Connection Between Personality, Death Among Chronically Ill

If a chronic disease struck the Hundred Acre Woods, who would live longer, Winnie the Pooh or Eeyore? According to new research about how personality affects survival rates in chronically ill patients, easy-going Pooh would have the edge over his gloomy friend.

The research, published as the lead article in the July issue of the journal Health Psychology, found that patients who were prone to depressed mood, pessimism and excessive worrying were 37.5 percent more likely than the average patient to die in an average four-year period, and those who tended to be highly conscientious, goal directed and dependable were 36.4 percent less likely to die.

Alan Christensen, a professor of psychology in the UI College of Liberal Arts and Sciences, professor of internal medicine in the UI Carver College of Medicine and the primary investigator, said this study provides the first strong connection between personality and mortality among the chronically ill.

"We've seen many decades of speculation about whether psychological traits affect physical health, but until recently there has not been a lot of good, hard evidence," he said.

In this study, Christensen and his team, including Dr. William Lawton, UI associate professor of internal medicine, followed 174 patients suffering from chronic renal insufficiency (impaired kidney function). Each patient completed a standard personality assessment at the outset consisting of 60 questions designed to gauge five areas of personality -- neuroticism, conscientiousness, extraversion, openness to experience and agreeableness. At follow-up, which ranged from 24 to 69 months depending on when the patients were enrolled in the study, 49 (28.2 percent) of the patients had died.

The researchers also conducted extensive reviews of each patient's medical history and status to control for such factors as age, diabetes and anemia, which are significant physical conditions contributing to mortality. For example, each additional year in age increased patients' risk of death 5.4 percent.

The study showed that both neuroticism and conscientiousness were significant factors in predicting patient mortality beyond the effects of age and many medical factors.

Neuroticism generally refers to having a negative outlook on life, being prone to mildly depressed mood and excessive worrying. Those high in neuroticism are generally not severely depressed or being treated for depression. Individuals high in neuroticism may be at risk for poor health due to a reduction in immune functioning or simply because they do not engage in healthy behaviors.

Conscientiousness refers to diligence, a strong sense of personal control and a willingness to take on personal challenges. Those low in conscientiousness may be lax about engaging in healthy behaviors and are known to be less willing to follow prescribed medical treatments or advice. This reluctance to follow important medical treatments may contribute to their decreased survival rates.

"The data suggest that it may be as important for patients and physicians to think about patients' psychological traits, emotions and behaviors and how they see and approach the world and themselves as it is to consider the medical or physical status of the patient," Christensen said. "We all know people who are not severely depressed but who chronically tend toward moderate depression or anxiety. Typically we just think 'Oh, that's just how they are,' and don't pay attention to it as a potentially important factor in their physical health. This research shows that we should be paying attention because these traits could be shortening their lives."

Although we don't usually think of such lifelong enduring traits as being easy to change, Christensen said that there is reason to believe individuals can alter their degree of neuroticism and conscientiousness. Moreover, doctors should be able to use information about how their patients' personalities may be putting them at risk to judge how closely they need to be monitored and how aggressively to treat them.

This research was funded by the National Institutes of Health. In addition to Christensen and Lawton, the research team included Shawna L. Ehlers, Patricia J. Moran, Katherine Raichle, Karin Ferneyhough, all of the UI Department of Psychology; and John S. Wiebe, of the University of Texas at El Paso Department of Psychology.