Personality traits and the risk of incident (hypo)mania among subjects initially suffering from depressive and anxiety disorders in a 9-year cohort study

• Published in: Journal of affective disorders Vol. 259; pp. 451 - 457
• Main Authors: Mesbah, R., Koenders, M.A., Spijker, A.T., de Leeuw, M., Boschloo, L., Penninx, B.W.J.H., van Hemert, A.M., Giltay, E.J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2019
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2019.08.043

•This large prospective cohort study had a follow-up of 9 years to study personality traits in relation to incident (hypo)mania within patients with depression and anxiety disorders.•Analysis on (hypo)mania symptoms (based on MDQ >7) revealed 233 new cases, with low agreeableness as the independent risk factor.•The analysis on (hypo)manic episodes (based on CIDI), with four follow-up measurements resulting in 31 new cases, consistently found that low agreeableness was the independent risk factor. Bipolar disorder (BD) is characterized by the alternating occurrence of (hypo)manic and depressive episodes. The aim of the current study was to determine whether personality traits independently predicted the subsequent development of (hypo)manic episodes within a group of patients who were initially diagnosed with depressive and anxiety disorders. The Netherlands Study of Depression and Anxiety is a cohort study with measurements taken at baseline and at 2-, 4-, 6-, and 9-year follow-up. Development of a (hypo)manic episode during follow-up was assessed with the Composite International Diagnostic Interview and (hypo)manic symptoms were evaluated with the Mood Disorder Questionnaire. The Big Five personality traits were the independent variables in multivariable Cox regression analyses. There were 31 incident cases of (hypo)manic episodes (n = 1888, mean age 42.5 years, 68.3% women), and 233 incident cases of (hypo)manic symptoms (n = 1319, mean age 43.1, 71.9% women). In multivariable analyses, low agreeableness was independently associated with an increased risk of developing a (hypo)manic episode, with a hazard ratio (HR) of 0.54 (p = 0.002, 95% CI [0.37, 0.78]). This finding was consistent with the development of (hypo)manic symptoms (HR 0.77, p = 0.001, 95% CI [0.66, 0.89]). The 2-year lag-time analysis reduced the number of participants at risk of a (hypo)manic episode. We conclude that low agreeableness is a personality-related risk factor for incident (hypo)mania among subjects initially suffering from depressive and anxiety disorders. Increased attention to personality deviances could help to recognize BD at an early stage.