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Representative Sample
Health Status and the Five-factor Personality Traits in a Nationally
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643
Health Status and the
Five-factor Personality
Traits in a Nationally
Representative
Sample
R E N E E D. G O O DW I N
Columbia University, USA
H OWA R D S. F R I E D M A N
University of California-Riverside, USA
Journal of Health Psychology
Copyright © 2006 SAGE Publications
London, Thousand Oaks and New Delhi,
www.sagepublications.com
Vol 11(5) 643–654
DOI: 10.1177/1359105306066610
Abstract
The authors’ objective was to
determine the association between the
‘big-five’ personality traits and mental
and physical disorders among adults in
the United States. The Midlife
Development in the United States
Survey, a nationally representative
sample of 3032 adults ages 25–74, was
used to determine the association
between the five-factor traits of
personality and common mental and
physical disorders. Findings are
consistent with and extend previous
results showing that conscientiousness
is associated with significantly reduced
likelihood of a wide range of mental
and physical disorders among adults in
the general population, and inversely
that neuroticism is associated with
increased rates. Among adults with
physical illnesses, associations were
found between personality and
likelihood of physical limitations,
especially conscientiousness. These
findings provide a framework upon
which research on complex causal
processes may proceed. Thus future
research attention might profitably be
directed to conscientiousness-relevant
processes, such as adherence to health
and treatment recommendations and
internalization of healthy societal
norms for sensible health-related
behavior.
Keywords
■
conscientiousness
■
epidemiology
■
health status
■
personality
■
physical illness
C O M P E T I N G I N T E R E S T S
: None declared.
A D D R E S S
. Correspondence should be directed to:
R E N E E D
.
G O O DW I N
, Department of Epidemiology, Mailman School
of Public Health, Columbia University, 722 West 168th Street, Room
1706, New York, New York 10032, USA. [email: rdg66@columbia.edu]
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R E S E A R C H E R S
in health psychology have
traditionally used a wide but unsystematic range
of personality concepts in efforts to link indi-
vidual differences and health. These include
nervousness, anger, hostility, aggression, Type A,
repression, sensation-seeking, anxiety, cynicism,
locus of control, hardiness, vital exhaustion,
ambition, delinquency, trust and many others.
Recent research in personality theory, however,
has shown the value of a five-factor model, which
involves neuroticism, extraversion, conscien-
tiousness, agreeableness and openness to experi-
ence. Although there is some disagreement
about the details, there is substantial agreement
that it would be useful to use some variant of the
five-factor model in studying individual differ-
ences and health (Smith & Williams, 1992). For
example, conscientiousness has been previously
studied under a variety of classifications and
rubrics that now might be united (Costa &
McCrae, 1998; Goldberg, 1999).
One of the most surprising findings to emerge
from health psychology research in the past
decade is the apparent importance of the
personality dimension of conscientiousness to
health. At the beginning of the 1990s, most
attention in the area of personality and health
was still focused around anger and hostility
(Smith & Pope, 1990), which was an outgrowth
of pioneering research on Type A behavior. In
the decade that followed, however, conscien-
tiousness emerged as a key factor. Friedman and
colleagues showed that conscientiousness in
childhood was a good predictor of life-span
mortality risk (Friedman et al., 1993). Others
then confirmed that conscientiousness may be a
key personality predictor of health (Christensen
et al., 2002; Roberts & Bogg, in press).
Research on personality and health is ulti-
mately important because of the information it
provides about likely causal mechanisms linking
psychology and health. Although many causal
and reciprocal relations have been documented,
some associations draw attention to certain
temperamental mechanisms, coping mechan-
isms or behavioral mechanisms.
Research in personality and health has also
now begun turning away from an artificial
separation of mental and physical illness. It is
increasingly clear that traditionally ‘mental’
disorders such as depression, anxiety and
substance abuse should often be conceptually
linked to traditionally ‘physical’ disorders such
as diabetes, skin disorders and hypertension, as
the complex ties among physiology, psychology,
behavior, environment and health are better
appreciated. For example, multifaceted ties
have been demonstrated among personality,
stress, hormones, body fat and eating (Bradley,
Pierce, Hendrieckx, Riazi, & Barendse, 2001;
Epel, Spanakos, Kasl-Godley, & Brownell, 1996;
Goldston, Kovacs, Obrosky, & Iyengar, 1995).
The present study therefore includes both types
of illness.
Once illness occurs, personality is often
associated with limitations on physical function-
ing, although here too there is limited infor-
mation on national samples. There are various
potential pathways affecting adaptation over
time (Graziano & Ward, 1992). These adapta-
tions may shed light on the broader causal links
among personality and disease, and so we exam-
ined limits on physical functioning.
In sum, the present study employed a nation-
ally representative sample to determine the
association between the big-five personality
traits, including conscientiousness, extraversion,
openness to experience, agreeableness and
neuroticism, and common mental and physical
disorders.
Materials and methods
Sample
The Midlife Development in the United States
(MIDUS) survey is a nationally representative
survey of 3032 persons aged 25–74 years in the
non-institutionalized civilian population of the
48 coterminous United States (Brim et al., 1996;
Kessler, DuPont, Berglund, & Wittchen, 1999).
The survey was carried out by the John D. and
Catherine T. MacArthur Foundation Network
on Successful Midlife Development between
January 1995 and January 1996. All respondents
completed a 30-minute telephone interview
(70.0 percent response rate) and filled out 2
mailed questionnaires estimated to take a total
of about 90 minutes to complete (86.8 percent
conditional response rate in the subsample of
telephone respondents). The overall response
rate was 60.8 percent. The participants were
grouped by those who were and were not
married, white and minority racial status, and
educational attainment (dichotomized into
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those who had and had not completed high
school). More details on the MIDUS survey
design, field procedures and representativeness
are available elsewhere (Brim et al., 1996;
Kessler et al., 1999).
Diagnostic assessment
All measures were independently validated in
previous research. The MIDUS survey diag-
noses were based on the Composite Inter-
national Diagnostic Interview (CIDI) Short
Form scales, a series of diagnostic-specific scales
that were developed from item-level analyses of
the CIDI questions in the National Comorbid-
ity Survey (Kessler et al., 1994). The CIDI Short
Form scales were designed to reproduce the full
Composite International Diagnoses as exactly
as possible with only a small subset of the orig-
inal questions. Comparison of the CIDI Short
Form classifications of major depression with
the full CIDI (Wittchen, 1994) classifications in
the National Comorbidity Survey yielded a
sensitivity of 89.6 percent, a specificity of 93.9
percent and an overall agreement of 93.2
percent (Kessler, Andrews, Mroczek, Ustun, &
Wittchen, 1998). Major depression, panic
attacks, generalized anxiety disorder (GAD)
and alcohol and drug abuse and dependence
were included in the current study.
Physical illnesses were assessed by self-report
of past 12-month prevalence including the
following disorders: asthma/chronic bronchi-
tis/emphysema, tuberculosis, other lung disease,
persistent skin problems,
sciatica/lumbago
(lower back pain), urinary/bladder problems,
high blood pressure, diabetes/high blood sugar,
stroke,
ulcer,
bone/joint problems and
hernia/rupture. While the data are limited in
that there were no objective physician diagnoses
or accompanying physical exams, previous
epidemiologic studies have documented
adequate reliability and validity for the self-
report physical illnesses included above (Idler,
Hudson, & Leventhal, 1999). Nevertheless,
some of the conditions are likely subject to self-
report biases, and so overall patterns were the
focus of the present study.
Personality factors
Assessment of personality traits in the Midlife
Development Inventory Personality Scales
(MIDI), based on the ‘big-five’ factor model, was
developed based on the results of a pilot study,
which was conducted in 1994 with a probability
sample of 1000 men and women, age 30–70 (574
valid cases were usable for item analysis). Items
with the highest item to total correlations and
factor loadings were selected for MIDI (Gold-
berg, 1992; John, 1990; Lachman & Weaver, 1997;
Trapnell & Wiggins, 1990). Forward regressions
were also run to determine the smallest number
of items needed to account for over 90 percent
of the total scale variance. Scales included extra-
version (alpha = 0.78), openness to experience
(alpha = 0.77), conscientiousness (alpha = 0.57),
agreeableness (alpha = 0.80) and neuroticism
(alpha = 0.74). Responses were on a Likert-type
scale from one to four, asking respondents to
describe how much of the time the word
described them. Items of the measure of consci-
entiousness included, ‘organized’, ‘responsible’,
‘careless (not)’ and ‘hardworking’. The scale
asked ‘all’, ‘most’, ‘some’ and ‘a little’. For each
trait, the score for each case was computed by
finding the mean of the relevant personality
items for cases that had valid values for at least
half of the items for that trait. The alphas are
based on the MIDUS national sample.
Limitations on physical
functioning
Within the MIDUS survey, a series of questions
was asked of each participant about the amount
that the individual was limited in specific physi-
cal activities. Respondents were asked separate
questions about whether respondents had
experienced limitations in the following areas of
functioning within the past 12 months: lifting or
carrying groceries; bathing or dressing yourself;
climbing stairs; bending, kneeling, stooping;
walking more than one mile; walking several
blocks; and walking one block. Respondents
were also asked whether they experienced limi-
tations in moderate and/or vigorous physical
activity. Respondents could reply by indicating
one out of four items on a Likert scale for 1 =
never; 2 = occasionally; 3 = sometimes; 4 = often.
These items have been collapsed into one
measure of limitation of physical functioning for
use in these analyses.
Analytic strategy
Because illnesses were classified either as present
or absent, one-way ANOVA was deemed a
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simple yet powerful strategy used to determine
the difference in conscientiousness between
those with and without each mental and physi-
cal illness. These analyses were then run for each
of the four remaining big-five personality
factors (i.e. extraversion, agreeableness, open-
ness to experience and neuroticism). Because
overall patterns rather than individual disease
comparisons were of primary interest, the p-
values were not adjusted for multiple tests;
instead, a rational examination of patterns was
undertaken—with a focus on personality dimen-
sions where more than three-fourths of the
comparisons were reliably different in the
expected direction.
Next, linear regression analyses were used to
determine the association between conscien-
tiousness and level of limitations on physical
activity among adults who reported at least one
physical illness (current/past 12-months) (Table
6), adjusted for differences in age, gender, race,
marital status, education and mental disorders.
Again, these analyses were then repeated for
each of the big-five personality factors.
Results
Personality and
socio-demographic
characteristics
Females had significantly higher levels of consci-
entiousness than males (3.43 (0.46) vs 3.36
(0.46), F = 14.8, d.f. (1, 2619), p < 0.0001). There
was a significant association between conscien-
tiousness and level of education, with higher
education being associated with higher level of
conscientiousness (3.41 (0.46) vs 3.31 (0.48), F =
12.2, d.f. (1, 2619), p < 0.0001). There was no
significant association between conscientious-
ness and age, race or marital status (data not
shown).
Females had significantly higher levels of
extraversion (3.6 (0.4) vs 3.4 (0.5), F = 2.1, d.f.
(1, 2619), p = 0.01), but there were no other
sociodemographic differences associated with
extraversion. Openness to experience was
significantly higher among married adults,
compared with those who are not married (3.1
(0.5) vs 3.0 (0.5), F = 16.2, d.f. (1, 2619), p <
0.0001), males (3.1 (0.5) vs 3.0 (0.5), F = 22.7, d.f.
(1, 2619), p < 0.0001) and those who had more
formal education (3.1 (0.5) vs 2.8 (0.5), F = 44.4,
d.f. (1, 2619), p < 0.0001). Females had signifi-
cantly higher levels of agreeableness (3.36 (0.5)
vs 3.6 (0.4), F = 175.5, d.f. (1, 2619), p < 0.0001)
as did those with higher education (3.48 (0.48)
vs 3.54 (0.46), F = 4.5, d.f. (1, 2619), p = 0.034).
Females also had significantly higher levels of
neuroticism (2.35 (0.7) vs 2.15 (0.6), F = 59.8, d.f.
(1, 2619), p < 0.0001), and neuroticism was
associated with being younger (p < 0.0001), but
there were no other sociodemographic charac-
teristics associated with neuroticism.
Personality and illness among
adults in the community
Mental disorders The level of conscientious-
ness among those with each mental disorder was
significantly lower, compared to those without
mental disorders (Table 1). Specifically, those
with major depression, panic attacks, GAD and
alcohol/substance use disorders had reliably
lower levels of conscientiousness compared to
those without these disorders. A similar pattern
was evident for extraversion and mental health
(Table 2), with lower means among those with
major depression, panic attacks and GAD
compared to those without each of these
disorders. There was no significant association
between openness to experience and mental
disorders (Table 3), and agreeableness had a
lower mean among those with alcohol/substance
use disorders but was unrelated to other mental
disorders (Table 4). Neuroticism (Table 5) was
significantly higher among those with each
mental disorder, compared to those without.
Physical illness With the exception of asthma/
bronchitis, and other lung problems, each
physical illness queried was associated with a
significantly lower level of conscientiousness,
compared to those without each physical disor-
der. Extraversion showed no clear pattern,
although there was evidence for significantly
lower extraversion among respondents with
high blood pressure, sciatica, stroke and
tuberculosis, compared to those without. Simi-
larly, openness to experience showed no clear
pattern, although mean scores on openness to
experience were lower among those with stroke,
hernia, tuberculosis and bone/joint problems
compared to those without. Agreeableness like-
wise showed no clear pattern, although it was
higher among those with diabetes and high
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blood pressure (and marginally with bone/joint
problems and asthma/respiratory disease) but
lower among those with tuberculosis. Neuroti-
cism, like conscientiousness, showed a clear
pattern. Neuroticism was higher among respon-
dents with skin problems, sciatica, urinary prob-
lems, asthma/respiratory disease, ulcer and other
lung problems, compared to those without.
Personality and physical
limitations among adults with
physical illness
As predicted, among adults with a physical
illness, higher conscientiousness was associated
with a decreased frequency of physical limi-
tations (Table 6, columns 17–19). Among those
with self-reported physical illnesses, limitations
in physical exertion were fewer among those
with high conscientiousness compared to those
with low conscientiousness. This held true even
after adjusting for age, gender, race, marital
status, education and mental disorders.
In terms of the other personality traits, effects
were much weaker. Higher agreeableness was
associated with a decreased frequency of limi-
tations on bathing, dressing and walking short
distances (among those with self-reported phys-
ical illnesses). Higher openness and extraversion
GOODWIN: PERSONALITY AND HEALTH STATUS
647
Table 1. Level of conscientiousness among adults with and without common mental and physical disorders in
the community
Past 12 months
No disorder
Disorder present
r
p-value
Major depression
3.41 (0.45)
3.31 (0.48)
0.080
p < 0.0001
(n = 2592)
(n = 440)
Panic attack
3.41 (0.46)
3.31 (0.47)
0.049
p = 0.012
(n = 2844)
(n = 188)
Generalized anxiety disorder
3.40 (0.46)
3.27 (0.49)
0.047
p = 0.015
(n = 2952)
(n = 80)
Alcohol/substance use disorder
3.41 (0.45)
3.03 (0.65)
0.137
p < 0.0001
(n = 2564)
(n = 74)
Regular cigarette smoking
3.33 (0.50)
3.38 (0.50)
0.089
p < 0.0001
(n = 2345)
(n = 685)
Diabetes
3.41 (0.46)
3.25 (0.43)
0.078
p < 0.001
(n = 2492)
(n = 145)
High blood pressure
3.41 (0.46)
3.35 (0.45)
0.048
p = 0.015
(n = 2150)
(n = 484)
Persistent skin problems
3.41 (0.45)
3.32 (0.52)
0.063
p = 0.001
(n = 2353)
(n = 278)
Sciatica/lumbago
3.41 (0.45)
3.36 (0.48)
0.041
p = 0.036
(n = 2042)
(n = 534)
Urinary/bladder problems
3.41 (0.45)
3.35 (0.48)
0.042
p = 0.03
(n = 2286)
(n = 339)
Stroke
3.40 (0.45)
3.19 (0.54)
0.043
p = 0.028
(n = 2610)
(n = 24)
Ulcer
3.40 (0.45)
3.32 (0.55)
0.037
p = 0.057
(n = 2521)
(n = 114)
Hernia
3.41 (0.46)
3.22 (0.47)
0.074
p < 0.0001
(n = 2541)
(n = 92)
Tuberculosis
3.40 (0.45)
2.66 (0.13)
0.084
p < 0.0001
(n = 2625)
(n = 7)
Bone/joint problems
3.41 (0.46)
3.35 (0.47)
0.050
p = 0.011
(n = 2139)
(n = 491)
Asthma/bronchitis
3.40 (0.46)
3.40 (0.42)
0.000
NS
(n = 2287)
(n = 343)
Other lung problems
3.40 (0.46)
3.33 (0.44)
0.028
NS
(n = 2534)
(n = 93)
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were also both associated with decreased likeli-
hood of physical limitations in each area. In
contrast, higher neuroticism was associated with
an increased likelihood of limitations in physi-
cal functioning in each category among adults
with self-reported physical illnesses. These
associations persisted after adjusting for differ-
ences in sociodemographic characteristics and
comorbid mental disorders.
Discussion
A key step in understanding the public health
implications of the associations between person-
ality and illness is the careful measurement of
the associations between a variety of personal-
ity measures and a variety of illnesses. The
present study focused on the comprehensive
five-factor model of personality and a range of
both mental and physical illnesses, in a nation-
ally representative sample. This study then also
analyzed the relationship between personality
factors and physical limitations among indi-
viduals with physical illnesses.
This investigation complements studies that
have focused on causal mechanisms in restricted
samples, such as those that relate childhood
personality, health behaviors, longevity and
JOURNAL OF HEALTH PSYCHOLOGY 11(5)
648
Table 2. Level of extraversion among adults with and without common mental and physical disorders in the
community
Past 12 months
No disorder
Disorder present
r
p-value
Major depression
3.21 (0.56)
3.08 (0.57)
0.082
p < 0.0001
(n = 2592)
Panic attack
3.20 (0.56)
3.10 (0.57)
0.042
p = 0.03
(n = 2844)
Generalized anxiety disorder
3.20 (0.56)
3.02 (0.61)
0.051
p = 0.009
(n = 2952)
Alcohol/substance use disorder
3.20 (0.56)
3.10 (0.67)
0.029
p = 0.1
(n = 2564)
Regular cigarette smoking
3.19 (0.6)
3.20 (0.60)
0.005
NS
(n = 2345)
Diabetes
3.20 (0.57)
3.16 (0.55)
0.014
NS
(n = 2492)
High blood pressure
3.21 (0.57)
3.13 (0.53)
0.056
p = 0.004
(n = 2150)
Persistent skin problems
3.20 (0.56)
3.12 (0.60)
0.048
p = 0.015
(n = 2353)
Sciatica/lumbago
3.21 (0.56)
3.13 (0.57)
0.055
p = 0.005
(n = 2042)
Urinary/bladder problems
3.20 (0.56)
3.14 (0.59)
0.034
p = 0.087
(n = 2286)
Stroke
3.20 (0.56)
2.87 (0.58)
0.055
p = 0.005
(n = 2610)
Ulcer
3.20 (0.56)
3.17 (0.64)
0.011
NS
(n = 2521)
(n = 114)
Hernia
3.20 (0.56)
3.22 (0.49)
0.006
NS
(n = 2541)
(n = 92)
Tuberculosis
3.20 (0.56)
2.42 (1.16)
0.072
p < 0.0001
(n = 2625)
(n = 7)
Bone/joint problems
3.20 (0.56)
3.17 (0.57)
0.025
NS
(n = 2139)
(n = 491)
Asthma/bronchitis
3.20 (0.56)
3.20 (0.58)
0.002
NS
(n = 2287)
(n = 343)
Other lung problems
3.20 (0.56)
3.12 (0.60)
0.027
NS
(n = 2534)
(n = 93)
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cause of death (Friedman, Tucker, Schwartz,
Wingard, & Criqui, 1995b), or those that relate
mental health status and longevity (Martin et
al., 1995). The current study cannot and does not
attempt to establish direct causal links but
rather provides important clues for process
research. Specifically, the data are consistent
with but extend previous findings by document-
ing an association between conscientiousness
and decreased likelihood of mental and physical
disorders among adults in the general popu-
lation, as well as decreased physical limitations
among those with physical illnesses. Consistent
with recent research, the findings confirm that
conscientiousness must be a key consideration
in understanding personality and health (Fried-
man, Tucker, Schwartz, & Tomlinson, 1995a;
Roberts & Bogg, in press).
Our findings regarding the association
between neuroticism and mental disorders and
physical health problems are in line with previ-
ous work. Study results have consistently indi-
cated links between neuroticism and poor
physical health (Charles, Gatz, Pedersen, &
Dahlberg, 1999; Goodwin & Stein, 2003), poorer
treatment outcomes among those treated for
cardiac and other health conditions (Glazer,
Emery, Frid, & Banyasz, 2002; Pedersen, Middel,
GOODWIN: PERSONALITY AND HEALTH STATUS
649
Table 3. Level of openness to experience among adults with and without common mental and physical
disorders in the community
Past 12 months
No disorder
Disorder present
r
p-value
Major depression
3.04 (0.52)
3.03 (0.52)
0.007
NS
(n = 2592)
(n = 440)
Panic attack
3.04 (0.52)
3.00 (0.54)
0.017
NS
(n = 2844)
(n = 188)
Generalized anxiety disorder
3.04 (0.51)
2.96 (0.65)
0.024
NS
(n = 2952)
(n = 80)
Alcohol/substance use disorder
3.04 (0.52)
3.10 (0.51)
0.019
NS
(n = 2564)
(n = 74)
Regular cigarette smoking
3.00 (0.50)
3.10 (0.50)
0.028
NS
(n = 2345)
(n = 685)
Diabetes
3.04 (0.52)
2.94 (0.54)
0.046
p = 0.018
(n = 2492)
(n = 145)
High blood pressure
3.06 (0.52)
2.95 (0.51)
0.080
p < 0.0001
(n = 2150)
(n = 484)
Persistent skin problems
3.04 (0.52)
3.00 (0.52)
0.020
NS
(n = 2353)
(n = 278)
Sciatica/lumbago
3.05 (0.52)
3.00 (0.51)
0.033
p = 0.053
(n = 2042)
(n = 534)
Urinary/bladder problems
3.04 (0.52)
3.05 (0.51)
0.012
NS
(n = 2286)
(n = 339)
Stroke
3.04 (0.52)
2.76 (0.51)
0.050
p = 0.01
(n = 2610)
(n = 24)
Ulcer
3.04 (0.51)
2.96 (0.63)
0.033
p = 0.095
(n = 2521)
(n = 114)
Hernia
3.04 (0.52)
2.88 (0.53)
0.057
p = 0.003
(n = 2541)
(n = 92)
Tuberculosis
3.04 (0.52)
2.44 (0.76)
0.060
p = 0.002
(n = 2625)
(n = 7)
Bone/joint problems
3.06 (0.51)
2.96 (0.55)
0.071
p < 0.0001
(n = 2139)
(n = 491)
Asthma/bronchitis
3.04 (0.52)
3.06 (0.53)
0.015
NS
(n = 2287)
(n = 343)
Other lung problems
3.04 (0.52)
3.09 (0.52)
0.018
NS
(n = 2534)
(n = 93)
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& Larsen, 2002) and increased risk of mental
disorders (Bienvenu et al., 2001; Goodwin,
Fergusson, & Horwood, 2003; van Os & Jones,
2001), such as depression and schizophrenia.
Our findings add to this literature by providing
evidence of a link between neuroticism and
increased impairment and limitations in func-
tioning among those with self-reported physical
illnesses. Although it is known that some associ-
ations between neuroticism and health result
from reporting artifacts (Watson & Pennebaker,
1989), it is increasingly clear that causal links are
also relevant. Overall, the consistency of these
findings supports the validity and generalizability
of our findings regarding both conscientiousness
and neuroticism, and they should encourage
public health attention to the complex, life-long
processes that produce associations between
individual differences and health.
Higher levels of extraversion and openness to
experience were somewhat associated with
decreased levels of impairment among those
with physical illness as well. Agreeableness was
not associated with level of impairment among
those with physical illnesses. These other basic
dimensions of personality may be more relevant
to specific people in specific circumstances but
not generally very predictive of health.
JOURNAL OF HEALTH PSYCHOLOGY 11(5)
650
Table 4. Agreeableness among adults with and without common mental and physical disorders in the
community
Past 12 months
No disorder
Disorder present
r
p-value
Major depression
3.48 (0.48)
3.51 (0.46)
0.021
NS
(n = 2592)
(n = 440)
Panic attack
3.48 (0.48)
3.51 (0.60)
0.015
NS
(n = 2844)
(n = 188)
Generalized anxiety disorder
3.48 (0.48)
3.56 (0.41)
0.025
NS
(n = 2952)
(n = 80)
Alcohol/substance use disorder
3.49 (0.47)
3.30 (0.66)
0.067
p = 0.001
(n = 2564)
(n = 74)
Regular cigarette smoking
3.47 (0.50)
3.49 (0.50)
0.014
NS
(n = 2345)
(n = 685)
Diabetes
3.49 (0.48)
3.56 (0.49)
0.040
p = 0.039
(n = 2492)
(n = 145)
High blood pressure
3.47 (0.49)
3.53 (0.46)
0.050
p = 0.01
(n = 2150)
(n = 484)
Persistent skin problems
3.49 (0.47)
3.47 (0.54)
0.019
NS
(n = 2353)
(n = 278)
Sciatica/lumbago
3.48 (0.48)
3.49 (0.47)
0.008
NS
(n = 2042)
(n = 534)
Urinary/bladder problems
3.48 (0.49)
3.52 (0.43)
0.031
NS
(n = 2286)
(n = 339)
Stroke
3.48 (0.48)
3.53 (0.43)
0.009
NS
(n = 2610)
(n = 24)
Ulcer
3.48 (0.48)
3.52 (0.58)
0.018
NS
(n = 2521)
(n = 114)
Hernia
3.48 (0.48)
3.46 (0.43)
0.008
NS
(n = 2541)
(n = 92)
Tuberculosis
3.49 (0.44)
2.63 (1.30)
0.092
p < 0.0001
(n = 2625)
(n = 7)
Bone/joint problems
3.47 (0.49)
3.52 (0.45)
0.039
p = 0.048
(n = 2139)
(n = 491)
Asthma/bronchitis
3.48 (0.48)
3.53 (0.46)
0.041
p = 0.038
(n = 2287)
(n = 343)
Other lung problems
3.48 (0.48)
3.49 (0.46)
0.005
NS
(n = 2534)
(n = 93)
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The observed association between decreased
likelihood of physical limitations and conscien-
tiousness among adults with physical illnesses is
consistent with piecemeal previous results but
has not been documented previously. For
instance, conscientiousness has been found to be
the only personality modifier of cardiovascular
response to occupational stress reflected by
systolic blood pressure (Merecz, Makowska, &
Makowiec-Dabrowska, 1999). This link appears
conceptually distinct from the associations
between conscientiousness and mental and
physical disorders. Specifically, the association
between conscientiousness and improved phys-
ical functioning may be related to an association
between conscientiousness and health-promoting
physical health behaviors. For example, consci-
entiousness is associated with participation in
exercise programs after breast cancer diagnosis,
compared to those with lower conscientiousness
(Rhodes, Courneya, & Bobick, 2001). Together,
these data are not inconsistent with findings by
Friedman et al. (35, 36) that the association
between conscientiousness and improved health
may result from avoidance of health risk
behaviors (e.g. smoking, alcohol consumption,
substance abuse) and could conceivably relate
to participation in health promotion behaviors.
It is also likely that this relationship is some-
times influenced by the extent of the respondents’
GOODWIN: PERSONALITY AND HEALTH STATUS
651
Table 5. Neuroticism among adults with and without common mental and physical disorders in the community
Past 12 months
No disorder
Disorder present
r
p-value
Major depression
2.18 (0.63)
2.69 (0.66)
0.267
p < 0.0001
(n = 2592)
(n = 440)
Panic attack
2.20 (0.65)
2.79 (0.6)
0.210
p < 0.0001
(n = 2844)
(n = 188)
Generalized anxiety disorder
2.20 (0.64)
3.17 (0.59)
0.232
p < 0.0001
(n = 2952)
(n = 80)
Alcohol/substance use disorder
2.30 (0.66)
2.47 (0.74)
0.055
p = 0.005
(n = 2564)
(n = 74)
Regular cigarette smoking
2.32 (0.60)
2.30 (0.70)
0.058
NS
(n = 2345)
(n = 685)
Diabetes
2.26 (0.66)
2.24 (0.70)
0.004
NS
(n = 2492)
(n = 145)
High blood pressure
2.25 (0.66)
2.27 (0.67)
0.014
NS
(n = 2150)
(n = 484)
Persistent skin problems
2.24 (0.66)
2.40 (0.68)
0.053
p = 0.006
(n = 2353)
(n = 278)
Sciatica/lumbago
2.22 (0.65)
2.41 (0.68)
0.114
p < 0.0001
(n = 2042)
(n = 534)
Urinary/bladder problems
2.20 (0.66)
2.40 (0.68)
0.087
p < 0.0001
(n = 2286)
(n = 339)
Stroke
2.30 (0.66)
2.53 (0.68)
0.040
p = 0.04
(n = 2610)
(n = 24)
Ulcer
2.24 (0.66)
2.58 (0.68)
0.100
p < 0.0001
(n = 2521)
(n = 114)
Hernia
2.30 (0.66)
2.40 (0.73)
0.036
p = 0.065
(n = 2541)
(n = 92)
Tuberculosis
2.24 (0.66)
2.74 (0.55)
0.038
p = 0.05
(n = 2625)
(n = 7)
Bone/joint problems
2.25 (0.66)
2.27 (0.67)
0.010
NS
(n = 2139)
(n = 491)
Asthma/bronchitis
2.24 (0.66)
2.32 (0.65)
0.041
p = 0.034
(n = 2287)
(n = 343)
Other lung problems
2.25 (0.66)
2.44 (0.76)
0.054
p = 0.006
(n = 2534)
(n = 93)
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adherence to treatment for illnesses, which
could also be influenced by such aspects of
personality. For instance, the extent to which an
individual adheres to a physical therapy treat-
ment schedule may have a profound impact on
limitations in physical functioning. The lack of a
strong and consistent association between agree-
ableness, openness to experience and extra-
version and health outcomes further supports
the specificity of the association between consci-
entiousness and health outcomes. The associ-
ation between higher levels of neuroticism and
increased impairment is also consistent with
previous findings in terms of the pervasiveness
of the influence of neuroticism on daily living.
Methodological limitations of this study
should be noted while interpreting results. First,
there is obviously an increased risk of Type I
error due to a large number of comparisons, and
so small effects should not be over-interpreted.
One of the main objectives of the article was to
identify associations between conscientiousness
and specific illnesses; therefore we thought the
inclusion of each was important and that reveal-
ing patterns, rather than proving statistical
significance in each case, was the main goal. In
other words, given the primitive state of the field,
it is more important to avoid a Type II error
(missing an effect that is really there). In addi-
tion, use of cross-sectional analyses precludes
causal interpretations, and as such physical
illnesses may lead to lower conscientiousness, or
the reverse. Moreover, it is possible that there
may be a third underlying factor affecting both
personality and health. Second, the age range of
the MIDUS ranges between age 25 and 74, which
limits our ability to examine the full range of
ages across the lifespan. Third, it should be noted
that measurement of physical illness was by self-
report and not objective assessment, and there-
fore may be vulnerable to self-report bias and to
the influence of neuroticism in particular. There-
fore, replication is needed with data using objec-
tive assessment of physical health.
In sum, these data suggest consistent linkages
between conscientiousness and improved health
outcomes, compared with those lower on consci-
entiousness. Moreover, conscientiousness was
associated with significantly improved functional
health status, in terms of lower levels of func-
tional impairment, among adults with physical
illnesses. Confirmation of the importance of
JOURNAL OF HEALTH PSYCHOLOGY 11(5)
652
T
able 6.
Association between limitations in physical functioning among adults with physical illnesses in the community
Limitations
A
N
O
E
C
on the
–––––––––––––––––––––––
–––––––––––––––––––––––––
––––––––––––––––––––––––
–––––––––––––––––––––––––
––––––––––––––––––––––––
–
follo
wing
Adj
a
Adj
a
Adj
a
Adj
a
Adj
a
activities
B
(se)
p
r
B
(se)
p
r
B
(se)
p
r
B
(se)
p
r
B
(se)
p
r
Bathing and
0.061
(0.028)
0.009
0.231
–0.044
(0.021)
<
0.073
0.229
0.066
(0.025)
0.004
0.235
0.068
(0.023)
<
0.003
0.235
0.167
(0.035)
<0.0001
0.248
dressing
Climbing 0.027
(0.047)
0.230
0.321
–0.104
(0.036)
<
0.004
0.326
0.141
(0.043)
0.001
0.328
0.176
(0.038)
<0.0001
0.335
0.305
(0.038)
<0.0001
0.361
stairs
W
alking 0.040
(0.043)
0.072
0.331
–0.129
(0.033)
<0.0001
0.341
0.119
(0.039)
0.002
0.338
0.152
(0.035)
<0.0001
0.344
0.237
(0.034)
<0.0001
0.358
several
blocks
Moderate
0.021
(0.044)
0.300
0.339
–0.136
(0.034)
<0.0001
0.347
0.051
(0.339)
0.021
0.339
0.106
(0.036)
<
0.003
0.341
0.205
(0.035)
<0.0001
0.351
physical
activity
a
Adjusted for differences in age
,
gender
,
race
,
marital status
,
education and mental disorders
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conscientiousness to health using a nationally
representative sample, potentially very import-
ant to understanding major psychosocial influ-
ences on public health, should encourage future
studies that employ research designs which
focus more directly on the specific causal links
among conscientiousness, behavior, psycho-
physiology and health.
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Author biographies
R E N E E D
.
G O O DW I N
, PhD, MPH is Assistant
Professor of Epidemiology in the Department
of Epidemiology, Mailman School of Public
Health.
H O WA R D S
.
F R I E D M A N
, PhD is Professor
of Psychology at the University of
California-Riverside. This work was supported
in part by MH64736 from the National Institute
of Mental Health.
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