Summary

This study was designed to determine the role extroversion and neuroticism play in influencing our anxiety levels. Anxiety diagnoses among youth increased from an initial 11.6% to 25.6% during the COVID pandemic, resulting in an increase in larger populations of teenagers to develop persistent, long-term anxiety. As a result, it is extremely important to study anxiety to better understand the driving forces behind it, which can lead us to ways in how to most effectively treat it. In fact, one major precursor to anxiety disorders being studied is personality. Extroversion and neuroticism especially have been shown to affect mental health and overall health care use longitudinally. These studies however, did not look specifically at teens, a group highly susceptible to stress during the COVID pandemic. Therefore, an online survey of teens between the ages 14-19 was conducted to determine their level of neuroticism, extroversion, and anxiousness. Results of the study revealed that extraversion has a negative correlation with anxiety, meaning that students who were more extroverted were less likely to experience anxiety, while students who were more introverted experienced higher levels of anxiety. On the other hand, neuroticism revealed to have no correlation with anxiety. These results indicate the importance of personality traits such as neuroticism and extroversion in being powerful predictors and may be key risk factors in preventive mental health care. 

Introduction

Anxiety is one of the most common psychiatric disorders that people face, affecting 30% of individuals worldwide (1). Defined as a feeling of worry due to anticipation of a future concern, anxiety causes feelings of nervousness and deep anxiousness that can result in avoidance behavior (1). With the outbreak of COVID, anxiety has become particularly worse for students due to growing worry of their health and increased loneliness as a result of enforced quarantines (2). In addition, recent studies by JAMA Pediatrics have asserted that the COVID pandemic has increased estimates of anxiety diagnoses among youth from an initial 11.6% to an astounding 25.6%, resulting in currently 1 in 5 youth to experience clinically elevated anxiety symptoms (3). With this increase in anxiety, it can pose the risk of a larger population of teenagers to develop persistent, long-term anxiety; this would not only lead to an increase of mental and emotional distress, but generate adverse effects to one’s physical health as anxiety gives rise to symptoms like insomnia, headaches, and an upset stomach (4). With our future generation growing up anxious, it is extremely important to study anxiety to better understand the driving forces behind it, which can lead us to ways in improving intervention strategies and treatment plans in combating anxiety disorders.

With precursors to developing mental disorders being an area that is actively studied, one particularly fascinating area of study is the possible relationship between personality and mental health. In psychology, personality has been defined to consist of five broad traits: extraversion, agreeableness, openness, conscientiousness, and neuroticism. Extraversion refers to the tendency to experience positive emotional states and having a positive outlook on life. Agreeableness refers to the tendency to be empathetic and caring of others. Openness refers to the tendency to be receptive and welcoming of new ideas and opinions. Conscientiousness refers to the tendency to be responsible, diligent, and thoughtful. Neuroticism refers to the tendency to experience negative emotional states, including anger, depression, and anxiety. First coined the “Big 5 Personality traits” by Lewis Goldberg (5), or the “five factor model” by John M. Digman (5), these five personality traits reveal variations in which individuals experience emotions and behave.

A recent study on the Big Five personality traits investigated whether personality affected health care use longitudinally (6). It was initially hypothesized that higher levels of neuroticism would correlate to greater healthcare use as “high levels of neuroticism prior to onset reflects a vulnerability to feeling anxious and being distressed (6).” As a result, those who are more neurotic are more likely to be anxious and more likely to seek mental health services, increasing the likelihood of hospital visits (6). After data was collected, it was revealed that physician visits were positively associated with neuroticism–higher levels of neuroticism led to greater hospital visits (6). The data also indicated that physician visits were negatively associated with extraversion, while agreeableness, openness, and conscientiousness had no effect (6). Therefore, those who were more extroverted had a lower tendency to visit the hospital, indicating they were more healthy. 

Similarly, another study revealed that individuals who are more extroverted live longer, healthier lives compared to those who are introverted (7). In fact, the study reported that extraversion has a negative correlation with depression and can even exert protective effects against depression (7). It was additionally noted that individuals who were more introverted had greater hospital visits compared to those less introverted as low extraversion proved to be a vulnerability factor for depression (7). 

So far, no studies have been done on high school students to assess the effect of personality on anxiety disorders. With studies indicating that agreeableness, openness, and conscientiousness have no effect on one’s health, I wanted to further investigate the relationship between neuroticism and extraversion and our health, especially in adolescents. Thus, I conducted an experiment to determine the effect of neuroticism and extraversion on anxiety in adolescents. After collecting the data, it revealed that extraversion has a negative correlation with anxiety, meaning that students who were more extroverted were less likely to experience anxiety, while students who were more introverted experienced high levels of anxiety. On the other hand, neuroticism revealed to have no correlation with anxiety.

Results 

In this research study, an online survey of teens between the ages 14-19 was conducted to determine their level of neuroticism, extroversion, and anxiousness. A questionnaire regarding physical and mental health was additionally attached to limit any possible confounding variables. The rationale for conducting an online survey is that its anonymity allows for potentially more accurate/truthful response rates of teens in the greater Los Angeles area. Once the data was collected, regression analyses were performed to examine the relationship between neuroticism and anxiety, as well as extraversion and anxiety to determine if these personality traits are correlated with higher or lower levels of anxiety.

In order to quantify our results, we created an “anxiety score” that was calculated based on the responses subjects gave in the anxiety questionnaire. For each of the 12 anxiety questions in the survey, participants would indicate their level of anxiety by responding with one of the following responses: Never, Rarely, Sometimes, Often, Very Often. “Never” and “Rarely” were assigned a numerical value of 1 to represent a low anxiety response; “Sometimes” was assigned a numerical value of 2 to represent a mild anxiety response; “Often” and “Very Often” were assigned a numerical value of 3 to represent a high anxiety response. These values were then averaged to result in an average anxiety score (see methods for more details). We then binned the anxiety scores into four categories of increasing scores: “low” (score 1-1.5), “mid-low” (1.51-2), “mid-high” (2.1-2.5) and “high” (2.51-3) and graphed the average number of participants that reported scores within each range (Figure 1). 

We first examined the effect of neuroticism on anxiety. When comparing the effect of neuroticism scores on anxiety, we found no significant differences in anxiety scores between at least two groups (one-way ANOVA F(3,36) = [0.86476], p = 0.468237).

In order to look at individual responses, we also graphed the data using a scatter plot method. This method shows little-to-no direct correlation between neuroticism and anxiety as the plots on the scatterplot are widely spread out and do not reveal a trend, indicating no clear relationship between the two variables (Pearson correlation coefficient: r = -0.26).

Next, we looked at levels of extroversion and anxiety, plotting the data both in terms of average anxiety score groups, and individually as previously described. From this analysis, we observed that those who are more extroverted experience less anxiety (have significantly lower anxiety scores), whereas those who are less extroverted experience greater anxiety (have higher anxiety scores). When we statistically compared the effect of Extroversion scores on anxiety (one-way ANOVA) we found there was a statistically significant difference in anxiety scores between at least two groups (F(3,36) = [15.28], p = 0). A Tukey’s HSD Test for multiple comparisons found that the mean value of anxiety was significantly different between groups “low” and “mid high”  (p = 0.00034), “low” and “high” (p = 0.00001), “mid-low” and “mid-high” (p = 0.01184) and “mid-low” and “high” (p = 0.00026) levels of anxiety. Notably, there was no statistically significant difference between anxiety groups “low” and “mid-low” (p = 0.59482) or “mid-high” and “high” (p = 0.53532).

The inverse relationship between anxiety and extroversion is once again observed when the data is plotted individually as the less extroverted an individual is, the more anxious they reported to be. A negative correlation between extroversion and anxiety was found to be significant by a Pearson correlation test (Pearson correlation coffiecient: r = -0.827). 

Discussion

In conclusion, the results of this study indicate that those who are more introverted are more inclined to experience anxiety. On the other hand, scoring higher in extroversion is associated with lower levels of anxiety. In this study, we observed that neuroticism has no link to anxiety, therefore being more or less neurotic shows no correlation to the level of anxiety an individual experiences. This data was represented in multiple ways, both binned and averaged across “anxiety score” as well as reported individually to maximize the efficacy of our interpretations. Our extroversion and anxiety data support previously published claims that report extraversion has a negative correlation with depression (7), however, this study did not look specifically at anxiety. Another study reported that subjects with higher levels of extroversion were less likely to visit the hospital, which might also indicate an overall “protective effect” (6).

In regards to our neuroticism and anxiety data, these results do not support previously published papers that observed higher levels of neuroticism to be associated with an increase in physician visits and greater participation in mental health services (6). Higher neuroticism is associated with an increase in negative emotions, which in turn can lead to adverse mental and physical health outcomes. However, the fact that increases in neuroticism were not associated with increased anxiety might be explained by the diathesis stress model of anxiety symptoms. Some studies have emphasized the interaction between neuroticism and stress, indicating that both neuroticism and stress combined directly influence anxiety, but without a multiplication effect between the two (8). Nevertheless, further research is required to explain why anxiety levels do not increase with increasing neuroticism.

A limitation to this experiment is that the subjects that were anonymously surveyed belong to a fairly narrow region, the greater Los Angeles area. In future experiments, it would be useful to survey subjects nationally or internationally so that the results can be more applicable to high school students around the globe and across a wide range of demographic backgrounds. Another limitation of this study was the majority of participants were of Asian/Pacific Islander descent (Asian/Pacific Islander- 37.5%, Middle Eastern or North African - 25%, Black or African American - 12.5%, Hispanic, Latino or of Spanish origin - 12.5%, and White or Caucasian - 12.5%), therefore, a larger study could better compare results across ethnicities and cultural regions. Another limitation in this experiment was that the data was collected from only 40 participants, resulting in a relatively small sample size that could create accidental bias within the data. To remedy this, in a future experiment a sample size of at least 200 participants would be collected to allow for a more precise estimate of the relationship between neuroticism and anxiety & extraversion and anxiety. 

The significance of this study is to evaluate whether the personality traits such as neuroticism and extroversion may be a key risk factor in preventive health care. For example, although most age-related diseases occur after midlife, it is now well established that the pathophysiology of these diseases (such as type 2 diabetes, arthritis, and dementia) begin earlier in life. As a result, healthcare professionals are bringing attention to the importance of targeting younger populations for disease prevention. In fact, the Institute of Medicine reported that a greater focus on patient centeredness in health care is needed as attending to patients' values and characteristic patterns of behaving, thinking, and feeling – essentially their personality – is an accurate predictor for health outcomes, such as mortality and morbidity (9). Accordingly, Dr. Salomon Israel of Duke University Medical Center claimed that “if a doctor knows a patient’s personality, it is possible to develop a more effective preventative healthcare plan that will result in a much healthier life (9).” Similarly, APA Executive Director Norman B. Anderson stated that, “The best healthcare is one that treats the whole person including how their personality traits impacts their attitudes and behaviors vis-à-vis their health (9).” Personality tests like the big 5 are fairly easy to administer and if incorporated into a patient’s file, may help identify patients at risk specifically for mental health issues in the future. By identifying patients at risk early on, it will aid in quickly addressing the symptoms that may signify a problem, leading to successful treatment. When mental illness remains untreated, the symptoms can worsen a deteriorate the individual’s wellbeing. In fact, a significant proportion of mass school shooters experienced unmedicated and untreated psychiatric disorder (10).

Given the previously published resport that subjects with higher levels of extroversion were less likely to visit the hospital (6), studies like that one and ours are in important area of research to determine if strategically tailoring lifestyle practices to combat anxiety (like specific types of exercises or limiting alcohol intake) to individuals low in extraversion may promote health benefits. Perhaps high schools students could be given a questionnaire on extraversion — either via paper and pencil or administered online — that determines their standing on that personality trait. Low scores would then indicate those students who are most likely to benefit from, and are most in need of, intervention. 

Materials & Methods

Participants

For this study, a google form was made available to high school students in the greater Los Angeles area that asked questions to see how extroverted or introverted they were and the level of anxiety they are prone to experience. The form was sent electronically and was conducted anonymously. At the top of the survey, there was a place for the subject to electronically sign to indicate that all personal information would be confidential and that it was a voluntary and honest survey. 

The age range of the subjects were from fourteen years old to nineteen years old, with 51.2% of subjects identified as female and the other 48.8% identified as male. The demographics of our subjects were: 25% Middle Eastern or North African, 12.5% White or Caucasian, 37.5% Asian/Pacific Islander, 12.5% Black or African American, and 12.5% Hispanic, Latino, or Spanish origin. The form also inquired about basic health information to rule out significant health concerns and possible confounding factors. We also asked about past issues with mental health so we could be aware of any subjects that were currently experiencing mental illness.

General Health Questionnaire:
Answer Choices:
1. Please state your age (Fill in the blank).
2. Indicate from the following options how you identify yourself (Male, Female, Nonbinary, Prefer not to say).
3. What is your ethnicity? (Asian/Pacific Islander, Black or African American, Hispanic, Latino, or Spanish origin, Middle Eastern or North African, American Indian or Alaska Native, White or Caucasian).
4. How long do you exercise per week? (Never, 1-2 hours, 3-6 hours, More than 6 hours).
5. How often do you eat fried or fast foods? Like baked goods, burgers, french fries, etc. (Never, 1-2 times a week, 3-6 times a week, More than 6 times).
6. How many hours do you sleep per night during the week (Mon-Fri)? (1-3 hours, 4-6 hours, 7-9 hours, 10 or more hours).
7. How often do you drink? (Never, Occasionally, 1-3 drinks per week, 4-6 drinks per week, More than 6 drinks per week)
8. How often do you smoke? Like tobacco, marijuana, vape, etc (Never, Occasionally, Often).

The bulk of our survey consisted of 14 questions. These were divided into two sections: a personality section and an anxiety questionnaire. We first asked our participants to take the Big 5 Personality test (openpsychometrics.org/tests/IPIP-BFFM/) then asked them to report their percentile on extraversion and emotional stability. For the anxiety section, we asked participants to reflect on their anxiety for the previous 3-6 months and to respond to each question with the following answers: rarely = a few times, sometimes = a couple times a month, often = a couple times a week, very often = once a day or more. We then gave each subject an anxiety “score” by categorizing each “never” or rarely” answer as “low anxiety levels” (worth 1 point), “mild” (worth 2 points), and “high” (worth 3 points). Each subject’s total score was calculated by summing their points from each individual question and averaged to get an average “anxiety score”.  Subject’s reported extraversion and emotional stability (neuroticism) percentiles were then graphed separately in relation to their anxiety score to determine if there was a positive or negative correlation. In general, higher percentiles in extraversion is associated with more extraversion and higher emotional stability is associated with less neuroticism.  

Anxiety Questionnaire
Answer Choices:
1. After taking the Big 5 Personality Test listed above, what was your score percentile for extroversion? (Fill in the blank). 
2. And what was your score percentile for emotional stability? (Fill in the blank).
3. Do you worry/have anxiety about a lot of things? (Never, Rarely, Sometimes, Often, Very Often).
4. Does worrying/anxiety make you feel tired? (Never, Rarely, Sometimes, Often, Very Often).
5. Does worrying/anxiety cause you to have trouble sleeping? (Never, Rarely, Sometimes, Often, Very Often).
6. Do you struggle with controlling your worry/anxiety? (Never, Rarely, Sometimes, Often, Very Often).
7. Do your muscles get tense when you are worried or anxious? (Never, Rarely, Sometimes, Often, Very Often).
8. Do you become so restless that it's hard to sit still when you are worried/anxious? (Never, Rarely, Sometimes, Often, Very Often).
9. Does worrying/having anxiety make it difficult for you to concentrate? (Never, Rarely, Sometimes, Often, Very Often).
10. Do you worry about events that have already happened in the past? (Never, Rarely, Sometimes, Often, Very Often).
11. Do you worry about how things will work out in the future? (Never, Rarely, Sometimes, Often, Very Often).
12. Do you experience strong fear that causes panic, shortness of breath, shaking, sweating, nausea, dizziness, and/or a pounding heart? (Never, Rarely, Sometimes, Often, Very Often).
13. Do you ever avoid places or social situations out of fear for this panic? (Never, Rarely, Sometimes, Often, Very Often)
14. Do you ever engage in repetitive behaviors to manage your worry/anxiety? (Never, Rarely, Sometimes, Often, Very Often)

Statistics

Two types of statistical analysis were used in this study, depending on whether the data was presented in averaged groups or individually. For averaged groups, the groups were statisically compared using a one-way ANOVA to compare the effect of neuroticism or extroversion scores on anxiety. This test is aimed to determine if there was a significant difference in anxiety scores between at least two groups. A Tukey’s HSD Test was then conducted for multiple comparisons which reported whether or not the mean value of anxiety was not significantly different between any specific groups.For all tests, a confidence interval of 95% was used.

In the individually reported data, a Pearson correlation coefficient (r) was calculated. This test is a measure of linear correlation between two sets of data (in our case, anxiety and either neuroticism or extroversion). The coefficient is represented as a ratio between covariance of two variables and the product of their standard deviations. The coefficient can range from -1 to 1 where scores between 0 and -1 represent a negative correlation and scores between 0 and 1 represent a positive correlation.

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