Staying afloat with OCEAN traits: The five-factor model of personality and psychological resilience in multiple sclerosis.

BACKGROUND: Psychological resilience predicts better outcomes in persons with multiple sclerosis (pwMS), yet factors which sustain it over time remain poorly understood, particularly in diverse populations. Personality traits may represent stable determinants of resilience. OBJECTIVES: To examine the influence of personality on resilience in Black and Non-Hispanic White pwMS (BpwMS/WpwMS) and their healthy counterparts (BHCs/WHCs). METHODS: Psychological resilience and personality were assessed in a matched cohort of 120 pwMS and 80 HCs using the Connor-Davidson Resilience Scale and NEO-Five Factor Inventory-3. Personality and resilience were compared across groups. In pwMS, cross-sectional regression and longitudinal mixed-effects models evaluated personality-resilience associations; sensitivity analyses adjusted separately for depressive symptoms, psychiatric history, and subjective social status to evaluate the robustness of these associations. RESULTS: PwMS and HCs reported similar levels of Neuroticism, Agreeableness, and Conscientiousness; Extraversion and Openness were lower in pwMS. PwMS had worse resilience compared to HCs at follow-up. Higher Neuroticism predicted lower resilience, with a stronger association observed in BpwMS; higher Extraversion and Conscientiousness predicted better resilience. Higher Conscientiousness was associated with less longitudinal decline in resilience. Adjustment for depression attenuated the Conscientiousness and Neuroticism × Race associations, whereas Neuroticism and Extraversion associations remained significant. In prospective models, Conscientiousness continued to predict follow-up resilience independent of baseline depression. CONCLUSIONS: Personality traits may identify pwMS susceptible to reduced psychological resilience; Conscientiousness in particular may help sustain it over time. Although depression contributes to personality-resilience relationships, Neuroticism and Extraversion remain independently associated with resilience. Our findings support personality-informed approaches to strengthen psychological resilience in pwMS and identify depression as a clinically actionable target for future intervention.