Personality factors and self-perceived health in Chi-lean elderly population

doi:10.4236/health.2013.512A012

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Vol.5, No.12A, 86-96 (2013) Health

http://dx.doi.org/10.4236/health.2013.512A012

Personality factors and self-perceived health in

Chilean elderly population

Pedro Olivares-Tirado*, Gonzalo Leyton, Eduardo Salazar

Studies and Development Department, Superintendence of Health, Santiago, Chile;

*Corresponding Author: polivares@superdesalud.gob.cl

Received 15 October 2013; revised 16 November 2013; accepted 25 November 2013

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Empirical evidence suggests that the stability of

personality itself contributes to successful age-

ing and is associated with longer life. The aim of

this study was to investigate the association be-

tween personality traits and the self-perceived

health status, stratified by medical conditions in

a representative sample of non-institutionalized

elderly people in Chile. The data used for this

study come from the fourth waves (2009) of the

Chilean Social Protection Survey (SPS-2009). In-

cluded were a total of 2655 subjec ts aged 65 and

over. The results showed that higher scores of

all five personality factors were associated with

good health. Those with the perception of poor

health were more likely to be female, with lower

education level and older than those with good

health. With the exception of agreeablen ess, strong

and significant associations with self-perceived

health were demonstrated for extraversion, con-

scientiousness, emotional stability and open-

ness, among elderly with medical conditions.

Among elderly without medical problems, sig-

nificant associations with self-perceived health

were demonstrated only for extraversion, agree-

ableness and emotional stability. This study has

shown that there is a consistent association

between personality factors and self-perceived

health throughout the older population. Our re-

sults suggest that extraversion and openness

traits could be acting as “protector” factors and

agreeableness and conscientiousness traits as

“resilient” factors, facing to the health problems

among elderly people.

Keywords: Serous Personality; Self-Perceived

Health; Ageing; TIPI Questionnaire

1. INTRODUCTION

Along with most other nations, Chile is undergoing an

accelerated growth of older populations with the in-

creased life expectancies. By 2025, the proportion of

people aged 65 and over is expected to reach 14% of the

total population and more than one million will be per-

sons aged 75 or more in Chile [1]. With the moderniza-

tion of the society and socioeconomic development in

the last 3 decades, the cultural values and the family

structure have been modified. Furthermore, values, be-

liefs and preferences of the elderly themselves have been

changing, and the current older generations tend to have

a stronger desire for autonomy and independence. Thus,

in this changing society, it is important to examine life

conditions of older people to better understand their ad-

aptation to the aging process and consequences on their

health and wellbeing.

Interest in the association between personality charac-

teristics and health has been renewed in recent years.

Studies have shown a strong association between per-

sonality characteristics and health suggesting that per-

sonality traits could contribute to self-perceived health,

health outcomes and longevity [2,3]. It has also been

shown that self-perception of health has shown its sig-

nificant ability to predict a variety of outcomes, includ-

ing service utilization, emotional distress, morbidity and

mortality [4-6].

Increased empirical evidence shows that personality in

terms of enduring dispositions remains stable after ap-

proximately age 30, exerting fairly generalized effects on

human behavior and constituting an important determi-

nant of psychological well-being in old age [7-9]. It is

suggested that the stability of personality itself contrib-

utes to successful ageing by allowing the individual to

plan the future [10], enhance their health-related quality

of life, prevent the disease progression [11] and even is

associated with longer life [3].

Personality constructs deserve special consideration

P. Olivares-Tirado et al. / Health 5 (2013) 86-96 87

when attempting to predict individual differences in be-

haviors. One of the current, predominant frameworks of

the personality is the five-factor model (FFM). The FFM

is a comprehensive, empirical, data-driven research find-

ing [12]. The five-factor model has emerged as an im-

portant taxonomy of global personality traits and appears

to hold a great promise for investigations of correlation

between the personality and various behaviors because of

its robustness and parsimony [13-15].

The five-factor model of personality is a hierarchical

organization of personality traits in terms of five broad

bipolar domains or dimensions that are defined by clus-

ters of interrelated specific traits: extraversion, agree-

ableness, conscientiousness, neuroticism, and openness

to experience. These five overarching domains have been

found to contain and subsume most known personality

traits and are assumed to represent the basic structure

behind all personality traits. Extraversion describes de-

grees of interpersonal interactions. Agreeableness esti-

mates the quality of interpersonal orientation. Conscien-

tiousness estimates motivation in goal-directed behavior.

Neuroticism measures degrees of emotional stability.

And openness to experience estimates the willingness to

accept novel ideas [16].

These five factors provide a rich conceptual frame-

work for integrating all the research findings and theory

in the personality psychology [17]. All five factors were

shown to have convergent and discriminant validity acro-

ss instruments and observers, and to endure across dec-

ades in adults [13,14]. The most frequently used meas-

ures of the five factors comprise either items that are

self-descriptive sentences [18] or items that are single

adjectives in the case of lexical measures [19]. A research

using both self-descriptive sentences and lexical meas-

ures supports the comprehensiveness of the FFM model

and its applicability across observers and cultures [13].

The advantages and limitations of the five-factor mo-

del of personality as an integrating framework for studies

of personality and health had been widely discussed. Al-

though the FFM model has some potential limitations,

the application of this method—as well as other aspects

of current personality theory and research—is likely to

facilitate progress in the study of how personality influ-

ences health. Personality attributes have been shown to

mediate health-related behaviors and health outcomes

[2,20-24].

On the other hand, self-perceived health (SPH) is one

of the most commonly used psychometric indicators in

health surveys. SPH has often been thought of as meas-

uring only “subjective” health, the opposite to physi-

cian-rated health, which is considered as an “objective”

measurement. However, in several longitudinal studies,

SPH has been found to be a good predictor for survival

and for future health outcomes even better than a physi-

cian’s assessment [25-32]. SPH is a reliable and valid

measure for assessing the subjective and objective health

of individuals and in a large-scale survey [5,25,33,34].

Since elderly people are prone to several health prob-

lems which have physical, psychological and social com-

ponents, self-perceived health is an important factor in

old age. Self-perceived health has been extensively stud-

ied in older populations. A range of important factors

such as chronic diseases, mortality, health care utiliza-

tion, long-term care utilization and health-related quality

of life have been associated with self-perceived health in

the elderly population [26-32,35-38].

Some authors have reported that old people perceive

their health in positive terms and tend to over-estimate

their health compared with objective health measure-

ments [32,39-44]. Other data support the view that eld-

erly people are more pessimistic in their perceptions of

their own health than younger people, even after control-

ling for objective health conditions [45,46]. It is possible

that these differences are explained at least partly, by the

individual personality traits.

On the other hand, the association of some socio-

demographic variables or medical conditions with SPH

of the elderly people has varied in previous studies. Eld-

erly men tend to report poorer health than elderly women

for similar objective health conditions [40,42,47]. Poor

education and low socio-economical status are associated

with poor self-rated health [39,44,48]. The number of

symptoms and medical conditions, depression, heart dis-

ease, stroke decreased functional capacity and sensory

problems all correlate positively with low self-rated

health in elderly [26,39-44,47].

The purpose of this study was to investigate the asso-

ciation between personality traits and the perceived

health status in a representative sample of the older

Chilean population. The evaluation of personality traits

was based on the FFM model, and measured with the

Questionnaire of Personality TIPI (Ten-Item Personality

Inventory). The self-perceived health evaluation was

based on the question of the European Union Statistics

on Income and Living Room Conditions [49]: “How is

your health in general?” To the best of our knowledge,

this is the first study to investigate the role of personality

traits in explaining variations in self-perceived health in

the elderly Chilean population.

2. METHODS

2.1. Data & Participants

The data used for this study comes from the fourth

(2009) waves of the Chilean Social Protection Survey

(SPS). The SPS is a nationally and regionally representa-

tive household survey that contains extensive individual

information about participation in the labor market and

P. Olivares-Tirado et al. / Health 5 (2013) 86-96

in the social protection system, as well as socioeconomic

characteristics. It also contains a detailed set of health

and wealth questions, as well as questions that measure

the financial knowledge of respondents and their level of

risk aversion. The SPS contains longitudinal data for a

sample of 20,000 individuals firstly interviewed in 2002,

with follow-ups in 2004, 2006 and 2009 [50].

The fourth wave of the SPS was fielded between April

and December of 2009. The overall response rate was

76.5% on a sample of 19,512 peoples. Thus, the fourth

wave of the SPS-2009 contains longitudinal data for

14,463 individuals [50]. In the SPS elderly people were

oversampling to enhance the likelihood to build a sample

with sufficient representation of this age group. The

study sample corresponds to 2655 subjects aged 65 and

over.

2.2. Measures

2.2.1. Personality Traits

The evaluation of personality traits was based on the

FFM model, and measured with the Questionnaire of

Personality TIPI (Ten-Item Personality Inventory) de-

veloped by Gosling, Renfro & Swann [51]. The TIPI

questionnaire is a validated short-form for use in applied

research settings where questionnaire space and respon-

dent time are limited [51]. TIPI is a standard 10-item

measure of the Big-Five personality dimensions. Each

item consists of two descriptors, separated by a comma,

using the common stem, ‘‘I see myself as:’’. Two sepa-

rate items together covered the breadth of each domain

including the high (+) and low(−) poles. The resulting

five dimension were: Extraversion [(+): extraverted, en-

thusiastic/(−): reserved, quiet], Agreeableness [(+): sym-

pathetic, warm/(-): critical, quarrelsome], Conscien-

tiousness [(+): dependable, self-disciplined/(−): disorgan-

ized, careless], Emotional stability [(+): calm, emotion-

ally stable/(−): anxious, easily upset] and Openness to

experience [(+): open to new experience, complex/(−):

conventional, uncreative]. Each item is rated on a 7-point

scale that ranges from 1 (disagree strongly) to 7 (agree

strongly). To score TIPI scales, items 2, 4, 6, 8, and 10

are reversed-scored (i.e., recode a 7 with 1, a 6 with 2, a

5 with 3, etc) and then, take the average of the two items

(the standard item and the recoded reverse-scored item

(R)) that make up each scale. Extraversion: item 1, 6R;

Agreeableness: 2R, item 7; Conscientiousness: item 3,8R;

Emotional stability: 4R, item 9 and Openness to experi-

ence: item 5,10R (51). This variable was included as a

continuous variable with one decimal.

2.2.2. Self-Perception of Health

Self-perception of health status was assessed with a

Likert-scale item question based on EU-SILC question

on self-perceived health (“How is your health in gen-

eral?”), which contains six answering categories; 1) ex-

cellent; 2) very good; 3) good; 4) fair; 5) poor and 6) very

poor. The European Union Statistics on Income and Liv-

ing Conditions (EU-SILC, 2003) question on selfper-

ceived health is part of the Minimum European Health

Module (MEHM), which is also included in the Euro-

pean Health Interview Survey (EHIS). Self-perceived

general health (based on EU-SILC data) is one of the

indicators of the health and long term care developed

under the Open Method of Coordination (OMC) [49].

This variable was aggregated into two categories: good

health (i.e., excellent, very good and good) and poor

health (i.e., poor and very poor). Given that “fair” con-

cept, is generally evasive and ambiguous in Chilean

idiosyncrasy, fair category was excluded of the analysis.

2.2.3. Medical Conditions

It is clear that physical illness and mental disorders in-

fluence self-perception of health.

One of the health questions (f38) in the SPS-2009,

contribute to the evaluation of health problems and con-

sequently with the burden of diseases at the population

level. Individuals were asked to report whether they had

specific diseases diagnosed by a physician, in the list on

a yes/no format. The list of diseases includes eleven

chronic diseases and conditions commonly found among

older populations i.e.; respiratory problems, depression,

diabetes, high blood pressure, cardiac problems, cancer,

arthritis/arthrosis, kidney/urinary problems, stroke and

mental disorders. With the exception of HIV/AIDS, the

total number from the list was used for the analysis.

2.2.4. Socio-Demographics Features

With the purpose to adjust for potential confounders,

variables as; age, gender, educational level and marital

status were included in the analysis. Age (years) was

included as a continuous variable, gender as a dichoto-

mous variable (0 = male, 1 = female), educational level

as a categorical variable with 3 levels; primary (include-

ing illiterates), high school and university level (include

ing post-degree) and marital status as a categorical vari-

able with 4 levels: single, married, divorced and wid-

owed.

2.2.5. Statistical Analysis

One-way ANOVAs were used to compare each dimen-

sion of the personality between those with good and poor

self-perceived health. The Mantel-Haenszel chi-square

test was utilized to study the lineal associations between

prevalence of self-reported health problems and self-

perceived health status. A binary logistic regression was

used to examine the association between personality

traits and prevalence of self-reported health problems.

Multivariate Analysis of Variance (MANOVA), with the

P. Olivares-Tirado et al. / Health 5 (2013) 86-96

Wilks-Lambda statistics, was used to study personality

factors between those with self-perceived health good

and poor health in both strata; with and without medical

conditions. All the 5 personality dimensions were ana-

lyzed simultaneously. Age, gender, education and marital

status were incorporated as covariates. The results were

presented as adjusted means and standard errors (S.E.)

evaluated at the mean for the covariates in the total sam-

ple. All analyses were conducted using the SAS software,

version 9.1 for Windows (SAS Institute Inc.).

3. RESULTS

3.1. Descriptive Statistics

Table 1 shows socio-demographic, health and person-

ality characteristics for the whole sample. From the 2655

participants, 36% (961 cases) had good health. About

43% (1147cases) and 21% (547 cases) of the sample had

either fair health or poor health, respectively.

Mean age for the whole sample was 74 years. Fifty-

one percent of the whole sample was females and 10.6%

illiterates. Among those with good health; 44% were

females, the mean age was 73 years, 8.7% had superior

education level and 54.3% were married. The corre-

sponding figures for those with poor health were; 60%,

75 years, 1.6% and 54.2%, respectively.

As shown in Table 1, the prevalence of medical prob-

lems increased with the decline in level of the selfper-

ceived health among all conditions queried. With the ex-

ception of high blood pressure, differences between good

and poor health groups were highly significant (p <

0.0001). Table 1, also depicts means and standard devia-

tions of all TIPI domain scores. For the whole sample,

people who reported a good health had better scores in

all TIPI personality dimensions than those reported a

poor health.

Table 1. Descriptive socio-demographic, medical condition and personality traits by self-perceived health (n: 2655).

self-perceived health

Poor/very poor (n: 547) Fair (n:1,147) Excellent/very good/good (n:961)

Age (mean, std) 75 (7.46) 74 (7.05) 73 (6.60)

Gender (% female) 60% 53% 44%

Educational level (%)

Primary 77.9% 75.0% 57.6%

High school 18.5% 22.0% 33.7%

Superior 1.6% 3.0% 8.7%

Marital status (%)

Single 10.5% 11.3% 11.6%

Married 54.2% 55.2% 54.3%

Divorced 5.5% 5.0% 7.6%

Widowed 29.8% 28.5% 26.5%

Medical conditions (% with condition)

Respiratory problems 17.4% 9.0% 2.9%

Depression 20.8% 10.5% 3.3%

Diabetes mellitus 30.0% 20.3% 10.1%

High blood pressure 68.2% 60.5% 39.9%

Cardiac problems 27.6% 17.6% 5.3%

Cancer 7.3% 2.7% 2.1%

Arthritis/arthrosis 36.2% 21.7% 10.4%

Kidney/urinary diseases 10.2% 3.6% 1.6%

Stroke 2.7% 0.4% 0.2%

Mental disorders 3.3% 0.9% 0.4%

Personality scale(TIPI) (mean, std)

Extraversion 3.7 (1.52) 3.8 (1.46) 4.2 (1.45)

Agreeableness 5.1 (1.37) 5.3 (1.31) 5.2 (1.34)

Conscientiousness 5.4 (1.33) 5.6 (1.32) 5.7 (1.31)

Emotional stability 4.8 (1.41) 5.1 (1.35) 5.1 (1.36)

Openness 3.9 (1.39) 4.1 (1.44) 4.3 (1.52)

P. Olivares-Tirado et al. / Health 5 (2013) 86-96

3.2. Personality Factors and So

Cio-Demographics Characteristics

For the whole sample, women had higher mean scores

of extraversion, agreeableness and openness than the

men. In turn, men had higher means scores of conscien

tiousness and emotional stability than women. With ex-

ception of openness (p = 0.05), there were no significant

differences in mean personality trait scores between

women and men (not shown).

For the whole sample, an increasing association level

was observed between the gradient of education levels -

lower to higher education- and extraversion (p = 0.02),

conscientiousness (p = 0.104) and openness (p = 0.002).

There were no significant differences in mean scores of

agreeableness and emotional stability among education

levels (not shown).

For the whole sample, there were no significant asso-

ciation between personality trait scores and marital status.

However, single individuals shown higher mean scores

of conscientiousness (mean: 5.6), emotional stability

(mean: 4.9), and openness (mean: 4.5). Married subjects

shown higher mean scores of extraversion (mean: 4.2)

and good scores of conscientiousness (mean: 5.5), agree-

ableness (mean: 5.1), emotional stability (mean: 4.9) and

openness (mean: 4.9).Widowed individuals shown simi-

lar pattern than single individuals, excepting agreeable-

ness (mean: 5.2) where they were the best scored. Di-

vorced individuals showed the worse personality traits

scores (not shown).

3.3. Personality Factors and Medical

Conditions (Morbidity)

For the whole sample, there were no significant dif-

ferences in mean scores of extraversion, conscientious-

ness, emotional stability and openness between subjects

with and without medical conditions. However, those

with medical conditions showed agreeableness mean

score significantly better than individuals without medi-

cal conditions (5.16 vs 5.02, p = 0.02). After adjustment

for socio-demographic factors the association between

agreeableness and reported medical conditions remained

significant (OR: 1.081, 95% CI: 1.004-1.165) (not

shown).

Separate analysis for medical conditions and after ad-

justing for socio-demographic factors, there were no sig-

nificant associations between personality traits and respi-

ratory problems, high blood pressure, cardiac problems,

cancer, arthritis/arthrosis and kidney/urinary illness (Ta-

ble 2).

The level of extraversion and emotional stability

(neuroticism) among those with depression was signifi-

cantly lowers, compared to those without depression. On

the other hand, a lower score of agreeableness was sig-

nificant associated with diabetes compared with those

without this medical condition. The level of conscien-

tiousness among those with mental disorder was signifi-

cantly lower, compared to those without mental disorders.

Finally, the level of openness among those with stroke

was significantly lower, compared to those without

stroke (Table 2).

3.4. Personality Factors, Medical Conditions

and Self-Perceived Health

The results of the ANOVA shows relationships be-

tween each of the individual items of the personality in-

ventory and self-perceived health in both strata; with and

without medical conditions are presented in Table 3.

Without adjustment for socio-demographics factors, and

with the exception of agreeableness all of the other per-

sonality dimensions were significantly associated with

self-perceived health in those who reported medical con-

ditions. On the other hand, in those without medical con-

ditions just extraversion and emotional stability were

significantly associated with self-perceived health.

Among those with and without medical conditions,

comparing individual self-perception of health, those

with perception of poor health were more likely to be

female. Mean age of individuals with perception of poor

health was higher than among those with good health.

Higher education level was significantly associated with

good health.

The results of the MANOVAs are exhibited in Table 4.

The overall MANOVAs were highly significant both

among those with and without medical conditions. After

adjustments for socio-demographic factors, all personal-

ity traits except for agreeableness, were significantly

associated with self-perceived health among those with

medical conditions. Among those without medical condi-

tions, and after adjustments; extraversion, agreeableness

and emotional stability were significantly associated with

self-perceived health.

Of interest, three personality traits—conscientiousness,

emotional stability and openness—that were significant

among those with medical conditions and good self-

perceived health, showed higher mean scores than those

with perception of good self-perceived health among tho-

se without medical conditions.

4. DISCUSSION

The present study focused on the comprehensive five-

factor model of personality and self-perceived health

among subjects with and without medical conditions, in a

nationally representative sample of elderly people. To

our knowledge, this is the first study in Chile to observe

an association between personality traits and self-per-

ception of health in a community-based elderly popula-

P. Olivares-Tirado et al. / Health 5 (2013) 86-96 91

Table 2. Adjusted OR (95% CI) for personality traits among elderly with and without medical conditions (n: 1914).

Extraversion Agreeableness Conscientiousness Emotional stability Openness

Respiratory problems