Personality, Healthcare Use and Costs—A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy and Selection Criteria
2.2. Data Extraction and Analysis
2.3. Quality Assessment
3. Results
3.1. Overview: Included Studies
3.2. Extraversion and HCU
3.3. Agreeableness and HCU
3.4. Conscientiousness and HCU
3.5. Neuroticism and HCU or Costs
3.6. Openness to Experience and HCU
3.7. Quality Assessment
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Ethics Statement
References
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# | Search Term |
---|---|
#1 | Personality [Title/Abstract] |
#2 | Big five [Title/Abstract] |
#3 | #1 OR #2 |
#4 | Health care |
#5 | Health service * |
#6 | #4 OR #5 |
#7 | Use |
#8 | Utili * |
#9 | #7 OR #8 |
#10 | #6 AND #9 |
#11 | cost |
#12 | Expense * |
#13 | Expenditure * |
#14 | Economic * |
#15 | #11 OR #12 OR #13 OR #14 |
#16 | #10 OR #15 |
#17 | #3 AND #16 |
First Author | Country | Assessment of Personality | Assessment of Healthcare Utilization | Study Type | Sample Description | Sample Size | Age | Proportion of Women (in %) | Results |
---|---|---|---|---|---|---|---|---|---|
Andersen (2012) | Denmark | Neuroticism: Mini International Personality Item Pool—Five-Factor Model measure (five items) | Visits to the general practitioner (duration: 1.5 years) | Cross-sectional | Representative (not specified) population | n = 5068 | 17–65 | 55.5% | Ordinal logistic regression revealed that people with neuroticism had more visits (OR = 1.2, 95% CI: 1.0–1.4) to the general practitioner. |
M = 46.1 | |||||||||
SD = 12.9 | |||||||||
Chapman (2009) | United States of America | NEO Five-Factor Inventory (60 items) | Emergency department utilization (duration: three years) | Longitudinal | Recruited in primary care clinics | Baseline | 65–94 | 63.8% | Generalized linear mixed models revealed that a one sample deviation * (which means 50th versus 83rd population percentile) increase in extroversion increased the odds of emergency department utilization by 51% (OR = 1.51, 95% CI: 1.03–2.21). An equal decrease in agreeableness (which means 50th versus 17th population percentile) increased the odds by 54% (OR = 1.54, 95% CI: 1.05–2.22). |
n = 747 | M = 75.2 | ||||||||
SD = 6.6 | |||||||||
Cuijpers (2010) | Netherlands | Neuroticism scale from the Amsterdam Biographic Inventory (14 items) | Costs: health service uptake in primary and secondary mental healthcare, out-of-pocket costs, and production losses | Cross-sectional | Netherlands Mental Health Survey and Incidence Study | n = 5504 | 18–65 | 49.1% | Total per capita excess costs were $12,362 per year (reference year: 2007) in the 5% highest scorers of neuroticism (top 10%: $8243; top 25%: $5572). Total excess costs of neuroticism per 1 million inhabitants resulting from the 25% highest scorers was $1.393 billion (top 10%: $824.3 million; top 5%: $618.1 million). |
M = 41.1 | |||||||||
SD = 11.9 | |||||||||
den Boeft (2016) | Netherlands | NEO Five-Factor Inventory (60 items) | Trimbos and iMTA (instituut voor Medische Technology Assessment) questionnaire on costs associated with psychiatric illness | Longitudinal | Netherlands Study of Anxiety and Depression | Baseline | 18–65 | 66.4% | Generalized estimating equations showed that all five personality traits (neuroticism: RR = 1.01, 95% CI: 1.01–1.02; extraversion: RR = 1.02, 95% CI: 1.02–1.02; openness: RR = 1.02, 95% CI: 1.02–1.02; agreeableness: RR = 1.02, 95% CI: 1.02–1.02; conscientiousness: RR = 1.02, 95% CI: 1.02–1.02) are significantly associated with healthcare use. |
n = 2981 | M = 41.9 | ||||||||
SD = 13.1 | |||||||||
Friedman (2013) | United States of America | NEO Five-Factor Inventory (number of items not specified) | Daily use of thirty different services (duration not specified) | Cross-sectional | Recruited for the Medicare Primary and Consumer-Directed Care Demonstration | n = 1074 | 65–100 | 72.7% | Controlling for various need variables from the Andersen Behavioral Model, neuroticism increased the use of any emergency department (β = 0.03, p < 0.001), and any custodial nursing home (β = 0.04, p < 0.05). Agreeableness (β = 0.03, p < 0.05) and conscientiousness (β = −0.05, p < 0.01) were associated with using any custodial nursing home as well. Openness to experience was associated with any custodial home care (β = 0.02, p < 0.05). |
M = 79.7 | |||||||||
SD = 7.5 | |||||||||
Hajek (2017) | Germany | Short version of the Big Five Inventory (15 items) | Hospital stays for at least one night and number of physician visits (duration: three months) | Longitudinal | German Socioeconomic Panel | Baseline | 17–103 | 54.3% | FE Poisson regressions showed that neuroticism was associated with physician visits (β = 0.01, p < 0.001). Furthermore, conditional FE logistic regressions showed that extraversion was associated with the risk of hospitalization (OR = 1.02, p < 0.05). |
M = 51.6 | |||||||||
n = 37,185 | SD = 16.7 | ||||||||
Honda (2005) | United States of America | Big five factor model (25 items) | Use of acupuncture, biofeedback, chiropractic, energy healing, exercise/movement therapy, herbal medicine, high-dose megavitamins, homeopathy, hypnosis, imagery techniques, massage, prayer/spiritual practice, relaxation/mediation, and special diet (duration: twelve months) | Cross-sectional | Midlife development in the United States Survey | n = 3032 | 25–74 | 50.2% among non-users of complementary and alternative medicine; | Logistic regression stated that openness (OR = 1.65, 95% CI: 1.18–2.31) and extraversion (OR = 0.65, 95% CI: 0.46–0.91) were associated with the use of any alternative medicine. |
(mean age and SD for the total sample not specified) | 62.5% among users of complementary and alternative medicine | ||||||||
Kennedy (1990) | United States of America | EPI-Q (Eysenck Personality Inventory Questionnaire) (18 items) | Dental utilization as measured by percent restored | Cross-sectional | VA (Veterans Affairs) Dental Longitudinal Study | n = 593 | 28–80 | 0.0% | A plot of neuroticism versus utilization stated that there was a curvilinear association: those scoring lowest and highest on this scale sought less treatment. Linear regressions showed that neuroticism squared was significantly associated with dental utilization (β = −0.3, p = 0.03). |
M = 47.8 | |||||||||
SD = 8.1 | |||||||||
Metin (2019) | Turkey | Ten-Item Personality Inventory (10 items) | Holistic Complementary and Alternative Health Questionnaire | Cross-sectional | Academicians working for three leading universities in Turkey | n = 227 | M = 38.9 SD = 10.4 (age range not specified) | 65.6% | t-tests revealed that openness was positively associated with the use of complementary and alternative healthcare utilization (p = 0.02). |
Reber (2018) | Germany | Short version of the Big Five Inventory (15 items) | Number of physician visits (duration: three months) | Longitudinal | German Socioeconomic Panel | n = 2140 | In men: | 31.0% | Poisson fixed effects regressions did not show any association for all big five personality domains and the number of physician visits. |
M = 48.3 years | |||||||||
SD = 9.4 | |||||||||
In women: | |||||||||
M = 46.2 | |||||||||
SD = 9.3 | |||||||||
(age range not specified) | |||||||||
Sirois (2008) | Canada | Big Five Factor Inventory (44 items) | Seven domains of complementary and alternative medicine (duration: one year) | Cross-sectional | Clients of complementary and alternative medicine | n = 184 | 15–86 | 83.2% | Hierarchical multiple regression revealed that agreeableness was associated with a higher use of complementary and alternative medicine (β = 0.21, p < 0.01). |
M = 41.4 | |||||||||
SD = 13.7 | |||||||||
Tomenson (2012) | United Kingdom | Revised NEO Personality Inventory for neuroticism (number of items not specified) | Number of primary care consultations (duration: one year) | Cross-sectional | Random sample of the U.K. adult population | n = 961 | 25–65 | 54.0% | According to the Spearman correlation coefficient, there is a significant positive correlation between neuroticism and primary care consultations (year before baseline: ρ = 0.17, p < 0.001; year after baseline: ρ = 0.12, p = 0.003). |
M = 47.4 | |||||||||
SD = 11.6 | |||||||||
van Hemert (1993) | Netherlands | Dutch Personality Inventory (132 items) | Using any medication daily (duration not specified) | Longitudinal | Data from the Epidemiological Preventive Investigation at Zoetermeer | n = 1167 | 45–64 | 100.0% | Controlling for age and education, logistic regressions showed that the upper quintile concerning neuroticism had higher chances than the lower quintile to use medication (OR = 2.8, 95% CI: 1.8–4.5). |
M = 53.2 | |||||||||
SD = 5.7 | |||||||||
Wikehult (2005) | Sweden | Swedish universities Scales of Personality (91 items) | Receiving healthcare (duration: “currently”) | Cross-sectional | Victims of burn injury | n = 69 | N = 46.1 | 23.2% | Mann–Whitney U tests stated a significant correlation between neuroticism and currently receiving healthcare (p = 0.022). |
SD = 15.5 | |||||||||
(range not specified) | |||||||||
Westhead (1985) | United Kingdom | Eysenck Personality Questionnaire (number of items not specified) | Being a frequent attender (ten percent most frequent attenders in each decade age group for each sex) | Cross-sectional | Practice population | n = 1491 | Mean age, SD, and range not specified | 50.9% | Chi-square tests revealed that mean scores for neuroticism were higher among frequent attenders, both among men (p < 0.05) and women (p < 0.01). |
First Author (Year) | Type of Study (HCU/COI) | Study Objective | Inclusion and Exclusion Criteria | Cost Description | Comparison Group- or Disorder-Specific Costs | HCU Description | Comparison Group- or Disorder-Specific HCU | Currency | Reference Year | Perspective | Costs from More than One Category | Data Source | Valuation of Costs | Discounting |
Cuijpers (2010) | COI | ✓ | ✓ | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
Andersen (2012) | HCU | ✓ | X | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Chapman (2009) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
den Boeft (2016) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Friedman (2013) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Hajek (2017) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Honda (2005) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Kennedy (1990) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Metin (2019) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Reber (2018) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Sirois (2008) | HCU | ✓ | X | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Tomenson (2012) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
van Hemert (1993) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Westhead (1985) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
Wikehult (2005) | HCU | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | n.a. | n.a. | n.a. | n.a. | ✓ | n.a. | n.a. |
% of criteria fulfilled by studies | 100 | 86.7 | 100 | 100 | 100 | 100 | 100 | 100 | 100 | 100 | 100 | 100 | 100 | |
First Author (Year) | Missing Data | Statistics | Consideration of Confounders | Sensitivity Analysis | Sample Size (Sub-group) | Demographics | Arithmetic Mean Costs | SD (SE) or CI | Results Discussed with Respect to Other Studies | Results Discussed Regarding Generalizability | Limitations | Conclusion Supported by Data | Conflict of interest/funders | % of Criteria Fulfilled by Study |
Cuijpers (2010) | X | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 95.8 |
Andersen (2012) | X | ✓ | ✓ | ✓ | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | 87.5 |
Chapman (2009) | ✓ | ✓ | ✓ | X | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | 93.8 |
den Boeft (2016) | X | ✓ | ✓ | X | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | 87.5 |
Friedman (2013) | X | ✓ | ✓ | ✓ | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | 93.8 |
Hajek (2017) | X | ✓ | ✓ | ✓ | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | 93.8 |
Honda (2005) | X | ✓ | ✓ | X | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | 87.5 |
Kennedy (1990) | X | ✓ | ✓ | X | ✓ | ✓ | n.a. | n.a. | ✓ | X | ✓ | ✓ | ✓ | 81.3 |
Metin (2019) | X | ✓ | X | X | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | 81.3 |
Reber (2018) | X | ✓ | ✓ | ✓ | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | 93.8 |
Sirois (2008) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | 93.8 |
Tomenson (2012) | X | ✓ | ✓ | X | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | ✓ | ✓ | ✓ | 87.5 |
van Hemert (1993) | X | ✓ | ✓ | X | ✓ | ✓ | n.a. | n.a. | ✓ | X | ✓ | ✓ | ✓ | 81.3 |
Westhead (1985) | X | ✓ | ✓ | X | ✓ | X | n.a. | n.a. | ✓ | X | X | ✓ | X | 62.5 |
Wikehult (2005) | X | ✓ | ✓ | X | ✓ | ✓ | n.a. | n.a. | ✓ | ✓ | X | ✓ | ✓ | 81.3 |
% of criteria fulfilled by studies | 13.3 | 100 | 93.3 | 40 | 100 | 93.3 | 100 | 100 | 100 | 80 | 86.7 | 100 | 93.3 |
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Hajek, A.; Kretzler, B.; König, H.-H. Personality, Healthcare Use and Costs—A Systematic Review. Healthcare 2020, 8, 329. https://doi.org/10.3390/healthcare8030329
Hajek A, Kretzler B, König H-H. Personality, Healthcare Use and Costs—A Systematic Review. Healthcare. 2020; 8(3):329. https://doi.org/10.3390/healthcare8030329
Chicago/Turabian StyleHajek, André, Benedikt Kretzler, and Hans-Helmut König. 2020. "Personality, Healthcare Use and Costs—A Systematic Review" Healthcare 8, no. 3: 329. https://doi.org/10.3390/healthcare8030329