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Differences Between Individual and Societal Health State Valuations: Any Link With Personality?

Chapman, Benjamin P. PhD*; Franks, Peter MD†; Duberstein, Paul R. PhD*; Jerant, Anthony MD‡

Medical Care:
doi: 10.1097/MLR.0b013e3181a8112e
Original Article
Abstract

Objective: The concept of “adaptation” has been proposed to account for differences between individual and societal valuations of specific health states in patients with chronic diseases. Little is known about psychological indices of adaptational capacity, which may predict differences in individual and societal valuations of health states. We investigated whether such differences were partially explained by personality traits in chronic disease patients.

Research Design: Analysis of baseline data of randomized controlled trial.

Subjects: Three hundred seventy patients with chronic disease.

Measures: The NEO-five factor inventory measure of personality, EuroQoL-5D (EQ-5D) societal-based, and the EQ visual analogue scale individually-based measures of health valuation.

Results: Regression analyses modeled Dev, a measure of difference between the EQ-Visual Analogue Scale and EQ-5D, as a function of personality traits, sociodemographic factors, and chronic diseases. Individual valuations were significantly and clinically higher than societal valuations among patients in the second and third quartile of conscientiousness (Dev = 0.08, P = 0.01); among covariates, only depression (Dev = −0.04, P = 0.046) was also associated with Dev.

Conclusion: Compared with societal valuations of a given health state, persons at higher quartiles of conscientiousness report less disutility associated with poor health. The effect is roughly twice that of some estimates of minimally important clinical differences on the EQ-5D and of depression. Although useful at the aggregate level, societal preference measures may systematically undervalue the health states of more conscientious individuals. Future work should examine the impact this has on individual patient outcome evaluation in clinical studies.

Author Information

From the *Laboratory of Personality and Development, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York; †Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, California; and ‡Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, California.

Supported by Agency for Health Research and Quality grant R01HS013603, and National Institutes of Health grants T32MH073452, K08AG031328, and K24MH072712.

Trial Registration: Homing in on Health: Study of a Home Delivered Chronic Disease Self Management Program. Available at: www.clincaltrials.gov identifier: NCT00263939.

Reprints: Benjamin P. Chapman, PhD, Laboratory of Personality and Development, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 300 Crittenden, Rochester, NY 14642. E-mail: ben_chapman@urmc.rochester.edu.

© 2009 Lippincott Williams & Wilkins, Inc.