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Combined Effects of Neuroticism and Extraversion: Findings From a Matched Case Control Study of Suicide in Rural China

Fang, Le PhD*†; Heisel, Marnin J. PhD‡§; Duberstein, Paul R. PhD§; Zhang, Jie PhD†∥

The Journal of Nervous and Mental Disease: July 2012 - Volume 200 - Issue 7 - p 598–602
doi: 10.1097/NMD.0b013e31825bfb53
Original Articles

Neuroticism and extraversion are potentially important markers of personality vulnerability to suicide. Whereas previous studies have examined these traits independently, we examined their combined effects. Data were collected from family members and/or friends of individuals 18 years or older who died by suicide (n = 64) in rural China and from age-, sex-, and geographically matched controls (n = 64). Personality was assessed with the NEO-Five Factor Inventory. Individuals with a personality style characterized by high neuroticism and low extraversion were at 3.07 (95% confidence interval [CI], 1.44–6.55) times greater risk for suicide than were individuals without this personality style; in contrast, a style characterized by low neuroticism and high extraversion conferred decreased suicide risk (odds ratio, 0.41; 95% CI, 1.44–6.55). We conclude that it may be clinically inadequate to conceptualize neuroticism, by itself, as a risk marker for suicide. However, when the negative affect characteristic of neuroticism is combined with the joylessness, pessimism, and hopelessness characteristic of low extraversion, risk for suicide is elevated.

*Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China; †Shandong University Center for Suicide Prevention Research, Jinan, Shandong, China; ‡Departments of Psychiatry and of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada; §Center for the Study and Prevention of Suicide, Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, New York; and ∥Department of Sociology, State University of New York College at Buffalo, Buffalo, New York.

This research was supported by US Public Health Service Grant R03MH60828 (J. Z.) and TW-01-003 (L. F.), a New Investigator Award from the Canadian Institutes of Health Research (M. J. H.), and an Ontario Ministry of Research and Innovation Early Researcher Award (M. J. H.).

Send reprint requests to Professor Jie Zhang, PhD, Department of Sociology, State University of New York College at Buffalo, 1300 Elmwood Avenue, Buffalo, NY 14222. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.