An individual’s personality, especially how strongly they react to uncertainty, may help indicate how vulnerable they are to prolonged mental distress during a major crisis, according to a new USC-led study.

An analysis of several years of nationally representative U.S. data found that people scoring higher in neuroticism experienced larger and more persistent increases in anxiety and depression symptoms during the COVID-19 pandemic than people scoring lower in the trait, said lead author Marco Angrisani, senior economist with the Center for Economic and Social Research (CESR) at the USC Schaeffer Institute for Public Policy & Government Service and associate professor (research) of economics at the USC Dornsife College of Letters, Arts and Sciences.

“There is a wide variety of mental health responses to large-scale societal stressors,” Angrisani said. “Our study shows that personality traits, and neuroticism in particular, play a role in shaping heterogeneous responses in a major crisis across individuals and could therefore inform better targeted interventions.”

The study appeared in PLOS ONE on Wednesday.

The ‘Big 5’ personality traits

The researchers followed 4,030 U.S. adults using data from the Understanding America Study, a nationally representative internet panel managed by CESR. The analysis included more than 100,000 survey responses collected from 2019 through early 2024, allowing researchers to compare mental health before, during and after the pandemic.

The study examined five broad personality characteristics:

• Neuroticism: A tendency to experience worry, emotional sensitivity and stronger reactions to stress or uncertainty.
• Extraversion: A tendency to be outgoing, energetic and motivated by social interaction.
• Openness: Curiosity about new ideas and experiences, along with a willingness to consider change.
• Agreeableness: A tendency to be cooperative, trusting and concerned about social harmony.
• Conscientiousness: A tendency to be organized, dependable, self-disciplined and goal-oriented.

These characteristics occur on a continuum. Everyone has some degree of each, and a high or low score does not constitute a disorder.

Distress not equally distributed

In the study, mental distress was measured with the PHQ-4, a brief questionnaire assessing symptoms of anxiety and depression. A score of 6 or higher indicates moderate-to-severe symptoms, though it is not itself a clinical diagnosis.

During the pandemic, increases in the probability of moderate or severe distress were approximately 11 to 20 percentage points greater among participants who scored in the highest 25% for neuroticism versus those in the lowest quarter. The association persisted across young, middle-aged and older adults and remained evident into the post-pandemic observation period.

Participants higher in neuroticism also perceived greater health and financial risks, adopted more protective behaviors and reported exercising and relaxing less frequently while consuming more alcohol. Measurements of extraversion, openness and agreeableness showed weaker or inconsistent associations, while conscientiousness appeared modestly protective, particularly among adults aged 60 and older.

Predicting mental health needs in a crisis

The findings could help clinicians and emergency planners recognize who may need closer follow-up after disasters, public-health emergencies or other prolonged disruptions. Public information campaigns could also be tested to ensure they inform people without unnecessarily increasing distress among those who are more vulnerable to it. Importantly, personality should be just one part of a broader risk assessment, alongside symptoms, previous mental-health conditions, and social circumstances, not a label or an automatic trigger for treatment, Angrisani explained.

However, neuroticism is a risk factor, not a diagnosis or a determinant of an individual’s mental health status. In the paper, the authors advocate for monitoring and stepped care: following people over time and offering treatments such as cognitive behavioral therapy or emotion-regulation training when significant, persistent symptoms emerge, rather than treating people solely because of a personality score.

Because the study was observational, it identifies associations and cannot prove that personality, especially neuroticism, caused distress. All personality and mental distress measures were self-reported, and the findings may not generalize beyond the United States, Angrisani cautioned. Still, the results suggest that crisis communication emphasizing practical, controllable actions — combined with accessible mental-health support — could help protect psychologically vulnerable groups, he said.

---

About the study: Angrisani’s co-authors include Wändi Bruine de Bruin, Provost Professor of Public Policy, Psychology and Behavioral Science at the USC Schaeffer Institute for Public Policy & Government Service as well as Vincenzo Atella of the University of Rome Tor Vergata and Joanna Kopinska of Sapienza University of Rome. The study was funded by the National Institute on Aging (grant U01AG077280 to Angrisani).

In the sixth game of their 2026 football season, the Trojans face West Coast rivals the University of Washington Huskies. On the field, the two universities look forward to fierce competition. Off the field, their researchers have spent years working together on interdisciplinary collaborations, addressing disparities in healthcare, accelerating scientific and medical innovation, and helping transform the world for the better.

“USC and the University of Washington share a commitment to research that improves lives and deepens our understanding of the world,” said Ishwar K. Puri, USC’s senior vice president of research and innovation. “Trojans and Huskies may be competing on the football field, but … our scholars work together across disciplines to advance discovery and address some of society’s most complex challenges.”

University of Washington leaders share that commitment to collaboration.

“We are proud to collaborate with USC … to address complex challenges in areas like healthcare, energy, the environment, technology and beyond,” said Mari Ostendorf, University of Washington’s vice provost for research. “We can be intense rivals on the field and work as teammates just as fiercely to tackle challenges we face together.”

Unraveling Alzheimer’s disease and dementia

Paul Thompson, professor at the Keck School of Medicine of USC and associate director of the USC Mark and Mary Stevens Neuroimaging and Informatics Institute, collaborated with Paul Crane of the University of Washington Memory and Brain Wellness Center on the project Ultrascale Machine Learning to Empower Discovery in Alzheimer’s Disease Biobanks. The project uses advances in deep learning, machine learning and artificial intelligence to tackle critical challenges in Alzheimer’s disease research.

Another collaboration, the AHEAD Plasma Extension, or APEX, project, is a four-year, multicenter observational study of blood-based biomarkers, memory and other measures of brain health in older adults.

Co-principal investigator Paul Aisen, USC professor of neurology at Keck School of Medicine and director of the USC Epstein Family Alzheimer’s Therapeutic Research Institute, and Michael Rosenbloom of the University of Washington Memory and Brain Wellness Center are tracking how Alzheimer’s disease-related blood biomarkers, brain amyloid and cognitive function change over time.

Their team is comparing cognitive, functional and biomarker data among three participant groups and examining how changes vary by race, ethnicity, sex and apolipoprotein E (APOE) status. Aisen also works with University of Washington researchers via the Alzheimer’s Clinical Trials Consortium, the Alzheimer’s Plasma Extension (APEX) Study and the AHEAD 3-45 Study.

Arthur W. Toga, director of the USC Stevens Neuroimaging and Informatics Institute and the institute’s Laboratory of NeuroImaging (LONI), collaborated with the University of Washington’s National Alzheimer’s Coordinating Center (NACC) to receive neuroimaging Alzheimer’s Disease Research Centers (ADRCs) based on the Standardized Centralized Alzheimer’s and Related Dementias Neuroimaging (SCAN) initiative.

Alzheimer’s Disease Research Centers (ADRCs) have historically used different methods to collect PET and MRI scans, making it difficult to combine their data. SCAN standardizes that information so it can be shared with researchers in the United States and around the world.

Understanding early influences on health

Health risks can take shape early in life — and researchers from USC and the University of Washington are exploring new ways to address them.

Associate Professor Leah Stein Duker of the USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy is working with Donald L. Chi, professor of oral health sciences and associate dean for research at the University of Washington School of Dentistry, to improve toothbrushing among children with autism.

Launched last year, the study is gathering quantitative and qualitative data to guide the development of a mobile app that helps children build better toothbrushing skills and habits. Stein Duker leads the research related to sensory processing challenges and helps translate data into autism-friendly modifications for the mobile app.

Another collaborative project examines how childhood experiences can affect health decades later.

Stress can accelerate aging, while both HIV and Adverse Childhood Experiences (ACEs) can further contribute as stressors later in life. In the project, “How Adverse Childhood Experiences affect ageing with HIV,” USC Instructional Professor of Gerontology Paul Nash and his team will study the effects of ACEs on stress and inflammation biomarkers in older adults living with HIV. They are also examining the intervening roles of psychological and social factors that influence participants’ well-being.

The researchers hope their findings will inform targeted interventions for this population. The University of Washington’s Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) team will provide testing infrastructure and biostatistician support, while samples will be analyzed at the USC-Buck Nathan Shock Center of Excellence in the Biology of Aging.

New approaches to disease

USC and University of Washington researchers are also working together to improve care for people facing cancer, HIV, post-traumatic stress disorder and other serious health concerns.

As a co-investigator of the project “Care Inequities in Advanced Cancer and Limited-English Proficiency,” Linda K. Ko, professor and vice chair of research at the department of family medicine at Keck School of Medicine, provides expertise for assessing community palliative care resources for patients with advanced cancer and limited English proficiency.

Ko also advises the team on community engagement and recruiting community-based organizations; she collaborates with University of Washington colleagues on conference presentations and manuscript preparation.

In April 2024, Professor of Urology Siamak Daneshmand of Keck Medicine of USC and John Gore, an associate professor of urology and surgery and the Jessie H. Bridges Endowed Professor in Prostate Cancer and Urology Research at the University of Washington School of Medicine, began studying the treatment of recurrent NMIBC (Non-muscle-invasive bladder cancer). Their research seeks to determine which patients benefit from radical cystectomy (surgery to remove all or part of the urinary bladder) and which may fare better with continued bladder-sparing treatment.

Other collaborations are addressing disparities in HIV prevention and care.

Structural and institutional barriers have long limited access to HIV services among vulnerable populations, according to Associate Professor Jane Lee of the USC Suzanne Dworak-Peck School of Social Work.

In 2025, Lee helped develop and lead a social media campaign for the project “Facilitating Engagement in ‘Whole Person Care’ for Transgender Latina Women.” The campaign sought to reach transgender Latinx women in Washington state and connect them with HIV testing, treatment and prevention services.

Lee worked with Entre Hermanos, a Latino/a LGBTQ+ organization based in Seattle, and Professor E. Roberto Orellana and senior research scientist David Katz of the University of Washington.

The project focused on reducing barriers to HIV services and encouraging greater engagement with care.

Its second year built on that research with a culturally relevant, community-informed social media campaign designed to increase HIV testing and the use of pre-exposure prophylaxis, or PrEP, among Latino men who have sex with men.

Professor Lawrence Palinkas of the USC Suzanne Dworak-Peck School of Social Work partnered with Professor Douglas F. Zatzick of the University of Washington to research interventions targeting post-traumatic stress disorder and co-occurring conditions across U.S. trauma care systems.

Investigating the roots of heart disease

USC’s Charles Murry and the University of Washington’s David Shechner are studying the molecular processes involved in cardiomyopathy, a disease of the heart muscle.

Their project, “Function, composition and mechanism of RNA splicing factories in cardiomyopathy,” examines the molecular architecture of a single-locus subnuclear compartment. The researchers want to identify new principles by which new transcripts regulate chromatin organization and reveal new therapeutic targets for heart disease.

Understanding the ever-changing environment

Collaboration between the two universities extends from human health to the health of the planet.

In “Animals as Living Bioreactors: The role of animal gut microbiomes in shaping oceanic carbon cycling and export,” researchers are developing biogeochemical models to explore how animal gut microbiomes may influence the movement of carbon through the ocean carbon cycling.

The term biogeochemical refers to the cycle of chemical elements and compounds through living and nonliving matter. Principal Investigator Naomi Levine of the USC Dornsife College of Letters, Arts and Sciences and her collaborators from the University of Washington hope the study will provide new insight into the impact of animals on particle flux in the ocean.

Patients consistently describe David Peng as an exceptional physician whose expertise, compassion and thoughtful communication have made a meaningful difference in their lives.

Across the university, Peng is admired by physicians, nurses, medical students and colleagues as an extraordinary leader who has helped foster a culture of clinical excellence, collaboration and patient-centered care across the health sciences.

In recognition of Peng’s many contributions, USC Trustee Alia Tutor has established the Alia Tutor Chair for the Chief Clinical Officer for USC Health. The endowed chair will provide enduring support for the executive leader responsible for USC’s clinical operations, including the Office of Health Affairs, and will strengthen Keck Medicine’s commitment to delivering exceptional care, advancing medical innovation and supporting the physicians and caregivers who serve its patients.

“David is an extraordinary physician and leader,” Tutor said. “I have seen firsthand the compassion with which he cares for patients and the unwavering commitment he brings to advancing excellence throughout Keck Medicine. It is my hope that this endowed chair will provide Dr. Peng — and the outstanding leaders who follow him — with enduring support to continue delivering world-class care while advancing innovation, education and research.”

“David has earned the trust and admiration of patients and colleagues alike through his exceptional leadership, clinical excellence and genuine compassion,” USC President Beong-Soo Kim said. “Alia’s generosity honors one remarkable physician while creating a lasting investment in the future of Keck Medicine and the patients it serves.”

Peng serves as deputy executive vice president for health affairs and USC’s chief clinical officer, overseeing health research and clinical care across the university, and as professor of dermatology at the Keck School of Medicine of USC. Since joining USC in 2004, he has held several significant leadership positions, including chair of the Department of Dermatology, president of USC Care Medical Group and interim chair of the Department of Medicine.

Earlier this year, Peng received the USC Presidential Medallion, one of the university’s highest honors, in recognition of his outstanding leadership of USC’s medical community, including during the COVID-19 pandemic.

“Dr. Peng represents the very best of academic medicine,” said Steven D. Shapiro, executive vice president for health affairs. “His leadership has strengthened every aspect of our clinical enterprise, and this extraordinary gift from Alia Tutor ensures that excellence in clinical leadership will continue to define our health enterprise for generations.”

A philanthropic leader of the Trojan Family

Philanthropist, attorney and former business executive Alia Tutor joined the USC Board of Trustees in 2024, building on more than a decade of volunteer leadership at the university as a member of the President’s Leadership Council and the boards of councilors of the USC Shoah Foundation and Keck Medicine.

A graduate of Columbia Law School, where she was recognized as a Harlan Fiske Stone Scholar, Tutor received Columbia Law School’s 2024 Medal for Excellence in recognition of her distinguished professional achievements and philanthropic leadership.

She also serves as a trustee of Children’s Hospital Los Angeles, where she is a member of the board of directors, and of the Ronald Reagan Presidential Foundation and Institute.

As president of the Alia Tutor Family Foundation, she supports transformative initiatives in healthcare, education and the arts. Her philanthropy has advanced medical innovation, expanded educational opportunities and strengthened institutions dedicated to improving lives.

At USC, Tutor previously established the Alia Tutor Chair in Reproductive Medicine at Keck School of Medicine. She has also supported an innovative pediatric medicine training program at Children’s Hospital Los Angeles.

Her latest gift reflects her longstanding belief that exceptional clinical leadership is essential to advancing patient care, medical education and innovation at one of the nation’s leading academic health systems.

Tutor’s contributions are among the many gifts the Tutor family has made in support of USC. The Ronald Tutor Campus Center, the USC Viterbi School of Engineering’s Ronald Tutor Hall, the Ron Tutor Pavilion in the John McKay Center and the USC Marshall School of Business’ Ronald N. Tutor Chair in Visionary Business are all named in honor of her husband, USC Life Trustee Ronald N. Tutor.

Ronald Tutor is also a recipient of the Asa V. Call Alumni Achievement Award, USC’s highest alumni honor.

“I am deeply honored by Alia’s extraordinary generosity,” Peng said. “This endowed chair reflects our shared commitment to delivering exceptional patient care, supporting our physicians and caregivers, and continually advancing the quality of medicine at USC. It is a privilege to serve this institution and the patients who place their trust in us.”

National leaders in clinical excellence

The university’s innovative health discoveries and excellent clinical care, under the auspices of the USC Office of Health Affairs, are widely recognized locally and nationally. In particular, Keck Medicine holds numerous prestigious national distinctions for patient safety, quality of care and clinical excellence. The hospitals — including Keck Hospital of USC and USC Norris Cancer Hospital — have earned top-tier accreditations and ratings from leading national organizations.

Patient safety and quality of care: Keck Hospital of USC repeatedly earns a five-star rating from the Centers for Medicare & Medicaid Services, placing it among the nation’s leading hospitals for care quality, mortality outcomes and patient experience. The hospital has also earned Top Performer status for three consecutive years in the Vizient Quality and Accountability Study.

Safety: Keck Medicine hospitals routinely receive “A” hospital safety grades from The Leapfrog Group, reflecting a strong record of keeping patients safe from preventable harm.

Specialty care: Keck Medical Center of USC ranks among the top hospitals annually in U.S. News & World Report’s Best Hospitals and is recognized as the highest ranked neurology and neurosurgery program in Southern California. Several other specialties — including geriatrics, urology and cancer — also frequently appear among the nation’s top programs.

Nursing excellence: Keck Hospital of USC has earned Magnet Recognition from the American Nurses Credentialing Center, the highest national distinction awarded for nursing excellence.