this meta-analysis seem to be very reliable (based on very good values of fail-safe N and Trimm and fill coefficients as well as the results of Egger’s test), there still are some limitations of the conclusions drawn on their basis. The most important restriction is the lack of a sufficient number of prospective studies, the only studies which allow us to directly conclude about the ES without the possible reciprocal effects. The second limitation is the fact that the data included in the meta-analyses were gathered only in Poland. The next one refers to the inclusion of mostly all categorical variables as moderators while some of them were highly correlated with each other. Last but not least, there is a small number of studies using DSM-5 and FCB-TI(R) versions. We hope that the results of this meta-analysis will be an inspiration to conduct further international research on the relationship between temperament and PTSD symptoms, which will help to overcome the limitations mentioned above.

Conclusion

Implications for Practice, Policy, and Research

Further research on gender differences in a relation between personality/temperament and PTSD symptoms is needed.

Significant relation between all temperament traits and PTSD justify the need of personality/temperament assessment in recruitment processes for occupations that deal with trauma victims or are in a high risk of trauma exposure.

Temperament/personality traits may moderate the effectiveness of PTSD treatment—the research in this area is needed.

We need more studies of longitudinal and prospective design in order to compare the relation of temperament and PTSD between different types of the study in a more conclusive way than we are able to do today.

Detailed information about time elapsed since the trauma is appreciated.

Research on strictly clinical populations would be valuable.

Sample	Type of Trauma	Authors and Studies	Sample Description	DSM Version	FCB-TI Version	N (F, M)	Age	Year
Soldiers (Iraq)	Combat	Glibowska (unpublished; sample see Zawadzki, Popiel, Cyniak-Cieciura & Glibowska, 2018)	Professional soldiers taking part in a mission in Iraq, assessed before the mission (temperament assessment) and 15 months after the first assessment (both temperament and PTSD assessments)	DSM-IV	FCB-TI	56 (0, 56)	23–43	No data
Soldiers (Afghanistan)	Combat	Glibowska (unpublished; sample see Zawadzki, Popiel, Cyniak-Cieciura & Glibowska, 2018)	Professional soldiers taking part in a mission in Afghanistan, assessed before the mission (temperament assessment) and 6 months after the first assessment (both temperament and PTSD assessments)	DSM-IV	FCB-TI	148 (0, 148)	21–44	No data
Soldiers (Kosovo and others)	Combat	Unpublished master thesis, Karolczyk (2015)	Professional soldiers taking part in different missions, mostly in Kosovo and Iraq, assessed once few years after the missions	DSM-IV	FCB-TI(R)	73 (0, 73)	23–60	2015
Firefighters	Occupational	Oniszczenko (2014)	Firefighters, assessed once	DSM-IV	FCB-TI	284 (0, 284)	21–55	2009–2012
Policemen	Occupational	Oniszczenko (2014)	Policemen, assessed once	DSM-IV	FCB-TI	58 (0, 58)	22–45	2009–2012
Soldiers	Combat	Oniszczenko (2014)	Professional soldiers from the mission in Afghanistan, assessed once	DSM-IV	FCB-TI	75 (0, 75)	21–42	2009–2012
Firefighters	Occupational	Zawadzki (unpublished; sample see: Cyniak-Cieciura, Staniaszek, Popiel, Pragłowska, and Zawadzki 2017)	Firefighters, assessed once	DSM-5	FCB-TI(R)	300 (0, 300)	20–52	2015
Firefighters	Occupational	Popiel, Zawadzki, Praglowska, Habrat, and Gajda (2019)	Firefighters assessed twice—before the service and 1 year after the service	DSM-5	FCB-TI(R)	184 (0,184)	19–45	2015
MVA survivors	MVA	Zawadzki and Popiel (2012), Kaczmarek and Zawadzki (2012), and Kaźmierczak, Strelau, and Zawadzki (2012)	MVA survivors from Warsaw and surroundings, assessed twice within 12–24 months after the accident	DSM-IV	FCB-TI	550 (222, 328)	18–66	2008–2010
MVA survivors	MVA	Zawadzki and Popiel (2012), Kaczmarek and Zawadzki (2012), and Kaźmierczak, Strelau, and Zawadzki (2012)	MVA survivors from Warsaw and surroundings, assessed twice within 24–36 months after the accident	DSM-IV	FCB-TI	329 (109, 220)	19–66	2010–2012
MVA survivors	MVA	Barańczuk (2014)	MVA survivors from Warsaw and surroundings, assessed once within 24 months after the accident	DSM-IV	FCB-TI	280 (147, 133)	18–80	2013
MVA survivors	MVA	Zawadzki (unpublished; sample see: Cyniak-Cieciura et al. 2017)	MVA survivors from Warsaw and surroundings, assessed once within 24 months after the accident	DSM-5	FCB-TI(R)	301 (169, 132)	18–68	2015
Different trauma victims	Different traumas	Barańczuk and Zawadzki (2013)	MVA survivors, victims of natural disasters, physical or sexual assaults, diseases, and so on from Warsaw and surroundings, assessed once	DSM-IV	FCB-TI	250 (151, 98)	18–30	2013
Coal miners	Mining disaster	Strelau and Zawadzki (2005)	Miners assessed twice within 24 months after the disaster	DSM-IV	FCB-TI	52 (0, 52)	23–54	No data
Flood victims	Flood	Strelau and Zawadzki (2005) and Zawadzki, Kaczmarek, and Strelau (2009)	Flood victims from Raciborz and surroundings, assessed twice within 3 years after the flood	DSM-IV	FCB-TI	276 (144, 132)	14–75	2000
Flood victims	Flood	Strelau and Zawadzki (2005), Zawadzki, Kaczmarek, and Strelau (2009), and Strelau and Zawadzki (2004)	Flood victims from Gdansk, assessed 3 times in 3, 15, and 27 months after the flood	DSM-IV	FCB-TI	267 (158, 109)	14–77	2001–2003
Flood victims	Flood	Strelau and Zawadzki (2005) and Zawadzki, Kaczmarek, and Strelau (2009)	Flood victims from Budzow and Makow Podhalanski, assessed once in 2 years after the flood	DSM-IV	FCB-TI	214 (117, 97)	27–66	2003
Flood victims	Flood	Zawadzki, Kaczmarek, and Strelau (2009)	Flood victims from Andrychow, Zagorz, Jaslo, and Piechowice, assessed twice in 3 and 15 months after the flood	DSM-IV	FCB-TI	413 (210, 203)	14–74	2005–2007
Flood victims	Flood	Strelau, Zawadzki, Oniszczenko, and Sobolewski (2002) and Zawadzki, Bieniek, Strelau, Oniszczenko, and Sobolewski (2002)	Flood victims from Klodzko, Kedzierzyn Kozle, and Raciborz, assessed twice within 24 months after the flood	DSM-IV	FCB-TI	377 (198, 179)	14–85	1999
Flood victims	Flood	Zawadzki (unpublished; sample see: Cyniak-Cieciura et al. 2017)	Flood victims from Sandomierz, assessed once within 5 years after the flood	DSM-5	FCB-TI(R)	303 (173, 130)	18–85	2015
Fire victims	Fire	Zawadzki, Kaczmarek, and Strelau (2008)	Fire victims from Slubice and big Polish cities, assessed twice in 12 and 24 months after the fire	DSM-IV	FCB-TI	321 (178, 143)	13–85	No data
Neurosurgery patients	Chronic illness	Oniszczenko (unpublished)	Patients after neurological surgeries, assessed once	DSM-IV	FCB-TI	100 (50, 50)	18–82	No data
Oncological patients	Chronic illness	Oniszczenko and Laskowska (2011)	Oncological patients, assessed once	DSM-IV	FCB-TI	150 (54, 96)	20–79	No data
Surgery patients	Chronic illness	Oniszczenko (unpublished)	Patients after surgeries, assessed once	DSM-IV	FCB-TI	31 (22, 9)	22–60	No data
Urological patients	Chronic illness	Oniszczenko (unpublished)	Urological patients, assessed once	DSM-IV	FCB-TI	17 (6, 11)	24–63	No data
Internal patients	Chronic illness	Oniszczenko (unpublished)	Internal patients, assessed once	DSM-IV	FCB-TI	42 (23, 19)	23–66	No data
Gynecologic patients	Chronic illness	Oniszczenko, Szulc, Bulsa, and Zebielowicz (2016)	Women with gynecologic pathology (uterine disorders, sarcomas and polyps, tubal occlusion, ovarian cysts, endometriosis, and adnexal inflammation), assessed once	DSM-IV	FCB-TI	136 (136, 0)	18–60	No data
HIV carriers	Chronic illness	Rzeszutek, Oniszczenko, and Firląg-Burkacka (2012), Rzeszutek, Oniszczenko, Schier, Biernat-Kałuża, and Gasik (2016), and Rzeszutek and Oniszczenko (2013)	HIV carriers from Warsaw without an AIDS diagnosis, assessed once	DSM-IV	FCB-TI	128 (87, 95)	19–62	2013–2015
AIDS sufferers	Chronic illness	Rzeszutek, Oniszczenko, and Firląg-Burkacka (2012), Rzeszutek et al. (2015), and Rzeszutek and Oniszczenko (2013)	HIV carriers from Warsaw in an active phase of AIDS, assessed once	DSM-IV	FCB-TI	128 (66, 62)	22–68	2013–2015
Rheumatoid arthritis sufferers	Chronic illness	Rzeszutek et al. (2016)	Rheumatoid arthritis sufferers from Warsaw, assessed once	DSM-IV	FCB-TI	150 (108, 42)	20–84	2013–2015

Traits	ES [95% CI]	Z (p)	Q (p)	I²
BR	–.26 [–.30, –.22]	–12.40 (<.01)	114.26 (<.01)	56.24
PE	.23 [.20, .26]	12.94 (<.01)	83.42 (<.01)	40.06
SS	–.14 [–.17, –.10]	–7.13 (<.01)	95.97 (<.01)	47.90
EN	–.26 [–.30, –.22]	–13.26 (<.01)	102.19 (<.01)	51.07
ER	.34 [.31, .37]	18.52 (<.01)	93.22 (<.01)	46.36
AC	–.16 [–.19, –.13]	−9.36 (<.01)	75.77 (.01)	34.01

Trait	Gender	Study Type	Trauma	Time After the Trauma	DSM Version	FCB-TI Version
BR	−.24	−.27	−.15*	−.24*	−.28*	−.30*	−.25*	−.25*	−.09*	−.47*	−.25	−.23	−.28**	−.13**	−.28*	−.16*
PE	.15**	.28**	.21*	.15*	.25*	.26**	.19**	.21**	.35**	.32**	.21	.19	.22	.26	.22	.27
SS	−.16	−.12	−.07	−.15	−.16	−.23**	−.14**	−.10**	.01**	−.24**	−.12	−.16	−.16**	.00**	−.16**	−.01**
EN	−.20**	−.30**	−.31	−.27	−.26	−.22*	−.27*	−.26*	−.20*	−.42*	−.28	−.21	−.27	−.22	−.26	−.24
ER	.29**	.37**	.23*	.32*	.35*	.38	.34	.32	.32	.45	.32	.30	.35*	.27*	.35*	.29*
AC	−.17	−.15	−.15	−.20	−.15	−.16*	−.21*	−.10*	−.12*	−.20*	−.16*	−.15	−.17	−.10	−.17*	−.09*

Traits	Fail-Safe N	Egger’s Test (1997)	Trimm and Fill
BR	4,588	−0.79 (.62)	1.28 (.21)	−.26/−.24
PE	3,671	0.43 (.54)	0.81 (.43)	.23/.23
SS	1,257	−1.35 (.55)	2.47 (.02)	−.14/−.10
EN	4,691	−0.53 (.59)	0.90 (.37)	−.26/−.26
ER	8,449	0.58 (.56)	1.03 (.31)	.34/.32
AC	1,662	−0.24 (.51)	0.46 (.65)	−.16/−.17

General Findings
All six temperament traits, defined according to Regulative Theory of Temperament, are significantly related to PTSD symptoms. The traits responsible for high arousal level (emotional reactivity and perseveration) show positive relation to PTSD symptoms. The traits responsible for the low arousal level (endurance, briskness, sensory sensitivity, and activity) show negative relation to PTSD symptoms. Most temperament traits (apart from sensory sensitivity) are related to PTSD symptoms when measured in a pretraumatic period, which suggests their predictive role in determining the vulnerability to PTSD development following a traumatic event. Among different moderators a previously unrecognized effect of gender is revealed as it explains a significant amount of the variance in the case of emotional reactivity, endurance, and perseveration—the relation is significantly stronger among men than women.

Footnotes

Acknowledgments

The authors are grateful to the team of the Interdisciplinary Center for Behavior Genetic Research at Warsaw University and to all scientists for sharing their results: Wlodzimierz Oniszczenko, PhD, Marcin Rzeszutek, PhD, Urszula Baranczuk, PhD, Anna Glibowska, and Katarzyna Karolczyk. We would like to thank the anonymous reviewers for their valuable comments.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was supported by the Grant 2012/06/A/HS6/00340 PTSD: Diagnosis Therapy Prevention from the Polish National Science Centre.

ORCID iD

Maria Cyniak-Cieciura

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Traits	Fail-Safe N	Egger’s Test (1997)		Trimm and Fill
Traits	Fail-Safe N	Intercept (SE)	t (p)	ES obs./adj.
BR	4,588	−0.79 (.62)	1.28 (.21)	−.26/−.24
PE	3,671	0.43 (.54)	0.81 (.43)	.23/.23
SS	1,257	−1.35 (.55)	2.47 (.02)	−.14/−.10
EN	4,691	−0.53 (.59)	0.90 (.37)	−.26/−.26
ER	8,449	0.58 (.56)	1.03 (.31)	.34/.32
AC	1,662	−0.24 (.51)	0.46 (.65)	−.16/−.17