Skip to main content Accessibility help

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

  • M. Jokela (a1) (a2), C. Hakulinen (a1), A. Singh-Manoux (a3) (a4) and M. Kivimäki (a3)



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.


Corresponding author

* Address for correspondence: Dr M. Jokela, Institute of Behavioural Sciences, Siltavuorenpenger 1A, PO Box 9, 00014 University of Helsinki, Finland. (Email:


Hide All
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.
Baird, BM, Lucas, RE, Donnellan, MB (2010). Life satisfaction across the lifespan: findings from two nationally representative panel studies. Social Indicators Research 99, 183203.
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.
Bogg, T, Roberts, BW (2004). Conscientiousness and health-related behaviors: a meta-analysis of the leading behavioral contributors to mortality. Psychological Bulletin 130, 887919.
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.
Carver, CS, Connor-Smith, J (2010). Personality and coping. Annual Review of Psychology 61, 679704.
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.
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.
Crimmins, EM (2004). Trends in the health of the elderly. Annual Review of Public Health 25, 7998.
Davydov, DM, Stewart, R, Ritchie, K, Chaudieu, I (2010). Resilience and mental health. Clinical Psychology Review 30, 479495.
de Ridder, D, Geenen, R, Kuijer, R, van Middendorp, H (2008). Psychological adjustment to chronic disease. Lancet 372, 246255.
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.
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.
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.
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.
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.
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.
Jokela, M, Batty, GD, Kivimäki, M (2013 a). Ageing and the prevalence and treatment of mental health problems. Psychological Medicine 43, 20372045.
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.
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.
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.
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.
Juster, FT, Suzman, R (1995). An overview of the Health and Retirement Study. Journal of Human Resources 30, S7S56.
Katz, PP, Yelin, EH (1995). The development of depressive symptoms among women with rheumatoid arthritis. The role of function. Arthritis and Rheumatism 38, 4956.
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.
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.
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.
McCathie, HCF, Spence, SH, Tate, RL (2002). Adjustment to chronic obstructive pulmonary disease: the importance of psychological factors. European Respiratory Journal 19, 4753.
Mendelsohn, GA, Dakof, GA, Skaff, M (1995). Personality change in Parkinson's disease patients: chronic disease and aging. Journal of Personality 63, 233257.
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.
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.
Osterberg, L, Blaschke, T (2005). Adherence to medication. New England Journal of Medicine 353, 487497.
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.
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.
Prince, M, Patel, V, Saxena, S, Maj, M, Maselko, J, Phillips, MR, Rahman, A (2007). No health without mental health. Lancet 370, 859877.
Raison, CL, Miller, AH (2013). The evolutionary significance of depression in Pathogen Host Defense (PATHOS-D). Molecular Psychiatry 18, 1537.
Reich, M (2008). Depression and cancer: recent data on clinical issues, research challenges and treatment approaches. Current Opinion in Oncology 20, 353359.
Remer-Osborn, J (1998). Psychological, behavioral, and environmental influences on post-stroke recovery. Topics in Stroke Rehabilitation 5, 4553.
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.
Robins, Wahlin T-B, Byrne, GJ (2010). Personality changes in Alzheimer's disease: a systematic review. International Journal of Geriatric Psychiatry 26, 10191029.
Saulsman, LM, Page, AC (2004). The five-factor model and personality disorder empirical literature: a meta-analytic review. Clinical Psychology Review 23, 10551085.
Sharpe, L, Curran, L (2006). Understanding the process of adjustment to illness. Social Science and Medicine 62, 11531166.
Sheikh, AI (2004). Posttraumatic growth in the context of heart disease. Journal of Clinical Psychology in Medical Settings 11, 265273.
Stanton, AL, Revenson, TA, Tennen, H (2007). Psychological adjustment to chronic disease. Annual Review of Psychology 58, 565592.
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.
Strong, K, Mathers, C, Leeder, S, Beaglehole, R (2005). Preventing chronic diseases: how many lives can we save? Lancet 366, 15781582.
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.
Wollmering, E (ed.) (2007). Wisconsin Longitudinal Study Handbook (12.10.07). University of Wisconsin: Madison.
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.
Wu, S (2001). Adapting to heart conditions: a test of the hedonic treadmill. Journal of Health Economics 20, 495508.


Type Description Title
Supplementary materials

Jokela Supplementary Material
Supplementary Material

 Word (697 KB)
697 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed