Decreased physical effort, fatigue, and mental distress in patients with coronary artery disease: importance of personality-related differences

Anxiety, depression, and Type D personality in ischaemic heart disease patients receiving treatment from outpatient clinics in a government hospital in Sri Lanka

BACKGROUND

Anxiety, depression, and Type D personality are strongly correlated with the prognosis of IHD and the effectiveness of therapy. The main purpose of this study was to assess the proportions and associations of anxiety, depression, and Type D personality among clinically stable IHD patients (aged 18-60) treated at an outpatient clinic operated by a government hospital in Sri Lanka, who were diagnosed with IHD within the preceding three months.

METHODS

A cross-sectional study design was analysed using SPSS® version 23.0. The validated Sinhalese version of the Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression, while the DS-14 was used to determine Type D personality traits.

RESULTS

Among the 399 patients, 29.8% (n = 119) had anxiety, 24.8% (n = 99) had depression, and 24.6% (n = 24.6) had Type D personality. The level of anxiety had a significant association with depression (p = 0.002) and Type D personality (p = 0.003). Furthermore, depression was significantly associated with ethnicity (p = 0.014), occupation (p = 0.010), and type D personality (p = 0.009). Type D personality was the strongest predictor of anxiety, with patients being 1.902 times more likely to experience anxiety (95% CI 1.149-3.148; p = 0.012). Anxiety was a significant predictor of depression, with patients being 1.997 times more likely to experience depression (95% CI 1.210-3.296; p = 0.007). Non-Sinhalese ethnic background was also a significant predictor of depression (OR: 0.240; 95% CI 0.073-0.785; p = 0.018). Anxiety increased the likelihood of having Type D personality traits by 1.899 times (95% CI 1.148-3.143; p = 0.013).

CONCLUSION

The current study recommends the importance of screening and treating the psychological risk factors of IHD patients parallel to their IHD treatment to improve their prognosis. These insights highlight the need for targeted interventions that address depression, anxiety and the impact of Type D personality traits in enhancing the overall management and prognosis of IHD.

The DS-14 questionnaire: psychometric characteristics and utility in patients with obstructive sleep apnea

Little is known about type D personality in patients with obstructive sleep apnea (OSA). The DS-14 questionnaire is the standard tool to assess this personality type, but it has not been properly validated in patients with OSA, nor has it been correlated with clinical features in these patients.

PURPOSE

To determine the internal consistency and test-retest reliability of the DS-14 questionnaire, as well as the prevalence of type D personality in the overall OSA sample and subgroups. We assessed the influence of type D on perceived symptoms and its congruence with self-reported measures of personality, depression, fatigue, anxiety, quality of life, and quality of sleep.

METHODS

Patients with OSA completed the DS-14 questionnaire, Big Five Inventory-2 questionnaire, Hospital Anxiety and Depression Scale, SF-36 Health Survey Questionnaire, Epworth Sleepiness Scale and Stanford Sleepiness Scale, Pittsburgh Sleep Quality Index and Insomnia Severity Index, Fatigue Assessment Scale, and Checklist Individual Strength. After 1 month, the DS-14 questionnaire was repeated.

RESULTS

The overall prevalence of type D personality was 32%. Internal consistency (negative affectivity: α = 0.880, social inhibition: α = 0.851) and diagnostic test-retest reliability (kappa value = 0.664) of the DS-14 questionnaire were high. Significantly more symptoms of anxiety, depression, poor sleep quality, fatigue, and a worse health perception were found in OSA with type D. Neither OSA severity nor REM predominance altered these observations.

CONCLUSION

The DS-14 questionnaire showed excellent psychometric properties in patients with OSA. The prevalence of type D personality in patients with OSA was higher than in the general population. The presence of type D personality was associated with higher symptom burden.

Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Meta-analysis

OBJECTIVE

Type D personality, a joint tendency toward negative affectivity and social inhibition, has been linked to adverse events in patients with heart disease, although with inconsistent findings. Here, we apply an individual patient-data meta-analysis to data from 19 prospective cohort studies ( N = 11,151) to investigate the prediction of adverse outcomes by type D personality in patients with acquired cardiovascular disease.

METHOD

For each outcome (all-cause mortality, cardiac mortality, myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, major adverse cardiac event, any adverse event), we estimated type D's prognostic influence and the moderation by age, sex, and disease type.

RESULTS

In patients with cardiovascular disease, evidence for a type D effect in terms of the Bayes factor (BF) was strong for major adverse cardiac event (BF = 42.5; odds ratio [OR] = 1.14) and any adverse event (BF = 129.4; OR = 1.15). Evidence for the null hypothesis was found for all-cause mortality (BF = 45.9; OR = 1.03), cardiac mortality (BF = 23.7; OR = 0.99), and myocardial infarction (BF = 16.9; OR = 1.12), suggesting that type D had no effect on these outcomes. This evidence was similar in the subset of patients with coronary artery disease (CAD), but inconclusive for patients with heart failure (HF). Positive effects were found for negative affectivity on cardiac and all-cause mortality, with the latter being more pronounced in male than female patients.

CONCLUSION

Across 19 prospective cohort studies, type D predicts adverse events in patients with CAD, whereas evidence in patients with HF was inconclusive. In both patients with CAD and HF, we found evidence for a null effect of type D on cardiac and all-cause mortality.

Predictive value of baseline cognitive functioning on health-related quality of life in individuals with coronary artery disease: a 5-year longitudinal study

AIMS

Emerging studies suggest an association exists between coronary artery disease (CAD) and the development of neurodegenerative diseases, with CAD acting as a precursor. Our study aimed to investigate the relationship between baseline measures of cognitive functioning and long-term health-related quality of life (HRQoL) in individuals with CAD with specification to Type D personality traits and sex.

METHODS AND RESULTS

This prospective observational cohort study consisted of 864 participants (mean age 58 SD = 9 years, 74.0% men) with CAD after acute coronary syndrome. Baseline characteristics included comprehensive cognitive testing, measures of sociodemographic and clinical factors, and psychological assessment scales, such as Type D personality scale and the Hospital Anxiety and Depression scale. The Minnesota Living with Heart Failure Questionnaire assessed participants' HRQoL, conducted through phone interviews at baseline, every 6 months for up to 2 years, and after 5 years. Cognitive functioning correlated with HRQoL at all time intervals over the 5-year follow-up. Regarding sex and Type D personality, significant differences emerged in associations between impaired cognitive functioning at baseline and HRQoL measured over the period of 5 years. Men participants with characteristics of Type D personality were especially vulnerable to impaired cognitive functioning affecting the 5-year quality of life.

CONCLUSION

Men with CAD who obtained scores indicating characteristics of Type D personality were significantly more likely to have lower baseline cognitive functions and long-term HRQoL outcomes. This information could inform healthcare practitioners to screen for personality characteristics and closely follow-up those at a greater risk.

A review and conceptual model of the association of Type D personality with suicide risk

The role of personality as distal risk factor for suicidal thoughts and behavior is still unclear. This review aims to propose two conceptual models that explain the psychological plausibility of Type D personality as distal risk factor and contributor to the transition from general to suicide distress. To support this aim, we performed a systematic review of existing studies on the association between Type D personality and suicidal distress. A systematic search yielded eight studies that reported on Type D personality and suicidal distress. Type D personality was robustly associated with suicidal thoughts and behaviors, across populations and countries. Type D was related to the level/frequency of suicidal ideation in seven studies, and suicide attempt in two studies. Our first theoretical model identifies intra-psychic (depression, alcohol misuse, posttraumatic stress) and interpersonal (low belonging, social isolation, lack of support) vulnerabilities of individuals with Type D that may fuel the development of suicidal thoughts and behaviors. Type D by itself will not account for why people become suicidal, but our second theoretical model suggests that the avoidant-passive tendencies of Type D individuals may result in persistent problem-solving deficits, and, eventually, feelings of entrapment that may contribute to the desire to escape from pain. We conclude that empirical evidence supports the hypothesized link between Type D personality, and suicidal thoughts and behaviors. Our conceptual models - albeit often supported by indirect evidence - further substantiate the plausibility of this link, and offer concrete guidance for future studies. Primarily, more longitudinal research is necessary.

The Influence of Personality Type D on Cardiovascular Prognosis in Patients After Coronary Artery Bypass Grafting: Data from a 5-Year-Follow-up Study

BACKGROUND

Type D personality is accompanied by a set of negative behavioral patterns: low physical activity, high levels of psychological distress, low adherence to treatment. However, studies regarding predictive value of the type D personality remain inconclusive: the results varied depending on the examined cohort, age, and ethnicity. The aim of the study was to evaluate the influence of type D personality on the 5-year prognosis in patients undergoing coronary artery bypass grafting (CABG) in Russian population.

METHODS

The study included 602 patients with stable coronary artery disease (490 males, 57.7 ± 7.3 years) who had received CABG and were divided into two groups: patients with type D personality (n = 134) and patients without type D (n = 468). The risk of fatal and nonfatal events within 5 years after CABG was assessed.

RESULTS

There was no difference in total mortality in patients with type D and without type D (7.9% and 7.7%, respectively) over the 5-year period. The absence of cardiac events was detected much less frequently in patients with type D (28%) compared with patients without type D (82%; p = 0.021). Multivariate analysis found independent association between the unfavorable outcome and presence of diabetes mellitus (p = 0.021), type D personality (p = 0.039), and multifocal atherosclerosis (p = 0.033) regardless of gender, age, previous myocardial infarction, and stroke.

CONCLUSIONS

Type D patients had a greater risk for cardiac events over 5 years after CABG compared with non-type D patients. Obtained data indicates that it is reasonable to consider personality type while detecting patients at risk of development of stress induced cardiac complications after CABG.

The Relationship Between Type D Personality and the Complexity of Coronary Artery Disease

PURPOSE

The relationship between personality traits and cardiovascular disease has gathered sustained interest over the last years, type -D personality (TDP) being significantly associated with coronary artery disease (CAD). However, data regarding the connection between the TDP and the severity of CAD disease is scarce. The aim of our study was to assess the relationship between TDP and the complexity of CAD, and to compare it with other sociodemographic and clinical features.

PATIENTS AND METHODS

We conducted a cross-sectional case-control clinical-based study on 221 consecutive hospitalized patients with chest pain (60 ± 10.2 years; 131 men), referred for coronary angiography.

RESULTS

TDP was identified in 42 (19%) patients, using the DS 14 scale. Symptomatology profile was evaluated using the SCL-90 scale. Syntax score was greater in the subgroup of patients with TDP in comparison to non-TDP subgroup (26.21±12.03 vs 15.49±8.89, respectively, p<0.001), and most of SCL-90 symptom dimensions have significantly higher levels in the subgroup of TDP with CAD patients (all p < 0.05). Smoking (β=0.132, p=0.037), dyslipidemia (β=0.149, p=0.013), Diabetes Mellitus (β=232, p<0.001), NA dimension of TDP (β=0.255, p<0.001) and SI (β=0.279, p<0.001) dimension of TDP have a significant contribution to the complexity of CAD assessed by Syntax score.

CONCLUSION

TDP was associated with a more complex CAD assessed by Syntax score, and may represent a dynamic interface between the biological and psychological vulnerabilities and the symptoms of CAD.

Canonical Correlation between Behavioral-Psychological Variables and Predictors of Coronary Artery Disease Prognosis

Metabolic syndrome (MetS) and severity of coronary artery disease (CAD) are considered predictors of CAD prognosis. Unhealthy lifestyles and type-D personality are associated with MetS and are potential causes of primary and secondary CAD. In this cross-sectional descriptive study, we aimed to investigate the relationship between behavioral-psychological variables and predictors of CAD prognosis. The behavioral-psychological variable set contained six lifestyle categories and two type-D personality categories. Descriptive analyses, t-tests, analysis of variance, Pearson’s correlation, and canonical correlation were used. The behavioral-psychological variable set was related to the predictor set for CAD prognosis, with a significant canonical variate of 0.67 (45% overlapping variance). Significant pairs of canonical variates indicated that poor physical activity and weight control (−0.77), poor dietary habits (−0.78), alcohol consumption and cigarette smoking (−0.37), lack of sleep and rest (−0.40), stress (−0.64) in the lifestyle set, higher negative affectivity (0.52), and social inhibition (0.71) in the type-D personality set were associated with a high MetS score (0.59) and severity of CAD (0.91). A combination of behavioral and psychological variables was found to be important in predicting the prognosis of CAD; therefore, interventions aimed at preventing combinations of these variables may be effective in improving CAD prognosis.

Mental Distress Factors and Exercise Capacity in Patients with Coronary Artery Disease Attending Cardiac Rehabilitation Program

PURPOSE

There is still insufficient data on mental distress factors contributing to exercise capacity (EC) improvement before and after cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). The aim of our study was to evaluate the associations between various mental distress factors and EC before and after exercise-based CR (EBCR).

METHODS

Over 12 months, 223 CAD patients (70% men, mean age 58 ± 9 years) were evaluated for socio-demographic, clinical, and mental distress symptoms as measured by the Hospital Anxiety and Depression scale (HADS), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Patients were tested for EC at baseline and after EBCR.

RESULTS

In a multivariate linear regression model, EC before EBCR was associated with HADS anxiety subscale (β = -.186, p = .002) and BDI-II somatic/affective subscale (β = -.249, p < .001). EC after EBCR was associated with HADS anxiety and depression subscales (β = -.198, p < .001; β = -.170, p = .002, respectively) and BDI-II (β = -.258, p < .001). The BDI-II somatic/affective subscale was the best predictor of reduced EC before and after EBCR.

CONCLUSIONS

Mental distress and somatic/affective symptoms of depression are strongly associated with EC both at the beginning and after EBCR. Analysis of possible mediating or moderating factors was beyond the scope of our study. Future studies should focus on comprehensive evaluation of EC risk factors including other mental distress characteristics, subjectively experienced fatigue, and post-operative CAD symptoms.

Type D Personality as a Risk Factor in Coronary Heart Disease: a Review of Current Evidence

PURPOSE OF THE REVIEW

This review article synthesizes recent research findings on the psychological context of Type D personality and the mechanisms through which Type D affects disease progression and prognosis among patients with coronary heart disease (CHD).

RECENT FINDINGS

One in four patients with CHD has a Distressed (Type D) personality, which is characterized by two stable traits: social inhibition and negative affectivity. Type D personality predicts increased mortality and morbidity burden, and poorer health-related quality of life. Type D is part of a family of psychosocial risk factors that affect CHD prognosis. The pattern of co-occurrence of these psychosocial factors and intra-individual differences in psychosocial profiles may affect risk prediction accuracy. Multiple biological and behavioral processes have been associated with Type D personality. Identifying pathways explaining the observed associations between Type D personality and CHD is important to improve etiological and pathophysiological knowledge and to design personalized interventions, and targeting specific risk-associated pathways.

Type D Personality, Social Support, and Depression Among Ethnic Chinese Coronary Artery Disease Patients Undergoing a Percutaneous Coronary Intervention: An Exploratory Study

This study investigated the relationships between Type D personality, depression, and social support among ethnic Chinese coronary artery disease (CAD) patients undergoing percutaneous coronary interventions. Type D personality is associated with CAD, and may increase patients' depression and mortality rate. However, very few studies have explored the relationships between depression and social support among ethnic Chinese Type D CAD patients. A longitudinal, repeated-measures design was used; 105 Taiwanese CAD patients undergoing a percutaneous coronary intervention were recruited between January and December 2015. A demographic questionnaire, Type D Scale, ENRICHD Social Support Inventory, and Patient Health Questionnaire-9 were completed by 102 participants (mean age = 64.42, SD = 13.67 years) at hospitalization, and at the second week and third month after discharge. Data were analyzed using t tests and a generalized estimating equation. Results indicated that 46.7% of participants who had Type D personality had lower social support and higher depression than did the remaining (non-Type D) participants. At two weeks after discharge, the improvement in social support was higher among Type D patients than non-Type D participants; the same was true for depression at two weeks and three months after discharge each. Type D Taiwanese CAD patients showed lower perceived social support and higher depression during hospitalization than did non-Type D participants. Furthermore, the more social support patients received at home, the lower was their depression. Health-care providers should provide continuous mental health care, conduct early screening of mental health issues, and ensure that patients receive sufficient social support to reduce depression.

Type D personality in patients with upper extremity musculoskeletal illness: Internal consistency, structural validity and relationship to pain interference

OBJECTIVE

Type D personality - the joint tendency toward negative affectivity (NA) and social inhibition (SI) - is associated with greater symptom perception and negative health outcomes among various patient populations. We investigated Type D personality among patients with upper extremity musculoskeletal illness.

METHOD

In cross-sectional design, we estimated the prevalence of Type D personality in this population and explored the associations of two different Type D conceptualizations (i.e., categorical and dimensional as the NA×SI interaction) and the individual NA and SI traits with pain interference as well as structural-internal validity of DS14.

RESULTS

The categorical Type D personality and greater NA and SI were associated with pain interference above and beyond descriptive variables, but the interaction term between NA and SI was not. NA explained a larger proportion of the variance in pain interference than SI. DS14 showed a two-factor structure and high internal consistency in this sample.

CONCLUSIONS

The categorical Type D allows for identifying individuals who struggle with recovery from musculoskeletal injury. Although the dimensional conceptualization didn't prove to be associated with pain interference, NA and SI appear to have individual effects on pain interference, with most variance being accounted for by NA. Implications for clinical care are discussed.

Management of Chronic Stable Angina

Chronic stable angina (CSA) is a symptomatic problem that is precipitated by ischemic heart disease. CSA is diagnosed when symptoms are present for at least 2 months without changes in severity, character, or triggering circumstances. This article is a summary of current treatment strategies aimed to prevent progression of atherosclerosis, and medication therapies to control angina symptoms and improve quality of life for the individual.

Social inhibition and emotional distress in patients with coronary artery disease: The Type D personality construct

We examined the validity of the social inhibition component of Type D, its distinctiveness from negative affectivity, and value regarding emotional distress as measured with the DS14 in 173 coronary artery disease patients. In dimensional analysis, social inhibition and negative affectivity emerged as distinct traits. Analysis of continuous negative affectivity and social inhibition measures showed main effects for several emotional and inhibition markers and an interaction effect for social anxiety. Categorical analysis indicated that Type D patients reported more depression, negative mood, social anxiety, and less positive mood. Social inhibition is not a redundant trait, but has additional conceptual value.

Type D personality and physical inactivity: The mediating effects of low self-efficacy

Type D personality is associated with health-damaging behaviours among the general population. This study assessed the relationship between Type D personality, physical activity and self-efficacy. A total of 189 participants completed measures of Type D personality, physical activity and self-efficacy. Type D individuals had significantly lower levels of self-efficacy and engaged in significantly less walking and total exercise compared to non-Type D's. Furthermore, self-efficacy fully mediated the relationship between Type D and physical activity. Low levels of self-efficacy may be one mechanism to help explain why Type D individuals engage in more disease-promoting behaviours.

Association of Type D personality with increased vulnerability to depression: Is there a role for inflammation or endothelial dysfunction? - The Maastricht Study

BACKGROUND

Type D personality - the combination of negative affectivity (NA) and social inhibition (SI) - has been associated with depression but little is known about underlying mechanisms. We examined whether (1) Type D is a vulnerability factor for depression in general, (2) Type D is associated with inflammation or endothelial dysfunction, and (3) these biomarkers alter the possible association between Type D and depression.

METHODS

In the Maastricht Study, 712 subjects underwent assessment of NA, SI and Type D personality (DS14), depressive disorder (Mini-International Neuropsychiatric Interview) and depressive symptoms (Patient Health Questionnaire-9). Plasma biomarkers of inflammation (hsCRP, SAA, sICAM-1, IL-6, IL-8, TNF-α) and endothelial dysfunction (sVCAM-1, sICAM-1, E-selectin, vWF) were measured with sandwich immunoassays or ELISA and combined into standardized sumscores.

RESULTS

Regarding personality, 49% of the study population was low in NA and SI, 22% had SI only, 12% NA only and 17% had Type D. Depressive disorder and depressive symptoms were significantly more prevalent in Type D versus the other three personality subgroups. Multivariable regression analyses showed that Type D was associated with inflammation (β=0.228, p=0.014) and endothelial dysfunction (β=0.216, p=0.022). After adjustment for these biomarkers, Type D remained independently associated with increased vulnerability to depressive disorder (OR=13.20, p<0.001) and depressive symptoms (β=3.87, p<0.001).

LIMITATIONS

The cross-sectional design restrained us to draw any conclusions on causality. The relatively low prevalence of depressive disorder restrained us to adjust for more potential confounders.

CONCLUSIONS

Type D personality may be a vulnerability factor for depression, irrespective of levels of inflammation or endothelial dysfunction. Future research should examine possible underlying mechanisms.

Personality subtypes and chest pain in patients with nonobstructive coronary artery disease from the TweeSteden Mild Stenosis study: mediating effect of anxiety and depression

BACKGROUND

Patients presenting with chest pain in nonobstructive coronary artery disease (CAD, luminal narrowing <60%) are at risk for emotional distress and future events. We aimed to examine the association of personality subtypes with persistent chest pain, and investigated the potential mediating effects of negative mood states.

METHODS

Any chest pain in the past month was the primary outcome measure reported by 523 patients with nonobstructive CAD (mean age 61.4 years, SD = 9.4; 48% men), who participate in the TweeSteden Mild Stenosis (TWIST) observational cohort. Personality was categorized into a 'reference group', a high social inhibition ('SI only'), a high negative affectivity ('NA only') and a 'Type D' (NA and SI) group. Negative mood states included symptoms of depression and anxiety (Hospital Anxiety and Depression Scale) and cognitive and somatic depression (Beck Depression Inventory). The PROCESS macro was used to examine the relation between personality subtypes and chest pain presence, with the negative mood states as potential mediators.

RESULTS

Persistent chest pain was present in 44% of the patients with nonobstructive CAD. Type D personality (OR = 1.91, 95% CI 1.24-2.95), but not the 'NA only' (OR = 1.48, 95% CI 0.89-2.44) or the 'SI only' (OR = 0.93, 95% CI 0.53-1.64) group was associated with chest pain, adjusted for age and sex. Negative mood states mediated the association between personality and chest pain.

CONCLUSIONS

Type D personality, but not negative affectivity or social inhibition, was related to chest pain in nonobstructive CAD, which was mediated by negative mood states.

The role of personality in the course of health-related quality of life and disease-specific health status among colorectal cancer survivors: A prospective population-based study from the PROFILES registry

BACKGROUND

Prospective studies in various cardiovascular populations show that Type D personality predicted impaired health-related quality of life (HRQoL) and disease-specific health status. We examined the effect of negative affectivity (NA), social inhibition (SI) and their combined effect (Type D personality) on HRQoL and disease-specific health status among colorectal cancer (CRC) patients.

METHODS

CRC patients diagnosed between 2000 and 2009, as registered in the Dutch population-based Eindhoven Cancer Registry, received questionnaires on Type D personality (DS14), HRQoL (EORTC QLQ-C30) and disease-specific health status (EORTC QLQ-CR38) in 2010, 2011 and 2012.

RESULTS

Response rates were 73% (n = 2625), 83% (n = 1643) and 82% (n = 1458), respectively. Analyses were done on those completing at least two questionnaires (n = 1735). Individuals with Type D (NA+/SI+; 19%) and high NA (NA+/SI-; 11%) reported a significantly worse HRQoL and disease-specific health status compared to NA-/SI+ and NA-/SI-. Differences were stable over time. Linear mixed effects models showed that Type Ds had a lower quality of life, cognitive and emotional functioning, more insomnia, diarrhea, gastrointestinal, defecation and stoma-related problems and poor body image and future perspective compared to the reference group (NA-/SI-), even after controlling for sociodemographic and clinical variables. High NA individuals (NA+/SI-) reported similar poor health outcomes as Type Ds. However, they also reported lower social functioning and more fatigue, pain, micturition- and financial problems, while Type Ds reported more constipation, sexual problems and less sexual enjoyment.

CONCLUSIONS

Type D personality and high NA both have a significant negative stable impact on HRQoL and disease-specific health status among CRC patients.

Type D personality, suboptimal health behaviors and emotional distress in adults with diabetes: results from Diabetes MILES-The Netherlands

AIMS

Type D personality - defined as high negative affectivity (NA) and high social inhibition (SI) - has been associated with adverse cardiovascular prognosis. We explored the differential associations of Type D personality and its constituent components with health behaviors, emotional distress and standard biomedical risk factors as potential risk mechanisms in adults with diabetes.

METHODS

3314 Dutch adults with self-reported type 1 or 2 diabetes completed an online survey, including the DS14 Type D Scale. AN(C)OVAs and X(2) tests were used to compare participants scoring (i) low on NA and SI; (ii) high on SI only; (iii) high on NA only; (iv) high on NA and SI (Type D).

RESULTS

Participants with Type D personality (29%) were less likely to follow a healthy diet or to consult healthcare professionals in case of problems with diabetes management than those scoring high on neither or only one component. They also reported more barriers surrounding medication use, diabetes-specific social anxiety, loneliness and symptoms of depression and anxiety. There were no differences in standard biomedical risk factors (body mass index, blood pressure, cholesterol, HbA1c). After adjustment for demographics, clinical characteristics, NA, and SI in multivariable logistic regression analyses, Type D personality was independently associated with 2 to 3-fold increased odds of suboptimal health behaviors and over 15-fold increased odds of general emotional distress.

CONCLUSIONS

Type D personality was not related to standard biomedical risk factors, but was associated with unhealthy behaviors and negative emotions that are likely to have adverse impact on adults with diabetes.

Health behaviour mediates the relationship between Type D personality and subjective health in the general population

Type D personality is associated with unhealthy behaviour and poor subjective health in the general population. This study investigated whether health behaviour mediates the relationship between Type D and subjective health. There were 217 participants who completed measures of Type D, health-related behaviour, physical symptoms and quality of life. Type D individuals reported significantly less healthy behaviour and significantly poorer subjective health than non-Type Ds. In addition, it was found that health behaviour partially mediates these relationships. The study demonstrates that health behaviour may partly explain the relationship between Type D and poor health outcomes.

Screening for anxiety disorders in patients with coronary artery disease

Background

Anxiety disorders are prevalent and associated with poor prognosis in patients with coronary artery disease (CAD). However, studies examining screening of anxiety disorders in CAD patients are lacking. In the present study we evaluated the prevalence of anxiety disorders in patients with CAD and diagnostic utility of self-rating scales for screening of anxiety disorders.

Methods

Five-hundred and twenty-three CAD patients not receiving psychotropic treatments at initiation of rehabilitation program completed self-rating scales (Hospital Anxiety and Depression Scale or HADS; Spielberger State-Anxiety Inventory or SSAI; and Spielberger Trait-Anxiety Inventory or STAI) and were interviewed for generalized anxiety disorder (GAD), social phobia, panic disorder and agoraphobia (Mini-International Neuropsychiatric Interview or MINI).

Results

Thirty-eight (7%) patients were diagnosed with anxiety disorder(s), including GAD (5%), social phobia (2%), agoraphobia (1%) and panic disorder (1%). Areas under the ROC curve of the HADS Anxiety subscale (HADS-A), STAI and SSAI for screening of any anxiety disorder were .81, .80 and .72, respectively. Optimal cut-off values for screening of any anxiety disorders were ≥8 for the HADS-A (sensitivity = 82%; specificity = 76%; and positive predictive value (PPV) = 21%); ≥45 for the STAI (sensitivity = 89%; specificity = 56%; and PPV = 14%); and ≥40 for the SSAI (sensitivity = 84%; specificity = 55%; PPV = 13%). In a subgroup of patients (n = 340) scoring below the optimal major depressive disorder screening cut-off value of HADS-Depression subscale (score <5), the HADS-A, STAI and SSAI had moderate-high sensitivity (range from 69% to 89%) and low PPVs (≤22%) for GAD and any anxiety disorders.

Conclusions

Anxiety disorders are prevalent in CAD patients but can be reliably identified using self-rating scales. Anxiety self-rating scales had comparable sensitivities but the HADS-A had greater specificity and PPV when compared to the STAI and SSAI for screening of anxiety disorders. However, false positive rates were high, suggesting that patients with positive screening results should undergo psychiatric interview prior to initiating treatment for anxiety disorders and that routine use of anxiety self-rating scales for screening purposes can increase healthcare costs. Anxiety screening has incremental value to depression screening for identifying anxiety disorders.