Neuroticism and low self-esteem as risk factors for psychosis

Background Low self-esteem and high neuroticism are common features in psychosis, but in the absence of longitudinal studies it is unclear whether they represent consequences of the illness or risk factors acting before illness onset. Methods A population sample of 3,929 individuals with no lifetime evidence of psychosis were interviewed with the Composite International Diagnostic Interview and were administered the Groningen Neuroticism Scale and the Rosenberg Self-Esteem Scale at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify incident psychotic or psychosis-like symptoms. Results Baseline neuroticism and self-esteem predicted first-ever onset of psychotic symptoms at year 3 (neuroticism, OR 1.16, 95% CI 1.09, 1.23; self-esteem, OR 1.09,95% CI 1.01, 1.18). When adjusted for each other and for level of anxiety and depression, neuroticism was the strongest independent predictor for onset of psychotic symptoms (OR 1.16, 95% CI 1.07, 1.26). Conclusions Neuroticism increases the risk for development of psychotic symptoms. Mechanisms of risk may involve certain cognitive styles associated with neuroticism, such as beliefs about the uncontrollability of certain events and experiences. The association between low self-esteem and psychosis may involve the area of overlap between self-esteem and neuroticism.