2026 Theses Doctoral

Adolescent and Caregiver Personality: Associations with Dietary Behavior and Well-being in Celiac Disease

Chen, Zhijun

Background: The treatment for celiac disease (CeD) is lifelong adherence to a strict gluten-free diet (GFD), which can be particularly challenging during adolescence. Little is known about whether adolescent and caregiver personality traits are related to GFD adherence and well-being. This cross-sectional study of 50 adolescent-caregiver dyads examined how personality traits relate to dietary behaviors and quality of life (QOL).

Methods: Adolescents aged 14-17 years who had biopsy and/or serology-diagnosed CeD and their caregivers were recruited from a CeD referral center. Adolescents and caregivers completed the Big Five Inventory (BFI) personality test. Adolescents completed the Celiac Dietary Adherence Test (CDAT) and the Food Attitudes and Behaviors questionnaire (CD-FAB). Well-being was assessed by QOL (CDPQOL), anxiety (STAI-C), and depression (CES-DC). Associations were tested using multiple regression, adjusting for age at diagnosis and gender.

Results: Adolescents were mostly female (76%), with a mean age of 15.2 years. Caregivers were primarily mothers (94%). Sixty-two percent of adolescents demonstrated good or excellent GFD adherence (CDAT < 13). Overall QOL was rated as “good” (mean CDPQOL: 62.8). Maladaptive food attitudes and behaviors were common (mean CDFAB: 32.0), and about one-third of adolescents reported anxiety or depression. Poorer adherence to a GFD was associated with lower conscientiousness (β = −0.44, p = .02). More maladaptive food attitudes and behaviors were associated with higher openness (β = 0.45, p = .01). Lower QOL was associated with higher openness (β = −1.28, p = .006), poorer adherence (β = −1.28, p = .015), more maladaptive attitudes (β = − 0.48, p = .009), and older age at diagnosis (β = −1.07, p = .045). Increased trait anxiety (32%) was associated with higher neuroticism (β = 1.03, p < .001). Increased depressive symptoms (36%) were associated with higher neuroticism (β = 0.71, p = .005), lower extraversion (β = −0.45, p = .034), and poorer adherence (β = 0.64, p = .016). Among caregiver-adolescent personality associations, only higher caregiver neuroticism was linked to higher adolescent openness (β = 0.38, p = .02). Caregivers’ personality traits were not significantly associated with adolescents’ outcomes (all p > .05).

Discussion: This study found links between personality traits and adolescents’ GFD adherence and well-being. Higher openness (openness to new ideas) may heighten desire for sensory variety and make a GFD feel more limiting. Lower conscientiousness (goal-directed behavior) may hinder planning for adherence, and higher neuroticism (proneness to negative emotions and stress) may heighten anxiety and depression risk. Personality-informed counseling may help clinicians tailor support to improve adherence and socio-emotional health in CeD.