Personality domains in early stages of psychosis: a systematic review and meta-analysis

Background: Personality traits influence symptoms, functioning, and illness trajectory in chronic psychosis. However, their role in early-stage psychosis remains poorly defined, particularly regarding potential differences from healthy controls and their association with clinical outcomes. Methods: We conducted a systematic review and meta-analysis of studies assessing personality domains in early-stage psychosis using validated dimensional instruments. Searches were performed in PubMed/MEDLINE, CINAHL, and Web of Science until March 2025. The meta-analysis included studies using the NEO Five-Factor Inventory (NEO-FFI), with patient scores compared to published normative data. Studies reporting T-scores and those reporting raw scores were analyzed separately. Associations between personality domains and clinical features were narratively synthesized. Results: Eighteen studies met the inclusion criteria; eight were included in the meta-analysis (n = 1109). Considering studies reporting T-scores, individuals with early-stage psychosis showed higher neuroticism (MD = 27.4, 95% CI [25.0 to 29.9]) and lower extraversion (MD = −6.0, 95% CI [–8.6 to −3.5]) and conscientiousness (MD = −5.5, 95% CI [–7.9 to −3.2]), relative to normative data. Analyses of studies reporting raw scores showed similar effects, though not statistically significant. The same personality domains were consistently associated with symptom severity, treatment adherence, functioning, and service use. Conclusions: Early-stage psychosis may be characterized by a specific personality profile that modulates clinical presentation. Early personality assessment may guide tailored treatment strategies. Longitudinal studies are needed to clarify their prognostic relevance and potential role in the personalization of treatment.