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  • Robert Reuss

Personality and health

The association between personality factors and physical and mental health

  1. Personality/Psychological traits and health outcomes

  2. Personality/Psychological traits and adherence to health treatments

  3. Importance of personality characteristics "emotional DNA" for a treatment plan

  4. Personality/Psychological traits and health diagnosis

  5. Personality/Psychological traits and health communication

1. Personality/Psychological traits and health outcomes

In the studies brought here there is a clear relationship between psychological factors and health outcomes. The more we know about the individual’s personality traits, behaviours, and attitudes, the better we can predict health outcomes. This was found in studies that focused on compulsive behaviour, whether alcoholism or gambling and alcoholism but also in general health and in cardiac issues. As the researchers say in their concluding remarks, (Barroilhet et al., 2020 in General Hospital Psychiatry) “In aggregate, our results demonstrate that individual personality features can be identified in narrative clinical notes drawn from nonpsychiatric cohorts, and that such features associate with outcomes including mortality and readmission”.

Carpeggiani, C., Emdin, M., Bonaguidi, F., Landi, P., Michelassi, C., Trivella, M. G., ... & L'Abbate, A. (2005). Personality traits and heart rate variability predict long-term cardiac mortality after myocardial infarction. European Heart Journal, 26(16), 1612-1617.‏

The researchers investigated Psychological traits in 246 patients at discharge of an ACUTE MYOCARDIAL INFARCTION (AMI). Patients were followed-up to 8 years for the occurrence of cardiac death and non-fatal reinfarction. The study found that low emotional sensitivity (an inability to express emotion and adapting to society or coping) and insecurity (anxiety) were significant predictors of cardiac death at 8-year follow-up after AMI.

Barroilhet, S. A., Bieling, A. E., McCoy Jr, T. H., & Perlis, R. H. (2020). Association between DSM-5 and ICD-11 personality dimensional traits in a general medical cohort and readmission and mortality. General hospital psychiatry, 64, 63-67.‏

The study examined personality features that are associated with readmission to and mortality risk. The researchers analyzed electronic health records of a cohort of patients admitted to a general hospital using a previously developed natural language processing tool for extracting DSM-5 and ICD-11 personality domains. The results indicated that presence of disinhibition was independently associated with a higher mortality risk, while anankastic traits were associated with a lower mortality risk. In addition, increased likelihood of readmission was predicted by detachment, while decreased likelihood of readmission was associated with disinhibition and psychoticism traits. The researched concluded that developing treatment strategies that target patients with higher personality symptom burden in specific dimensions could enable more efficient and focused interventions.

Sahoo, S., Padhy, S. K., Padhee, B., Singla, N., & Sarkar, S. (2018). Role of personality in cardiovascular diseases: An issue that needs to be focused too!. Indian heart journal, 70, S471-S477.

There has been a sustained interest over the last half a century on the issue of relationship between personality traits and CVDs. Type A behaviour was the initial focus of inquiry as it was observed that individuals who were competitive, hostile, and excessively driven were more likely to have cardiovascular complications. Studies have recently found that negative effects (including anger and hostility) were also associated with adverse cardiovascular outcomes. Subsequently, a new personality entity named as the type D ‘distressed’ personality, which combined negative affectivity and social inhibition. Was associated with negative outcomes. Interestingly, a few personality traits such as optimism, conscientiousness, openness to experience, and curiosity have been found to be protective factors against development of CVDs and therefore are called ‘cardioprotective’ personality traits.

  • Higher order personality dimension of Negative Affectivity or Negative Emotionality (NE; presented in greater detail later) is associated with a wide variety of psychopathological conditions, including mood, anxiety, and somatoform disorders (Tellegen & Waller, 1994; Watson & Clark,1984).

2. Personality/Psychological traits and adherence to health treatments

Müller, S. E., Weijers, H. G., Böning, J., & Wiesbeck, G. A. (2008). Personality traits predict treatment outcome in alcohol-dependent patients. Neuropsychobiology, 57(4), 159-164.

Personality traits build the basis of consistent patterns of experience and behaviour, which in turn have been found to predict the outcome of treatment in different diseases. For example, personality traits emerged as useful predictors of treatment outcome in patients with gastrointestinal disorders obesity, hyperopia and even individual responses to certain surgical treatments seem to be associated with personality. In psychiatry, personality traits have been successfully linked to treatment outcome in depression, anorexia nervosa, schizophrenia, and withdrawal severity in benzodiazepine dependence. In alcoholism research, personality traits have become a matter of scientific interest as well. Regarding treatment outcome, several authors identified specific personality traits as predictors of relapse in alcohol dependent patients. For example, the personality trait ‘novelty seeking’ is a strong predictor of relapse in detoxified male alcoholics, whereas the trait ‘harm avoidance’ has been shown to predict early relapse in females. This is in line with results of Kravitz et al., which revealed that dropouts in a study of alcohol-dependent men had higher novelty-seeking scores than non-dropouts.The risk of relapse, 1 year after an inpatient treatment program for alcohol-dependent patients, is greatest in patients with low scores in conscientiousness and high scores in neuroticism. In addition, several follow-up studies over 6 months revealed low persistence scores as predictors of relapse in alcohol-dependent patients. In conclusion, the evidence suggests that personality traits are important individual factors influencing treatment outcome, not only in various diseases, but also in alcoholism.

Ramos-Grille, I., Gomà-i-Freixanet, M., Aragay, N., Valero, S., & Vallès, V. (2015). Predicting treatment failure in pathological gambling: the role of personality traits. Addictive Behaviours, 43, 54-59.

Although few studies have focused on the personality profile of pathological gamblers (PG), still fewer have focused on which personality traits might predict treatment outcome. Systematic reviews on treatment outcome have found that the prevalence of relapses in pathological gambling is very high and that dropouts from psychological treatment identified percentages ranging from 14–50% with a median of 26%. These findings are highly significant if we consider that PGs who seek treatment comprise a minority within those found in community samples.

Reviewing the literature on treatment outcome, specifically on relapse and dropout, Ledgerwood and Petry and Melville et al. found that personality variables such as Neuroticism and Impulsivity were associated with treatment failure. Their reviews highlighted, inter alia, that individual differences in personality may play an important role in explaining the risk of relapsing and dropping out.

Ramos-Grille, I., Gomà-i-Freixanet, M., Aragay, N., Valero, S., & Vallès, V. (2013). The role of personality in the prediction of treatment outcome in pathological gamblers: A follow-up study. Psychological assessment, 25(2), 599.

A recent study by Ramos-Grille, Gomài-Freixanet, Aragay, Valero, and Vallès (2013) researched which personality domains would predict relapse and dropout after 1-year follow-up by administering the Revised NEO Personality Inventory to 73 treatment-seeking slot-machine PGs attending an open program of individual cognitive-behavioural therapy. This study identified low scores on Conscientiousness as a significant predictor of relapse; whereas low scores on Conscientiousness and Agreeableness were significant predictors of dropout. These findings support the importance of differential patterns of individual differences on treatment outcome.

Mols, F., Thong, M., Denollet, J., Oranje, W. A., Netea-Maier, R. T., Smit, J. W., & Husson, O. (2020). Are illness perceptions, beliefs about medicines and Type D personality associated with medication adherence among thyroid cancer survivors? A study from the population-based PROFILES registry. Psychology & health, 35(2), 128-143.

Adherence in health care is defined as the extent to which a person’s behaviour (e.g. taking medication or following treatment guidelines corresponds with the recommendations given by a health care provider. Research has shown that poor adherence is expected in approximately 50% of adults This is a missed opportunity for health improvement and identifying the personality or circumstances where this occurs may very well have a positive effect on health outcomes.

Several examples of the relationship between personality and compliance can be provided. Medication adherence is important among thyroid cancer survivors. Research findings show that more than 50% of such patients do not comply fully to treatment recommendation. In particular, the findings of one recent study showed that, opposite to what one would think, those with a higher perceived necessity of medication reported higher nonadherence. This might sound a bit inconsistent, however, the researchers argued that those who believe in the necessity of their medication might simultaneously feel that they currently do not receive the optimal dose of levothyroxine which might explain their (intentional) nonadherence. Talking and explaining exactly what is involved in the treatment and making sure they understand it is a way of increasing compliance.

Aflakseir, A., Nikroo, F., & Mollazade, J. (2020). Predicting Medication Adherence Based on Personality Characteristics in Individuals with Type 2 Diabetes Mellitus. Iranian journal of diabetes and obesity.

In another study, one hundred twenty individuals with type 2 diabetes who visited health centers were investigated. The researchers used the BIG-Five personality test to see which factors are related to compliance. Their study indicated that a large proportion of patients with type 2 diabetes did not adhere to their medications. The Big-Five personality factors, include measures of agreeableness, conscientiousness, extraversion, neuroticism, and openness to experience. This study highlighted that the personality trait of neuroticism (neuroticism is described as poor ability to cope with psychological stress) was important in predicting medication adherence in patients with type 2 diabetes. In other words, patients with higher neuroticism were less likely to adhere to their prescribed medication.

Baroletti, S., & Dell'Orfano, H. (2010). Medication adherence in cardiovascular disease. Circulation, 121(12), 1455-1458.

In the area of cardiovascular disease, many characteristics have been found to associated with compliance. Nonadherence to medications has been documented to occur in >60% of cardiovascular patients. Those with depression or other significant psychiatric illnesses, heavy drinkers, and nonwhite patients have been associated with risk for low adherence rates. Individuals with low levels of motivation are in a sense building a barrier to medication adherence….Working on increasing motivation may very well lead to better outcomes in cardiac patients.

3. Importance of personality characteristics "emotional DNA" for a treatment plan

  • Treatment should be personal as the diagnosis that refers to a single person. Using the ordinary medical model alone for treatment exposes patients to serious threats, prolongs hospitalization, and raises treatment costs. The holistic nursing care of patients with minor injuries attending the A&E department. Olive P Accid Emerg Nurs. 2003 Jan; 11(1):27-32.)

  • The features the diagnostician focuses on may be consequences of (a) extreme levels of personality traits, (b) especially problematic configurations of trait levels (Grove & Tellegen, 1991), or (c) extreme (i.e., socially or personally maladaptive) adaptations to personality traits or their configural properties (see Clark, Watson, & Mineka, 1994; Eberly, Harkness, & Engdahl,1991; Watson, Clark, & Harkness, 1994).

  • The cognitive attributional style typical of individuals with major depression, that is, a propensity to make stable, global, and perhaps internal causal attributions for negative life events (Abramson, Seligman, & Teasdale, 1978), may in some cases reflect elevated levels of NE (Clark & Watson, 1991a). Specifically, individuals with high NE tend to focus on the negative aspects of their life situations and to dwell on their inadequacies (Watson & Clark, 1984). As Tellegen (1991) noted (see also Wachtel,1977), personality traits tend to have an assimilative character in a Piagetian sense in that they influence how individuals interpret and construe life events.

  • Personality assessment first contributes to treatment planning by helping to decide if problems are intimately linked with a person's broad personality dispositions or whether they are more circumscribed. According to Beutler (1986; Beutler & Clarkin,1990), simple problems involve situationally specific and transitory habits that are primarily products of current environmental contingencies.

  • Understand the person will bring to a better outcome and stick to the treatment of the single (placebo effect when understand the single, and effect of psychotherapy in psychosomatic patient)

  • Although not yet well-explored, personality traits logically relate to mental health treatment usage, modality preference, and efficacy, and their use in this context could improve treatment efficacy (Bagby, Gralnick, Al-Dajani, & Uliaszek, 2016; Harkness and Lillienfeld, 1997; Lengel, Helle, DeShong, Meyer, & Mullins-Sweatt, 2016; Miller 1991; Zinbarg, Uliaszek, & Adler, 2008).

  • Self-report scores on personality inventories predict important life outcomes, including health and longevity, marital outcomes, career success, and mental health problems (Thalmayer, A. G. (2018). Personality and mental health treatment: Traits as predictors of presentation, usage, and outcome. Psychological Assessment, 30(7), 967–977.)

  • High role of personality traits in predicting treatment usage and outcome and for the utility of a 6-factor model. (Thalmayer, A. G. (2018). Personality and mental health treatment: Traits as predictors of presentation, usage, and outcome. Psychological Assessment, 30(7), 967–977.)

  • Therapy is no different from any other interpersonal situation in its capacity to enthrall, entice, bore, or revolt a patient. If one seeks to have a patient stay in therapy, to remain engaged in the work, and to suffer as little discomfort as possible, then matching treatment to personality offers a strategy. Harkness, A. R., & Lilienfeld, S. O. (1997). Individual differences science for treatment planning: Personality traits. Psychological Assessment, 9(4), 349.‏

4. Personality/Psychological traits and health diagnosis

Need of holistic understanding of physical and psychological status of patient for good diagnosis.

  • Holistic care is described as a behaviour that recognises a person as a whole and acknowledges the interdependence among one's biological, social, psychological, and spiritual aspects. Holistic care includes a wide range of approaches, including medication, education, communication, self-help, and complementary treatment (Morgan S, Yoder LH. A concept analysis of person-centered care. J Holist Nurs. 2012 Mar;30(1):6-15. doi: 10.1177/0898010111412189. Epub 2011 Jul 19. PMID: 21772048.)

  • The philosophy behind holistic care is based on the idea of holism which emphasises that for human beings the whole is greater than the sum of its parts and that mind and spirit affect the body. (Tjale AA, Bruce J. A concept analysis of holistic nursing care in paediatric nursing. Curationis. 2007; 30:45–52.)

  • Holistic care increases the depth of care providers’ understanding of patients and their needs. On the contrary if only the patients’ corporeal needs are considered, patients’ other needs and sometimes more serious problems are not addressed (The holistic nursing care of patients with minor injuries attending the A&E department.)

  • Holistic care is a comprehensive model of caring which is believed to be the heart of the science of nursing (Strandberg EL, Ovhed I, Borgquist L, Wilhelmsson S. The perceived meaning of a (w)holistic view among general practitioners and district nurses in Swedish primary care: a qualitative study. BMC Fam Pract. 2007 Mar 8;8:8. doi: 10.1186/1471-2296-8-8. PMID: 17346340; PMCID: PMC1828160.)

  • Stress is an example and with it the role of the Cytokines (Turner, A. I., Smyth, N., Hall, S. J., Torres, S. J., Hussein, M., Jayasinghe, S. U., ... & Clow, A. J. (2020). Psychological stress reactivity and future health and disease outcomes: A systematic review of prospective evidence. Psychoneuroendocrinology, 114, 104599.)

  • Malfunction of the stress system is associated with behavioural and somatic disorders (Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature reviews endocrinology, 5(7), 374).

  • “Long-Covid syndrome” is another example that refers to a non-biological illness elicited after the Covid’s recovery and attach not only some organs but most of all refers to a psychological and chronical syndrome that should be treated through different medical point of view (Nalbandian, A. (2021, March 22). Post-acute COVID-19 syndrome. Nature Medicine.

5. Personality/Psychological traits and health communication

Importance of impactful personalized communication for compliance especially long term

  • Withdrew from medication and exercise, no motivation … need more impactful communication. Image done for the smoking person as a warning for the outcome, prevention and personal advertising for better outcome.

  • Personalized Healthcare in the integrated practice of well-being, healthcare and patient support, based on an individual’s unique biological behavioural social and cultural characteristics. Services tailored proactively for each patient at several level empowers the individual by “the right care for the right person at the right time” leads to better outcome. (Simmons, L. et al. 2014. Patient engagement as a risk factor in personalized health care: a systematic review of the literature on chronic disease).

  • The first step to personalization, however, is collecting the right data. According to an article published in Health Data Management, “Many healthcare organizations are using consumer insights—including demographic and psychographic data, past care program data and claims history—to develop tailored communications designed to maximise patient participation.” (Kenney, K., 2018. HIT Think Four ways payers and providers can use tech to aid patients' experience).

  • In the current age of the internet, social media and instant gratification, people and particularly millennials are demanding more personalization and greater use of technology when it comes to their healthcare. (Hussey, K. 2016. How Personalization Drives Effective Patient Engagement and Delivers Enriched)

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