Hostname: page-component-7d684dbfc8-v2qlk Total loading time: 0 Render date: 2023-10-01T13:36:34.169Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false

Personality change associated with chronic diseases: pooled analysis of four prospective cohort studies

Published online by Cambridge University Press:  19 February 2014

M. Jokela*
Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland Department of Psychology, University of Cambridge, Cambridge, UK
C. Hakulinen
Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
A. Singh-Manoux
Research Department of Epidemiology and Public Health, University College London, London, UK Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
M. Kivimäki
Research Department of Epidemiology and Public Health, University College London, London, UK
*Address for correspondence: Dr M. Jokela, Institute of Behavioural Sciences, Siltavuorenpenger 1A, PO Box 9, 00014 University of Helsinki, Finland. (Email:



Common chronic conditions, such as heart disease and cancer, are associated with increased psychological distress, functional limitations and shortened life expectancy, but whether these diseases alter aspects of personality remains unclear.


To examine whether the onset of heart disease, stroke, diabetes, cancer, hypertension, arthritis and respiratory disease is associated with subsequent changes in personality traits of the five-factor model, we pooled data from the Health and Retirement Study, the Midlife in the United States Survey, and the graduate and sibling samples of the Wisconsin Longitudinal Study for an individual-participant meta-analysis (total n = 17 493; mean age at baseline 55.8 years).


After adjustment for age, we observed consistent decreases in extraversion [−0.25 T-scores per one disease; 95% confidence interval (CI) −0.40 to −0.10], emotional stability (−0.40, 95% CI −0.61 to −0.19), conscientiousness (−0.44, 95% CI −0.57 to −0.30) and openness to experience (−0.25, 95% CI −0.37 to −0.13) but not in agreeableness (−0.05, 95% CI −0.19 to 0.08) after the onset of chronic diseases. The onset of each additional chronic disease accelerated the average age-related personality change by 2.5 years in decreasing extraversion, 5.5 years in decreasing conscientiousness, and 1.6 years in decreasing openness to experience, and attenuated the increasing levels of emotional stability by 1.9 years. Co-morbid conditions were associated with larger changes than single diseases, suggesting a dose–response association between morbidity and personality change.


These results support the hypothesis that chronic diseases influence personality development in adulthood.

Original Articles
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Affleck, G, Tennen, H, Zautra, A, Urrows, S (2001). Women's pursuit of personal goals in daily life with fibromyalgia: a value–expectancy analysis. Journal of Consulting and Clinical Psychology 69, 587596.CrossRefGoogle ScholarPubMed
Baird, BM, Lucas, RE, Donnellan, MB (2010). Life satisfaction across the lifespan: findings from two nationally representative panel studies. Social Indicators Research 99, 183203.CrossRefGoogle ScholarPubMed
Barskova, T, Oesterreich, R (2009). Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: a systematic review. Disability and Rehabilitation 31, 17091733.CrossRefGoogle ScholarPubMed
Bogg, T, Roberts, BW (2004). Conscientiousness and health-related behaviors: a meta-analysis of the leading behavioral contributors to mortality. Psychological Bulletin 130, 887919.CrossRefGoogle ScholarPubMed
Bostock, L, Sheikh, AI, Barton, S (2009). Posttraumatic growth and optimism in health-related trauma: a systematic review. Journal of Clinical Psychology in Medical Settings 16, 281296.CrossRefGoogle ScholarPubMed
Carver, CS, Connor-Smith, J (2010). Personality and coping. Annual Review of Psychology 61, 679704.CrossRefGoogle ScholarPubMed
Cho, HJ, Kivimäki, M, Bower, JE, Irwin, MR (2013). Association of C-reactive protein and interleukin-6 with new-onset fatigue in the Whitehall II prospective cohort study. Psychological Medicine 43, 17731783.CrossRefGoogle ScholarPubMed
Clark, AE, Diener, E, Georgellis, Y, Lucas, RE (2008). Lags and leads in life satisfaction: a test of the baseline hypothesis. Economic Journal 118, F222F243.CrossRefGoogle Scholar
Crimmins, EM (2004). Trends in the health of the elderly. Annual Review of Public Health 25, 7998.CrossRefGoogle ScholarPubMed
Davydov, DM, Stewart, R, Ritchie, K, Chaudieu, I (2010). Resilience and mental health. Clinical Psychology Review 30, 479495.CrossRefGoogle ScholarPubMed
de Ridder, D, Geenen, R, Kuijer, R, van Middendorp, H (2008). Psychological adjustment to chronic disease. Lancet 372, 246255.CrossRefGoogle ScholarPubMed
Evers, AWM, Zautra, A, Thieme, K (2011). Stress and resilience in rheumatic diseases: a review and glimpse into the future. Nature Reviews Rheumatology 7, 409415.CrossRefGoogle ScholarPubMed
Franzén-Dahlin, Å, Billing, E, Näsman, P, Mårtensson, B, Wredling, R, Murray, V (2006). Post-stroke depression – effect on the life situation of the significant other. Scandinavian Journal of Caring Sciences 20, 412416.CrossRefGoogle ScholarPubMed
Gao, S, Dolan, N, Hall, KS, Hendrie, HC (2000). The association of demographic factors and physical illness with personality change in a community sample of elderly African Americans. American Journal of Geriatric Psychiatry 8, 209214.CrossRefGoogle Scholar
Go, AS, Mozaffarian, D, Roger, VL, Benjamin, EJ, Berry, JD, Borden, WB, Bravata, DM, Dai, S, Ford, ES, Fox, CS, Franco, S, Fullerton, HJ, Gillespie, C, Hailpern, SM, Heit, JA, Howard, VJ, Huffman, MD, Kissela, BM, Kittner, SJ, Lackland, DT, Lichtman, JH, Lisabeth, LD, Magid, D, Marcus, GM, Marelli, A, Matchar, DB, McGuire, DK, Mohler, ER, Moy, CS, Mussolino, ME, Nichol, G, Paynter, NP, Schreiner, PJ, Sorlie, PD, Stein, J, Turan, TN, Virani, SS, Wong, ND, Woo, D, Turner, MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2013). Executive summary: Heart disease and stroke statistics – 2013 update: a report from the American Heart Association. Circulation 127, 143152.CrossRefGoogle ScholarPubMed
Headey, B (2010). The set point theory of well-being has serious flaws: on the eve of a scientific revolution? Social Indicators Research 97, 721.CrossRefGoogle Scholar
Hulbert-Williams, N, Neal, R, Morrison, V, Hood, K, Wilkinson, C (2012). Anxiety, depression and quality of life after cancer diagnosis: what psychosocial variables best predict how patients adjust? Psycho-Oncology 21, 857867.CrossRefGoogle ScholarPubMed
Jokela, M, Batty, GD, Kivimäki, M (2013 a). Ageing and the prevalence and treatment of mental health problems. Psychological Medicine 43, 20372045.CrossRefGoogle ScholarPubMed
Jokela, M, Batty, GD, Nyberg, ST, Virtanen, M, Nabi, H, Singh-Manoux, A, Kivimäki, M (2013 b). Personality and all-cause mortality: individual-participant meta-analysis of 3,947 deaths in 76,150 adults. American Journal of Epidemiology 178, 667675.CrossRefGoogle ScholarPubMed
Jokela, M, Elovainio, M, Nyberg, ST, Tabák, AG, Hintsa, T, Batty, GD, Kivimäki, M (2013 c). Personality and risk of diabetes in adults: pooled analysis of 5 cohort studies. Health Psychology. Published online 19 August 2013 . doi:10.1037/hea0000003.Google ScholarPubMed
Jokela, M, Hamer, M, Singh-Manoux, A, Batty, GD, Kivimäki, M (2013 d). Association of metabolically healthy obesity with depressive symptoms: pooled analysis of eight studies. Molecular Psychiatry. Published online 3 December 2013 . doi:10.1038/mp.2013.162.Google ScholarPubMed
Jokela, M, Hintsanen, M, Hakulinen, C, Batty, GD, Nabi, H, Singh-Manoux, A, Kivimäki, M (2013 e). Association of personality with the development and persistence of obesity: a meta-analysis based on individual-participant data. Obesity Reviews 14, 315323.CrossRefGoogle ScholarPubMed
Juster, FT, Suzman, R (1995). An overview of the Health and Retirement Study. Journal of Human Resources 30, S7S56.CrossRefGoogle Scholar
Katz, PP, Yelin, EH (1995). The development of depressive symptoms among women with rheumatoid arthritis. The role of function. Arthritis and Rheumatism 38, 4956.CrossRefGoogle ScholarPubMed
Kivimäki, M, Shipley, MJ, Batty, GD, Hamer, M, Akbaraly, TN, Kumari, M, Jokela, M, Virtanen, M, Lowe, GD, Ebmeier, KP, Brunner, EJ, Singh-Manoux, A (2014). Long-term inflammation increases risk of common mental disorder: a cohort study. Molecular Psychiatry 19, 149150.CrossRefGoogle ScholarPubMed
Lucas, RE, Donnellan, MB (2011). Personality development across the life span: longitudinal analyses with a national sample from Germany. Journal of Personality and Social Psychology 101, 847861.CrossRefGoogle ScholarPubMed
Martin, LR, Friedman, HS, Schwartz, JE (2007). Personality and mortality risk across the life span: the importance of conscientiousness as a biopsychosocial attribute. Health Psychology 26, 428436.CrossRefGoogle ScholarPubMed
McCathie, HCF, Spence, SH, Tate, RL (2002). Adjustment to chronic obstructive pulmonary disease: the importance of psychological factors. European Respiratory Journal 19, 4753.CrossRefGoogle ScholarPubMed
Mendelsohn, GA, Dakof, GA, Skaff, M (1995). Personality change in Parkinson's disease patients: chronic disease and aging. Journal of Personality 63, 233257.CrossRefGoogle ScholarPubMed
Nelson, LD, Cicchetti, D, Satz, P, Stern, S, Sowa, M, Cohen, S, Mitrushina, M, van Gorp, W (1993). Emotional sequelae of stroke. Neuropsychology 7, 553560.CrossRefGoogle Scholar
Obonsawin, MC, Jefferis, S, Lowe, R, Crawford, JR, Fernandes, J, Holland, L, Woldt, K, Worthington, E, Bowie, G (2007). A model of personality change after traumatic brain injury and the development of the brain injury personality scales. Journal of Neurology, Neurosurgery Psychiatry 78, 12391247.CrossRefGoogle ScholarPubMed
Osterberg, L, Blaschke, T (2005). Adherence to medication. New England Journal of Medicine 353, 487497.CrossRefGoogle ScholarPubMed
Penley, JA, Tomaka, J, Wiebe, JS (2002). The association of coping to physical and psychological health outcomes: a meta-analytic review. Journal of Behavioral Medicine 25, 551603.CrossRefGoogle ScholarPubMed
Powdthavee, N (2009). What happens to people before and after disability? Focusing effects, lead effects, and adaptation in different areas of life. Social Science and Medicine 69, 18341844.CrossRefGoogle ScholarPubMed
Prince, M, Patel, V, Saxena, S, Maj, M, Maselko, J, Phillips, MR, Rahman, A (2007). No health without mental health. Lancet 370, 859877.CrossRefGoogle ScholarPubMed
Raison, CL, Miller, AH (2013). The evolutionary significance of depression in Pathogen Host Defense (PATHOS-D). Molecular Psychiatry 18, 1537.CrossRefGoogle Scholar
Reich, M (2008). Depression and cancer: recent data on clinical issues, research challenges and treatment approaches. Current Opinion in Oncology 20, 353359.CrossRefGoogle ScholarPubMed
Remer-Osborn, J (1998). Psychological, behavioral, and environmental influences on post-stroke recovery. Topics in Stroke Rehabilitation 5, 4553.CrossRefGoogle Scholar
Roberts, BW, Walton, KE, Viechtbauer, W (2006). Patterns of mean-level change in personality traits across the life course: a meta-analysis of longitudinal studies. Psychological Bulletin 132, 125.CrossRefGoogle ScholarPubMed
Robins, Wahlin T-B, Byrne, GJ (2010). Personality changes in Alzheimer's disease: a systematic review. International Journal of Geriatric Psychiatry 26, 10191029.CrossRefGoogle Scholar
Saulsman, LM, Page, AC (2004). The five-factor model and personality disorder empirical literature: a meta-analytic review. Clinical Psychology Review 23, 10551085.CrossRefGoogle ScholarPubMed
Sharpe, L, Curran, L (2006). Understanding the process of adjustment to illness. Social Science and Medicine 62, 11531166.CrossRefGoogle ScholarPubMed
Sheikh, AI (2004). Posttraumatic growth in the context of heart disease. Journal of Clinical Psychology in Medical Settings 11, 265273.CrossRefGoogle Scholar
Stanton, AL, Revenson, TA, Tennen, H (2007). Psychological adjustment to chronic disease. Annual Review of Psychology 58, 565592.CrossRefGoogle ScholarPubMed
Stone, J, Townend, E, Kwan, J, Haga, K, Dennis, MS, Sharpe, M (2004). Personality change after stroke: some preliminary observations. British Medical Journal 75, 17081713.Google ScholarPubMed
Strong, K, Mathers, C, Leeder, S, Beaglehole, R (2005). Preventing chronic diseases: how many lives can we save? Lancet 366, 15781582.CrossRefGoogle ScholarPubMed
Wang, H, Dwyer-Lindgren, L, Lofgren, KT, Rajaratnam, JK, Marcus, JR, Levin-Rector, A, Levitz, CE, Lopez, AD, Murray, PCJ (2012). Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 20712094.CrossRefGoogle ScholarPubMed
Wollmering, E (ed.) (2007). Wisconsin Longitudinal Study Handbook (12.10.07). University of Wisconsin: Madison.Google Scholar
Wortman, J, Lucas, RE, Donnellan, MB (2012). Stability and change in the Big Five personality domains: evidence from a longitudinal study of Australians. Psychology and Aging 27, 867874.CrossRefGoogle ScholarPubMed
Wu, S (2001). Adapting to heart conditions: a test of the hedonic treadmill. Journal of Health Economics 20, 495508.CrossRefGoogle ScholarPubMed
Supplementary material: File

Jokela Supplementary Material

Supplementary Material

Download Jokela Supplementary Material(File)
File 697 KB