Don't throw the baby out with the bathwater: Depressive traits are part and parcel of neuroticism

Five-factor personality traits and functional somatic disorder: A systematic review and meta-analysis

INTRODUCTION

Functional Somatic Disorders (FSD) is an umbrella term for various conditions characterized by persistent and troublesome physical symptoms, that are not better explained by other psychiatric or somatic conditions. Personality traits may play a crucial role in FSD, but the link is not fully understood. This study presents a systematic review and meta-analysis examines the relationship between the Five-Factor Model (FFM) of personality traits and FSD.

METHODS

The review was based on the PRISMA statement, and drew data from systematic searches in PsycInfo, PubMed, and Embase. To be eligible for inclusion, studies had to include eligible FSD groups and control groups and to assess FFM traits. Data were analyzed using random effects models. Sub-group and sensitivity analyses as well as meta-regression were used to explore the heterogeneity and robustness of findings.

RESULTS

In total 6841 records were screened and 52 included. FSD cases scored higher on neuroticism (k = 46, Hedge's g = 0.72, [95 % CI, 0.61: 0.83]) and lower on extraversion (k = 31, g = -0.41, [-0.55:-0.28]) and agreeableness (k = 15, g = -0.22, [-0.36:-0.09]) than healthy/unspecified controls. FSD cases scored higher on neuroticism (k = 9, g = 0.26 [0.08:0.44]) and agreeableness (k = 4, g = 0.43 [0.28:0.59]) than somatic controls, but did not differ on extraversion (k = 6, g = -0.17 [-0.45:0.11]). No significant differences were found for conscientiousness and openness. For psychiatric controls, meta-analysis was only possible for neuroticism (k = 3,= -0.61, [-1.98:0.77]). Findings displayed significant heterogeneity but no publication bias.

CONCLUSIONS

This review reveals significant associations between FFM traits and FSD, providing insight into the etiology, classification, and management of FSD.

Neuroticism, loneliness, all-cause and cause-specific mortality: A 17-year study of nearly 500,000 individuals

BACKGROUND

Neuroticism is related to mental and physical health. This study examined whether neuroticism and its underlying components were associated with risk of all-cause and cause-specific mortality.

METHODS

Community-dwelling adults (N = 491,323) in the UK Biobank completed a neuroticism scale between 2006 and 2010. Vital status was tracked up to December 2022 via linkage with the UK National Health Service.

RESULTS

Over 17 years of follow-up, 43,400 (8.8 %) participants died. Accounting for age, sex, and ethnicity, participants who scored 1 SD higher on neuroticism had a 10 % greater risk of dying (HR = 1.10, 95%CI = 1.09-1.11), an association that remained significant but was explained partly by socioeconomic status, health behaviors, and chronic conditions. Item-level analyses found that loneliness was the neuroticism item most predictive of mortality (HR = 1.46, 95%CI = 1.43-1.49), especially in males. Neuroticism and loneliness were more predictive of mortality among relatively younger adults and those with lower education. Among the causes of death, neuroticism and loneliness had the strongest association with deaths due to intentional self-harm, respiratory and digestive system diseases.

LIMITATIONS

Loneliness was assessed with a single item. The associations could be due to increases in neuroticism and loneliness approaching death. However, contrary to expectations from reverse causality, the associations were similar when excluding deaths within the first five or ten years of follow-up. Future research should examine whether findings from this high-income country replicate in middle- and lower-income communities.

CONCLUSIONS

Loneliness was the component of neuroticism most strongly associated with premature mortality, including from intentional self-harm, respiratory, and digestive system causes of death.

Psychological risk factors and the course of depression and anxiety disorders: A review of 15 years NESDA research

BACKGROUND

The Netherlands Study of Depression and Anxiety (NESDA; N_baseline=2981) is an ongoing longitudinal, multi-site, naturalistic, cohort study examining the etiology, course, and consequences of depression and anxiety. In this article we synthesize and evaluate fifteen years of NESDA research on prominent psychological risk factors for the onset, persistence, recurrence, and comorbidity of affective disorders.

METHODS

A narrative review of 62 NESDA articles examining the specificity and predictive value of neuroticism, behavioral inhibition, repetitive negative thinking, experiential avoidance, cognitive reactivity, locus of control, (implicit) self-esteem, (implicit) disorder-specific self-associations, and attentional bias for the course of affective disorders.

RESULTS

All self-reported risk factors showed cross-sectional relationships with singular and comorbid affective disorders, and prospective relationships with the development and chronicity of depression and anxiety disorders. High neuroticism, low self-esteem, and negative repetitive thinking showed most prominent transdiagnostic relationships, whereas cognitive reactivity showed most pronounced depression-specific associations. Implicit self-esteem showed predictive validity for the persistence and recurrence of anxiety and depression over and above self-reported risk factors. Automatic approach-avoidance behavior and attentional bias for negative, positive, or threat words showed no relationship with affective disorders.

CONCLUSION

NESDA identified both (a) transdiagnostic factors (e.g., neuroticism, low implicit self-esteem, repetitive negative thinking) that may help explain the comorbidity between affective disorders and overlap in symptoms, and (b) indications for disorder-specific risk factors (e.g., cognitive responsivity) which support the relevance of distinct disorder categories and disorder-specific mechanisms. Thus, the results point to the relevance of both transdiagnostic and disorder-specific targets for therapeutic interventions.

The contributions of affective traits and emotion regulation to internalizing disorders: Current state of the literature and measurement challenges

Dysfunctional affective processes are central to the experience of internalizing disorders (e.g., depression, anxiety, and related disorders). Specifically, extreme positive affect and elevated negative affect each have unique and robust patterns of associations with internalizing symptoms. This article examines affect as both an individual difference and a within-person dynamic process that unfolds over time. Recent research is reviewed that clarifies the hierarchical structure of affect and facet-level associations with symptoms, affect-laden traits that confer risk for internalizing psychopathology, models of emotion regulation, and how emotion regulation abilities and strategies contribute to or detract from psychological well-being. Several measurement challenges in this literature are identified and discussed, including possible conceptual and content overlap, mood-state distortion, naturalistic assessment in daily life, and the benefits and limitations of self-reported affective experience. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Are rumination and neuroticism genetically or environmentally distinct risk factors for psychopathology?

Neuroticism, a dispositional trait of heightened negative emotionality, is a vulnerability factor for psychopathology. Given neuroticism's strong association with rumination, a repetitive thought pattern that intensifies and prolongs emotions, some question whether these constructs capture the same or unique information about vulnerability for psychopathology. The present study examined whether neuroticism is genetically and environmentally distinct from two clinically relevant ruminative subtypes-anger and depressive rumination-and whether genetic and environmental influences specific to rumination versus shared with neuroticism overlap with internalizing and externalizing psychopathology. These analyses were conducted on 439 same-sex twin pairs in the Colorado Longitudinal Twin study. Rumination and neuroticism latent variables were created from multiple rumination questionnaires administered at age 23 and shortened Eysenck Personality Questionnaires administered at ages 17 and 21, respectively. Lifetime psychopathology symptoms, assessed by two structured clinical interviews, were used to create ordinal composite variables. Multivariate Cholesky decompositions indicated that neuroticism, anger rumination, and depressive rumination have common genetic and nonshared environmental influences but are differentiated by nonshared environmental influences specific to each ruminative subtype. Genetic influences common to rumination and neuroticism explained considerable variance in internalizing psychopathology, suggesting possible genetic mediation or common genetic causes. Genetic and environmental influences on externalizing psychopathology did not substantially overlap with those on neuroticism and rumination. These findings suggest that rumination and neuroticism share most genetic influences yet are influenced by distinct environmental influences. Furthermore, our results indicate that a comprehensive understanding of transdiagnostic risk factors must include an examination of both genetic and environmental influences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Characterizing Depression Issues on Sina Weibo

The prevalence of depression has increased significantly over the past few years both in developed and developing countries. However, many people with symptoms of depression still remain untreated or undiagnosed. Social media may be a tool to help researchers and clinicians to identify and support individuals who experience depression. More than 394,000,000 postings were collected from China’s most popular social media website, Sina Weibo. 1000 randomly selected depression-related postings was coded and analyzed to learn the themes of these postings, and a text classifier was built to identify the postings indicating depression. The identified depressed users were compared with the general population on demographic characteristics, diurnal patterns, and patterns of emoticon usage. We found that disclosure of depression was the most popular theme; depression displayers were more engaged with social media compared to non-depression displayers, the depression postings showed geographical variations, depression displayers tended to be active during periods of leisure and sleep, and depression displayers used negative emoticons more frequently than non-depression displayers. This study offers a broad picture of depression references on China’s social media, which may be cost effectively developed to detect and help individuals who may suffer from depression disorders.

Why Does Frustration Predict Psychopathology? Multiple Prospective Pathways over Adolescence: A Trails Study

Adolescents’ temperamental frustration is a developmental precursor of adult neuroticism and psychopathology. Because the mechanisms that underlie the prospective association between adolescents’ high frustration and psychopathology (internalizing/externalizing) have not been studied extensively, we quantified three pathways: stress generation [mediation via selection/evocation of stressful life events (SLEs)], cross–sectional frustration–psychopathology overlap (‘carry–over’/common causes), and a direct (non–mediated) vulnerability effect of frustration, including moderation of SLE impact. Frustration and psychopathology were assessed at age 16 with the Early Adolescent Temperament Questionnaire and the Youth Self–Report. No gender differences in frustration were observed. At age 19, psychopathology was reassessed by using the Adult Self–Report, while occurrence of endogenous (self–generated) and exogenous (not self–generated) SLEs during the interval (ages 16–19) were ascertained with the Life Stress Interview, an investigator–based contextual–stressfulness rating procedure (N = 957). Half of the prospective effect of frustration on psychopathology was explained by baseline overlap, including effects of ‘carry–over’ and common causes, about 5% reflected stress generation (a ‘vicious’ cycle with the environment adolescents navigate and shape), and 45% reflected unmediated association: a direct vulnerability effect including stress sensitivity or moderation of SLE impact. After adjustment for their overlap, frustration predicted the development of externalizing but not internalizing symptoms. Copyright © 2016 European Association of Personality Psychology

Neuroticism and Individual Differences in Neural Function in Unmedicated Major Depression: Findings from the EMBARC Study

BACKGROUND

Personality dysfunction represents one of the only predictors of differential response between active treatments for depression to have replicated. In this study, we examine whether depressed patients with higher neuroticism scores, a marker of personality dysfunction, show differences versus depressed patients with lower scores in the functioning of two brain regions associated with treatment response, the anterior cingulate and anterior insula cortices.

METHODS

Functional magnetic resonance imaging data during an emotional Stroop task were collected from 135 adults diagnosed with major depressive disorder at four academic medical centers participating in the Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) study. Secondary analyses were conducted including a sample of 28 healthy individuals.

RESULTS

In whole-brain analyses, higher neuroticism among depressed adults was associated with increased activity in and connectivity with the right anterior insula cortex to incongruent compared to congruent emotional stimuli (ks>281, ps<0.05 FWE corrected), covarying for concurrent psychiatric distress. We also observed an unanticipated relationship between neuroticism and reduced activity in the precuneus (k=269, p<0.05 FWE corrected). Exploratory analyses including healthy individuals suggested that associations between neuroticism and brain function may be nonlinear over the full range of neuroticism scores.

CONCLUSIONS

This study provides convergent evidence for the importance of the right anterior insula cortex as a brain-based marker of clinically meaningful individual differences in neuroticism among adults with depression. This is a critical next step in linking personality dysfunction, a replicated clinical predictor of differential antidepressant treatment response, with differences in underlying brain function.

Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants

BACKGROUND

This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory.

METHOD

This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants.

RESULTS

The results showed large unadjusted prospective associations between neuroticism and symptoms/diagnosis of anxiety, depression, and non-specific mental distress (d = 0.50-0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half (d = 0.10-0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker (d = 0.03-0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short (<4 year) than long (⩾4 years) follow-up intervals, suggesting a substantial decay of the association with increasing time intervals. Adjusted effects, however, were only slightly larger over short v. long time intervals. This indicates that confounding by baseline symptoms and psychiatric history masks the long-term stability of the neuroticism vulnerability effect.

CONCLUSION

High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.