Neuroticism and common mental disorders: Meaning and utility of a complex relationship

Johan Ormel*, Bertus F Jeronimus, Roman Kotov, Harriëtte Riese, Elisabeth H Bos, Benjamin Hankin, Judith G M Rosmalen, Albertine J Oldehinkel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

264 Citations (Scopus)

Abstract

Neuroticism's prospective association with common mental disorders (CMDs) has fueled the assumption that neuroticism is an independent etiologically informative risk factor. This vulnerability model postulates that neuroticism sets in motion processes that lead to CMDs. However, four other models seek to explain the association, including the spectrum model (manifestations of the same process), common cause model (shared determinants), state and scar models (CMD episode adds temporary/permanent neuroticism). To examine their validity we reviewed literature on confounding, operational overlap, stability and change, determinants, and treatment effects. None of the models is able to account for (virtually) all findings. The state and scar model cannot explain the prospective association. The spectrum model has some relevance, especially for internalizing disorders. Common causes are most important but the vulnerability model cannot be excluded although confounding of the prospective association by baseline symptoms and psychiatric history is substantial. In fact, some of the findings, such as interactions with stress and the small decay of neuroticism's effect over time, are consistent with the vulnerability model. We describe research designs that discriminate the remaining models and plea for deconstruction of neuroticism. Neuroticism is etiologically not informative yet but useful as an efficient marker of non-specified general risk.

Original languageEnglish
Pages (from-to)686-697
Number of pages12
JournalClinical Psychology Review
Volume33
Issue number5
DOIs
Publication statusPublished - Jul-2013

Keywords

  • Neuroticism
  • Vulnerability model
  • Common cause model
  • Spectrum model
  • Scar model
  • Common mental disorders
  • SUBSTANCE USE DISORDERS
  • NATIONAL COMORBIDITY SURVEY
  • ENVIRONMENTAL RISK-FACTORS
  • COMPREHENSIVE DEVELOPMENTAL MODEL
  • ANTISOCIAL PERSONALITY-DISORDER
  • ADVERSE CHILDHOOD EXPERIENCES
  • ADULT PSYCHIATRIC-DISORDERS
  • SELF-MEDICATION HYPOTHESIS
  • MAJOR DEPRESSIVE EPISODE
  • AXIS-II DISORDERS

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