The role of personality in comorbidity among anxiety and depressive disorders in primary care and specialty care: a cross-sectional analysis

Objective: Almost no cross-sectional studies directly compared the rate and pattern of comorbidity of affective disorders in relation to personality traits of patients seen in primary care versus specialty mental health care. Method: Using data from the Netherlands Study of Depression and Anxiety, we compared 1086 primary care patients with 790 consecutive specialized mental health care patients. All participants had at least one lifetime Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition-based diagnosis of depression or anxiety. Personality was assessed with the NEO Five-Factor Inventory. Results: In both settings it was common to have at least one lifetime comorbid affective disorder. Compared to primary care patients, specialty care patients showed elevated scores for Neuroticism and lower scores for Extraversion and conscientiousness. The odds of having another disorder given any one disorder was no longer significant after accounting for personality dimensions. Only Neuroticism proved to be positively associated with comorbidity per se. Conclusions: Prevalence of and comorbidity among anxiety and depressive disorders in primary care were very similar to those in specialty care. Neuroticism - but no other personality traits - may help to understand the comorbidity among anxiety and depressive disorders irrespective of recruitment setting. (C) 2009 Elsevier Inc. All rights reserved.