Beyond the direct effect of neuroticism : a cross-sectional study testing a dual-pathway stress adaptation model in mood disorders

Neuroticism is a well-established vulnerability factor for anxiety and depression. However, the mechanisms through which neuroticism is related to negative affect in patients with mood disorders remain incompletely understood. In particular, the roles of stress perception and coping processes in mediating this relationship require further clarification. In this study, we examined the relationships among neuroticism, negative stress perception, maladaptive coping, and negative affect (anxiety and depression) in 420 patients with mood disorders (bipolar and related disorders, n = 279; depressive disorders, n = 141). Structural equation modeling was used to compare two competing mediation models describing stress-related cognitive appraisal and coping pathways. Specific indirect effects, differences between diagnostic groups, and the robustness of the findings were additionally examined. The integrated mediation model demonstrated better model fit than the sequential mediation model. The association between neuroticism and negative affect was statistically accounted for by stress-related processes. Neuroticism was associated with anxiety and depression through two pathways of comparable magnitude: one involving negative stress perception and another involving maladaptive coping after accounting for negative stress perception. Emotion-oriented coping carried most of the indirect association, and the structural paths were similar across bipolar and depressive disorders. Anxiety showed numerically stronger associations with stress-related processes than depression, although this difference was not formally tested. These findings suggest that individual differences in neuroticism are associated with negative affect through distinct dual pathways involving cognitive appraisal and dispositional coping. Although longitudinal studies are needed to confirm these associations, clinical interventions may benefit from an integrated approach—simultaneously targeting cognitive reframing and habitual coping reactivity—to reduce vulnerability to anxiety and depressive symptoms in mood disorders.