Commentary: Personality and health inequality: inconclusive evidence for an indirect hypothesis

Nabi et al.1 explore the ‘indirect selection’ hypothesis for health inequality, linking personality to relative all cause and cardiovascular mortality using data from the GAZEL study. There have been previous studies linking personality constructs to mortality2 and linking quasi-personality constructs to health inequality3 but none linking psychological status to relative mortality. For men, adjustment for personality factors reduced relative all cause mortality between 34% for education and 28% for income. Surprisingly, father's social class was not related to male mortality. For women the evidence favoured the null hypothesis. The strengths of this study include that mortality was the outcome and that complete follow-up was achieved. Limitations lie in the small number of deaths in women, the range of socioeconomic position (SEP) indicators available and the type of psychological assessment used.