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Gao Y, Amin N, van Duijn C, Littlejohns TJ. Association of neuroticism with incident dementia, neuroimaging outcomes, and cognitive function. Alzheimers Dement 2024; 20:5578-5589. [PMID: 38984680 PMCID: PMC11350007 DOI: 10.1002/alz.14071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/01/2024] [Accepted: 05/21/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Higher neuroticism might be associated with dementia risk. Here we investigated modification by genetic predisposition to dementia, mediation by mental health and vascular conditions, neuroimaging outcomes, and cognitive function. METHODS Cox proportional-hazards models were used to assess the association between neuroticism score and incident dementia over up to 15 years in 1,74,164 participants. Cross-sectional analyses on dementia-related neuroimaging outcomes and cognitive function were conducted in 39,459 dementia-free participants. RESULTS Higher neuroticism was associated with an 11% higher risk of incident dementia, especially vascular dementia (15% higher risk), regardless of genetic predisposition to dementia. Mental and vascular conditions mediated the association of neuroticism with all-cause dementia and vascular dementia. Neuroticism was associated with higher cerebrovascular pathology, lower gray matter volume, and worse function across multiple cognitive domains. DISCUSSION Neuroticism could represent a risk factor for dementia, and vascular and mental health might drive these associations. HIGHLIGHTS Neuroticism was associated with an increased risk of incident all-cause dementia, particularly vascular dementia. Associations were not modified by genetic predisposition to dementia. Associations were largely mediated by mental and vascular conditions. Neuroticism was associated with increased cerebrovascular pathology and lower gray matter volume. Neuroticism was associated with worse function across multiple cognitive domains.
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Affiliation(s)
- Yaqing Gao
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Najaf Amin
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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2
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Neupert SD, Graham EK, Ogle D, Ali S, Zavala DV, Kincaid R, Hughes ML, Hu RX, Antonucci T, Suitor JJ, Gilligan M, Ajrouch KJ, Scott SB. A Coordinated Data Analysis of Four Studies Exploring Age Differences in Social Interactions and Loneliness During a Global Pandemic. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae086. [PMID: 38761103 PMCID: PMC11247406 DOI: 10.1093/geronb/gbae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVES Examining loneliness and social isolation during population-wide historical events may shed light on important theoretical questions about age differences, including whether these differences hold across different regions and the time course of the unfolding event. We used a systematic, preregistered approach of coordinated data analysis (CDA) of 4 studies (total N = 1,307; total observations = 18,492) that varied in design (intensive repeated-measures and cross-sectional), region, timing, and timescale during the first year of the coronavirus disease 2019 pandemic. METHODS We harmonized our data sets to a common period within 2020-2021 and created a common set of variables. We used a combination of ordinary least squares regression and multilevel modeling to address the extent to which there was within- and between-person variation in the associations between social isolation and loneliness, and whether these associations varied as a function of age. RESULTS Within- and between-person effects of social interactions were negatively associated with loneliness in 1 study; in follow-up sensitivity analyses, these patterns held across early and later pandemic periods. Across all data sets, there was no evidence of age differences in the within-person or between-person associations of social interactions and loneliness. DISCUSSION Applying the CDA methodological framework allowed us to detect common and divergent patterns of social interactions and loneliness across samples, ages, regions, periods, and study designs.
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Affiliation(s)
- Shevaun D Neupert
- Department of Psychology, North Carolina State University, Raleigh, North Carolina, USA
| | - Eileen K Graham
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Destiny Ogle
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Sumbleen Ali
- Department of Human Ecology, SUNY Oneonta, Oneonta, New York, USA
| | - Daisy V Zavala
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Reilly Kincaid
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - MacKenzie L Hughes
- School of Psychology, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Rita X Hu
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Toni Antonucci
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - J Jill Suitor
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Megan Gilligan
- Department of Human Development and Family Science, University of Missouri, Columbia, Missouri, USA
| | - Kristine J Ajrouch
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Department of Sociology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Stacey B Scott
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
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Allemand M, Fend HA, Hill PL. Negative Emotional Reactivity and Somatic Symptoms during Adolescence Predict Adult Health and Wellbeing in Early and Middle Adulthood. J Youth Adolesc 2024; 53:1513-1528. [PMID: 38282066 PMCID: PMC11136711 DOI: 10.1007/s10964-024-01940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
Longitudinal research is lacking with respect to how negative emotional reactivity and somatic symptoms during adolescence set the stage for later health. The aim of this longitudinal study was to examine within-person associations between negative emotional reactivity and somatic symptoms during adolescence and their effects on health and wellbeing in adulthood. Participants (N = 1527; 48.3% female) were assessed annually at the age of 12 to 16 years and at the age of 35 and 45 years. Adolescents with frequent somatic symptoms reported higher reactivity. Individual differences in levels and changes of somatic symptoms and reactivity were independently associated with adult health and wellbeing decades later. The findings underscore the importance of considering how individual differences change during adolescent development.
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Affiliation(s)
- Mathias Allemand
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.
| | - Helmut A Fend
- Institute of Education, University of Zurich, Zurich, Switzerland
| | - Patrick L Hill
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, USA
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Stephan Y, Sutin AR, Terracciano A. Personality traits and polypharmacy: meta-analysis of five samples. Psychol Health 2024:1-15. [PMID: 38764247 PMCID: PMC11573927 DOI: 10.1080/08870446.2024.2352182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 04/30/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE The present study examined the prospective relationship between personality traits and the risk of polypharmacy. METHODS AND MEASURES Participants (age range: 16-101 years; N > 15,000) were from the English Longitudinal Study of Ageing (ELSA), the Midlife in the United States Study (MIDUS), the Health and Retirement Study (HRS), the Wisconsin Longitudinal Study of Aging (WLS), and the Longitudinal Internet Studies for the Social Sciences (LISS). In each sample, personality traits and demographic factors were assessed at baseline. Number of medications was obtained from 2 to 20 years later. RESULTS Random-effect meta-analyses revealed that higher neuroticism was related to a higher risk of polypharmacy (Odd Ratio = 1.30; 95% CI 1.17-1.46) and excessive polypharmacy (Odd Ratio = 1.44; 95% CI 1.18-1.77) whereas higher conscientiousness (Odd Ratio = 0.84; 95% CI 0.74-0.95) and extraversion (Odd Ratio = 0.85; 95% CI 0.73-0.98) were associated with a lower risk of polypharmacy. Openness and agreeableness were unrelated to polypharmacy. Body mass index, number of chronic conditions, and depressive symptoms partially mediated the association between personality and the number of medications. CONCLUSION The present study provides replicable and robust evidence that neuroticism is a risk factor for simultaneous use of multiple medications, whereas conscientiousness and extraversion may play a protective role.
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Affiliation(s)
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, USA
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Stephan Y, Sutin AR, Terracciano A. Personality traits and the risk of urinary incontinence: Evidence from three longitudinal samples. Int J Geriatr Psychiatry 2024; 39:e6084. [PMID: 38558175 DOI: 10.1002/gps.6084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Urinary incontinence (UI) is a common condition with a substantial negative impact on older adults' quality of life. This study examines whether individual differences in behavioral, cognitive, and emotional traits assessed by the five major dimensions of personality are related to the risk of concurrent and incident UI. METHODS Participants were older women and men (N > 26,000) from the Midlife in the United States Survey, the Health and Retirement Study, and the English Longitudinal Study of Aging. In each cohort, personality traits (measured with the Midlife Development Inventory) and demographic (age, sex, education, and race), clinical (body mass index, diabetes, blood pressure), and behavioral (smoking) factors were assessed at baseline. UI was assessed at baseline and again 8-20 years later. Results for each cohort were combined in random-effect meta-analyses. RESULTS Consistently across cohorts, higher neuroticism and lower conscientiousness were related to a higher risk of concurrent and incident UI. To a lesser extent, extraversion, openness, and agreeableness were also related to lower risk of concurrent and incident UI. BMI, diabetes, blood pressure, and smoking partially accounted for these associations. There was little evidence that age or sex moderated the associations. CONCLUSIONS The present study provides novel, robust, and replicable evidence linking personality traits to UI. The higher vulnerability for UI for individuals who score higher on neuroticism and lower on conscientiousness is consistent with findings for other multifactorial geriatric syndromes. Personality traits can help identify individuals at risk and may help contextualize the clinical presentation of comorbid emotional, cognitive, and behavioral symptoms.
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Affiliation(s)
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, Florida, USA
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Brandt ND, Drewelies J, Willis SL, Schaie KW, Ram N, Gerstorf D, Wagner J. Beyond Big Five trait domains: Stability and change in personality facets across midlife and old age. J Pers 2023; 91:1171-1188. [PMID: 36325745 DOI: 10.1111/jopy.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Accumulated evidence indicates both stable and malleable parts of inter-individual differences in the broad Big Five domains. Less is known, however, about stability and change at the more diversified facet level. With the current study, we fill this gap by investigating personality stability and change across midlife and old age. METHOD We apply local structural equation measurement models and second-order growth curve models to four waves of data obtained with the full NEO Personality Inventory (NEO-PI-R) collected over 11 years from 1667 adults (Mage = 62.69 years, SDage = 15.62, 55% female) who participated in the Seattle Longitudinal Study. RESULTS Measurement invariance analyses indicated that the psychometric properties of the NEO-PI-R facets are comparable across time and age. Results revealed substantial rank-order stabilities across all facets, yet the exact pattern varied strongly between facets of the same trait and across traits. Mean-level change of facets from midlife to old age largely mirrored the mean-level change observed for the broader traits. CONCLUSION We discuss conceptual implications and argue that in the face of overall stability across midlife and old age, changes in the rank-ordering of people reveals a much more complex and diverse pattern of development than analyses at the trait level suggest.
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Affiliation(s)
- Naemi D Brandt
- Department of Psychology, University of Hamburg, Hamburg, Germany
| | - Johanna Drewelies
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institut for Human Development, Berlin, Germany
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - K Warner Schaie
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Nilam Ram
- Department of Psychology, Stanford University, Stanford, California, USA
- Department of Communication, Stanford University, Stanford, California, USA
| | - Denis Gerstorf
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
- Department of Human Development and Family Studies, Pennsylvania State University, State College, Pennsylvania, USA
| | - Jenny Wagner
- Department of Psychology, University of Hamburg, Hamburg, Germany
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Stephan Y, Sutin AR, Terracciano A. Personality traits and the risk of sensory impairment: Evidence from the National Health and Aging Trends Study. J Psychosom Res 2023; 173:111459. [PMID: 37657125 PMCID: PMC10591274 DOI: 10.1016/j.jpsychores.2023.111459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Sensory impairment has pervasive effects on older individuals' quality of life and health. Although recent research found an association between personality traits and the risk of hearing and vision impairment, data on older adults is limited, and no study has examined dual-sensory impairment. Therefore, the present study examined the prospective relationship between personality traits and risk of hearing, vision, and dual sensory impairment among older adults. METHOD Participants were older adults aged 67 to 94 years (N = 829) from the National Health and Aging Trends Study (NHATS). Personality traits, demographic, clinical (body mass index, diabetes, and high blood pressure), and behavioral (smoking and physical activity) factors were assessed in 2013/2014. Objective measures of hearing and vision were obtained in 2021. RESULTS Controlling for demographic factors, higher conscientiousness was associated with a lower risk of hearing (OR: 0.81; 95%CI: 0.67-0.97, p = .022), vision (OR: 0.83, 95%CI: 0.71-0.97, p = .022) and dual sensory impairment (OR: 0.70, 95%CI: 0.56-0.86, p < .001). Higher openness (OR: 0.81, 95%CI: 0.68-0.97, p = .023) and neuroticism (OR: 0.74, 95%CI: 0.62-0.88, p < .001) were associated with a lower risk of hearing impairment. Clinical and behavioral covariates partially accounted for these associations. CONCLUSION Consistent with other age-related health and cognitive outcomes, conscientiousness may be protective against sensory impairment. Surprisingly, neuroticism had a protective effect for hearing, but not vision. The findings provide novel evidence for an association between personality and sensory impairment among older adults.
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Affiliation(s)
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, USA.
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, USA.
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Stephan Y, Sutin AR, Luchetti M, Aschwanden D, Terracciano A. Personality and Risk of Incident Stroke in 6 Prospective Studies. Stroke 2023; 54:2069-2076. [PMID: 37325920 PMCID: PMC10524767 DOI: 10.1161/strokeaha.123.042617] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND A large literature has examined a broad range of factors associated with increased risk of stroke. Few studies, however, have examined the association between personality and stroke. The present study adopted a systematic approach using a multi-cohort design to examine the associations between 5-Factor Model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and incident stroke using data from 6 large longitudinal samples of adults. METHODS Participants (age range: 16-104 years old, N=58 105) were from the MIDUS (Midlife in the United States) Study, the HRS (Health and Retirement Study), The US (Understanding Society) study, the WLS (Wisconsin Longitudinal Study), the NHATS (National Health and Aging Trends Study), and the LISS (Longitudinal Internet Studies for the Social Sciences). Personality traits, demographic factors, clinical and behavioral risk factors were assessed at baseline; stroke incidence was tracked over 7 to 20 years follow-up. RESULTS Meta-analyses indicated that higher neuroticism was related to a higher risk of incident stroke (hazard ratio, 1.15 [95% CI, 1.10-1.20]; P<0.001), whereas higher conscientiousness was protective (HR, 0.89 [95% CI, 0.85-0.93]; P<0.001). Additional meta-analyses indicated that BMI, diabetes, blood pressure, physical inactivity, and smoking as additional covariates partially accounted for these associations. Extraversion, openness, and agreeableness were unrelated to stroke incidence. CONCLUSIONS Similar to other cardiovascular and neurological conditions, higher neuroticism is a risk factor for stroke incidence, whereas higher conscientiousness is a protective factor.
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Affiliation(s)
| | - Angelina R. Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, USA
| | - Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, USA
| | - Damaris Aschwanden
- Department of Geriatrics, College of Medicine, Florida State University, USA
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, USA
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Stephan Y, Sutin AR, Luchetti M, Aschwanden D, Terracciano A. Personality and aging-related immune phenotype. Psychoneuroendocrinology 2023; 153:106113. [PMID: 37120948 PMCID: PMC10225343 DOI: 10.1016/j.psyneuen.2023.106113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
An aging-related immune phenotype (ARIP) has been defined as a decrease in naïve T cells (TN) relative to the accumulation of memory T cells (TM). Recent research implicates ARIP measures, such as CD4 +TN/TM and CD8 +TN/TM ratios, in multimorbidity and mortality. This study examined whether psychological dispositions that assess how people think, feel, and behave are related to CD4 +TN/TM and CD8 +TN/TM. Participants were adults aged 50-104 years (N = 4798; 58% women, Mean Age= 67.95, SD= 9.56) from the Health and Retirement Study. Data on CD4 +TN/TM and CD8 +TN/TM were obtained in 2016. Data on personality, demographic factors, and potential clinical (body mass index, disease burden), behavioral (smoking, alcohol, physical activity), psychological (depressive symptoms, stress), and biological (cytomegalovirus IgG antibodies) mediating factors were obtained in 2014/2016. Controlling for demographic factors, higher conscientiousness was related to higher CD4 +TN/TM and CD8 +TN/TM. To a lesser extent, higher neuroticism and lower extraversion were associated with lower CD4 +TN/TM. Physical activity, and to a lesser extent BMI and disease burden, were the most robust mediators between personality and ARIP measures. Cytomegalovirus IgG level mediated the association between conscientiousness and both CD4 +TN/TM and CD8 +TN/TM. This study provides novel evidence that personality is related to ARIP. Higher conscientiousness and, to a lesser extent, higher extraversion may be protective against age-related immunophenotype change, whereas neuroticism may be a risk factor.
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Affiliation(s)
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, USA
| | - Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, USA
| | - Damaris Aschwanden
- Department of Geriatrics, College of Medicine, Florida State University, USA; Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, USA
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Yoneda T, Lozinski T, Turiano N, Booth T, Graham EK, Mroczek D, Muniz Terrera G. The Big Five personality traits and allostatic load in middle to older adulthood: A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 148:105145. [PMID: 36996993 PMCID: PMC10106433 DOI: 10.1016/j.neubiorev.2023.105145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/10/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
Further understanding of the associations between personality traits and allostatic load (AL) may be important for predicting, addressing, and optimizing health outcomes. This review synthesized the existing literature reporting the association between the Big Five personality traits and AL in adults to identify the generalizability and robustness of relationships, potential mechanisms underlying the associations, and study characteristics that may be contributing to inconsistencies in the field. Published and unpublished empirical reports were included if at least one of the Big Five traits was examined and an AL index was constructed using at least two biomarkers in a sample of adults. The methodological plan and standardized coding guide were pre-registered and reported (https://osf.io/rxw5a). Based on 11 studies that met eligibility, meta-analysis of correlation coefficients indicated a small but significant positive association between neuroticism and AL, and small but significant inverse associations between both conscientiousness and openness with AL. This review identifies strengths and limitations within the field, as well as several avenues for future research.
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Affiliation(s)
- Tomiko Yoneda
- Department of Medical Social Sciences, Northwestern University, USA.
| | | | | | - Tom Booth
- Department of Psychology, University of Edinburgh, UK
| | - Eileen K Graham
- Department of Medical Social Sciences, Northwestern University, USA
| | - Daniel Mroczek
- Department of Medical Social Sciences, Northwestern University, USA; Department of Psychology, Northwestern University, USA
| | - Graciela Muniz Terrera
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, USA; Edinburgh Dementia Prevention, University of Edinburgh, UK
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11
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Huangfu N, Lu Y, Ma H, Hu Z, Cui H, Yang F. Genetic liability to mental disorders in relation to the risk of hypertension. Front Cardiovasc Med 2023; 10:1087251. [PMID: 36923957 PMCID: PMC10008891 DOI: 10.3389/fcvm.2023.1087251] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
Background Observational studies have indicated that psychosocial factors contribute to hypertension; however, the causality of these associations remains unclear due to reverse causality and confounders. We aim to assess the causal associations of mental health disorders with hypertension. Methods Instrumental variables of anxiety disorder, attention deficit/hyperactivity disorder, autism spectrum disorder, depression, obsessive-compulsive disorder, post-traumatic stress disorder, schizophrenia, and subjective well-being measure were obtained from the corresponding largest genome-wide association studies. Summary statistics for the association of essential hypertension were obtained from the FinnGen Study (42,857 cases and 162,837 controls) and UK Biobank cohort (54,358 cases and 408,652 controls). The multiplicative random-effects inverse-variance weighted method was utilized as the primary analysis and three other statistical methods were conducted in the supplementary analyses. The results were combined using the fixed-effects method. Results In the pooled analyses, genetic liability to depression was associated with higher risk of hypertension (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.17-1.35; p < 0.001). Besides, a suggestive association was found between genetically predicted higher weighted neuroticism sum-score and increased risk of hypertension (OR, 1.16; 95% CI, 1.02-1.33; p < 0.05). No associations were found for other mental health disorders. Sensitivity analyses revealed consistent evidence as the main results. Conclusion We provide consistent evidence for the causal effect of genetic liability to depression on hypertension, which highlights the importance of blood pressure measurement and monitoring in patients with depression.
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Affiliation(s)
- Ning Huangfu
- Department of Cardiology, Ningbo First Hospital, School of Medicine, Ningbo University, Ningbo, China.,Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, China.,Cardiovascular Disease Clinical Medical Research Center of Ningbo, Ningbo, China
| | - Yunlong Lu
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongchuang Ma
- Department of Cardiology, Ningbo First Hospital, School of Medicine, Ningbo University, Ningbo, China.,Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, China
| | - Ziwei Hu
- Department of Cardiology, Ningbo First Hospital, School of Medicine, Ningbo University, Ningbo, China.,Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, China
| | - Hanbin Cui
- Department of Cardiology, Ningbo First Hospital, School of Medicine, Ningbo University, Ningbo, China.,Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, China.,Cardiovascular Disease Clinical Medical Research Center of Ningbo, Ningbo, China
| | - Fangkun Yang
- Department of Cardiology, Ningbo First Hospital, School of Medicine, Ningbo University, Ningbo, China.,Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, China.,Cardiovascular Disease Clinical Medical Research Center of Ningbo, Ningbo, China
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Vogel M, Binneböse M, Wallis H, Lohmann CH, Junne F, Berth A, Riediger C. The Unhappy Shoulder: A Conceptual Review of the Psychosomatics of Shoulder Pain. J Clin Med 2022; 11:jcm11185490. [PMID: 36143137 PMCID: PMC9504378 DOI: 10.3390/jcm11185490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Chronic pain is a multifaceted disorder genuinely entangled with psychic and psychosomatic symptoms, which are typically involved in the processes of chronification. The impingement syndrome of the shoulder is no exception to this rule, but several studies have shown respective peculiarities among those with pain and impingement of the shoulder. Notably, chronic pain is a lateralized experience, and, similarly, its psychosomatic correlates may be attached to the hemispheres functionally. AIM The present review therefore gives an overview of the respective findings, with regard not only to psychopathology, but also to personality factors and psychologic trauma, since the latter are reportedly associated with chronic pain. Moreover, we acknowledge symmetry as a possible pathogenic factor. METHODS This narrative review followed the current standards for conducting narrative studies. Based on prior findings, our research strategy included the relevance of psychotraumatologic and symmetrical aspects, as well as comorbidity. We retrieved the relevant literature reporting on the impact of psychopathology as well as personality features on shoulder pain, as published up to January 2022 from the Medline database (1966-2022). Study selecton: We included numerous studies, and considered the contextual relevance of studies referring to the neuropsychosomatics of chronic pain. RESULTS Pain-specific fears, depression, and anxiety are important predictors of shoulder pain, and the latter is generally overrepresented in those with trauma and PTSD. Moreover, associations of shoulder pain with psychological variables are stronger as regards surgical therapies as compared to conservative ones. This may point to a specific and possibly trauma-related vulnerability for perioperative maladaptation. Additionally, functional hemispheric lateralization may explain some of those results given that limb pain is a naturally lateralized experience. Not least, psychosocial risk factors are shared between shoulder pain and its physical comorbidities (e.g., hypertension), and the incapacitated state of the shoulder is a massive threat to the function of the human body as a whole. CONCLUSIONS This review suggests the involvement of psychosomatic and psychotraumatologic factors in shoulder impingement-related chronic pain, but the inconclusiveness and heterogeneity of the literature in the field is possibly suggestive of other determinants such as laterality.
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Affiliation(s)
- Matthias Vogel
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
- Correspondence: ; Tel.: +49391-6714200; Fax: +49391-6714202
| | - Marius Binneböse
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Hannah Wallis
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Christoph H. Lohmann
- Department of Orthopedic Surgery, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Alexander Berth
- Department of Orthopedic Surgery, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Christian Riediger
- Department of Orthopedic Surgery, Otto-von Guericke-University of Magdeburg, 39120 Magdeburg, Germany
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13
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Personality traits and mental health care utilization: Longitudinal findings from the MIDUS. JOURNAL OF RESEARCH IN PERSONALITY 2022; 99:104260. [PMID: 36793507 PMCID: PMC9928170 DOI: 10.1016/j.jrp.2022.104260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Underutilization of mental health services is prevalent in the U.S., and an understanding of utilization patterns can inform interventions to enhance treatment use. The current study investigated longitudinal associations between changes in mental health care utilization (MHCU) and Big Five personality traits. Data included three waves (4,658 adult participants) of the Midlife Development in the United States (MIDUS) study. 1,632 participants provided data at all three waves. Second-order latent growth curve models showed that MHCU level predicted an increase in emotional stability, and emotional stability level predicted a decrease in MHCU. Increases in emotional stability, extraversion, and conscientiousness predicted decreases in MHCU. These results indicate that personality is associated with MHCU over time and may inform interventions to increase MHCU.
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14
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Luo J, Zhang B, Estabrook R, Graham EK, Driver CC, Schalet BD, Turiano NA, Spiro A, Mroczek DK. Personality and health: Disentangling their between-person and within-person relationship in three longitudinal studies. J Pers Soc Psychol 2022; 122:493-522. [PMID: 35157486 PMCID: PMC8867777 DOI: 10.1037/pspp0000399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Personality traits and physical health both change over the life span. Theoretical models and empirical evidence suggest that these changes are related. The current study investigated the dynamic relations between personality traits and physical health at both the between-person and the within-person levels. Data were drawn from three longitudinal studies: the Veterans Affairs Normative Aging Study (NAS; N = 1,734), the Longitudinal Internet Studies for the Social Sciences (LISS; N = 13,559), and the Swedish Adoption/Twin Study of Aging (SATSA, N = 2,209). Using random intercept cross-lagged panel models (RI-CLPMs) and the continuous time (CT) models, after controlling the between-person variance, generally, evidence was found for bidirectional associations between changes in neuroticism and extraversion and changes in self-rated health and general disease level. Bidirectional associations between changes in neuroticism and change in cardiovascular diseases and central nervous system diseases were observed only when time was modeled as continuous. We also found within-person associations between changes in neuroticism and extraversion and changes in performance-based ratings of motor functioning impairment. According to the current findings, the dynamic within-person relations between personality traits and health outcomes were largely in the direction consistent with their between-person connections, although the within-person relationships were substantially smaller in strength when compared their between-person counterparts. Findings from the current study highlight the importance of distinguishing between-person and within-person effects when examining the longitudinal relationship between personality traits and health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Jing Luo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., Chicago, IL 60611 USA
| | - Bo Zhang
- Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX 77843 USA
| | - Ryne Estabrook
- Department of Psychology, University of Illinois at Chicago, 1007 W. Harrison St., Chicago, IL 60607 USA
| | - Eileen K. Graham
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., Chicago, IL 60611 USA
| | - Charles C. Driver
- Max Planck Institute for Human Development, Humboldt University, Lentzeallee 94, Berlin 14195, Germany
| | - Benjamin D. Schalet
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., Chicago, IL 60611 USA
| | - Nicholas A. Turiano
- Department of Psychology, West Virginia University, 1124 Life Sciences Building, Morgantown, WV 26506 USA
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research & Information Center (MAVERIC), VA Boston Healthcare System, 150 S. Huntington Ave., Jamaica Plain, MA 02130 USA.,Department of Epidemiology, Boston University School of Public Health, 715 Albany St., Boston, MA 02118 USA.,Department of Psychiatry, Boston University School of Medicine, 720 Harrison Ave., Boston, MA 02118 USA
| | - Daniel K. Mroczek
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., Chicago, IL 60611 USA.,Department of Psychology, Weinberg College of Arts & Sciences, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208 USA
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15
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Graham EK, Willroth EC, Weston SJ, Muniz-Terrera G, Clouston SA, Hofer SM, Mroczek DK, Piccinin AM. Coordinated data analysis: Knowledge accumulation in lifespan developmental psychology. Psychol Aging 2022; 37:125-135. [PMID: 35113619 PMCID: PMC8814465 DOI: 10.1037/pag0000612] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Coordinated analysis is a powerful form of integrative analysis, and is well suited in its capacity to promote cumulative scientific knowledge, particularly in subfields of psychology that focus on the processes of lifespan development and aging. Coordinated analysis uses raw data from individual studies to create similar hypothesis tests for a given research question across multiple datasets, thereby making it less vulnerable to common criticisms of meta-analysis such as file drawer effects or publication bias. Coordinated analysis can sometimes use random effects meta-analysis to summarize results, which does not assume a single true effect size for a given statistical test. By fitting parallel models in separate datasets, coordinated analysis preserves the heterogeneity among studies, and provides a window into the generalizability and external validity of a set of results. The current article achieves three goals: First, it describes the phases of a coordinated analysis so that interested researchers can more easily adopt these methods in their labs. Second, it discusses the importance of coordinated analysis within the context of the credibility revolution in psychology. Third, it encourages the use of existing data networks and repositories for conducting coordinated analysis, in order to enhance accessibility and inclusivity. Subfields of research that require time- or resource- intensive data collection, such as longitudinal aging research, would benefit by adopting these methods. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Graciela Muniz-Terrera
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, Scotland, UK,University of Edinburgh, Centre for Dementia Prevention, Edinburgh, Scotland, UK
| | - Sean A.P. Clouston
- Department of Family, Population, and Preventive Medicine; Program in Public Health, University of Stony Brook
| | - Scott M. Hofer
- University of Victoria, Department of Psychology, Victoria, BC, Canada
| | - Daniel K. Mroczek
- Department of Medical Social Sciences, Northwestern University,Department of Psychology, Northwestern University
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16
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Singh P. Conscientiousness moderates the relationship between neuroticism and health-risk behaviors among adolescents. Scand J Psychol 2022; 63:256-264. [PMID: 35060640 DOI: 10.1111/sjop.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/25/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
Health-Risk-Behaviors (HRBs) are considered significant antecedent conditions of adolescents' poor health and mortality. Prevention of any adverse health outcome requires an in-depth understanding of the risk and protective factors associated with its development and maintenance. Among other potential causal pathways, the "neuroticism- HRBs-adverse health" link has been supported in previous studies. Trait neuroticism has been associated with poor health and HRBs, but several moderators were also observed, which might transform neuroticism into a desirable phenomenon, that is, healthy neuroticism, that leads to better health. Conscientiousness is one such potential moderator; however, the moderating effect of conscientiousness in the neuroticism-HRBs link has not been explored extensively among adolescents, especially in India; therefore, no conclusive evidence is available. Thus, the present study was planned to explore the moderating effect of conscientiousness in the relationship between neuroticism and HRBs among adolescents. The study was conducted in India and its cross-sectional sample, procured through a multi-stage stratified random sampling, consists of 648 (364 males) adolescents (Mage = 16.08). Participants provided relevant information on standardized questionnaires. Moderated regression analysis was applied to test the stated hypotheses. Individuals high on neuroticism and low on conscientiousness reported more indulgence in health-risk behaviors than individuals high on both neuroticism and conscientiousness. It indicates that a higher level of conscientiousness may reduce the negative impact that neuroticism has on HRBs. The findings imply that the assessment of conscientiousness and strategies to increase the same should be part of interventional programs to achieve adolescents' wellbeing.
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Affiliation(s)
- Parwinder Singh
- Department of Humanities and Social Sciences, Indian Institute of Technology Ropar, Ropar, India
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17
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Singh P. Emotion regulation difficulties, perceived parenting and personality as predictors of health-risk behaviours among adolescents. CURRENT PSYCHOLOGY 2022; 42:1-16. [PMID: 35035186 PMCID: PMC8741581 DOI: 10.1007/s12144-021-02536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 11/03/2022]
Abstract
Health-Risk Behaviours (HRBs) are significant antecedent conditions of adverse health outcomes among adolescents, and their prevention requires an in-depth understanding of associated factors. Like any other behaviour, HRBs may be an outcome of a complex interplay between personal and situational factors that determines our responses. Among other factors, emotional tendencies, specific behavioural patterns, and psychosocial environment may be the significant factors working at different hierarchical positions within a system and guiding human behaviours, including HRBs. Previous studies have explored the role of these specific factors in developing and maintaining HRBs, but mainly among the adult population, and no conclusive results could be observed regarding their contribution to HRBs in adolescents. The present study explored the predictability of adolescents' engagement in HRBs with regard to three representations of the mentioned factors, i.e., emotion regulation difficulties, perceived parenting practices and personality traits. A total of 723 (Males = 440) adolescents (Mage = 16.05, SD = 1.1) provided relevant information on the standardized questionnaires. Structural equation modelling was applied to test the stated hypotheses. Analysis revealed that the adolescents who reported more difficulty regulating one's emotions, perceived parenting practice as maladaptive, scored high on neuroticism and low on conscientiousness, showed more engagement in HRBs than their counterparts. Further, the findings indicated that emotion regulation difficulties and perceived parenting practices are stronger predictors of HRBs than personality traits. Interventional programs targeting HRBs among adolescents should address specific facets of emotional dysregulation and sensitise parents about their role in moderating adolescents' HRBs.
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Affiliation(s)
- Parwinder Singh
- Department of Humanities and Social Sciences, Indian Institute of Technology Ropar, Rupnagar, Punjab India
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18
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Cachioni M, Borim FSA, Cipolli GC, Alonso V, Yassuda MS, Neri AL. Associações diretas e indiretas entre autoavaliação de saúde, indicadores objetivos de saúde e neuroticismo em idosos. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.210210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo analisar associações diretas e indiretas entre autoavaliação de saúde, indicadores objetivos de saúde e neuroticismo em idosos Método Os dados foram extraídos dos registros de seguimento (2016-2017) do Estudo da Fragilidade em Idosos Brasileiros (Estudo FIBRA), de base populacional, sobre fragilidade e fatores associados na velhice. Trezentos e noventa e sete indivíduos com idade a partir de 73 anos no seguimento responderam a um item sobre autoavaliação de saúde. Polimedicação, dor crônica e multimorbidade foram autorrelatadas, fadiga foi mensurada pela CES-D, depressão pela EDG e neuroticismo pelo inventário NEO-PI-R. Foi realizada análise de caminhos, para verificar associações diretas e indiretas entre autoavaliação de saúde, indicadores objetivos de saúde e neuroticismo. Resultados Relações mais robustas foram observadas entre sexo e multimorbidade, depressão e neuroticismo, e neuroticismo e autoavaliação de saúde. Destaca-se que neuroticismo mediou a relação entre idade, dor crônica, multimorbidade e depressão com autoavaliação de saúde. Conclusão O neuroticismo é um importante mediador da relação entre autoavaliação de saúde e indicadores objetivos de saúde. Trabalhos longitudinais são necessários para explicar as relações observadas.
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Affiliation(s)
- Meire Cachioni
- Universidade de São Paulo, Brasil; Universidade Estadual de Campinas, Brasil
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19
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Aschwanden D, Sutin AR, Ledermann T, Luchetti M, Stephan Y, Sesker AA, Zhu X, Terracciano A. Subjective Cognitive Decline: Is a Resilient Personality Protective Against Progression to Objective Cognitive Impairment? Findings from Two Community-Based Cohort Studies. J Alzheimers Dis 2022; 89:87-105. [PMID: 35848026 PMCID: PMC9843496 DOI: 10.3233/jad-220319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is related to personality functioning and risk of subsequent objective cognitive impairment. OBJECTIVE The aim of this study was to examine whether lower neuroticism and higher conscientiousness-resilient personality traits-protect against conversion from SCD to objective cognitive impairment in two longitudinal community-based cohorts. METHODS Data from the Health and Retirement Study (N = 1,741, Mean age = 68.64 years, Follow-up mean = 7.34 years) and the National Health and Aging Trends Survey (N = 258, Mean age = 79.34 years, Follow-up mean = 4.31 years) were analyzed using Cox regression analysis, controlling for sociodemographic covariates, symptoms of anxiety and depression, and apolipoprotein ɛ4. RESULTS The pooled results showed that lower neuroticism and higher conscientiousness were associated with decreased risk of conversion from SCD to objective cognitive impairment. CONCLUSION Among individuals with SCD, those with a resilient personality may have more cognitive and psychological reserve to maintain cognitive functioning and delay conversion to objective cognitive impairment. The findings further contribute to a better understanding of personality along the cognitive continuum: The observed effect sizes were smaller than those reported in cognitively normal individuals but larger than in individuals with mild cognitive impairment. Personality could provide useful information to identify individuals with SCD who may develop objective cognitive impairment-namely those who hold a vulnerable personality (higher neuroticism, lower conscientiousness).
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Affiliation(s)
- Damaris Aschwanden
- Department of Geriatrics, Florida State University College of Medicine, Florida, USA
| | - Angelina R. Sutin
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida, USA
| | - Thomas Ledermann
- Department of Human Development and Family Science, Florida State University College of Health and Human Sciences, Florida, USA
| | - Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida, USA
| | | | - Amanda A. Sesker
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida, USA
| | - Xianghe Zhu
- Department of Geriatrics, Florida State University College of Medicine, Florida, USA
| | - Antonio Terracciano
- Department of Geriatrics, Florida State University College of Medicine, Florida, USA
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20
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Toyama M, Fuller HR, Hektner JM. Longitudinal Associations of Conscientiousness and Neuroticism With Perceived Mastery and Constraints for Aging Adults. Res Aging 2021; 44:83-95. [PMID: 33563107 DOI: 10.1177/0164027521992892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has not been well understood how conscientiousness and neuroticism are associated with two related but distinct dimensions of perceived control (i.e., perceived mastery and constraints) among aging adults. The present study examined these associations and their change over time, while addressing whether they differ by age or gender. For respondents aged 50+ at baseline (N = 2,768) in the Midlife in the United States (MIDUS) study, multilevel modeling analyses were conducted to assess how conscientiousness and neuroticism predicted perceived mastery and constraints over 2 decades. As expected, higher conscientiousness and lower neuroticism (for both between- and within-person variability) predicted higher perceived mastery and lower perceived constraints overall. Nuanced findings emerged related to age, gender and change over time for different associations of conscientiousness and neuroticism with the outcomes. These findings can inform future research suggesting directions of further investigations for these complex associations.
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Affiliation(s)
- Masahiro Toyama
- Division of Natural Sciences & Mathematics, University of the Ozarks, Clarksville, AR, USA.,Department of Human Development and Family Science, North Dakota State University, Fargo, ND, USA
| | - Heather R Fuller
- Department of Human Development and Family Science, North Dakota State University, Fargo, ND, USA
| | - Joel M Hektner
- Department of Human Development and Family Science, North Dakota State University, Fargo, ND, USA
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