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Cited by 41Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPersonality Disorders and Psychopathology

Neuroticism Traits Selectively Impact Long Term Illness Course and Cognitive Decline in Late-Life Depression

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Manning, Kevin J., Chan, Grace, Steffens, David C.·2017·The American Journal of Geriatric Psychiatry
DOI 10.1016/j.jagp.2016.10.006PMC PMC5316488
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Abstract

Objectives Neuroticism is a broad construct that conveys a predisposition to experience psychological distress and negative mood states. Vulnerability to stress (VS) is one neuroticism trait that has been linked to worse mood and cognitive outcomes in older adults. We hypothesized that elevated VS would be associated with worse illness course and cognitive decline in older adults with late-life major depression (LLD).Design Participants were enrolled in the Neurocognitive Outcomes of Depression in the Elderly (NCODE), a longitudinal investigation of the predictors of poor illness course and cognitive decline in LLD. Participants were followed upwards of 10 years.Setting NCODE operates in a naturalistic treatment milieu.Participants 112 participants aged 60 and older with a current diagnosis of major depressive disorder.Measurements Treatment response was assessed at least every 3 months and more often if clinically needed. Participants also completed the NEO Personality Inventory-Revised (NEO PI-R) and an annual cognitive examination. Neuroticism traits from the NEO PI-R included anxiety, depression, anger-hostility, self-consciousness, impulsivity, and VS.Results Higher neuroticism traits of VS, impulsivity, anger-hostility, and anxiety were associated with worse treatment response over time. High VS was the only neuroticism trait significantly associated with cognitive functioning. High VS negatively influenced the rate of global cognitive decline over time.Conclusions Individual personality traits within the neuroticism dimension are associated with treatment resistance and cognitive impairment in LLD. It remains to be seen whether these individual traits are associated with different neurobiological substrates and clinical characteristics of LLD.

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Crossref · 10.1016/j.jagp.2016.10.006

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Claims the paper makes

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  • Findingown data

    In older adults with late-life major depression, higher anger-hostility, when analyzed as a continuous raw score, is associated with a slower treatment response over time.

    “the interaction between time and anxiety (t = 2.03, df = 2834, b (SE) = 0.008 (0.004), p =0.04) and time and anger-hostility (t = 2.11, df = 2834, b (SE) = 0.010 (0.005), p =.03) were now statistically significant”
    • Also stated in: § Conclusions · plain
      “Elevations in impulsivity and anger-hostility / anxiety also predicted worse illness course over time.”
    • Also stated in: § Results · plain
      “Higher neuroticism traits of VS, impulsivity, anger-hostility, and anxiety were associated with worse treatment response over time.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Neuroticism remains relatively stable from the time cognition and mood were first assessed to the time the NEO-PI-R was added to the NCODE protocol.
    • Rests on an assumption: The MADRS has high interrater reliability ranging from 0.89 to 0.97.
    • Rests on an assumption: No scientifically validated cutoffs exist for personality scales.
  • Findingown data

    In older adults with late-life major depression, high vulnerability to stress is associated with higher MADRS scores than low vulnerability to stress at baseline, year 5, and year 10 (5.0, 3.5, and 2.0 points higher, respectively).

    “high VS participants scored an average of 5.0, 3.5, and 2.0 MADRS points higher at baseline, year five, and year 10, respectively”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Neuroticism remains relatively stable from the time cognition and mood were first assessed to the time the NEO-PI-R was added to the NCODE protocol.
    • Rests on an assumption: The MADRS has high interrater reliability ranging from 0.89 to 0.97.
    • Rests on an assumption: No scientifically validated cutoffs exist for personality scales.
  • Findingown data

    In older adults with late-life major depression, high vulnerability to stress is associated with a 10-point greater decline in global cognitive functioning on the CERAD at 10 years compared with low vulnerability to stress.

    “the difference in CERAD scores was 10 points at 10 years.”
    • Also stated in: § Conclusions · boosted
      “The current findings demonstrate a clinically meaningful 10-point difference in global cognition between high and low VS LLD subjects at 10 years.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Neuroticism remains relatively stable from the time cognition and mood were first assessed to the time the NEO-PI-R was added to the NCODE protocol.
    • Rests on an assumption: No scientifically validated cutoffs exist for personality scales.
  • Findingown data

    In older adults with late-life major depression, no neuroticism trait other than vulnerability to stress is significantly linked to cognitive functioning.

    “High VS was the only neuroticism trait significantly associated with cognitive functioning.”
    • Also stated in: § Cognitive Decline · plain
      “No other significant associations between neuroticism and cognitive functioning were found.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Neuroticism remains relatively stable from the time cognition and mood were first assessed to the time the NEO-PI-R was added to the NCODE protocol.
    • Rests on an assumption: No scientifically validated cutoffs exist for personality scales.
  • Findingown data

    In older adults with late-life major depression, higher total neuroticism is associated with a slower treatment response over time.

    “only VS, impulsivity, and total neuroticism influenced progression of depression over time, with participants who scored high in these traits experiencing a slower treatment response after controlling for age and gender”
    • Also stated in: § Conclusions · plain
      “Higher total neuroticism was associated with a slower rate of treatment response, but was not correlated with cognitive functioning.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Neuroticism remains relatively stable from the time cognition and mood were first assessed to the time the NEO-PI-R was added to the NCODE protocol.
    • Rests on an assumption: The MADRS has high interrater reliability ranging from 0.89 to 0.97.
    • Rests on an assumption: No scientifically validated cutoffs exist for personality scales.
  • May combine two claims. 7
  • Classified as probably not a substantial claim. 15

  • May combine two claims.

    Findingown data

    In older adults with late-life major depression, when vulnerability to stress is analyzed as a continuous raw score, it has a significant main effect on global cognition on the CERAD, but its interaction with time is not significant.

    “there was a statistically significant main effect of vulnerability to stress on global cognition using the CERAD (t = 2.10, df = 248, b (SE) = 0.038 (0.018), p =0.03) whereas the interaction between time and vulnerability to stress was no longer significant (t = 0.46, df = 248, b (SE) = 0.001 (0.002), p =0.64).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Neuroticism remains relatively stable from the time cognition and mood were first assessed to the time the NEO-PI-R was added to the NCODE protocol.

  • May combine two claims.

    Interpretationcitation

    The present findings replicate and extend existing evidence that neuroticism, and vulnerability to stress specifically, affects both treatment response and cognitive decline in late-life major depression.

    “The present findings replicate and extend existing evidence for the impact of neuroticism, and VS specifically, on both treatment response and cognitive decline in LLD (18, 19).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [18] Steffens DC McQuoid DR Smoski MJ Clinical outcomes of older depressed patients with and without comorbid neuroticism. International psychogeriatrics / IPA 2013 25 1985 1990 PMC3830609 23941723 source

      Not checked in the free run.

    • cites [19] Hayward RD Taylor WD Smoski MJ Association of five-factor model personality domains and facets with presence, onset, and treatment outcomes of major depression in older adults. The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 2013 21 88 96 23290206 PMC3382026 source

      Not checked in the free run.

    • The authors state this as an assumption: Neuroticism remains relatively stable from the time cognition and mood were first assessed to the time the NEO-PI-R was added to the NCODE protocol.
    • Rests on an assumption: No scientifically validated cutoffs exist for personality scales.

  • May combine two claims.

    Interpretationcitation

    In older adults with late-life major depression, the cognitive decline in the high vulnerability to stress group approaches the normative mild cognitive impairment range, while the low vulnerability to stress group remains cognitively stable.

    “the extent of cognitive decline in the high VS group approaches that of the normative mild cognitive impairment range (24), whereas the global cognitive functioning of the low VS group remained stable over the same 10 year period.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Chandler MJ Lacritz LH Hynan LS A total score for the CERAD neuropsychological battery. Neurology 2005 65 102 106 16009893 source

      Not checked in the free run.

    • The authors state this as an assumption: Neuroticism remains relatively stable from the time cognition and mood were first assessed to the time the NEO-PI-R was added to the NCODE protocol.
    • Rests on an assumption: No scientifically validated cutoffs exist for personality scales.

  • May combine two claims.

    Interpretationown data

    The six neuroticism traits differ in how strongly they relate to clinical outcomes, supporting discriminant validity among them.

    “by showing neuroticism traits vary in the strength of their relationships with clinical outcomes, our findings are consistent with prior evidence of discriminant validity among the six neuroticism traits”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The six neuroticism traits are not independent and share modest to moderate variance.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The CERAD battery provides normative standards for older adults and is established for longitudinal cognitive impairment research.

    “the Consortium to Establish a Registry in Alzheimer's Disease (CERAD ) neuropsychological battery (22), a collection of measures with normative standards for the elderly and established utility in longitudinal studies of cognitive impairment (23).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [22] Morris JC Heyman A Mohs RC The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989 39 1159 1165 2771064 source

      Not checked in the free run.

    • cites [23] Welsh KA Butters N Mohs RC The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part V. A normative study of the neuropsychological battery. Neurology 1994 44 609 614 8164812 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    In non-depressed older adults followed for three years, only higher vulnerability to stress and anxiety were linked to global cognitive decline.

    “Elsewhere, increased VS and anxiety were the only neuroticism traits associated with global cognitive decline in non-depressed older adults followed over three years (11).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Wilson RS Begeny CT Boyle PA Vulnerability to stress, anxiety, and development of dementia in old age. The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 2011 19 327 334 21427641 PMC3078621 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In older adults without depression, higher total neuroticism predicts greater risk of depression and cognitive decline.

    “Total neuroticism is associated with increased risk of depression (10) and cognitive decline (11, 12) in non-depressed older adults”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] Kendler KS Gatz M Gardner CO Personality and major depression: a Swedish longitudinal, population-based twin study. Archives of general psychiatry 2006 63 1113 1120 17015813 source

      Not checked in the free run.

    • cites [11] Wilson RS Begeny CT Boyle PA Vulnerability to stress, anxiety, and development of dementia in old age. The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 2011 19 327 334 21427641 PMC3078621 source

      Not checked in the free run.

    • cites [12] Luchetti M Terracciano A Stephan Y Personality and Cognitive Decline in Older Adults: Data From a Longitudinal Sample and Meta-Analysis. The journals of gerontology. Series B, Psychological sciences and social sciences 2016 71 591 601 PMC4903032 25583598 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Anger-hostility is estimated to be common among middle-aged adults with major depression.

    “This is despite the high prevalence estimates of anger-hostility in middle aged adults with major depression (36)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Fava M Rosenbaum JF Anger attacks in patients with depression. The Journal of clinical psychiatry 1999 60 Suppl 15 21 24 10418810

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Normative standards suggest healthy elderly typically perform around 79 on the CERAD, while patients with mild cognitive impairment and dementia exhibit average scores of 68 and 49, respectively.

    “Normative standards suggest healthy elderly typically perform around 79 whereas patients with mild cognitive impairment and dementia exhibit average scores of 68 and 49, respectively (24).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Chandler MJ Lacritz LH Hynan LS A total score for the CERAD neuropsychological battery. Neurology 2005 65 102 106 16009893 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In children, neuroendocrine markers of stress and adversity at baseline, such as high cortisol, predict smaller amygdala and hippocampal volumes and cognitive functioning.

    “In children, neuroendocrine markers of stress and adversity at baseline (i.e., high cortisol) are predictive of smaller amygdala and hippocampal volumes and cognitive functioning (31, 32).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [31] Pagliaccio D Luby JL Bogdan R Stress-system genes and life stress predict cortisol levels and amygdala and hippocampal volumes in children. Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 2014 39 1245 1253 24304824 PMC3957120 source

      Not checked in the free run.

    • cites [32] Saridjan NS Henrichs J Schenk JJ Diurnal cortisol rhythm and cognitive functioning in toddlers: the Generation R Study. Child neuropsychology: a journal on normal and abnormal development in childhood and adolescence 2014 20 210 229 23391483 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In healthy adults, urgency is associated with brain regions involved in emotion regulation and reward.

    “Urgency correlates with emotional regulation and reward regions in healthy adults (42)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Muhlert N Lawrence AD Brain structure correlates of emotion-based rash impulsivity. NeuroImage 2015 115 138 146 25957991 PMC4463859 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The analyses were initially conducted with high and low neuroticism scores and then repeated with continuous raw scores to ensure findings were not biased by dichotomization or gender-normalization.

    “Analyses were initially conducted with high and low neuroticism scores (based upon a T cut-score of 55) and then repeated with continuous raw scores to ensure findings were not biased as a result of dichotomization or gender-normalization.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    One earlier study reported no link between reward-related decision making and three-month antidepressant response in older depressed adults.

    “a prior study found no association between reward related decision making and antidepressant treatment response over three months in older adults with major depression (44).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Alexopoulos GS Manning KJ Kanellopoulos D Cognitive control, reward related decision making and response of late-life depression to an antidepressant. Psychological medicine 2015 Accepted PMC4631680 26169527 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analyses adjusted for potential baseline confounders.

    “Separate generalized linear mixed models (GLMM) were used to examine the relationships between neuroticism (total score and each of the six neuroticism trait scores) and each of the five outcomes (MADRS, CERAD, Logical Memory, Symbol Digit Modalities, and Trail Making Part B) over time after adjusting for potential baseline confounders.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The impulsivity subscale of the NEO PI-R is considered equivalent to urgency, meaning rash action triggered by negative emotion.

    “The NEO PI-R impulsivity subscale is thought to be synonymous with the construct of urgency, or rash action in response to negative emotion (41).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Whiteside SP Lynam DR Understanding the role of impulsivity and externalizing psychopathology in alcohol abuse: application of the UPPS impulsive behavior scale. Experimental and clinical psychopharmacology 2003 11 210 217 12940500 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Chronic stress is thought to have diffuse neurological consequences.

    “The neurological sequelae of chronic stress is considered diffuse (33)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] McKlveen JM Morano RL Fitzgerald M Chronic stress increases prefrontal inhibition: a mechanism for stress-induced prefrontal dysfunction. Biological psychiatry 2016 PMC5629635 27241140 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A large number of hypothesis tests were done without correction for multiple comparisons.

    “There was also a large number of hypothesis tests done without correction for multiple comparisons.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In younger adults, urgency is linked to impulsive behavior and addiction.

    “and is correlated with impulsive behavior and addiction in younger adults (43).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Dir AL Karyadi K Cyders MA The uniqueness of negative urgency as a common risk factor for self-harm behaviors, alcohol consumption, and eating problems. Addictive behaviors 2013 38 2158 2162 23454879 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Individuals high in vulnerability to stress are described as becoming dependent, hopeless, or panicked when facing trying situations.

    “Individuals high in VS are described as becoming dependent, hopeless, or panicked when facing trying situations (9)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Costa PT McCrae RR NEO PI-R professional manual 1992 Psychological Assessment Resources Odessa Florida

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A subset of 76 participants had cognitive assessments available.

    “Cognitive assessments were available for a subset of 76 participants who underwent an average of 5.2 annual cognitive batteries (SD = 3.8).”
    Quote in the paperNot a substantial claim
20 of 20

  • The authors state this as an assumption.

    Neuroticism remains relatively stable from the time cognition and mood were first assessed to the time the NEO-PI-R was added to the NCODE protocol.

    “neuroticism is treated as a retrospective measure and therefore assumed to remain relatively stable from the time cognition and mood were first assessed and the time the NEO-PI-R was added to the NCODE protocol”

  • The paper relies on this without support.

    The MADRS has high interrater reliability ranging from 0.89 to 0.97.

    “It has been found to have high interrater reliability ranging from 0.89 to 0.97.”

  • The paper relies on this without support.

    Hostility and treatment response in late-life major depression has not been well studied.

    “Hostility and treatment response in LLD has not been well studied.”

  • The paper relies on this without support.

    The six neuroticism traits are not independent and share modest to moderate variance.

    “individual neuroticism traits are not orthogonal and modestly to moderately overlap in shared variance.”

  • The paper relies on this without support.

    No scientifically validated cutoffs exist for personality scales.

    “Whereas there are no scientifically validated thresholds for personality scales, we selected a T-score of ≥ 55 to define high neuroticism traits.”
5 of 5

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Each contradiction between two passages listed here was confirmed by an independent check.

  • Cognitive assessments did not all precede personality assessment

    Minor

    The methods say cognitive data preceded the personality assessment by 0-63 months, but the results place some cognitive testing as late as seven months after it.

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Authors
Manning, K. J., Chan, G., & Steffens, D. C.
Affiliations
UConn Health (US)
Corresponding author
Manning, Kevin J.
ORCID
Venue
The American Journal of Geriatric Psychiatry
Publisher
Elsevier BV
Published
2017-03
Volume
25
Issue
3
Pages
220-229
ISSN
1064-7481 (ISSN-L)
DOI
10.1016/j.jagp.2016.10.006
PMC
PMC5316488
OpenAlex
W2516529099
Cited by
41
References
50
Citations by year
2026: 5 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 7 · 2021: 1 · 2020: 3 · 2019: 5 · 2018: 4 · 2017: 3 · 2016: 1
FWCI
3.51
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • American Journal of Geriatric Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
NIH (R01 MH054846)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
neuroticism, vulnerability to stress, geriatric depression, cognitive decline, treatment response, personality traits, impulsivity, anger-hostility, anxiety, clinical course, treatment resistance
MeSH terms
Neuroticism, Aged, Aging, Major Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Middle Aged, Disease Progression, Cognitive Dysfunction

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