Translating personality psychology to help persona.docx

Translating personality psychology to help persona.docx

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Translatingpersonalitypsychologytohelppersona

Translatingpersonalitypsychologytohelppersonalizepreventivemedicineforyoungadultpatients

Keywords:

conscientiousness,personperception,personality,personalizedmedicine,physicalhealth,personalitypsychology,healthcarereform,youngadultpatients,poorhealthrisk

Abstract:

Therisingnumberofnewlyinsuredyoungadultsbroughtonbyhealthcarereformwillsoonincreasedemandsonprimarycarephysicians.Physicianswillfacemoreyoungadultpatients,whichpresentsanopportunityformoreprevention-orientedcare.Inthepresentstudy,weevaluatedwhetherbriefobserverreportsofyoungadults’personalitytraitscouldpredictwhichindividualswouldbeatgreaterriskforpoorhealthastheyenteredmidlife.Followingthecohortof1,000individualsfromtheDunedinMultidisciplinaryHealthandDevelopmentStudy（Moffitt,Caspi,Rutter,&Silva,2001）,weshowthatverybriefmeasuresofyoungadults’personalitiespredictedtheirmidlifephysicalhealthacrossmultipledomains（metabolicabnormalities,cardiorespiratoryfitness,pulmonaryfunction,periodontaldisease,andsystemicinflammation）.IndividualsscoringlowonthetraitsofConscientiousnessandOpennesstoExperiencewentontodeveloppoorerhealthevenafteraccountingforpreexistingdifferencesineducation,socioeconomicstatus,smoking,obesity,self-reportedhealth,medicalconditions,andfamilymedicalhistory.Moreover,personalityratingsfrompeerinformantswhoknewparticipantswell,andfromanurseandreceptionistwhohadjustmetparticipantsforthefirsttime,predictedhealthdeclinefromyoungadulthoodtomidlifedespitestrikingdifferencesinlevelofacquaintance.Personalityeffectsizeswereonparwithotherwell-establishedhealthriskfactorssuchassocioeconomicstatus,smoking,andself-reportedhealth.Wediscussthepotentialutilityofpersonalitymeasurementtofunctionasaninexpensiveandaccessibletoolforhealthcareprofessionalstopersonalizepreventivemedicine.Addingpersonalityinformationtoexistinghealthcareelectronicinfrastructurescouldalsoadvancepersonalitytheorybygeneratingopportunitiestoexaminehowpersonalityprocessesinfluencedoctor–patientcommunication,healthserviceuse,andpatientoutcomes.（PsycINFODatabaseRecord（c）2014APA,allrightsreserved）（journalabstract）

By:

SalomonIsrael

DepartmentofPsychologyandNeuroscienceandInstititueforGenomeSciencesandPolicy,DukeUniversity

TerrieE.Moffitt

DepartmentofPsychologyandNeuroscience,InstituteforGenomeSciencesandPolicy,DukeUniversity;DepartmentofPsychiatryandBehavioralSciences,DukeUniversityMedicalCenter;andSocial,Genetic,andDevelopmentalPsychiatryCentre,InstituteofPsychiatry,King’sCollegeLondon,London,UnitedKingdom

DanielW.Belsky

CenterfortheStudyofAgingandHumanDevelopment,DukeUniversity

RobertJ.Hancox

DepartmentofPreventiveandSocialMedicine,UniversityofOtago,Dunedin,NewZealand

RichiePoulton

DunedinMultidisciplinaryHealthandDevelopmentResearchUnit,UniversityofOtago,Dunedin,NewZealand

BrentRoberts

DepartmentofPsychology,UniversityofIllinoisatUrbana–Champaign

W.MurrayThomson

DepartmentofOralSciences,UniversityofOtago,Dunedin,NewZealand

AvshalomCaspi

DepartmentofPsychologyandNeurosciece,InstituteforGenomeSciencesandPolicy,DukeUniversity;DepartmentofPsychiatryandBehavioralSciences,DukeUniversityMedicalCenter;andSocial,Genetic,andDevelopmental

PsychiatryCentre,InstituteofPsychiatry,King’sCollegeLondon,London,UnitedKingdom;

Althoughmostoftheclinicalburdenofage-relateddiseases（e.g.,cardiovasculardisease,typeIIdiabetes,hypertension）occursaftermidlife,itisnowwellestablishedthatthepathophysiologyofthesediseasesbeginsearlierinlifeandaccumulatesacrossthelifecourse（Weintraubetal.,2011）.Accordingly,healthprofessionalsareplacingincreasedemphasisontargetingyoungerpopulationsfordiseaseprevention（Kavey,Simons-Morton,&deJesus,2011;McGill&McMahan,2003）.Variousalgorithm-basedmodels（e.g.,FraminghamRiskScore,SystematicCoronaryRiskEvaluation,ReynoldsRiskScore）areavailabletofacilitatehealthriskstratification（seeBerger,Jordan,Lloyd-Jones,&Blumenthal,2010,foranoverview）,butthesehavelimitedefficacyinpatientsyoungerthan30years（Berry,Lloyd-Jones,Garside,&Greenland,2007）,inpartbecausemedical-basedtestsinyoungadultsdonotprovideclearclinicaldirection.Consequently,primarycarepractitionersusecomplementaryapproachessuchasmedicalrecordreviews,familyhistoriesofdisease,andpatientsurveysoflifestylehabits（e.g.,diet,smoking）toforecastanindividualpatient’spotentialhealthrisk.Inthisstudy,weexaminedwhetherbriefobserverreportsofpersonalityadministeredinyoungadulthoodwereabletoimprovepredictionofpeople’shealthatmidlife.

WhyUsePersonalityTraitstoPredictHealth?

Theriseinthenumberofnewlyinsuredyoungadultsbroughtonbyhealthcarereformwillincreasedemandsonthehealthcaresystem（Sommers&Kronick,2012）.Primarycarephysicianswillfacemorepatientswhoseneedsareunfamiliartothem.Avisionfororientinghealthcaretobettermeetpatients’needshasbeensetforthinarecentreportbytheInstituteofMedicine（M.Smith,Saunders,Stuckhardt,&McGinnis,2013）.Thereportcallsforgreaterpatientcenterednessinthehealthcaresystem,stressingthebenefitofattendingtopatients’preferences,values,andcharacteristicpatternsoffeeling,thinking,andbehaving—inshort,theirpersonality（Funder,1997;John,Robins,&Pervin,2010;Roberts,2009）.Howcanhealthcarepractitionersgettoknowtheirpatients?

Personalitytraitscanbemeasuredcheaply,easily,andreliably;arestableovermanyyears;andhavefar-rangingeffectsonimportantlifeoutcomes,includingmorbidityandearlymortality.Themagnitudeofpersonalityeffectsareonparwithotherwell-establishedfactorssuchasIQandsocioeconomicstatus（Deary,Weiss,&Batty,2011;Roberts,Kuncel,Shiner,Caspi,&Goldberg,2007）.

Althoughearlierresearchhasshownthatpersonalitytraitspredicthealthanddisease（Booth-Kewley&Friedman,1987）,thisearlierresearchusedabewilderingvarietyofapproachestodefinepersonality.Theresultingproliferationofassessmenttoolsandpiecemealresearchmadeitdifficultforclinicianstoknowwhatpersonalitymeasurestouse,orhowtousethem.Thepasttwodecadeshaveledtoaconsensusamongpsychologiststhatpersonalitydifferencescanbeorganizedalongfivebroaddimensions:

Extraversion,Agreeableness,Neuroticism,Conscientiousness,andOpennesstoExperience（withtheusefulacronym,OCEAN;John&Srivastava,1999）.Theseso-calledBigFivepersonalitytraitsprovidestructureforframingpreviousfindings（Digman,1990;Marshall,Wortman,Vickers,Kusulas,&Hervig,1994;McCrae&John,1992;T.W.Smith,2006;T.W.Smith&Williams,1992）andguidingtranslationtoclinicalpractice.Table1describestypicalhighandlowscorersforeachpersonalitytrait.

ThemostcompellingevidenceforthecontributionofpersonalitytohealthcomesfromlongitudinalstudiesshowingthatConscientiouspeoplelivelonger（Hill,Turiano,Hurd,Mroczek,&Roberts,2011;Kern&Friedman,2008）.NumerousstudiesalsolendsupporttotheinvolvementofExtraversion,Agreeableness,andNeuroticisminhealthprocesses（Chapman,Roberts,&Duberstein,2011;Sutin,Ferrucci,Zonderman,&Terracciano,2011;Sutinetal.,2010）.LessisknownaboutOpennesstoExperience,althoughheretoothereissuggestiveevidence（Ferguson&Bibby,2012;Turiano,Spiro,&Mroczek,2012）.

MovingFromPredictiontoTheory,andFromTheorytoTranslation

ResearchhasbegundissectingthepersonalityprocessesunderlyingtheBigFivefactorsinordertobetterunderstandthemechanismsbywhichpersonality“getsoutsidetheskin”toaffectmorbidityandmortality（Hampson,2012）.Personalitydifferencesaretheorizedtoaffecthealthinseveralways:

First,personalitydifferencesmayreflectunderlyingvariationinbiologicalsystemslinkedtothepathogenesisofdisease.Neuroticism,characterizedbyheightenedemotionalreactivitytoenvironmentalstimuli,hasbeentiedtogreateractivationofneuroendocrineandimmunesystems（Lahey,2009）.GreaterlevelsofNeuroticismcouldpossiblyreflectanunderlyinghyperresponsivenesstobothemotionalandphysiologicalnegativestimuli.Second,personalitydifferencesarethoughttorelatetothevariouswaysinwhichpeoplereacttoillness.Thisincludesthevarietyofprocessesinwhichpeoplecopewithstress,seekmedicalcare,adheretotreatment,andengagewithotherstoreceivesupport.Forexample,individualshigherinExtraversionmayseekoutmoresociallyengagingenvironmentsallowingthemtocallonarichernetworkofsocialsupportwhendealingwithillness（Carver&Connor-Smith,2010）.Third,personalitydifferencesarethoughttoberelatedtoawiderangeofhealthbehaviorsthateitherpromoteormitigatedisease.Forexample,individualshigherinConscientiousnessaremorelikelytoliveactivelifestyles,havehealthydiets,andrefrainfromsmokingandexcessivealcoholconsumption（Bogg&Roberts,2004）.Theseprocesses—diseasepathogenesis,reactiontoillness,andhealthbehaviors—arenotmutuallyexclusiveandmayworktogethertoaffecthealthoutcomes.

AnupcomingspecialissueinDevelopmentalPsychologyhighlightsthepressingneedforimplementationsciencetosupportpersonality–healthresearch（Chapman,Hampson,&Clarkin,inpress;Israel&Moffitt,inpress）.Tomoveforwardinapplyingpersonalitymeasur