Quality of Life Research

, Volume 17, Issue 9, pp 1195–1204

Personality and EQ-5D scores among individuals with chronic conditions

  • Anthony Jerant
  • Benjamin P. Chapman
  • Peter Franks
Article

Abstract

Background

Personality is associated with self-rated health, but prior studies have not examined associations with preference-based measures. We hypothesized similar associations would exist with preference-based health.

Methods

We analyzed baseline data from chronically ill individuals enrolled in a self-management intervention. We conducted regression analyses with the EQ-5D summary index score and dimension scores (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) as dependent variables, The key independent variables were NEO-Five Factor Inventory (NEO-FFI) personality factors (Neuroticism, Conscientiousness, Extraversion, Openness, Agreeableness), adjusting for age, gender, educational level, minority status, and chronic conditions.

Results

Of 415 participants, 245 (59%) had ≥2 chronic conditions, 384 (94%) completed the NEO-FFI and 397 (96%) the EQ-5D. After adjustment, Neuroticism was associated with EQ-5D summary index scores [−0.04 per 1 SD increase in Neuroticism (95% CI −0.06, −0.01)]. Neuroticism [AOR 2.99 (95% CI 2.06, 4.35; P < 0.001)] and Openness [1.32 (95% CI 1.00, 1.75; P = 0.05)] were associated with worse anxiety/depression scores, while Conscientiousness was associated with better usual activities scores [0.66 (95% CI 0.49, 0.89; P = 0.01)].

Conclusions

The associations between personality factors and self-rated health appear to extend to preference-based measures. Future studies should explore whether personality affects preference-based health estimates in cost-effectiveness analyses.

Keywords

Bias Chronic disease Health status Personality Quality of life 

Abbreviations

CDSMP

Chronic Disease Self-Management Program

CEA

Cost-effectiveness analysis

CES-D

Center for Epidemiologic Studies Depression Scale

CI

Confidence interval

CLAD

Censored least absolute deviations

COPD

Chronic obstructive pulmonary disease

FFM

Five Factor Model

HAQ

Health Assessment Questionnaire

HIOH

Homing in on Health

MCID

Minimal clinically important difference

NEO-FFI

Neo-Five Factor Inventory

OLS

Ordinary least squares

QALY

Quality-adjusted life-year

RCT

Randomized controlled trial

SD

Standard deviation

References

  1. 1.
    Perenboom, R. J., van Herten, L. M., Boshuizen, H. C., & van den Bos, G. A. (2005). Life expectancy without chronic morbidity: Trends in gender and socioeconomic disparities. Public Health Reports, 120, 46–54.PubMedGoogle Scholar
  2. 2.
    Barger, S. D. (2006). Do psychological characteristics explain socioeconomic stratification of self-rated health? Journal of Health Psychology, 11, 21–35. doi:10.1177/1359105306058839.PubMedCrossRefGoogle Scholar
  3. 3.
    Benyamini, Y., Idler, E. L., Leventhal, H., & Leventhal, E. A. (2000). Positive affect and function as influences on self-assessments of health: Expanding our view beyond illness and disability. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 55, 107–116.Google Scholar
  4. 4.
    Chapman, B. P., Duberstein, P. R., & Lyness, J. M. (2007). The distressed personality type: Replicability and general health associations. European Journal of Personality, 21, 1–19. doi:10.1002/per.645.CrossRefGoogle Scholar
  5. 5.
    Chapman, B. P., Duberstein, P. R., Sorensen, S., & Lyness, J. M. (2006). Personality and perceived health in older adults: The five factor model in primary care. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 61, P362–P365.PubMedGoogle Scholar
  6. 6.
    Duberstein, P. R., Sorensen, S., Lyness, J. M., King, D. A., Yeates, C., Seidlitz, L., et al. (2003). Personality is associated with perceived health and functional status in older primary care patients. Psychology and Aging, 18, 25–37. doi:10.1037/0882-7974.18.1.25.PubMedCrossRefGoogle Scholar
  7. 7.
    Gilhooly, M., Hanlon, P., Cullen, B., Macdonald, S., & Whyte, B. (2007). Successful ageing in an area of deprivation: Part 2—a quantitative exploration of the role of personality and beliefs in good health in old age. Public Health, 121, 814–821. doi:10.1016/j.puhe.2007.03.003.PubMedCrossRefGoogle Scholar
  8. 8.
    Goodwin, R., & Engstrom, G. (2002). Personality and the perception of health in the general population. Psychological Medicine, 32, 325–332.PubMedGoogle Scholar
  9. 9.
    Hooker, K., Monahan, D., Shifren, K., & Hutchinson, C. (1992). Mental and physical health of spouse caregivers: The role of personality. Psychology and Aging, 7, 367–375. doi:10.1037/0882-7974.7.3.367.PubMedCrossRefGoogle Scholar
  10. 10.
    Hooker, K., Monahan, D. J., Bowman, S. R., Frazier, L. D., & Shifren, K. (1998). Personality counts for a lot: Predictors of mental and physical health of spouse caregivers in two disease groups. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 53, P73–P85.PubMedGoogle Scholar
  11. 11.
    Jerram, K. L., & Coleman, P. G. (1999). The big five personality traits and reporting of health problems and health behaviour in old age. British Journal of Health Psychology, 4(Part 2), 181–192. doi:10.1348/135910799168560.CrossRefGoogle Scholar
  12. 12.
    Kempen, G. I., Jelicic, M., & Ormel, J. (1997). Personality, chronic medical morbidity, and health-related quality of life among older persons. Health Psychology, 16, 539–546. doi:10.1037/0278-6133.16.6.539.PubMedCrossRefGoogle Scholar
  13. 13.
    Korotkov, D., & Hannah, T. E. (2004). The Five Factor Model of personality: Strengths and limitations in predicting health status, sick-role, and illness behavior. Personality and Individual Differences, 36, 187–199. doi:10.1016/S0191-8869(03)00078-3.CrossRefGoogle Scholar
  14. 14.
    Kressin, N. R., Spiro, A., 3rd, & Skinner, K. M. (2000). Negative affectivity and health-related quality of life. Medical Care, 38, 858–867. doi:10.1097/00005650-200008000-00009.PubMedCrossRefGoogle Scholar
  15. 15.
    Moor, C., Zimprich, D., Schmitt, M., & Kliegel, M. (2006). Personality, aging self-perceptions, and subjective health: A mediation model. International Journal of Aging and Human Development, 63, 241–257. doi:10.2190/AKRY-UM4K-PB1V-PBHF.PubMedCrossRefGoogle Scholar
  16. 16.
    van Straten, A., Cuijpers, P., van Zuuren, F. J., Smits, N., & Donker, M. (2007). Personality traits and health-related quality of life in patients with mood and anxiety disorders. Quality of Life Research, 16, 1–8. doi:10.1007/s11136-006-9124-x.PubMedCrossRefGoogle Scholar
  17. 17.
    Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychological Review, 96, 234–254. doi:10.1037/0033-295X.96.2.234.PubMedCrossRefGoogle Scholar
  18. 18.
    Yamaoka, K., Shigehisa, T., Ogoshi, K., Haruyama, K., Watanabe, M., Hayashi, F., et al. (1998). Health-related quality of life varies with personality types: A comparison among cancer patients, non-cancer patients and healthy individuals in a Japanese population. Quality of Life Research, 7, 535–544. doi:10.1023/A:1008830509237.PubMedCrossRefGoogle Scholar
  19. 19.
    Costa, P. T., Jr., & McCrae, R. R. (1997). Stability and change in personality assessment: The revised NEO personality inventory in the year 2000. Journal of Personality Assessment, 68, 86–94. doi:10.1207/s15327752jpa6801_7.PubMedCrossRefGoogle Scholar
  20. 20.
    Bogg, T., & Roberts, B. W. (2004). Conscientiousness and health-related behaviors: A meta-analysis of the leading behavioral contributors to mortality. Psychological Bulletin, 130, 887–919. doi:10.1037/0033-2909.130.6.887.PubMedCrossRefGoogle Scholar
  21. 21.
    Chapman, B., Duberstein, P., & Lyness, J. M. (2007). Personality traits, education, and health-related quality of life among older adult primary care patients. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 62, 343–352.Google Scholar
  22. 22.
    Chapman, B. P., Lyness, J. L., & Duberstein, P. D. (2007). Personality and medical illness burden among older adults in primary care. Psychosomatic Medicine, 69, 277–282. doi:10.1097/PSY.0b013e3180313975.PubMedCrossRefGoogle Scholar
  23. 23.
    Christensen, A. J., & Smith, T. W. (1995). Personality and patient adherence: Correlates of the five-factor model in renal dialysis. Journal of Behavioral Medicine, 18, 305–313. doi:10.1007/BF01857875.PubMedCrossRefGoogle Scholar
  24. 24.
    Cohen, N. L., Ross, E. C., Bagby, R. M., Farvolden, P., & Kennedy, S. H. (2004). The 5-factor model of personality and antidepressant medication compliance. Canadian Journal of Psychiatry, 49, 106–113.Google Scholar
  25. 25.
    Hyphantis, T., Kaltsouda, A., Triantafillidis, J., Platis, O., Karadagi, S., Christou, K., et al. (2005). Personality correlates of adherence to type 2 diabetes regimens. International Journal of Psychiatry in Medicine, 35, 103–107. doi:10.2190/NBQA-08A7-6MG9-GC8W.PubMedCrossRefGoogle Scholar
  26. 26.
    O’Cleirigh, C., Ironson, G., Weiss, A., & Costa, P. T., Jr. (2007). Conscientiousness predicts disease progression (CD4 number and viral load) in people living with HIV. Health Psychology, 26, 473–480. doi:10.1037/0278-6133.26.4.473.PubMedCrossRefGoogle Scholar
  27. 27.
    Roberts, B. W., Kuncel, N. R., Shiner, R., Caspi, A., & Goldberg, L. R. (2007). The power of personality: The comparative validity of personality traits, socioeconomic status, and cognitive ability for predicting important life outcomes. Perspectives on Psychological Science, 2, 313–345. doi:10.1111/j.1745-6916.2007.00047.x.CrossRefGoogle Scholar
  28. 28.
    Lubetkin, E. I., Jia, H., Franks, P., & Gold, M. R. (2005). Relationship among sociodemographic factors, clinical conditions, and health-related quality of life: Examining the EQ-5D in the U.S. general population. Quality of Life Research, 14, 2187–2196. doi:10.1007/s11136-005-8028-5.PubMedCrossRefGoogle Scholar
  29. 29.
    Sullivan, P. W., & Ghushchyan, V. (2006). Preference-based EQ-5D index scores for chronic conditions in the United States. Medical Decision Making, 26, 410–420. doi:10.1177/0272989X06290495.PubMedCrossRefGoogle Scholar
  30. 30.
    Nyman, J. A., Barleen, N. A., Dowd, B. E., Russell, D. W., Coons, S. J., & Sullivan, P. W. (2007). Quality-of-life weights for the US population: Self-reported health status and priority health conditions, by demographic characteristics. Medical Care, 45, 618–628. doi:10.1097/MLR.0b013e31803dce05.PubMedCrossRefGoogle Scholar
  31. 31.
    Saarni, S. I., Suvisaari, J., Sintonen, H., Koskinen, S., Harkanen, T., & Lonnqvist, J. (2007). The health-related quality-of-life impact of chronic conditions varied with age in general population. Journal of Clinical Epidemiology, 60, 1288–1297. doi:10.1016/j.jclinepi.2007.03.004.PubMedCrossRefGoogle Scholar
  32. 32.
    Jia, H., & Lubetkin, E. I. (2005). The impact of obesity on health-related quality-of-life in the general adult US population. Journal of Public Health (Oxford, England), 27, 156–164. doi:10.1093/pubmed/fdi025.CrossRefGoogle Scholar
  33. 33.
    Gunther, O. H., Roick, C., Angermeyer, M. C., & Konig, H. H. (2008). The responsiveness of EQ-5D utility scores in patients with depression: A comparison with instruments measuring quality of life, psychopathology and social functioning. Journal of Affective Disorders, 105, 81–91. doi:10.1016/j.jad.2007.04.018.PubMedCrossRefGoogle Scholar
  34. 34.
    Pickard, A. S., Johnson, J. A., & Feeny, D. H. (2005). Responsiveness of generic health-related quality of life measures in stroke. Quality of Life Research, 14, 207–219. doi:10.1007/s11136-004-3928-3.PubMedCrossRefGoogle Scholar
  35. 35.
    Wu, A. W., Jacobson, K. L., Frick, K. D., Clark, R., Revicki, D. A., Freedberg, K. A., et al. (2002). Validity and responsiveness of the euroqol as a measure of health-related quality of life in people enrolled in an AIDS clinical trial. Quality of Life Research, 11, 273–282. doi:10.1023/A:1015240103565.PubMedCrossRefGoogle Scholar
  36. 36.
    Shikiar, R., Willian, M. K., Okun, M. M., Thompson, C. S., & Revicki, D. A. (2006). The validity and responsiveness of three quality of life measures in the assessment of psoriasis patients: Results of a phase II study. Health and Quality of Life Outcomes, 4, 71. doi:10.1186/1477-7525-4-71.PubMedCrossRefGoogle Scholar
  37. 37.
    Luce, B. R., Manning, W. G., Siegel, J. E., & Lipscomb, J. (1996). Estimating costs in cost-effectiveness analysis. In M. R. Gold, J. E. Siegel, L. B. Russell & M. C. Weinstein (Eds.), Cost-effectiveness in health and medicine (pp. 176–213). New York: Oxford University Press.Google Scholar
  38. 38.
    Grilo, C. M., Money, R., Barlow, D. H., Goddard, A. W., Gorman, J. M., Hofmann, S. G., et al. (1998). Pretreatment patient factors predicting attrition from a multicenter randomized controlled treatment study for panic disorder. Comprehensive Psychiatry, 39, 323–332. doi:10.1016/S0010-440X(98)90043-8.PubMedCrossRefGoogle Scholar
  39. 39.
    Ross, L., Thomsen, B. L., Boesen, E. H., & Johansen, C. (2004). In a randomized controlled trial, missing data led to biased results regarding anxiety. Journal of Clinical Epidemiology, 57, 1131–1137. doi:10.1016/j.jclinepi.2004.03.010.PubMedCrossRefGoogle Scholar
  40. 40.
    Shaw, W. S., Cronan, T. A., & Christie, M. D. (1994). Predictors of attrition in health intervention research among older subjects with osteoarthritis. Health Psychology, 13, 421–431. doi:10.1037/0278-6133.13.5.421.PubMedCrossRefGoogle Scholar
  41. 41.
    Tedlow, J. R., Fava, M., Uebelacker, L. A., Alpert, J. E., Nierenberg, A. A., & Rosenbaum, J. F. (1996). Are study dropouts different from completers? Biological Psychiatry, 40, 668–670. doi:10.1016/0006-3223(96)00204-1.PubMedCrossRefGoogle Scholar
  42. 42.
    Jerant, A. F., Chapman, B., Duberstein, P., & Franks, P. (2008). Is personality a key predictor of missing study data? An analysis from a randomized controlled trial. Annals of Family Medicine (in press).Google Scholar
  43. 43.
    Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown, B. W., Jr., Bandura, A., Ritter, P., et al. (1999). Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: A randomized trial. Medical Care, 37, 5–14. doi:10.1097/00005650-199901000-00003.PubMedCrossRefGoogle Scholar
  44. 44.
    Costa, P. T., & McCrae, R. R. (1992). Revised NEO personality inventory and NEO five factor inventory: Professional manual. Odessa, FL: Psychological Assessment.Google Scholar
  45. 45.
    Brooks, R. (1996). EuroQol: The current state of play. Health Policy (Amsterdam), 37, 53–72. doi:10.1016/0168-8510(96)00822-6.Google Scholar
  46. 46.
    Fries, J. F., Spitz, P., Kraines, R. G., & Holman, H. R. (1980). Measurement of patient outcome in arthritis. Arthritis and Rheumatism, 23, 137–145. doi:10.1002/art.1780230202.PubMedCrossRefGoogle Scholar
  47. 47.
    Irwin, M., Artin, K. H., & Oxman, M. N. (1999). Screening for depression in the older adult: Criterion validity of the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Archives of Internal Medicine, 159, 1701–1704. doi:10.1001/archinte.159.15.1701.PubMedCrossRefGoogle Scholar
  48. 48.
    Jerant, A. F., von Friederichs-Fitzwater, M. M., & Moore, M. (2005). Patients’ perceived barriers to active self-management of chronic conditions. Patient Education and Counseling, 57, 300–307. doi:10.1016/j.pec.2004.08.004.PubMedCrossRefGoogle Scholar
  49. 49.
    Jerant, A., Kravitz, R., Moore-Hill, M., & Franks, P. (2008). Depressive symptoms moderated the effects of chronic illness self-management training on self-efficacy. Medical Care, 46, 523–531. doi:10.1097/MLR.0b013e31815f53a4.PubMedCrossRefGoogle Scholar
  50. 50.
    Shaw, J. W., Johnson, J. A., & Coons, S. J. (2005). US valuation of the EQ-5D health states: Development and testing of the D1 valuation model. Medical Care, 43, 203–220. doi:10.1097/00005650-200503000-00003.PubMedCrossRefGoogle Scholar
  51. 51.
    Sullivan, P. W., Lawrence, W. F., & Ghushchyan, V. (2005). A national catalog of preference-based scores for chronic conditions in the United States. Medical Care, 43, 736–749. doi:10.1097/01.mlr.0000172050.67085.4f.PubMedCrossRefGoogle Scholar
  52. 52.
    Johnson, J. A., & Coons, S. J. (1998). Comparison of the EQ-5D and SF-12 in an adult US sample. Quality of Life Research, 7, 155–166. doi:10.1023/A:1008809610703.PubMedCrossRefGoogle Scholar
  53. 53.
    Johnson, J. A., & Pickard, A. S. (2000). Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta, Canada. Medical Care, 38, 115–121. doi:10.1097/00005650-200001000-00013.PubMedCrossRefGoogle Scholar
  54. 54.
    Huang, I. C., Frangakis, C., Atkinson, M. J., Willke, R. J., Leite, W. L., Vogel, W. B., et al. (2008). Addressing ceiling effects in health status measures: A comparison of techniques applied to measures for people with HIV disease. Health Services Research, 43, 327–339.PubMedCrossRefGoogle Scholar
  55. 55.
    Nettle, D. (2006). The evolution of personality variation in humans and other animals. The American Psychologist, 61, 622–631. doi:10.1037/0003-066X.61.6.622.PubMedCrossRefGoogle Scholar
  56. 56.
    Nowakowska, C., Strong, C. M., Santosa, C. M., Wang, P. W., & Ketter, T. A. (2005). Temperamental commonalities and differences in euthymic mood disorder patients, creative controls, and healthy controls. Journal of Affective Disorders, 85, 207–215. doi:10.1016/j.jad.2003.11.012.PubMedCrossRefGoogle Scholar
  57. 57.
    McCrae, R. R. (1993). Openness to Experiences as a basic dimension of personality. Imagination, Cognition and Personality, 13, 39–55. doi:10.2190/H8H6-QYKR-KEU8-GAQ0.CrossRefGoogle Scholar
  58. 58.
    Simpson, S. H., Eurich, D. T., Majumdar, S. R., Padwal, R. S., Tsuyuki, R. T., Varney, J., et al. (2006). A meta-analysis of the association between adherence to drug therapy and mortality. British Medical Journal, 333, 15. doi:10.1136/bmj.38875.675486.55.PubMedCrossRefGoogle Scholar
  59. 59.
    Tidermark, J., Bergstrom, G., Svensson, O., Tornkvist, H., & Ponzer, S. (2003). Responsiveness of the EuroQol (EQ 5-D) and the SF-36 in elderly patients with displaced femoral neck fractures. Quality of Life Research, 12, 1069–1079. doi:10.1023/A:1026193812514.PubMedCrossRefGoogle Scholar
  60. 60.
    Grutters, J. P., Joore, M. A., van der Horst, F., Verschuure, H., Dreschler, W. A., & Anteunis, L. J. (2007). Choosing between measures: Comparison of EQ-5D, HUI2 and HUI3 in persons with hearing complaints. Quality of Life Research, 16, 1439–1449. doi:10.1007/s11136-007-9237-x.PubMedCrossRefGoogle Scholar
  61. 61.
    Tidermark, J., & Bergstrom, G. (2007). Responsiveness of the EuroQol (EQ-5D) and the Nottingham health profile (NHP) in elderly patients with femoral neck fractures. Quality of Life Research, 16, 321–330. doi:10.1007/s11136-006-9004-4.PubMedCrossRefGoogle Scholar
  62. 62.
    Brazier, J., Roberts, J., Tsuchiya, A., & Busschbach, J. (2004). A comparison of the EQ-5D and SF-6D across seven patient groups. Health Economics, 13, 873–884. doi:10.1002/hec.866.PubMedCrossRefGoogle Scholar
  63. 63.
    Pickard, A. S., Wilke, C., Jung, E., Patel, S., Stavem, K., & Lee, T. A. (2008). Use of a preference-based measure of health (EQ-5D) in COPD and asthma. Respiratory Medicine, 102(4):519–536.PubMedCrossRefGoogle Scholar
  64. 64.
    Haywood, K. L., Garratt, A. M., Dziedzic, K., & Dawes, P. T. (2002). Generic measures of health-related quality of life in ankylosing spondylitis: Reliability, validity and responsiveness. Rheumatology (Oxford, England), 41, 1380–1387. doi:10.1093/rheumatology/41.12.1380.CrossRefGoogle Scholar
  65. 65.
    Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59, 877–883. doi:10.1001/archpsyc.59.10.877.PubMedCrossRefGoogle Scholar
  66. 66.
    Franks, P., Chapman, B., Duberstein, P., & Jerant, A. (2008). Five factor model personality factors moderated the effects of an intervention to enhance chronic disease management self-efficacy. British Journal of Health Psychology (in press).Google Scholar
  67. 67.
    Mroczek, D. K., & Spiro, A., 3rd. (2007). Personality change influences mortality in older men. Psychological Science, 18, 371–376. doi:10.1111/j.1467-9280.2007.01907.x.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Anthony Jerant
    • 1
  • Benjamin P. Chapman
    • 2
  • Peter Franks
    • 3
  1. 1.Department of Family & Community MedicineUniversity of California Davis School of MedicineSacramentoUSA
  2. 2.Laboratory of Personality and Development, Department of PsychiatryUniversity of Rochester Medical CenterRochesterUSA
  3. 3.Center for Healthcare Policy and Research, Department of Family & Community MedicineUniversity of California Davis School of MedicineSacramentoUSA

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