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Neuroticism and suicide in a general population cohort: results from the UK Biobank Project

  • Evyn M. Peters (a1), Ann John (a2), Rudy Bowen (a1), Marilyn Baetz (a1) and Lloyd Balbuena (a1)...

Neuroticism has often been linked to suicidal thoughts and behaviour.


To examine whether neuroticism is associated with suicide deaths after adjusting for known risks.


UK Biobank participants (n = 389 365) were assessed for neuroticism as well as social, demographic and health-related variables at study entry and followed for up to 10 years. Suicide risk was modelled using Cox regression stratified by gender.


Neuroticism increased the risk of suicide in both men (hazard ratio (HR) = 1.15, 95% CI 1.09–1.22) and women (HR = 1.16, 95% CI 1.06–1.27). In a subsample who were assessed for mood disorders, neuroticism remained a significant predictor for women (HR 1.25, 95% CI 1.03–1.51) but not for men.


Screening and therapeutic interventions for neuroticism may be important for early suicide prevention.

Declaration of interest


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Corresponding author
Correspondence Lloyd Balbuena, Department of Psychiatry, University of Saskatchewan, Saskatoon, SK S7N0W8, Canada. E-mail:
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1 O'Connor, RC, Nock, MK. The psychology of suicidal behaviour. Lancet Psychiatry 2014; 1(1): 7385.
2 Barlow, DH, Ellard, KK, Sauer-Zavala, S, Bullis, JR, Carl, JR. The origins of neuroticism. Perspect Psychol Sci 2014; 9(5): 481–96.
3 Batterham, PJ, Christensen, H. Longitudinal risk profiling for suicidal thoughts and behaviours in a community cohort using decision trees. J Affect Disord 2012; 142(1–3): 306–14.
4 Bluml, V, Kapusta, ND, Doering, S, Brahler, E, Wagner, B, Kersting, A. Personality factors and suicide risk in a representative sample of the German general population. PLoS ONE 2013; 8(10): e76646.
5 Brezo, J, Paris, J, Turecki, G. Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review. Acta Psychiatr Scand 2006; 113(3): 180206.
6 Chioqueta, AP, Stiles, TC. Personality traits and the development of depression, hopelessness, and suicide ideation. Pers Indiv Differ 2005; 38(6): 1283–91.
7 Conner, KR, Duberstein, PR. Predisposing and precipitating factors for suicide among alcoholics: empirical review and conceptual integration. Alcohol Clin Exp Res 2004; 28(5 suppl): 6S17S.
8 Cox, BJ, Enns, MW, Clara, IP. Psychological dimensions associated with suicidal ideation and attempts in the National Comorbidity Survey. Suicide Life Threat Behav 2004; 34(3): 209–19.
9 Duberstein, PR, Conwell, Y, Caine, ED. Age differences in the personality characteristics of suicide completers: preliminary findings from a psychological autopsy study. Psychiatry 1994; 57(3): 213–24.
10 Enns, MW, Cox, BJ, Inayatulla, M. Personality predictors of outcome for adolescents hospitalized for suicidal ideation. J Am Acad Child Adolesc Psychiatry 2003; 42(6): 720–7.
11 Fergusson, DM, Woodward, LJ, Horwood, LJ. Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychol Med 2000; 30(1): 2339.
12 Ormel, J, Jeronimus, BF, Kotov, R, Riese, H, Bos, EH, Hankin, B, et al. Neuroticism and common mental disorders: meaning and utility of a complex relationship. Clin Psychol Rev 2013; 33(5): 686–97.
13 Yen, S, Shea, MT, Sanislow, CA, Grilo, CM, Skodol, AE, Gunderson, JG, et al. Borderline personality disorder criteria associated with prospectively observed suicidal behavior. Am J Psychiatry 2004; 161(7): 1296–8.
14 Sareen, J, Cox, BJ, Afifi, TO, de Graaf, R, Asmundson, GJ, ten Have, M, et al. Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Arch Gen Psychiatry 2005; 62(11): 1249–57.
15 Moller-Leimkuhler, AM. The gender gap in suicide and premature death or: why are men so vulnerable?. Eur Arch Psychiatry Clin Neurosci 2003; 253(1): 18.
16 Distel, MA, Trull, TJ, Willemsen, G, Vink, JM, Derom, CA, Lynskey, M, et al. The five-factor model of personality and borderline personality disorder: a genetic analysis of comorbidity. Biol Psychiatry 2009; 66(12): 1131–8.
17 Paris, J, Zweig-Frank, H. A 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry 2001; 42(6): 482–7.
18 Samuel, DB, Carroll, KM, Rounsaville, BJ, Ball, SA. Personality disorders as maladaptive, extreme variants of normal personality: borderline personality disorder and neuroticism in a substance using sample. Journal of Personality Disorders 2013; 27(5): 625–35.
19 Kuntsche, E, Knibbe, R, Gmel, G, Engels, R. Who drinks and why? A review of socio-demographic, personality, and contextual issues behind the drinking motives in young people. Addict Behav 2006; 31(10): 1844–57.
20 Zvolensky, MJ, Taha, F, Bono, A, Goodwin, RD. Big five personality factors and cigarette smoking: a 10-year study among US adults. J Psychiatr Res 2015; 63: 91–6.
21 Valero, S, Daigre, C, Rodriguez-Cintas, L, Barral, C, Goma, IFM, Ferrer, M, et al. Neuroticism and impulsivity: their hierarchical organization in the personality characterization of drug-dependent patients from a decision tree learning perspective. Compr Psychiatry 2014; 55(5): 1227–33.
22 Darvishi, N, Farhadi, M, Haghtalab, T, Poorolajal, J. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. PLoS ONE 2015; 10(5): e0126870.
23 Li, D, Yang, X, Ge, Z, Hao, Y, Wang, Q, Liu, F, et al. Cigarette smoking and risk of completed suicide: a meta-analysis of prospective cohort studies. J Psychiatr Res 2012; 46(10): 1257–66.
24 Poorolajal, J, Bahrami, M, Karami, M, Hooshmand, E. Effect of smoking on multiple sclerosis: a meta-analysis. J Public Health 2016; 39(2): 312–20.
25 Wilcox, HC, Conner, KR, Caine, ED. Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depen 2004; 76: S119.
26 Zhang, J, Mckeown, RE, Hussey, JR, Thompson, SJ, Woods, JR. Gender differences in risk factors for attempted suicide among young adults: findings from the Third National Health and Nutrition Examination Survey. Ann Epidemiol 2005; 15(2): 167–74.
27 Hughes, JR. Smoking and suicide: a brief overview. Drug Alcohol Depend 2008; 98(3): 169–78.
28 Blakely, TA, Collings, SCD, Atkinson, J. Unemployment and suicide. Evidence for a causal association? J Epidemiol Commun H 2003; 57(8): 594600.
29 Chapman, BP, Fiscella, K, Kawachi, I, Duberstein, PR. Personality, socioeconomic status, and all-cause mortality in the United States. Am J Epidemiol 2010; 171(1): 8392.
30 Roberts, BW, Caspi, A, Moffitt, TE. Work experiences and personality development in young adulthood. J Pers Soc Psychol 2003; 84(3): 582–93.
31 Swickert, RJ, Hittner, JB, Foster, A. Big Five traits interact to predict perceived social support. Pers Indiv Differ 2010; 48(6): 736–41.
32 Costa, PT, Herbst, JH, McCrae, RR, Siegler, IC. Personality at midlife: stability, intrinsic maturation, and response to life events. Assessment 2000; 7(4): 365–78.
33 Evans, R, Scourfield, J, Moore, G. Gender, relationship breakdown, and suicide risk: a review of research in Western Countries. J Fam Issues 2016; 37(16): 2239–64.
34 Kposowa, AJ. Marital status and suicide in the National Longitudinal Mortality Study. J Epidemiol Commun H 2000; 54(4): 254–61.
35 Solomon, BC, Jackson, JJ. Why do personality traits predict divorce? Multiple pathways through satisfaction. J Pers Soc Psychol 2014; 106(6): 978–96.
36 Costa, PT, Mccrae, RR. Influence of extraversion and neuroticism on subjective well-being – happy and unhappy people. J Pers Soc Psychol 1980; 38(4): 668–78.
37 Uysal, SD, Pohlmeier, W. Unemployment duration and personality. J Econ Psychol 2011; 32(6): 980–92.
38 Kleiman, EM, Liu, RT. Social support as a protective factor in suicide: findings from two nationally representative samples. J Affect Disorders 2013; 150(2): 540–5.
39 Brock, A, Baker, A, Griffiths, C, Jackson, G, Fegan, G, Marshall, D. Suicide trends and geographical variations in the United Kingdom, 1991–2004. Health Stat Q 2006; 31: 622.
40 Rezaeian, M, Dunn, G, St Leger, S, Appleby, L. The ecological association between suicide rates and indices of deprivation in English local authorities. Soc Psych Psych Epid 2005; 40(10): 785–91.
41 Nock, MK, Borges, G, Bromet, EJ, Cha, CB, Kessler, RC, Lee, S. Suicide and suicidal behavior. Epidemiol Rev 2008; 30: 133–54.
42 Qin, P, Agerbo, E, Mortensen, PB. Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. Am J Psychiat 2003; 160(4): 765–72.
43 Marwaha, S, He, Z, Broome, M, Singh, SP, Scott, J, Eyden, J, et al. How is affective instability defined and measured? A systematic review. Psychol Med 2014; 44(9): 1793–808.
44 Bowen, R, Balbuena, L, Leuschen, C, Baetz, M. Mood instability is the distinctive feature of neuroticism. Results from the British Health and Lifestyle Study (HALS). Pers Indiv Differ 2012; 53(7): 896900.
45 Bowen, RC, Wang, Y, Balbuena, L, Houmphan, A, Baetz, M. The relationship between mood instability and depression: implications for studying and treating depression. Med Hypotheses 2013; 81(3): 459–62.
46 Peters, EM, Balbuena, L, Baetz, M, Marwaha, S, Bowen, R. Mood instability underlies the relationship between impulsivity and internalizing psychopathology. Med Hypotheses 2015; 85(4): 447–51.
47 Thompson, RJ, Berenbaum, H, Bredemeier, K. Cross-sectional and longitudinal relations between affective instability and depression. J Affect Disorders 2011; 130(1–2): 53–9.
48 Bowen, R, Block, G, Baetz, M. Mood and attention variability in women with alcohol dependence: a preliminary investigation. Am J Addiction 2008; 17(1): 7781.
49 Simons, JS, Gaher, RM. The Distress Tolerance Scale: development and validation of a self-report measure. Motiv Emotion 2005; 29(2): 83102.
50 Maples, J, Miller, JD, Hoffman, BJ, Johnson, SL. A test of the empirical network surrounding affective instability and the degree to which it is independent from neuroticism. Personal Disord 2014; 5(3): 268–77.
51 Peters, EM, Balbuena, L, Marwaha, S, Baetz, M, Bowen, R. Mood instability and impulsivity as trait predictors of suicidal thoughts. Psychol Psychotherapy 2016; 89(4): 435–44.
52 Bowen, R, Baetz, M, Leuschen, C, Kalynchuk, LE. Predictors of suicidal thoughts: mood instability versus neuroticism. Pers Indiv Differ 2011; 51(8): 1034–8.
53 Links, PS, Eynan, R, Heisel, MJ, Nisenbaum, R. Elements of affective instability associated with suicidal behaviour in patients with borderline personality disorder. Can J Psychiatry 2008; 53(2): 112–6.
54 Palmier-Claus, JE, Taylor, PJ, Varese, F, Pratt, D. Does unstable mood increase risk of suicide? Theory, research and practice. J Affect Disorders 2012; 143(1–3): 515.
55 Sudlow, C, Gallacher, J, Allen, N, Beral, V, Burton, P, Danesh, J, et al. UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med 2015; 12(3) e1001779.
56 UK Biobank. UK Biobank: Protocol for a Large-Scale Prospective Epidemiological Resource 2007. UK Biobank, 2007 (available at
57 Eysenck, SBG, Eysenck, HJ, Barrett, P. A revised version of the psychoticism scale. Pers Indiv Differ 1985; 6(1): 21–9.
58 Eysenck, HJ. The Scientific Study of Personality. Routledge & K. Paul, 1952.
59 Linsley, KR, Schapira, K, Kelly, TP. Open verdict v. suicide – importance to research. Br J Psychiatry 2001; 178: 465–8.
60 While, D, Bickley, H, Roscoe, A, Windfuhr, K, Rahman, S, Shaw, J, et al. Implementation of mental health service recommendations in England and Wales and suicide rates, 1997–2006: a cross-sectional and before-and-after observational study. Lancet 2012; 379(9820): 1005–12.
61 Luoma, JB, Pearson, JL. Suicide and marital status in the United States, 1991–1996: is widowhood a risk factor? American J Public Health 2002; 92(9): 1518–22.
62 Wyder, M, Ward, P, De Leo, D. Separation as a suicide risk factor. J Affect Disorders 2009; 116(3): 208–13.
63 Coope, C, Donovan, J, Wilson, C, Barnes, M, Metcalfe, C, Hollingworth, W, et al. Characteristics of people dying by suicide after job loss, financial difficulties and other economic stressors during a period of recession (2010–2011): a review of coroners records. J Affect Disord 2015; 183: 98105.
64 Adams, J, Ryan, V, White, M. How accurate are Townsend Deprivation Scores as predictors of self-reported health? A comparison with individual level data. J Public Health 2005; 27(1): 101–6.
65 Smith, DJ, Nicholl, BI, Cullen, B, Martin, D, Ul-Haq, Z, Evans, J, et al. Prevalence and characteristics of probable major depression and bipolar disorder within UK biobank: cross-sectional study of 172,751 participants. PLoS ONE 2013; 8(11): e75362.
66 Spitzer, RL, Kroenke, K, Williams, JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999; 282(18): 1737–44.
67 First, MB, Spitzer, RL, Gibbon, M, Williams, JB. User's Guide for the Structured Clinical Interview for DSM-IV Axis I Personality Disorders: SCID-I. American Psychiatric Press, 1997.
68 Cassano, GB, Rucci, P, Frank, E, Fagiolini, A, Dell'Osso, L, Shear, MK, et al. The mood spectrum in unipolar and bipolar disorder: arguments for a unitary approach. Am J Psychiatry 2004; 161(7): 1264–9.
69 Suzuki, T, Samuel, DB, Pahlen, S, Krueger, RF. DSM-5 alternative personality disorder model traits as maladaptive extreme variants of the five-factor model: an item-response theory analysis. J Abnorm Psychol 2015; 124(2): 343–54.
70 Brown, GK, Beck, AT, Steer, RA, Grisham, JR. Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. J Consult Clin Psychol 2000; 68(3): 371–7.
71 Holma, KM, Haukka, J, Suominen, K, Valtonen, HM, Mantere, O, Melartin, TK, et al. Differences in incidence of suicide attempts between bipolar I and II disorders and major depressive disorder. Bipolar Disord 2014; 16(6): 652–61.
72 Harrell FE, Jr, Lee, KL, Califf, RM, Pryor, DB, Rosati, RA. Regression modelling strategies for improved prognostic prediction. Stat Med 1984; 3(2): 143–52.
73 Schoenfeld, D. Partial residuals for the proportional hazards regression-model. Biometrika 1982; 69(1): 239–41.
74 Brent, DA, Mann, JJ. Family genetic studies, suicide, and suicidal behavior. Am J Med Genet C Semin Med Genet 2005; 133C(1): 1324.
75 Hettema, JM, Neale, MC, Myers, JM, Prescott, CA, Kendler, KS. A population-based twin study of the relationship between neuroticism and internalizing disorders. Am J Psychiat 2006; 163(5): 857–64.
76 Munafo, MR, Clark, TG, Roberts, KH, Johnstone, EC. Neuroticism mediates the association of the serotonin transporter gene with lifetime major depression. Neuropsychobiology 2006; 53(1): 18.
77 Smith, DJ, Escott-Price, V, Davies, G, Bailey, ME, Colodro-Conde, L, Ward, J, et al. Genome-wide analysis of over 106 000 individuals identifies 9 neuroticism-associated loci. Mol Psychiatry 2016; 21(11): 1644.
78 Gray, AL, Hyde, TM, Deep-Soboslay, A, Kleinman, JE, Sodhi, MS. Sex differences in glutamate receptor gene expression in major depression and suicide. Mol Psychiatry 2015; 20(9): 1057–68.
79 Middeldorp, CM, de Geus, EJC, Beem, AL, Lakenberg, N, Hottenga, JJ, Slagboom, PE, et al. Family based association analyses between the serotonin transporter gene polymorphism (5-HTTLPR) and neuroticism, anxiety and depression. Behav Genet 2007; 37(2): 294301.
80 Willis-Owen, SA, Turri, MG, Munafo, MR, Surtees, PG, Wainwright, NW, Brixey, RD, et al. The serotonin transporter length polymorphism, neuroticism, and depression: a comprehensive assessment of association. Biol Psychiatry 2005; 58(6): 451–6.
81 Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ. A longitudinal twin study of personality and major depression in women. Arch Gen Psychiatry 1993; 50(11): 853–62.
82 Moller-Leimkuhler, AM. The gender gap in suicide and premature death or: why are men so vulnerable?. Eur Arch Psy Clin N 2003; 253(1): 18.
83 Payne, S, Swami, V, Stanistreet, DL. The social construction of gender and its influence on suicide: a review of the literature. J Mens Health 2008; 5(1): 2335.
84 Bagby, RM, Costa, PT, Widiger, TA, Ryder, AG, Marshall, M. DSM-IV personality disorders and the five-factor model of personality: a multi-method examination of domain- and facet-level predictions. Eur J Personality 2005; 19(4): 307–24.
85 Haeffel, GJ, Voelz, ZR, Joiner, TE. Vulnerability to depressive symptoms: clarifying the role of excessive reassurance seeking and perceived social support in an interpersonal model of depression. Cogn Emotion 2007; 21(3): 681–8.
86 Joiner, TE, Metalsky, GI. A prospective test of an integrative interpersonal theory of depression – a naturalistic study of college roommates. J Pers Soc Psychol 1995; 69(4): 778–88.
87 Mccrae, RR, Costa, PT, Busch, CM. Evaluating comprehensiveness in personality systems – the California Q-set and the 5-factor model. J Pers 1986; 54(2): 430–46.
88 Starr, LR, Davila, J. Excessive reassurance seeking, depression, and interpersonal rejection: a meta-analytic review. J Abnorm Psychol 2008; 117(4): 762–75.
89 Trull, TJ, Widiger, TA, Burr, R. A structured interview for the assessment of the Five-Factor Model of personality: facet-level relations to the axis II personality disorders. J Pers 2001; 69(2): 175–98.
90 Bromberger, JT, Matthews, KA. A longitudinal study of the effects of pessimism, trait anxiety, and life stress on depressive symptoms in middle-aged women. Psychol Aging 1996; 11(2): 207–13.
91 Serfass, DG, Sherman, RA. Personality and perceptions of situations from the Thematic Apperception Test. J Res Pers 2013; 47(6): 708–18.
92 Lahey, BB. Public health significance of neuroticism. Am Psychol 2009; 64(4): 241–56.
93 Widiger, TA, Oltmanns, JR. Neuroticism is a fundamental domain of personality with enormous public health implications. World Psychiatry 2017; 16(2): 144–5.
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Neuroticism and suicide in a general population cohort: results from the UK Biobank Project

  • Evyn M. Peters (a1), Ann John (a2), Rudy Bowen (a1), Marilyn Baetz (a1) and Lloyd Balbuena (a1)...
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