Similar Associations Between Personality Dimensions and Anxiety or Depressive Disorders in a Population Study of Turkish-Dutch, Moroccan-Dutch, and Native Dutch Subjects Agnes C. Schrier, MD,* Matty A.S. de Wit, PhD,Þ Anneke Krol, MSc,Þ Thijs J.L. Fassaert, PhD,Þþ Arnoud P. Verhoeff, PhD,Þ§ Ralph W. Kupka, MD, PhD,*|| Jack Dekker, PhD,¶ # and Aartjan T.F. Beekman, MD, PhD||# Abstract: It is well established that personality traits are associated with anxiety and depressive disorders in Western populations, but it is not known whether this is true also for people from non-Western cultures. In this study, we examined whether ethnicity moderates the association between personality dimensions and anxiety or depressive disorders or symptoms. In a random urban population sample, stratified by ethnicity, in Amsterdam, the Netherlands, we interviewed 309 native Dutch subjects, 203 Turkish-Dutch subjects, and 170 Moroccan-Dutch subjects. Dimensions of personality were measured using the NEO Five-Factor Inventory. Anxiety and depressive disorders and symptom levels were assessed with the Composite International Diagnostic Interview and the Symptom Checklist-90-Revised. The association between personality factors and disorders or symptoms of anxiety and depression was very similar in the three ethnic groups: all show the typical profile of high neuroticism and low extraversion, agreeable- ness, and conscientiousness. Key Words: Five-factor model, anxiety, depression, acculturation, the Netherlands (J Nerv Ment Dis 2013;201: 421Y428) T he role of personality traits in anxiety and depression has long been emphasized and studied. One of the most extensively studied models of personality traits is the five-factor model of personality (FFM) (Costa and McCrae, 1992). Anxiety and depressive disorders are typically associated with a five-factor profile of high neuroticism, low conscientiousness, low agreeableness, and low extraversion. Openness is not significantly associated with these disorders (Laverdie `re et al., 2007; Malouff et al., 2005). Basic personality dimensions seem to be related not so much with a specific disorder but with the level of co- morbidity (Cuijpers et al., 2005; Spinhoven et al., 2009). The personality factor neuroticism is, in particular, an important predictor of onset, prognosis, and recurrence of anxiety and depression (Clark et al., 1994; Ormel et al., 2004). Knowledge of the role of personality factors in pa- tients with an anxiety or depressive disorder might improve the treatment of these disorders. For example, a high level of neuroticism may be a positive prognostic indicator of pharmacotherapy, whereas a high level of agreeableness seems a preferential indication for interpersonal psychotherapy (Bagby et al., 2008). Whereas most empirical studies of personality and anxiety and depression have been carried out in North American and West European populations, a substantial pro- portion of patients in West European mental health settings have a non- Western cultural background, and little is known about the relation between personality dimensions and anxiety or depression in these populations. Clinicians doubt whether they can adequately identify, and consequently address, unfavorable personality traits in immi- grant patients with an anxiety or depressive disorder (Kirmayer, 2001; Kleinman, 2004). The purpose of this study was to examine whether ethnicity moderates the association between personality dimensions and anxiety or depression. In the Netherlands, immigrants from Turkey and Mo- rocco form two of the major non-Western populations. From the mid- 1960s, they immigrated as labor workers and later on settled perma- nently with their families in the Netherlands. These young men had typically grown up in rural, underdeveloped areas in their countries of origin and had received little education. They tend to be poorly inte- grated in the Netherlands (Social and Cultural Planning Office of the Netherlands, 2004). Nowadays, first- and second-generation immi- grants from Turkey and Morocco constitute 14.3% of the population of Amsterdam (O+S Research and Statistics, 2009). Non-Western im- migrant groups in Europe are at high risk of anxiety disorders and depressive disorders (Carta et al., 2005; Leveque et al., 2007; de Wit et al., 2008), although rates differ substantially between countries, specific minority groups, and sex groups (Bhugra and Mastrogianni, 2004; Breslau et al., 2006; Swinnen and Selten, 2007). Recent studies, also by our group, have shown that anxiety and depressive disorders can be diagnosed validly in non-Western immigrant pa- tients, provided that validated, structured diagnostic instruments are used (Bhugra and Mastrogianni, 2004; Schrier et al., 2010). An extensive number of studies have shown that the five factors of the FFM can be recovered consistently across a broad range of soci- eties (McCrae and Allik, 1992). More specific, a few studies used mea- surement instruments for the FFM in Turkey or Morocco or in Turkish or Moroccan immigrants in Western Europe. Gu ¨lgo ¨z (2002) described the standardization process of the Turkish version of the Revised NEO Personality Inventory (NEO-PI-R) and found that the factor structure was highly replicable. In an international comparative study, Allik and McCrae (2004) reported that the personality traits, measured with the NEO-PI-R, of Turkish college students were very similar to those of students in European and American countries but less similar to those of students from Asian and African countries. Another personality study across 56 countries, using the Big Five Inventory, included samples from Turkey and Morocco (Schmitt et al., 2007). Differences in per- sonality traits across countries appeared small. To our knowledge, no other studies have been published on samples in Morocco, but one study investigated young French adults born to North-African immigrant parents (including Moroccans), using the Eysenck Personality Inventory (Bougerol et al., 1995). Compared with native French adults, immi- grants had higher scores for neuroticism and extraversion. One study ORIGINAL ARTICLE The Journal of Nervous and Mental Disease & Volume 201, Number 5, May 2013 www.jonmd.com 421 *Altrecht Institute for Mental Health Care, Utrecht; †Department of Epidemiology, Documentation and Health Promotion, Municipal Health Service Amsterdam, Amsterdam; ‡Department of Social Medicine, Academic Medical Centre/ UvA, Amsterdam; §Department of Sociology and Anthropology, University of Amsterdam, Amsterdam; Departments of ||Psychiatry and ¶Clinical Psy- chology and #EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands. Send reprint requests to Agnes C. Schrier, MD, Altrecht Institute for Mental Health Care, Lange Nieuwstraat 119, 3512 PG Utrecht, the Netherlands. E-mail: a.schrier@altrecht.nl. Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0022-3018/13/20105Y0421 DOI: 10.1097/NMD.0b013e31828e110d Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.