Abstract
Psychological factors were hypothesized to influence mortality, in particular, early versus later mortality. To explore the relationship between temperament, a psychological factor, and mortality in a prospective study of 1337 medical students, we constructed a measure portraying three temperament types, using latent class analysis. Death occurred in 113 subjects over 25–41 years of follow-up. In univariate survival analysis, subjects tending to direct tension “inward” when under stress (“Tension-In”) had a higher risk of mortality than “Tension-Out” or “Stable” types. These associations persisted after adjustment for age, smoking, cholesterol level, and Quetelet Index. The relative risk (RR) of mortality for Tension-In was 1.56 (95% confidence interval, 1.00–2.44) compared with the Stable group. The risk was due entirely to the excess risk in persons under 55 years of age (RR, 2.59; 95% confidence interval, 1.46–4.62); the corresponding risk of death in older persons was 0.66 (0.30–1.48). Thus temperament is a significant risk factor for mortality, in particular, premature death.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barefoot, J. C., Dahlstrom, W. G., and Williams, R. B. (1987). Hostility, CHD incidence, and total mortality: A 25-year follow-up study of 255 physicians.Psychosom. Med. 45: 59–63.
Bell, R. Q., and Waldrop, M. F. (1982). Temperament and minor physical anomalies. In Porter, R., and Collins, G. M. (eds.),Temperamental Differences in Infants and Young Children, CIBA Symposium No. 89, Pitman, London, pp. 206–220.
Benfante, R., Reed, D., and Brody, J. (1985). Biological and social predictors of health in an aging cohort.J. Chron. Dis. 38: 385–395.
Berkman, L. G., and Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents.Am. J. Epidemiol. 109: 186–204.
Betz, B. J., and Thomas, C. B. (1979). Individual temperament as a predictor of health or premature disease.Johns Hopkins Med. J. 144: 81–89.
Burks, J., and Rubenstein, M. (1979).Temperament Styles in Adult Interaction: Applications in Psychotherapy, Brunner/Mozel, New York.
Cox, D. R. (1972). Regression models and life-tables.J. R. Stat. Soc. Ser. B 34: 187–202.
Daum, I., and Schugens, M. M. (1986). The Strelau Temperament Inventory (STI): Preliminary results in a West German sample.Person. Individ. Diff. 7: 509–517.
Everitt, B. S. (1984).An Introduction to Latent Variable Models, Chapman and Hall, London.
Friedman, M. (1969).Pathogenesis of Coronary Artery Disease, McGraw-Hill, New York.
Gibbs, M. V., Reeves, D., and Cunningham, C. C. (1987). The application of temperament questionnaires to a British sample: Issues of reliability and validity.Child Psychol. Psychiat. 28: 61–77.
Goldsmith, H. H., and Campos, J. (1982). Toward a theory of infant temperament. In Emde, R. N., and Harmon, R. J. (eds.),The Development of Attachment and Affirmative Systems, Plenum, New York, pp. 161–193.
Goldsmith, H. H., Buss, A. H., Plomin, R., Rothbart, M. K., Thomas, A., Chess, S., Hinde, R. A., and McCall, R. B. (1987). Roundtable: What is temperament? Four approaches.Child Dev. 58: 505–529.
Graves, P. L., and Qaqish, B. F. (1991). Habit profile: A latent class model of temperament (submitted for publication).
Graves, P. L., and Thomas, C. F. (1981). Themes of interaction in medical students' Rorschach responses as predictors of midlife health or disease.Psychosom. Med. 43: 215–225.
Green, B. F. (1952). Latent structure analysis and its relation to factor analysis.J. Am. Stat. Assoc. 47: 71–76.
Greer, S., and Watson, M. (1985). Toward a psychobiological model of cancer: Psychological considerations.Soc. Sci. Med. 20: 773–777.
Hansson, L. (1988). Different presentation of hypertension in the elderly: Reasons and effects.Genet. Cardiovasc. Med. 1: 43–45.
House, J. S., Robbins, C., and Metzner, H. L. (1982). The association of social relationships and activities with mortality: Prospective evidence from the Tecumseh community health study.Am. J. Epidemiol. 116: 123–140.
Hubert, N. C., Wachs, T. D., Peters-Martin, P., and Gandour, J. (1982). The study of early temperament: Measurement and conceptual issues.Child Dev. 53: 571–600.
Kaplan, E. L. and Meier, P. (1958). Nonparametric estimation from incomplete observations.J. Am. Stat. Assoc. 53: 457–481.
Korn, S. J. (1984). Continuities and discontinuities in difficult/easy temperament: Infancy to young adulthood.Merrill Palmer Q. 30: 189–199.
Koskenvuo, M., Kaprio, J., Rose, R. R., Kesäniemi, A., Sarna, S., Heikkilä, K., and Langinvainio, H. (1988). Hostility as a risk factor for mortality and ischemic heart disease in men.Psychosom. Med. 50: 330–340.
Kretschmer, E. (1926).Physique and Character: An Investigation of the Nature of Constitution and of the Theory of Temperament, Harcourt, Brace, New York.
Larsen, R. J., and Baggs, D. W. (1986). Some psychophysical and personality correlates of the Strelau Temperament Inventory.Person. Individ. Diff. 7: 561–565.
Lerner, J. V., and Lerner, R. M. (1983). Temperament and adaptation across life: Theoretical and empirical issues. In Baltes, P. B., and Brim, Jr., O. G. (eds.),Life-Span Development and Behavior, Vol. 5, Academic Press, New York, pp. 197–231.
Lerner, R. M., Palermo, M., Spiro, A., III, and Nesselroade, J. R. (1982). Assessing the dimensions of temperamental individuality across the life span: The Dimensions of Temperament Survey (DOTS).Child Dev. 53: 149–159.
Liang, K.-Y., Self, S. G., and Liu, X. (1990). The Cox proportional hazards model with change point: An epidemiologic application.Biometrics 46: 783–793.
McCranie, E. W., Watkins, L. O., Brandsma, J. M. and Sisson, B. D. (1986). Hostility, coronary heart disease (CHD) incidence, and total mortality: Lack of association in a 25-year follow-up study of 478 physicians.J. Behav. Med. 9: 119–125.
McCutcheon, A. L. (1987).Latent Class Analysis, Sage, Newbury Park, CA.
Morris, T. A. (1980). A “Type C” for cancer? Low trait anxiety in the pathogenesis of breast cancer.Cancer Detect. Prev. 3: 102.
Paisey, T. J. H., and Mangan, G. L. (1982). Neo-Pavlovian temperament theory and the biological bases of personality.Person. Individ. Diff. 3: 189–203.
Paulhus, D. L. and Martin, C. L. (1986). Predicting adult temperament from minor physical anomalies.J. Person. Soc. Psychol. 50: 1235–1239.
Porter, R. and Collins, G. M. (eds.) (1982).Temperamental Differences in Infants and Young Children, CIBA Symposium No. 89. Pitman, London.
Ragland, D. R., and Brand, R. J. (1988). Type A behavior and mortality from coronary heart disease.N. Engl. J. Med. 318: 65–69.
Rothbart, M., and Derryberry, D. (1981). Development of individual differences in temperament. In Lamb, M. E., and Brown, A. L. (eds.),Advances in Developmental Psychology, Vol. 1, Erlbaum, Hillsdale, NY, pp. 37–86.
Shaffer, J. W., Duszynski, K. R., and Thomas, C. B. (1982). Family attitudes in youth as a possible precursor of cancer among physicians: A search for explanatory mechanisms.J. Behav. Med. 5: 143–163.
Shaffer, J. W., Graves, P. L., Swank, R. T., and Pearson, T. A. (1987). Clustering of personality traits in youth and the subsequent development of cancer among physicians.J. Behav. Med. 10: 441–447.
Shekelle, R. B., Gale, M., Ostfeld, A. M., and Paul, O. (1983). Hostility, risk of coronary heart disease, and mortality.Psychosom. Med. 45: 109–114.
Thomas, A., and Chess, S. (1977).Temperament and Development, Brunner/Mazel, New York.
Thomas, A., and Chess, S. (1982). Temperament and follow-up to adulthood. In Porter, R., and Collins, G. M. (eds.),Temperamental Differences in Infants and Young Children, CIBA Symposium 89, Pitman, London, pp. 168–175.
Thomas, A., Mittelman, M., Chess, S., Korn, S. J., and Cohen, J. (1982). A temperament questionnaire for early adult life.Educ. Psychol. Meas. 42: 593–600.
Thomas, C. B. et al. (1959, 1962, 1971, 1977, 1983).Collected Papers: The Precursors Study: A Prospective Study of a Cohort of Medical Students, The Johns Hopkins School of Medicine, Baltimore, MD, Vols. I–V.
Van der Werff, J. J. (1985). Heyman's temperamental dimensions in personality research.J. Res. Person. 19: 279–287.
Windle, M., and Lerner, R. M. (1986). Reassessing the dimensions of temperamental individuality across the life span: The revised Dimensions of Temperament Survey (DOTS-R)J. Adolesc. Res. 1: 213–230.
Windle, M., Hooker, K., Lenerz, K., East, P. L., Lerner, J. V., and Lerner, R. M. (1986). Temperament, perceived competence, and depression in early and late adolescents.Dev. Psychol. 22: 384–392.
World Health Organization (1964).Basic Documents (15th ed.), WHO, Geneva, p. 1.
Wright, L. (1988). The Type A behavior pattern and coronary artery disease. Quest for the active ingredients and the clusive mechanism.Am. Psychol. 43: 2–14.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Graves, P.L., Mead, L.A., Wang, NY. et al. Temperament as a potential predictor of mortality: Evidence from a 41-year prospective study. J Behav Med 17, 111–126 (1994). https://doi.org/10.1007/BF01858100
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01858100