Personality and longevity: knowns, unknowns, and implications for public health and personalized medicine

Personality in women and associations with mortality: a 40-year follow-up in the population study of women in Gothenburg

Background

The question of whether personality traits influence health has long been a focus for research and discussion. Therefore, this study was undertaken to examine possible associations between personality traits and mortality in women.

Methods

A population-based sample of women aged 38, 46, 50 and 54 years at initial examination in 1968–69 was followed over the course of 40 years. At baseline, 589 women completed the Cesarec-Marke Personality Schedule (the Swedish version of the Edwards Personal Preference Schedule) and the Eysenck Personality Inventory. Associations between personality traits and mortality were tested using Cox proportional hazards models.

Results

No linear associations between personality traits or factor indices and mortality were found. When comparing the lowest (Q1) and highest quartile (Q4) against the two middle quartiles (Q2 + Q3), the personality trait Succorance Q1 versus Q2 + Q3 showed hazard ratio (HR) = 1.37 (confidence interval (CI) = 1.08-1.74), and for the factor index Aggressive non-conformance, both the lowest and highest quartiles had a significantly higher risk of death compared to Q2 + Q3: for Q1 HR = 1.32 (CI = 1.03-1.68) and for Q4 HR = 1.36 (CI = 1.06-1.77). Neither Neuroticism nor Extraversion predicted total mortality.

Conclusions

Personality traits did not influence long term mortality in this population sample of women followed for 40 years from mid- to late life. One explanation may be that personality in women becomes more circumscribed due to the social constraints generated by the role of women in society.

Translating personality psychology to help personalize preventive medicine for young adult patients

The rising number of newly insured young adults brought on by health care reform will soon increase demands on primary care physicians. Physicians will face more young adult patients, which presents an opportunity for more prevention-oriented care. In the present study, we evaluated whether brief observer reports of young adults' personality traits could predict which individuals would be at greater risk for poor health as they entered midlife. Following the cohort of 1,000 individuals from the Dunedin Multidisciplinary Health and Development Study (Moffitt, Caspi, Rutter, & Silva, 2001), we show that very brief measures of young adults' personalities predicted their midlife physical health across multiple domains (metabolic abnormalities, cardiorespiratory fitness, pulmonary function, periodontal disease, and systemic inflammation). Individuals scoring low on the traits of Conscientiousness and Openness to Experience went on to develop poorer health even after accounting for preexisting differences in education, socioeconomic status, smoking, obesity, self-reported health, medical conditions, and family medical history. Moreover, personality ratings from peer informants who knew participants well, and from a nurse and receptionist who had just met participants for the first time, predicted health decline from young adulthood to midlife despite striking differences in level of acquaintance. Personality effect sizes were on par with other well-established health risk factors such as socioeconomic status, smoking, and self-reported health. We discuss the potential utility of personality measurement to function as an inexpensive and accessible tool for health care professionals to personalize preventive medicine. Adding personality information to existing health care electronic infrastructures could also advance personality theory by generating opportunities to examine how personality processes influence doctor-patient communication, health service use, and patient outcomes.

Personality Change Pre- to Post- Loss in Spousal Caregivers of Patients with Terminal Lung Cancer

Personality is relatively stable in adulthood but could change in response to life transitions, such as caring for a spouse with a terminal illness. Using a case-control design, spousal caregivers (n=31) of patients with terminal lung cancer completed the NEO-FFI twice, 1.5 years apart, before and after the patient's death. A demographically-matched sample of community controls (n=93) completed the NEO-FFI on a similar timeframe. Based on research and theory, we hypothesized that bereaved caregivers would experience greater changes than controls in interpersonal facets of extraversion (sociability), agreeableness (prosocial, nonantagonistic), and conscientiousness (dependability). Consistent with hypotheses, bereaved caregivers experienced an increase in interpersonal orientation, becoming more sociable, prosocial, and dependable (Cohen's d = .48-.67), though there were no changes in nonantagonism. Changes were not observed in controls (ds ≤ .11). These initial findings underscore the need for more research on the effect of life transitions on personality.

Illness perceptions and personality traits of patients with mental disorders: the impact of ethnicity

OBJECTIVE

To identify differences and similarities between immigrants of Turkish origin and native German patients in therapeutically relevant dimensions such as subjective illness perceptions and personality traits.

METHOD

Turkish and native German mentally disordered in-patients were interviewed in three psychiatric clinics in Hessen, Germany. The Revised Illness Perception Questionnaire (IPQ-Revised) and the Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI) were used. Differences of scales and similarities by k-means cluster analyses were estimated.

RESULTS

Of the 362 total patients, 227 (123 immigrants and 104 native Germans) were included. Neither demographic nor clinical differences were detected. Socioeconomic gradients and differences on IPQ-R scales were identified. For each ethnicity, the cluster analysis identified four different patient types based on NEO-FFI and IPQ-R scales. The patient types of each ethnicity appeared to be very similar in their structure, but they differed solely in the magnitude of the cluster means on included subscales according to ethnicity.

CONCLUSION

When subjective illness perceptions and personality traits are considered together, basic patient types emerge independent of the ethnicity. Thus, the ethnical impact on patient types diminishes and a convergence was detected.

Personality and the leading behavioral contributors of mortality

OBJECTIVE

Personality traits predict both health behaviors and mortality risk across the life course. However, there are few investigations that have examined these effects in a single study. Thus, there are limitations in assessing if health behaviors explain why personality predicts health and longevity.

METHOD

Utilizing 14-year mortality data from a national sample of over 6,000 adults from the Midlife in the United States Study, we tested whether alcohol use, smoking behavior, and waist circumference mediated the personality-mortality association.

RESULTS

After adjusting for demographic variables, higher levels of Conscientiousness predicted a 13% reduction in mortality risk over the follow-up. Structural equation models provided evidence that heavy drinking, smoking, and greater waist circumference significantly mediated the Conscientiousness-mortality association by 42%.

CONCLUSION

The current study provided empirical support for the health-behavior model of personality-Conscientiousness influences the behaviors persons engage in and these behaviors affect the likelihood of poor health outcomes. Findings highlight the usefulness of assessing mediation in a structural equation modeling framework when testing proportional hazards. In addition, the current findings add to the growing literature that personality traits can be used to identify those at risk for engaging in behaviors that deteriorate health and shorten the life span.

Is personality associated with health care use by older adults?

CONTEXT

The patterns of health care utilization in the United States pose well-established challenges for public policy. Although economic and sociological research has resulted in considerable knowledge about what influences the use of health services, the psychological literature in this area is underdeveloped. Importantly, it is not known whether personality traits are associated with older adults' use of acute and long-term care services.

METHODS

Data were collected from 1,074 community-dwelling seniors participating in a Medicare demonstration. First they completed a self-report questionnaire measuring the "Big Five" personality traits: Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. During the next two years, the participants maintained daily journals of their use of health care services. We used regression models based on the Andersen behavioral model of health care utilization to test for associations.

FINDINGS

Our hypothesis that higher Neuroticism would be associated with greater health care use was confirmed for three services-probability of any emergency department (ED) use, likelihood of any custodial nursing home use, and more skilled nursing facility (SNF) days for SNF users-but was disconfirmed for hospital days for those hospitalized. Higher Openness to Experience was associated with a greater likelihood of custodial home care use, and higher Agreeableness and lower Conscientiousness with a higher probability of custodial nursing home use. For users, lower Openness was associated with more ED visits and SNF days, and lower Conscientiousness with more ED visits. For many traits with significant associations, the predicted use was 16 to 30 percent greater for people high (low) versus low (high) in specific traits.

CONCLUSIONS

Personality traits are associated with Medicare beneficiaries' use of many expensive health care services, findings that have implications for health services research and policy. Accordingly, person-centered interventions, population-based translational effectiveness programs, and other personalized approaches that leverage the profound advances in personality psychology in recent decades should be considered.

Predictive value of social inhibition and negative affectivity for cardiovascular events and mortality in patients with coronary artery disease: the type D personality construct

OBJECTIVE

Methodological considerations and selected null findings indicate the need to reexamine the Type D construct. We investigated whether associations with cardiac events in patients with coronary artery disease (CAD) involve the specific combination of negative affectivity (NA) and social inhibition (SI), or rather the main effect of either trait alone.

METHODS

In this 5-year follow-up of 541 patients with CAD, the Type D construct (14-item Type D Scale) was tested by examining a) the interaction of continuous NA and SI z scores and b) a four-group classification defined by low/high trait scores. End points were major adverse cardiac events (MACEs; death, myocardial infarction [MI], coronary revascularization) and cardiac death/MI.

RESULTS

At follow-up, 113 patients had a MACE, including 47 patients with cardiac death/MI. After adjustment for disease severity, age, sex, and main trait effects, the interaction of NA and SI z scores was associated with MACE (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.11-1.67). This continuous measure of Type D was also associated with cardiac death/MI (OR = 1.48, 95% CI = 1.11-1.96) and remained an independent predictor of events after adjustment for depressive symptoms. Using a cutoff of 10 on both NA and SI scales, Type D was associated with an adjusted OR of 1.74 (95% CI = 1.11-2.73) for MACE and an OR of 2.35 (95% CI = 1.26-4.38) for death/MI but was unrelated to noncardiac death. Patients with high NA or SI alone were not at increased risk.

CONCLUSIONS

Continuous (NA × SI interaction) and dichotomized measures of Type D were associated with cardiovascular events in patients with CAD. Research is needed to explore moderating factors that may alter this association.

Type D personality is associated with psychological distress and poor self-rated health among the elderly: a population-based study in Japan

We investigated the association between Type D personality, psychological distress, and self-ratings of poor health in elderly Japanese people. In August 2010, questionnaires were sent to all residents aged ≥65 in three municipalities (n = 21232) in Okayama Prefecture, Japan, and. 13929 questionnaires were returned (response rate: 65.6%). To assess mental and physical health outcomes, we used the Kessler Psychological Distress Scale and a single item question regarding perceived general health. We analyzed 9759 questionnaires to determine odds ratios (ORs) and 95% confidence intervals (CIs) for several health outcomes, adjusting for sex, age, smoking status, frequency of alcohol consumption, overweight status, educational attainment, socioeconomic status, and number of cohabiters. The multiple imputation method was employed for missing data regarding Type D personality. The prevalence of Type D personality in our sample was 46.2%. After adjusting for covariates, we found that participants with Type D personality were at 4–5 times the risk of psychological distress, and twice the risk of poor self-rated health. This association was stronger in participants aged 65–74 years (psychological distress; OR: 5.80, 95% CI: 4.96–6.78, poor self-rated health; OR: 2.84, 95% CI: 2.38–3.38) than in those aged over 75 years (psychological distress; OR: 4.54, 95% CI: 3.96–5.19, poor self-rated health; OR: 2.05, 95% CI: 1.79–2.34). Type D personality is associated with adverse health status among Japanese elderly people in terms of mental and physical risk; therefore, further research into the implications of this personality type is warranted.

Emotion suppression and mortality risk over a 12-year follow-up

OBJECTIVE

Suppression of emotion has long been suspected to have a role in health, but empirical work has yielded mixed findings. We examined the association between emotion suppression and all-cause, cardiovascular, and cancer mortality over 12 years of follow-up in a nationally representative US sample.

METHODS

We used the 2008 General Social Survey-National Death Index (GSS-NDI) cohort, which included an emotion suppression scale administered to 729 people in 1996. Prospective mortality follow up between 1996 and 2008 of 111 deaths (37 by cardiovascular disease, 34 by cancer) was evaluated using Cox proportional hazards models adjusted for age, gender, education, and minority race/ethnicity.

RESULTS

The 75th vs. 25th percentile on the emotional suppression score was associated with hazard ratio (HR) of 1.35 (95% Confidence Interval [95% CI]=1.00, 1.82; P=.049) for all-cause mortality. For cancer and cardiovascular disease mortality, the HRs were 1.70 (95% CI=1.01, 2.88, P=.049) and 1.47 (95% CI=.87, 2.47, P=.148) respectively.

CONCLUSIONS

Emotion suppression may convey risk for earlier death, including death from cancer. Further work is needed to better understand the biopsychosocial mechanisms for this risk, as well as the nature of associations between suppression and different forms of mortality.

Invited commentary: Personality phenotype and mortality--new avenues in genetic, social, and clinical epidemiology

In this issue of the Journal, Jokela et al. (Am J Epidemiol. 2013;178(5):667-675) scrutinize the association between personality phenotype and all-cause mortality in remarkable detail by using an "individual-participant meta-analysis" design. Across 7 large cohorts varying in demographics and methods of personality measurement, they find varying prospective associations for 4 dimensions of the five-factor (or "Big Five") model of personality, but robust and consistent prospective associations for Big Five dimension of "conscientiousness." Jokela et al. place an important exclamation point on a long era of study of this topic and hint directly and indirectly at new avenues for this line of research. I consider the following 3 areas particularly rife for further inquiry: the role of genetics in personality and health studies; the role of personality in social inequalities in health; and the health policy and clinical implications of work like that of Jokela et al., including the potential role of personality phenotype in the evolution of personalized medicine.

Personality and dietary intake - findings in the Helsinki birth cohort study

Background

Personality traits are associated with health outcomes including non-communicable diseases. This could be partly explained by lifestyle related factors including diet. The personality traits neuroticism, extraversion, openness, agreeableness, and conscientiousness are linked with resilience, meaning adaptability in challenging situations. Resilient people usually comply with favorable health behaviors.

Objective

Our objective was to explore the associations between food and nutrient intake, personality traits and resilience.

Design

A validated semi-quantitative food frequency questionnaire was used to measure diet and the NEO-personality inventory to assess personality in 1681 subjects. Linear regression analysis was used to explore diet-personality associations and cluster analysis to define resilient and non-resilient personality profiles.

Results

Adjusting for age, education and energy intake, and applying Bonferroni corrections, openness in men was associated with higher vegetable (14.9 g/d for 1 SD increase in the personality score, P_Bonf <0.01) and lower confectionery and chocolate (−2.8 g/d, P_Bonf <0.01) intakes. In women, neuroticism was associated with lower fish (−4.9 g/d, P_Bonf <0.001) and vegetable (−18.9 g/d, P_Bonf <0.01) and higher soft drink (19.9 g/d, P_Bonf <0.001) intakes. Extraversion, in women, associated with higher meat (5.9 g/d, P_Bonf <0.05) and vegetable (24.8 g/d, P_Bonf<0.001) intakes, openness with higher vegetable (23.4 g/d, P_Bonf <0.001) and fruit (29.5 g/d, P_Bonf <0.01) intakes. Agreeableness was associated with a lower soft drink (−16.2 g/d, P_Bonf <0.01) and conscientiousness with a higher fruit (32.9 g/d, P_Bonf<0.01) intake in women. Comparing resilient and non-resilient subjects, we found resilience in women to be associated with higher intakes of vegetables (52.0 g/d, P<0.001), fruits (58.3 g/d, P<0.01), fish (8.6 g/d, P<0.01) and dietary fiber (1.6 g/d, P<0.01).

Conclusion

Personality traits are associated with dietary intake and especially subjects with resilient personality profiles had healthier dietary intakes. These associations were stronger in women than in men.

A questionnaire-wide association study of personality and mortality: the Vietnam Experience Study

OBJECTIVE

We examined the association between the Minnesota Multiphasic Personality Inventory (MMPI) and all-cause mortality in 4462 middle-aged Vietnam-era veterans.

METHODS

We split the study population into half-samples. In each half, we used proportional hazards (Cox) regression to test the 550 MMPI items' associations with mortality over 15years. In all participants, we subjected significant (p<.01) items in both halves to principal-components analysis (PCA). We used Cox regression to test whether these components predicted mortality when controlling for other predictors (demographics, cognitive ability, health behaviors, and mental/physical health).

RESULTS

Eighty-nine items were associated with mortality in both half-samples. PCA revealed Neuroticism/Negative Affectivity, Somatic Complaints, Psychotic/Paranoia, and Antisocial components, and a higher-order component, Personal Disturbance. Individually, Neuroticism/Negative Affectivity (HR=1.55; 95% CI=1.39, 1.72), Somatic Complaints (HR=1.66; 95% CI=1.52, 1.80), Psychotic/Paranoid (HR=1.44; 95% CI=1.32, 1.57), Antisocial (HR=1.79; 95% CI=1.59, 2.01), and Personal Disturbance (HR=1.74; 95% CI=1.58, 1.91) were associated with risk. Including covariates attenuated these associations (28.4 to 54.5%), though they were still significant. After entering Personal Disturbance into models with each component, Neuroticism/Negative Affectivity and Somatic Complaints were significant, although Neuroticism/Negative Affectivity's were now protective (HR=0.73; 95% CI=0.58, 0.92). When the four components were entered together with or without covariates, Somatic Complaints and Antisocial were significant risk factors.

CONCLUSIONS

Somatic Complaints and Personal Disturbance are associated with increased mortality risk. Other components' effects varied as a function of variables in the model.

Personality and risk of Alzheimer's disease: new data and meta-analysis

BACKGROUND

We examine whether broad factors and specific facets of personality are associated with increased risk of incident Alzheimer's disease (AD) in a long-run longitudinal study and a meta-analysis of published studies.

METHODS

Participants (n = 1671) were monitored for up to 22 years from a baseline personality assessment. The meta-analysis pooled results from up to five prospective studies (n = 5054).

RESULTS

Individuals with scores in the top quartile of neuroticism (hazard ratio = 3.1; 95% confidence interval = 1.6-6.0) or the lowest quartile of conscientiousness (hazard ratio = 3.3; 95% confidence interval = 1.4-7.4) had a threefold increased risk of incident AD. Among the components of these traits, self-discipline and depression had the strongest associations with incident AD. The meta-analysis confirmed the associations of neuroticism (P = 2 × 10(-9)) and conscientiousness (P = 2 × 10(-6)), along with weaker effects for openness and agreeableness (P < .05).

CONCLUSIONS

The current study and meta-analysis indicate that personality traits are associated with increased risk of AD, with effect sizes similar to those of well-established clinical and lifestyle risk factors.

Genome-wide association study of personality traits in the long life family study

Personality traits have been shown to be associated with longevity and healthy aging. In order to discover novel genetic modifiers associated with personality traits as related with longevity, we performed a genome-wide association study (GWAS) on personality factors assessed by NEO-five-factor inventory in individuals enrolled in the Long Life Family Study (LLFS), a study of 583 families (N up to 4595) with clustering for longevity in the United States and Denmark. Three SNPs, in almost perfect LD, associated with agreeableness reached genome-wide significance (p < 10⁻⁸) and replicated in an additional sample of 1279 LLFS subjects, although one (rs9650241) failed to replicate and the other two were not available in two independent replication cohorts, the Baltimore Longitudinal Study of Aging and the New England Centenarian Study. Based on 10,000,000 permutations, the empirical p-value of 2 × 10⁻⁷ was observed for the genome-wide significant SNPs. Seventeen SNPs that reached marginal statistical significance in the two previous GWASs (p-value <10⁻⁴ and 10⁻⁵), were also marginally significantly associated in this study (p-value <0.05), although none of the associations passed the Bonferroni correction. In addition, we tested age-by-SNP interactions and found some significant associations. Since scores of personality traits in LLFS subjects change in the oldest ages, and genetic factors outweigh environmental factors to achieve extreme ages, these age-by-SNP interactions could be a proxy for complex gene–gene interactions affecting personality traits and longevity.

Influence of personality on the relationship between gray matter volume and neuropsychiatric symptoms in multiple sclerosis

OBJECTIVE

Research has revealed an association between personality traits and health outcomes, and in multiple sclerosis (MS), there are preliminary data showing a correlation between personality traits and brain volume. We examined the general hypothesis that personality influences the relationship between gray matter volume (GMV) and cognitive/neuropsychiatric MS features.

METHODS

Participants were 98 patients with MS who underwent magnetic resonance imaging and were tested with the Symbol Digit Modalities Test and the Neuropsychiatric Inventory, the latter providing measures of depression and euphoria that can be characteristic of MS, that is, cheerful indifference and disinhibition. Personality traits were assessed with the NEO Five Factor Inventory. We examined the correlation between personality traits and both GMV and symptoms, and then modeled mediation and moderation influences on the relationships between GMV and cognitive/neuropsychiatric features.

RESULTS

Linear regression modeling revealed that GMV (r = 0.54, p < .001) and NEO Five Factor Inventory low conscientiousness (r = 0.36, p = .001) were associated with cognitive function, but no mediator or moderator effects were observed. However, conscientiousness mediated the relationship between GMV and symptoms of euphoria (p = .002). The moderator analysis revealed a significant influence of high neuroticism on the GMV-euphoria relationship (p = .029).

CONCLUSIONS

Low conscientiousness and high neuroticism are associated with neuropsychiatric complications in MS, and each influences the relationship between GMV and euphoria. The findings suggest that patients with low conscientiousness are at higher risk for MS-associated cognitive dysfunction and neuropsychiatric symptoms, a conclusion that has implications for the emerging role of personality in clinical neuroscience.

Personality and resilience to Alzheimer's disease neuropathology: a prospective autopsy study

Alzheimer's disease (AD) neuropathology is found at autopsy in approximately 30% of cognitively normal older individuals. We examined whether personality traits are associated with such resilience to clinical dementia in individuals with AD neuropathology. Broad factors and specific facets of personality were assessed up to 28 years (mean 11 ± 7 years) before onset of dementia and up to 30 years (mean 15 ± 7 years) before death in a cohort (n = 111) evaluated for AD neuropathology at autopsy. Individuals with higher baseline scores on vulnerability to stress, anxiety, and depression (neuroticism: odds ratio, 2.0; 95% confidence interval, 1.2-3.5), or lower scores on order and competence (conscientiousness: odds ratio, 0.4; 95% confidence interval, 0.2-0.9) were less likely to remain asymptomatic in the presence of AD neuropathology. Neuroticism (r = 0.26), low agreeableness (r = -0.34), and some facets were also significantly associated with advanced stages of neurofibrillary tangles, but the associations between personality traits and risk of clinical dementia were mostly unchanged by controlling for the extent of neurofibrillary tangles and Aβ neuritic plaques. In sum, a resilient personality profile is associated with lower risk or delay of clinical dementia even in persons with AD neuropathology.

Childhood conscientiousness relates to objectively measured adult physical health four decades later

OBJECTIVE

Many life span personality-and-health models assume that childhood personality traits result in life-course pathways leading through morbidity to mortality. Although childhood conscientiousness in particular predicts mortality, there are few prospective studies that have investigated the associations between childhood personality and objective health status in adulthood. The present study tested this crucial assumption of life span models of personality and health using a comprehensive assessment of the Big Five traits in childhood (M age = 10 years) and biomarkers of health over 40 years later (M age = 51 years).

METHODS

Members of the Hawaii Personality and Health Cohort (N = 753; 368 men, 385 women) underwent a medical examination at mean age 51. Their global health status was evaluated by well-established clinical indicators that were objectively measured using standard protocols, including blood pressure, lipid profile, fasting blood glucose, and body mass index. These indicators were combined to evaluate overall physiological dysregulation and grouped into five more homogeneous subcomponents (glucose intolerance, blood pressure, lipids, obesity, and medications).

RESULTS

Lower levels of childhood conscientiousness predicted more physiological dysregulation (β = -.11, p < .05), greater obesity (β = -.10, p < .05), and worse lipid profiles (β = -.10, p < .05), after controlling for the other Big Five childhood personality traits, gender, ethnicity, parental home ownership, and adult conscientiousness.

CONCLUSIONS

These findings are consistent with a key assumption in life span models that childhood conscientiousness is associated with objective health status in older adults. They open the way for testing mechanisms by which childhood personality may influence mortality through morbidity; mechanisms that could then be targeted for intervention.

Do psychosocial profiles predict self-rated health, morbidity and mortality in late middle-aged and older people?

Considering many psychosocial health risk factors are interrelated, determining psychosocial health risk might benefit from a more person-centered perspective. This paper explores to what extent a psychosocial profile that combines potentially synergistic effects of different psychosocial characteristics, including psychological attributes and functioning, coping styles and social support, predicts self-rated health, morbidity and mortality. Prospective, longitudinal data from 1,912 Dutch participants aged 55-91 years were used to determine distinct psychosocial profiles by means of two-step cluster analysis. The predictive power of these profiles over a 5-year follow-up was calculated with Cox regression models for all-cause mortality and general practitioner-diagnosed somatic morbidity, and logistic regression models for self-rated health. Three distinct psychosocial risk profiles emerged: an adverse, an average and a beneficial profile. These profiles strongly predicted self-rated health but not morbidity or mortality. The health effects of the cluster (profile) model suggest synergism between the psychosocial characteristics. Future research should replicate our findings to further validate the approach.

Extraversion predicts longer survival in gorillas: an 18-year longitudinal study

Personality plays an important role in determining human health and risk of earlier death. However, the mechanisms underlying those associations remain unknown. We moved away from testing hypotheses rooted in the activities of modern humans, by testing whether these associations are ancestral and one side of a trade-off between fitness costs and benefits. We examined personality predictors of survival in 283 captive western lowland gorillas (Gorilla gorilla gorilla) followed for 18 years. We found that of four gorilla personality dimensions--dominance, extraversion, neuroticism and agreeableness--extraversion was associated with longer survival. This effect could not be explained by demographic information or husbandry practices. These findings suggest that understanding how extraversion and other personality domains influence longevity requires investigating the evolutionary bases of this association in nonhuman primates and other species.

Big 5 personality traits and interleukin-6: evidence for "healthy Neuroticism" in a US population sample

The current study investigated if the Big 5 personality traits predicted interleukin-6 (IL-6) levels in a national sample over the course of 5years. In addition, interactions among the Big 5 were tested to provide a more accurate understanding of how personality traits may influence an inflammatory biomarker. Data included 1054 participants in the Midlife Development in the U.S. (MIDUS) biomarkers subproject. The Big 5 personality traits were assessed in 2005-2006 as part of the main MIDUS survey. Medication use, comorbid conditions, smoking behavior, alcohol use, body mass index, and serum levels of IL-6 were assessed in 2005-2009 as part of the biomarkers subproject. Linear regression analyses examined personality associations with IL-6. A significant Conscientiousness*Neuroticism interaction revealed that those high in both Conscientiousness and Neuroticism had lower circulating IL-6 levels than people with all other configurations of Conscientiousness and Neuroticism. Adjustment for health behaviors diminished the magnitude of this association but did not eliminate it, suggesting that lower comorbid conditions and obesity may partly explain the lower inflammation of those high in both Conscientiousness and Neuroticism. Our findings suggest, consistent with prior speculation, that average to higher levels of Neuroticism can in some cases be associated with health benefits - in this case when it is accompanied by high Conscientiousness. Using personality to identify those at risk may lead to greater personalization in the prevention and remediation of chronic inflammation.

Personality, metabolic rate and aerobic capacity

Personality traits and cardiorespiratory fitness in older adults are reliable predictors of health and longevity. We examined the association between personality traits and energy expenditure at rest (basal metabolic rate) and during normal and maximal sustained walking. Personality traits and oxygen (VO(2)) consumption were assessed in 642 participants from the Baltimore Longitudinal Study of Aging. Results indicate that personality traits were mostly unrelated to resting metabolic rate and energy expenditure at normal walking pace. However, those who scored lower on neuroticism (r = -0.12) and higher on extraversion (r = 0.11), openness (r = 0.13), and conscientiousness (r = 0.09) had significantly higher energy expenditure at peak walking pace. In addition to greater aerobic capacity, individuals with a more resilient personality profile walked faster and were more efficient in that they required less energy per meter walked. The associations between personality and energy expenditure were not moderated by age or sex, but were in part explained by the proportion of fat mass. In conclusion, differences in personality may matter the most during more challenging activities that require cardiorespiratory fitness. These findings suggest potential pathways that link personality to health outcomes, such as obesity and longevity.

Longitudinal correlated changes in conscientiousness, preventative health-related behaviors, and self-perceived physical health

OBJECTIVE

Previous research has found that conscientiousness has positive associations with preventative health-related behaviors and self-perceived health, but little is known about the links between changes in these variables over time. In the present study, we examined how levels and changes in conscientiousness were linked to levels and changes in both preventative health-related behaviors and self-perceived physical health.

METHOD

Personality and health questionnaires were administered to participants in two waves, with an interval of approximately three years. Participants ranged in age from 19 to 94. To elucidate the tripartite relations between conscientiousness, preventative health-related behaviors, and self-perceived physical health, we used latent change models to estimate levels and changes of these latent constructs over time.

RESULTS

Changes in conscientiousness were significantly and positively correlated with changes in preventative health behaviors and changes in self-perceived physical health. Changes in preventative health behaviors partially mediated the relation between changes in conscientiousness and changes in self-perceived physical health.

CONCLUSIONS

This longitudinal study extends previous research on conscientiousness and health by exploring the relations between latent variables over a 3-year period. It provides evidence that increases in conscientiousness and preventative health-related behaviors are associated with improvements in self-perceived health over the same time period.

Personality factors moderate the associations between apolipoprotein genotype and cognitive function as well as late onset Alzheimer disease

OBJECTIVES

We tested the hypothesis that neuroticism moderates the association between APOE (apolipoprotein E) genotype and two major outcomes, cognitive function and Alzheimer disease. We also explored whether other personality dimensions (extraversion, openness to experience, agreeableness, and conscientiousness) moderate the associations of APOE with these outcomes.

DESIGN

Primary analyses of existing randomized clinical trial data.

SAMPLE

Six-hundred two older adults (mean age of 78 years at baseline).

MEASUREMENTS

APOE genotype, the NEO-Five Factor Inventory, the Alzheimer's Disease Assessment Scale-Cognitive: measured every 6 months for 6.5 years) and relevant covariates.

RESULTS

Fully adjusted multivariate analyses showed that the association between the presence of APOE [Latin Small Letter Open E]-4 allele(s) and both outcomes was evident among individuals with high levels of neuroticism and extraversion but not among persons with low levels of these traits.

CONCLUSIONS

Phenotypic personality dimensions, primarily neuroticism and extraversion, moderate the relationship between APOE [Latin Small Letter Open E]-4 genotype and cognitive outcomes among older adults. Future research is needed to elucidate the physiological processes involved in these particular phenotype-genotype interactions.

Gene by neuroticism interaction and cognitive function among older adults

OBJECTIVES

Both apolipoprotein E (ApoE) ε-4 allele(s) and elevated trait neuroticism, the tendency to experience distress, are associated with cognitive function among older adults. We predicted that neuroticism moderates the association between ApoE and cognitive function and also explored whether other personality dimensions (openness to experience, agreeableness, extraversion, and conscientiousness) affect the association between ApoE status and cognitive function.

METHOD

Five-hundred and ninety-seven older adults (mean age of 78 years) enrolled in the Ginkgo Evaluation of Memory study completed the NEO five-factor inventory of personality. Cognitive function was assessed via the cognitive portion of the Alzheimer's Disease Assessment Scale, and a blood sample for ApoE genotyping was drawn.

RESULTS

As hypothesized, regression analysis indicated that neuroticism moderated the relationship between the presence of ApoE ε-4 and cognitive function. Individuals with high neuroticism scores had significantly lower scores on the cognitive portion of the Alzheimer's Disease Assessment Scale compared with individuals with low neuroticism scores, but this was true only among carriers of ApoE ε-4 (interaction effect β = 0.124, p = 0.028). There was scant evidence that other personality dimensions moderate the association between ApoE ε-4 and cognitive function.

CONCLUSIONS

Cognitive function may be affected by ApoE and neuroticism acting in tandem. Research on the underlying physiological mechanisms by which neuroticism amplifies the effect of ApoE ε-4 is warranted. The study of genotype by phenotype interactions provides an important and useful direction for the study of cognitive function among older adults and for the development of novel prevention programs.

Personality and physical functioning among older adults: the moderating role of education

OBJECTIVES

Drawing upon a vulnerability model, this study tested whether low educational level would amplify the negative contribution of risky personality traits, such as high neuroticism and low conscientiousness, on older adults physical functioning.

METHOD

Five hundred and thirteen French-speaking community-dwelling older adults aged 60-91 years (mean age = 66.37, SD = 5.32) completed measures of physical functioning, education, personality traits, chronic conditions, and demographic variables.

RESULTS

Results revealed that extraversion and conscientiousness were positively associated with physical functioning, whereas neuroticism was a negative predictor, beyond demographics, chronic conditions, and education. The negative relationship between neuroticism and physical functioning was stronger among individuals with low educational level and was nonsignificant among older people with higher level of education.

DISCUSSION

This study is the first to support a vulnerability model, which entails an amplification of neuroticism risk at low education, but a diminishment of neuroticism risk for activity limitations at high education. As a whole, it appears that a focus on either personality or education without taking into account each other provides only a partial account of the predictors of basic daily physical activities in old age.

Low conscientiousness and risk of all-cause, cardiovascular and cancer mortality over 17 years: Whitehall II cohort study

OBJECTIVE

To examine the personality trait conscientiousness as a risk factor for mortality and to identify candidate explanatory mechanisms.

METHODS

Participants in the Whitehall II cohort study (N=6800, aged 34 to 55 at recruitment in 1985) completed two self-reported items measuring conscientiousness in 1991-1993 ('I am overly conscientious' and 'I am overly perfectionistic', Cronbach's α=.72), the baseline for this study. Age, socio-economic status (SES), social support, health behaviours, physiological variables and minor psychiatric morbidity were also recorded at baseline. The vital status of participants was then monitored for a mean of 17 years. All-cause and cause-specific mortality was ascertained through linkage to a national mortality register until January 2010.

RESULTS

Each 1 standard deviation decrease in conscientiousness was associated with a 10% increase in all-cause (hazard ratio [HR]=1.10, 95% CI 1.003, 1.20) mortality. Patterns were similar for cardiovascular (HR=1.17, 95% CI 0.98, 1.39) and cancer mortality (HR=1.10, 95% CI 0.96, 1.25), not reaching statistical significance. The association with all-cause mortality was attenuated by 5% after adjustment for SES, 13% for health behaviours, 14% for cardiovascular risk factors, 5% for minor psychiatric morbidity, 29% for all variables. Repeating analyses with each item separately and excluding participants who died within five years of personality assessment did not change the results materially.

CONCLUSION

Low conscientiousness in midlife is a risk factor for all-cause mortality. This association is only partly explained by health behaviours, SES, cardiovascular disease risk factors and minor psychiatric morbidity in midlife.

Genes, environments, personality, and successful aging: toward a comprehensive developmental model in later life

BACKGROUND

Outcomes in aging and health research, such as longevity, can be conceptualized as reflecting both genetic and environmental (nongenetic) effects. Parsing genetic and environmental influences can be challenging, particularly when taking a life span perspective, but an understanding of how genetic variants and environments relate to successful aging is critical to public health and intervention efforts.

METHODS

We review the literature, and survey promising methods, to understand this interplay. We also propose the investigation of personality as a nexus connecting genetics, environments, and health outcomes.

RESULTS

Personality traits may reflect psychological mechanisms by which underlying etiologic (genetic and environmental) effects predispose individuals to broad propensities to engage in (un)healthy patterns of behavior across the life span. In terms of methodology, traditional behavior genetic approaches have been used profitably to understand how genetic factors and environments relate to health and personality in somewhat separate literatures; we discuss how other behavior genetic approaches can help connect these literatures and provide new insights.

CONCLUSIONS

Co-twin control designs can be employed to help determine causality via a closer approximation of the idealized counterfactual design. Gene-by-environment interaction (G × E) designs can be employed to understand how individual difference characteristics, such as personality, might moderate genetic and environmental influences on successful aging outcomes. Application of such methods can clarify the interplay of genes, environments, personality, and successful aging.

Type D personality and health status in cardiovascular disease populations: a meta-analysis of prospective studies

BACKGROUND

Knowledge of the factors associated with individual differences in patient-reported outcomes is essential to identify high-risk patients and improve secondary prevention.

DESIGN

In this meta-analysis, we examined the association between Type D personality and the individual differences in patient-reported physical and mental health status among cardiovascular patients.

METHODS

A computerized search of the literature through PUBMED and PsychINFO (from 1995 to May 2011) was performed and prospective studies were selected that analysed the association between Type D personality and health status in cardiovascular patients. Two separate meta-analyses were performed for the association of Type D personality with physical and mental health status, respectively.

RESULTS

Of all identified studies, ten studies met the selection criteria. The meta-analyses showed that Type D was associated with a two-fold increased odds for impaired physical health status (3035 patients, OR 1.94, 95% CI 1.49-2.52) and a 2.5-fold increased odds for impaired mental health status (2213 patients, OR 2.55, 95% CI 1.57-4.16). There was no significant heterogeneity between the studies on physical health status (Q = 12.78; p = 0.17; I(2 )= 29.59), but there was between those on mental health status (Q = 21.91; p = 0.003; I(2 )= 68.04). Subgroup analyses showed that the association between Type D and mental health status decreased yet remained significant when adjusting for baseline health status.

CONCLUSION

Type D personality was shown to be an independent correlate of impaired patient-reported physical and mental health status in various cardiovascular patient groups. Clinicians should be aware of the association between chronic psychological distress and poor patient-reported outcomes.

Quality of life among patients undergoing bariatric surgery: associations with mental health- A 1 year follow-up study of bariatric surgery patients

BACKGROUND

Preoperative mental health seems to have useful predictive value for Health Related Quality of Life (HRQOL) after bariatric surgery. The aim of the present study was to assess pre- and postoperative psychiatric disorders and their associations with pre- and postoperative HRQOL.

METHOD

Data were assessed before (n = 127) and one year after surgery (n = 87). Psychiatric disorders were assessed by Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview (SCID-II). HRQOL was assessed by the Short Form 36 (SF-36) questionnaire.

RESULTS

Significant improvements were found in HRQOL from preoperative assessment to follow-up one year after surgery. For the total study population, the degree of improvement was statistically significant (p values < .001) for seven of the eight SF-36 subscales from preoperative assessment to follow-up one year after surgery. Patients without psychiatric disorders had no impairments in postoperative HRQOL, and patients with psychiatric disorders that resolved after surgery had small impairments on two of the eight SF-36 subscales compared to the population norm (all effect sizes < .5) at follow-up one year after surgery. Patients with psychiatric disorders that persisted after surgery had impaired HRQOL at follow-up one year after surgery compared to the population norm, with effect sizes for the differences from moderate to large (all effect sizes ≥ .6).

CONCLUSION

This study reports the novel finding that patients without postoperative psychiatric disorders achieved a HRQOL comparable to the general population one year after bariatric surgery; while patients with postoperative psychiatric disorders did not reach the HRQOL level of the general population. Our results support monitoring patients with psychiatric disorders persisting after surgery for suboptimal improvements in quality of life after bariatric surgery.

TRIAL REGISTRATION

The trial is registered at http://www.clinicaltrials.gov prior to patient inclusion (ProtocolID16280).