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Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Meta-analysis. Psychosom Med 2023; 85:188-202. [PMID: 36640440 DOI: 10.1097/psy.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
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.
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Bisset CN, Dames N, Oliphant R, Alasadi A, Anderson D, Parson S, Cleland J, Moug SJ. Exploring shared surgical decision-making from the patient's perspective: is the personality of the surgeon important? Colorectal Dis 2020; 22:2214-2221. [PMID: 32628311 DOI: 10.1111/codi.15237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to determine the importance of a colorectal surgeon's personality to patients and its influence on their decision-making. METHODS We present a two-part mixed methods study using the Guidance for Reporting Involvement of Patients and the Public (GRIPP-2) long form. Part 1 was an online survey (25 questions) and Part 2 a face-to-face patient and public involvement exercise. Part 1 included patient demographics, details of surgery, overall patient satisfaction (net promoter score) and patient views on surgeon personality (Gosling 10 Item Personality Index). The thematic analysis of free-text responses generated four themes that were taken forward to Part 2. These themes were used to structure focus group discussions on surgeon-patient interactions. RESULTS Part 1 yielded 296 responses: 72% women, 75.3% UK-based and 55.1% aged 40-59 years. Inflammatory bowel disease (45.3%) and cancer (40.2%) were the main indications. 84.1% of respondents reported satisfaction with their surgical experience (net promoter score). Four key themes were generated from Part 1 and validated in Part 2: (i) surgeon personality stereotypes (media differed from patients' perspective); (ii) favourable and unfavourable surgical personality traits (openness, conscientiousness, emotional stability preferred over risk-taking and narcissism); (iii) patient-surgeon interaction (mutual respect and rapport valued); (iv) impact of surgeon personality on decision-making (majority unaware of second opinion option; management of postoperative complications). CONCLUSION Patients believe surgeon personality influences shared decision-making. Low levels of emotional stability and conscientiousness are perceived by patients to increase the likelihood of postoperative adverse events. Further work is required to explore the potential influence of surgeon personality on shared decision-making and postoperative outcomes.
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Affiliation(s)
- C N Bisset
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK.,University of Aberdeen, Aberdeen, UK
| | - N Dames
- ACPGBI Patient Liaison Group Member, Glasgow, UK
| | - R Oliphant
- University of Aberdeen, Aberdeen, UK.,Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - A Alasadi
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - D Anderson
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - S Parson
- Suttie Centre, University of Aberdeen, Aberdeen, UK
| | - J Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - S J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK.,University of Glasgow, Glasgow, UK
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Leu HB, Yin WH, Tseng WK, Wu YW, Lin TH, Yeh HI, Cheng Chang K, Wang JH, Wu CC, Chen JW. Impact of type D personality on clinical outcomes in Asian patients with stable coronary artery disease. J Formos Med Assoc 2018; 118:721-729. [PMID: 30243505 DOI: 10.1016/j.jfma.2018.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 08/16/2018] [Accepted: 08/24/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Some personality types are associated with cardiovascular (CV) diseases and may be related to clinical outcomes in coronary artery disease (CAD). This study investigates the association between type D personality and clinical outcomes in stable CAD patients in an Asian cohort. METHODS Stable CAD patients were enrolled and prospectively followed up for at least 1 year in Taiwan. The inclusion criteria were at least one successful percutaneous coronary intervention (PCI) and stable medical treatment for at least 1 month before enrollment. Vulnerability to psychological distress was measured by the Type D Personality Scale (DS14) after enrollment. The end point was the occurrence of total CV events. Cox regression models of CV events were used to investigate the role of type D personality in clinical outcomes. RESULTS The study included 777 patients, among which 122 (15.77%) had type D personality. Forty-two CV events were identified: 3 cardiac deaths, 5 nonfatal myocardial infarctions, 1 stroke, 4 congestive heart failures (CHF), 6 peripheral arterial occlusive disorder cases, and 23 readmissions for angina/revascularization treatment. Patients with type D personality had significantly higher incidence of future CV events (9.84% vs. 4.58%, p = 0.018%) and admission for angina/revascularization (5.74% vs. 2.44%, p = 0.049). Patients with subsequent CV events were more likely to have type D personality (28.57% vs. 14.97%, p=0.018). After proportional Cox regression analysis, type D personality remained an independent predictor of future CV events (HR: 3.21, 95% CI: 1.06-9.69). In subgroup analyses, type D personality was especially associated with higher risk of total CV events among females, the elderly, hypertension patients, diabetes patients, and non-smokers. CONCLUSION Type D personality was an independent predictor of CV outcomes in an Asian cohort of stable CAD patients. This personality type may be identified in risk stratification for secondary prevention after PCI.
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Affiliation(s)
- Hsin-Bang Leu
- Heath Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Kung Tseng
- Department of Medical Imaging and Radiological Sciences, I-Shou University and Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
| | - Kuan- Cheng Chang
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Taiwan Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Ji-Hung Wang
- Department of Cardiology, Buddhist Tzu-Chi General Hospital, Tzu-Chi University, Hualien, Taiwan
| | - Chau-Chung Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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Jeon SW, Lim HE, Yoon S, Na KS, Ko YH, Joe SH, Kim YH. Does Type D Personality Impact on the Prognosis of Patients Who Underwent Catheter Ablation for Atrial Fibrillation? A 1-Year Follow-Up Study. Psychiatry Investig 2017; 14:281-288. [PMID: 28539946 PMCID: PMC5440430 DOI: 10.4306/pi.2017.14.3.281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/20/2016] [Accepted: 06/03/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Although Type D personality has been associated with the prognosis of various cardiac diseases, few studies have investigated the influence of Type D personality on the cardiac and psychiatric prognoses of patients with atrial fibrillation (AF). METHODS Depression, anxiety, and quality of life were measured at baseline and 6 months. The recurrence of AF was measured during 1-year following radiofrequency catheter ablation (RFCA) for AF. The Kaplan-Meier method with log-rank tests were used to compare the cumulative recurrence of AF. ACox proportional hazard model was conducted to identify factors that contribute to the recurrence of AF. RESULTS A total of 236 patients admitted for RFCA were recruited. Patients with a Type D personality had higher levels of depression and anxiety and a poorer quality of life compared to controls. Although depression, anxiety, and quality of life had improved 6 months after RFCA, significant differences in psychiatric symptoms remained between patients with and without Type D personality. In the Cox models, the type of AF was the only factor that influenced the recurrence of AF. CONCLUSION Our results suggest that Type D personality predominately influences psychological distress in patients with AF, but not the recurrence of AF.
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Affiliation(s)
- Sang Won Jeon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea
| | - Seoyoung Yoon
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Kyoung Se Na
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Sook-Haeng Joe
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea
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Condén E, Rosenblad A, Wagner P, Leppert J, Ekselius L, Åslund C. Is type D personality an independent risk factor for recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients? Eur J Prev Cardiol 2017; 24:522-533. [PMID: 28071958 DOI: 10.1177/2047487316687427] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Type D personality refers to a combination of simultaneously high levels of negative affectivity and social inhibition. The present study aimed to examine whether type D personality was independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality. Design This was a prospective cohort study. Methods Utilising data from the Västmanland Myocardial Infarction Study, 946 post-acute myocardial infarction patients having data on the DS14 instrument used to measure type D personality were followed-up for recurrent myocardial infarction and all-cause mortality until 9 December 2015. Data were analysed using Cox regression, adjusted for established risk factors. Results In total, 133 (14.1%) patients suffered from type D personality. During a mean follow-up time for recurrent myocardial infarction of 5.7 (3.2) years, 166 (17.5%) patients were affected by recurrent myocardial infarction, of which 26 (15.7%) had type D personality, while during a mean follow-up time for all-cause mortality of 6.3 (2.9) years, 321 (33.9%) patients died, of which 42 (13.1%) had type D personality. After adjusting for established risk factors, type D personality was not significantly associated with recurrent myocardial infarction or all-cause mortality using any of the previously proposed methods for measuring type D personality. A weak association was found between the social inhibition part of type D personality and a decreased risk of all-cause mortality, but this association was not significant after taking missing data into account in a multiple imputation analysis. Conclusions No support was found for type D personality being independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality.
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Affiliation(s)
- Emelie Condén
- 1 Centre for Clinical Research, Uppsala University, Sweden.,2 School of Health, Care and Social Welfare, Malardalen University, Sweden
| | | | | | - Jerzy Leppert
- 1 Centre for Clinical Research, Uppsala University, Sweden
| | - Lisa Ekselius
- 3 Department of Neuroscience, Uppsala University, Sweden
| | - Cecilia Åslund
- 1 Centre for Clinical Research, Uppsala University, Sweden
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Prognostic value of type D personality for 10-year mortality and subjective health status in patients treated with percutaneous coronary intervention. J Psychosom Res 2015; 79:214-21. [PMID: 26084732 DOI: 10.1016/j.jpsychores.2015.05.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 05/16/2015] [Accepted: 05/27/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Given the debate around limitations and controversies in type D personality studies, we aimed to evaluate the prognostic value of 'synergistically' analyzed type D personality (interaction z-scores negative affectivity NA, and social inhibition SI) on 10-year mortality and on 10-year subjective health status in percutaneous coronary intervention (PCI) patients. METHODS This prospective study comprised a cohort of 1190 consecutive patients who underwent PCI between October 2001 and September 2002 (73% male, mean age: 62years, range [27-90]years). At baseline, type D personality (DS14), and depression/anxiety (HADS) were assessed. Primary endpoint was 10year all-cause mortality; secondary endpoint was 10-year subjective health status (SF-36). RESULTS After a median follow-up of 10.3years (IQR 9.8-10.8), 293 deaths of any cause (24.6%) were recorded. After adjustment for significant baseline characteristics, personality categories approached and dichotomously approached type D personality were associated with 10-year mortality, p<.05. Synergistically approached type D personality was not associated with all-cause mortality or subjective health status at 10years. In survivors, higher NA was associated with lower subjective health status. Type D was not associated with mortality after adjusting for continuous depression and anxiety in all approaches. CONCLUSIONS Synergistically analyzed type D was not associated with 10-year all-cause mortality in PCI patients whereas dichotomous type D was. However, after adjustment for depression most of the findings had disappeared. Depression played an important role in this. Type D was not associated with 10-year subjective health status.
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Schonberger RB, Feinleib J, Holt N, Dai F, Brandt C, Burg MM. Preoperative depression symptom severity and its impact on adherence to preoperative beta-blocker therapy. J Cardiothorac Vasc Anesth 2014; 28:1467-73. [PMID: 25263776 DOI: 10.1053/j.jvca.2014.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To test the association among depression symptoms, distressed personality type, and preoperative beta-blocker nonadherence and to estimate the prevalence of untreated major depression in this population. DESIGN Prospective observational study. SETTING A veterans hospital. PARTICIPANTS One hundred twenty patients on outpatient beta-blocker therapy presenting for surgery. INTERVENTIONS The Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires. MEASUREMENTS AND MAIN RESULTS Of 99 participants who presented for surgery, the incidence of preoperative nonadherence was 14.1% (95% confidence interval 7%-21%), consistent with prior research. Nonadherence was 9.5% among those with no depression, 27.8% among those with mild depression, and 28.6% among those with moderate-to-severe depression (Cochran-Armitage test for trend p = 0.03). Distressed personality type was found in 35% of the cohort (95% confidence interval 26-45%) and was not associated with beta-blocker nonadherence (Fisher's exact test, p = 0.24). Among participants with symptoms of major depressive disorder (n = 25, 25.3%), more than half (n = 14, 56%) had no indication of depression listed at their most recent primary care visit. CONCLUSIONS Patients with symptoms of depression on chronic beta-blocker therapy are susceptible to medication nonadherence on the day of surgery. Most surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus (1) identify a population at increased risk of beta-blocker withdrawal, and (2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition.
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Affiliation(s)
- Robert B Schonberger
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT.
| | - Jessica Feinleib
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT; Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, CT
| | - Natalie Holt
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT; Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, CT
| | - Feng Dai
- Yale School of Public Health, Yale Center for Analytical Sciences, New Haven, CT
| | - Cynthia Brandt
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT; Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, CT
| | - Matthew M Burg
- Department of Internal Medicine, University College of Physicians and Surgeons, West Haven, CT
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Lim HE, Lee MS, Ko YH, Park YM, Han C, Joe SH. Distressed personality without a partner enhances the risk of depression in patients with coronary heart disease. Asia Pac Psychiatry 2013; 5:284-92. [PMID: 23857939 DOI: 10.1111/appy.12016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 09/25/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cultural differences in the combined effects of Type D personality and other mediating factors in the Asian population have not been reported. We examined the influence of the Type D personality in relation to the presence of a partner by measuring symptoms of anxiety and depression, quality of life, self-perception of health status in coronary heart disease (CHD) patients and normal controls. METHODS Normal controls (n = 541) and patients with CHD (n = 110) were included. All participants completed self-report measures on Type D personality, questionnaires on socio-demographic factors, the Spielberger State and Trait Anxiety Inventory-State (STAI-S), and the Center for Epidemiologic Studies Depression Scale (CES-D). By stratifying participant group, personality type, and partner status, eight groups were constructed. RESULTS The subjects with Type D personality showed higher mean scores on the STAI-S and CES-D as well as perception of their health. In cases of depression, CHD patients with Type D personality and without partner showed about a 50-fold increase in odds ratio when compared with non-Type D normal controls with partners. Odds ratio for depression changed from 31.44 to 48.72 in CHD patients with Type D personality based on the existence of a partner. DISCUSSION Having a partner significantly predicted the risk of depression. It is important to identify social support systems in CHD patients with Type D personality.
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Affiliation(s)
- Hong Euy Lim
- Korea University Cardiovascular Centre, Guro Hospital, Seoul, Korea
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Predictive value of social inhibition and negative affectivity for cardiovascular events and mortality in patients with coronary artery disease: the type D personality construct. Psychosom Med 2013; 75:873-81. [PMID: 24163388 DOI: 10.1097/psy.0000000000000001] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Methodological considerations and selected null findings indicate the need to reexamine the Type D construct. We investigated whether associations with cardiac events in patients with coronary artery disease (CAD) involve the specific combination of negative affectivity (NA) and social inhibition (SI), or rather the main effect of either trait alone. METHODS In this 5-year follow-up of 541 patients with CAD, the Type D construct (14-item Type D Scale) was tested by examining a) the interaction of continuous NA and SI z scores and b) a four-group classification defined by low/high trait scores. End points were major adverse cardiac events (MACEs; death, myocardial infarction [MI], coronary revascularization) and cardiac death/MI. RESULTS At follow-up, 113 patients had a MACE, including 47 patients with cardiac death/MI. After adjustment for disease severity, age, sex, and main trait effects, the interaction of NA and SI z scores was associated with MACE (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.11-1.67). This continuous measure of Type D was also associated with cardiac death/MI (OR = 1.48, 95% CI = 1.11-1.96) and remained an independent predictor of events after adjustment for depressive symptoms. Using a cutoff of 10 on both NA and SI scales, Type D was associated with an adjusted OR of 1.74 (95% CI = 1.11-2.73) for MACE and an OR of 2.35 (95% CI = 1.26-4.38) for death/MI but was unrelated to noncardiac death. Patients with high NA or SI alone were not at increased risk. CONCLUSIONS Continuous (NA × SI interaction) and dichotomized measures of Type D were associated with cardiovascular events in patients with CAD. Research is needed to explore moderating factors that may alter this association.
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How are Depression and Type D Personality Associated with Outcomes in Chronic Heart Failure Patients? Curr Heart Fail Rep 2013; 10:244-53. [DOI: 10.1007/s11897-013-0139-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Are we witnessing the decline effect in the Type D personality literature? What can be learned? J Psychosom Res 2012; 73:401-7. [PMID: 23148805 DOI: 10.1016/j.jpsychores.2012.09.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 09/18/2012] [Accepted: 09/21/2012] [Indexed: 11/22/2022]
Abstract
After an unbroken series of positive, but underpowered studies seemed to demonstrate Type D personality predicting mortality in cardiovascular disease patients, initial claims now appear at least exaggerated and probably false. Larger studies with consistently null findings are accumulating. Conceptual, methodological, and statistical issues can be raised concerning the construction of Type D personality as a categorical variable, whether Type D is sufficiently distinct from other negative affect variables, and if it could be plausibly assumed to predict mortality independent of depressive symptoms and known biomedical factors, including disease severity. The existing literature concerning negative affect and health suggests a low likelihood of discovering a new negative affect variable that independently predicts mortality better than its many rivals. The apparent decline effect in the Type D literature is discussed in terms of the need to reduce the persistence of false positive findings in the psychosomatic medicine literature, even while preserving a context allowing risk-taking and discovery. Recommendations include greater transparency concerning research design and analytic strategy; insistence on replication with larger samples before accepting "discoveries" from small samples; reduced confirmatory bias; and availability of all relevant data. Such changes would take time to implement, face practical difficulties, and run counter to established practices. An interim solution is for readers to maintain a sense of pre-discovery probabilities, to be sensitized to the pervasiveness of the decline effect, and to be skeptical of claims based on findings reaching significance in small-scale studies that have not been independently replicated.
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Christensen SB, Dall CH, Prescott E, Pedersen SS, Gustafsson F. A high-intensity exercise program improves exercise capacity, self-perceived health, anxiety and depression in heart transplant recipients: a randomized, controlled trial. J Heart Lung Transplant 2012; 31:106-7. [PMID: 22153554 DOI: 10.1016/j.healun.2011.10.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 10/16/2011] [Accepted: 10/19/2011] [Indexed: 12/24/2022] Open
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Emons WHM, Mols F, Pelle A, Smolderen KG, Denollet J. Type D Assessment in Patients With Chronic Heart Failure and Peripheral Arterial Disease: Evaluation of the Experimental DS(3)Scale Using Item Response Theory. J Pers Assess 2012; 94:210-9. [DOI: 10.1080/00223891.2011.645933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Unrath M, Zeeb H, Letzel S, Claus M, Escobar Pinzón LC. The mental health of primary care physicians in Rhineland-Palatinate, Germany: the prevalence of problems and identification of possible risk factors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:201-7. [PMID: 22509227 PMCID: PMC3317534 DOI: 10.3238/arztebl.2012.0201] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 12/05/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND The generally high job-related stress level among physicians may lead to various health impairments in the long run. Apart from job-related stress, stress during leisure time and certain personality traits might be risk factors for health impairments. However, very little research on the health situation of primary care physicians (PCPs) in Germany is available. Therefore, the objective of the present study was to systematically assess the stress experience and the health situation of German PCPs. One main focus was on mental health. METHODS In 2009, a state-wide survey among practice-based PCPs in the federal German state of Rhineland-Palatinate (cross-sectional study, n = 2092) was carried out in order to assess stress and strain as well as the health situation. RESULTS 790 participants (37.7%) were eligible for the analyses. One in four PCPs exceeded the cut-off value ≥ 3 for depression in the PHQ-2 (PHQ, Patient Health Questionaire). Moreover, approximately one in six PCPs stated that he or she had used psychotropic drugs or other psychoactive substances at least once in the preceding year. Stress during leisure time, type D personality and low job satisfaction were associated with the presence of mental health impairments in the binary logistic regression analyses. CONCLUSION All in all, it appears that mental health impairments are a common health problem among the PCPs. Target-group-specific measures should be taken in order to reduce the subjective stress level, and to foster mental hygiene. Furthermore, the development of favorable personality profiles and the corresponding behavioral patterns should be supported.
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Affiliation(s)
- Michael Unrath
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz.
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Grande G, Romppel M, Barth J. Association Between Type D Personality and Prognosis in Patients with Cardiovascular Diseases: a Systematic Review and Meta-analysis. Ann Behav Med 2012; 43:299-310. [DOI: 10.1007/s12160-011-9339-0] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
OBJECTIVE Type D personality has been established as a predictor of adverse clinical events in patients with cardiovascular diseases. To date, all studies except one have been conducted by a single research group. Thus, the aim of our study was to provide an independent replication of the results regarding the prognostic validity of Type D personality in a German sample of cardiac patients. METHODS Cardiac patients (n = 1040) were recruited from cardiac rehabilitation centers (n = 484), an outpatient clinic (n = 249), and a university hospital (n = 307). Main analyses were based on the combined data from these three subsamples. Cardiac health status, medical risk factors, sociodemographic characteristics, psychological symptoms, and Type D personality were assessed at baseline. The primary end point was all-cause mortality. The Cox proportional hazards regression model was used to estimate the relative risk of death. RESULTS Vital status was known for 977 patients (22.5% women; mean [standard deviation] = 63.3 [10.7] years). Within the follow-up time (mean [standard deviation] = 71.5 [3.6] months), 172 patients died. Type D personality was found in 25.2% of survivors and in 22.2% of nonsurvivors (χ²= 0.78, p = .38). Depressive symptoms (p = .13) and anxiety (p = .27) were also not predictive of mortality. In the multivariate analyses, neither Type D (p = .95) nor negative affectivity (p = .71) and social inhibition (p = .59), as well as their interaction (p = .88), were associated with all-cause mortality. CONCLUSIONS In the present study, Type D personality and its constituents are not associated with increased mortality in patients with heart disease. The discrepancies with previous results deserve further investigation.
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Coyne JC, Jaarsma T, Luttik ML, van Sonderen E, van Veldhuisen DJ, Sanderman R. Lack of prognostic value of type D personality for mortality in a large sample of heart failure patients. Psychosom Med 2011; 73:557-62. [PMID: 21862826 DOI: 10.1097/psy.0b013e318227ac75] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms. METHODS We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression. RESULTS At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144). CONCLUSIONS In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.
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Affiliation(s)
- James C Coyne
- Health Psychology Section, Department of Health Science, University Medical Center Groningen, University of Groningen, HPC FA12, PO Box 196, NL-9700 AD Groningen, The Netherlands.
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Calia R, Lai C, Aceto P, Luciani M, Saraceni C, Lai S, Gargiulo A, Citterio F. Preoperative Psychological Factors Predicting Graft Rejection in Patients Undergoing Kidney Transplant: A Pilot Study. Transplant Proc 2011; 43:1006-9. [DOI: 10.1016/j.transproceed.2011.01.158] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reich J, Schatzberg A. Personality traits and medical outcome of cardiac illness. J Psychiatr Res 2010; 44:1017-20. [PMID: 20451216 DOI: 10.1016/j.jpsychires.2010.03.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 03/01/2010] [Accepted: 03/23/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our goal was to examine the empirical literature on the effect of personality traits on the medical outcome of cardiac illness. METHOD Pub Med and Psychological Abstracts were searched for the years 1990 to September 2009 using the terms personality, personality traits, personality disorder, health, recovery from illness, cardiac illness and surgical recovery. Articles were then selected that were prospective, had a peer review published measure of personality, a standardized measure of outcome of physical illness and at least one year follow up. RESULTS Seven articles were identified that met our criteria. All seven had a significant finding that personality traits predicted medical outcomes. Of these seven articles six had similar enough measures of personality to be included in a meta analysis. (All used Type D personality.) Meta analysis found an odds ratio of 3.76 for Type D personality traits predicting poorer medical outcome. This indicated that patients with Type D personality had a 276% increase in the odds of a poor medical outcome compared to patients without Type D personality. CONCLUSIONS These findings indicate that personality traits are a strong predictor of medical outcome of cardiac disease.
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Affiliation(s)
- James Reich
- Department of Psychiatry, UCSF Medical School, United States.
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Denollet J, Schiffer AA, Spek V. A General Propensity to Psychological Distress Affects Cardiovascular Outcomes. Circ Cardiovasc Qual Outcomes 2010; 3:546-57. [DOI: 10.1161/circoutcomes.109.934406] [Citation(s) in RCA: 251] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Johan Denollet
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
| | - Angélique A. Schiffer
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
| | - Viola Spek
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
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Clustering of negative affectivity and social inhibition in the community: prevalence of type D personality as a cardiovascular risk marker. Psychosom Med 2010; 72:163-71. [PMID: 20100886 DOI: 10.1097/psy.0b013e3181cb8bae] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the prevalence of Type D personality-the combination of negative affectivity and social inhibition-in the general population and its relationship to other cardiovascular risk factors, including psychopathological symptoms. Type D personality has been identified as a prognostic risk factor for various cardiovascular disease conditions. METHODS In a representative sample of 2698 individuals (aged 35-74 years), psychological, lifestyle, and somatic risk factors were investigated with laboratory testing, self-report measures, and a clinical interview. Type D was assessed with the German Type D Scale-14. RESULTS The prevalence of Type D was 23.4% (95% confidence interval [CI], 21.2-25.6) in men and 26.9% (95% CI, 23.7-30.1) in women and, thus, in the range of classical risk factors (e.g., hypercholesterolemia). In age-adjusted analysis, Type D was associated with psychopathological symptoms, including depression and somatic symptom burden. With the exception of physical inactivity in both sexes, hypertension in women and hypercholesterolemia in men, Type D was not associated with classical cardiovascular risk factors. Multivariate analysis revealed depression, exhaustion, anxiety, and low self-rated health as associated with Type D in both sexes (odds ratios, 1.97-3.21 in men, 1.52-2.44 in women). CONCLUSIONS A Type D personality disposition can be found in about a quarter of the general population, which is comparable to the prevalence of classical cardiovascular risk factors. In both sexes, an independent association to Type D appeared mainly in psychopathological symptoms. Type D constitutes a relevant and independent risk marker in the community and should receive attention in clinical practice.
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Pelle AJ, Pedersen SS, Schiffer AA, Szabó B, Widdershoven JW, Denollet J. Psychological distress and mortality in systolic heart failure. Circ Heart Fail 2010; 3:261-7. [PMID: 20071656 DOI: 10.1161/circheartfailure.109.871483] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression, anxiety, and type D ("distressed") personality (tendency to experience negative emotions paired with social inhibition) have been associated with poor prognosis in coronary heart disease, but little is known about their role in chronic heart failure. Therefore, we investigated whether these indicators of psychological distress are associated with mortality in chronic heart failure. METHOD AND RESULTS Consecutive outpatients with chronic heart failure (n=641; 74.3% men; mean age, 66.6+/-10.0 years) filled out a 4-item questionnaire to assess mixed symptoms of anxiety and depression and the 14-item type D scale. End points were defined as all-cause and cardiac mortality. After a mean follow-up of 37.6+/-15.6 months, 123 deaths (76 due to cardiac cause) were recorded. Cumulative hazard functions for elevated anxiety/depression symptoms differed marginally for all-cause (P=0.06), but not cardiac, mortality (P=0.43); type D personality was associated with neither all-cause mortality (P=0.63) nor cardiac mortality (P=0.87). In multivariable analyses, neither elevated anxiety/depression symptoms nor type D personality was associated with all-cause mortality (hazard ratio [HR]=1.18; 95% CI, 0.76 to 1.84; P=0.45 and HR=1.09; 95% CI, 0.67 to 1.77; P=0.73, respectively) or cardiac mortality (HR=1.13; 95% CI, 0.63 to 2.04; P=0.65 and HR=1.16; 95% CI, 0.62 to 2.18; P=0.67). In secondary analyses, a 1-point increase in anxiety/depression (range, 0 to 16) was associated with an 8% increase in risk for all-cause mortality (HR=1.08; 95% CI, 1.01 to 1.15; P=0.02). CONCLUSIONS Neither elevated anxiety/depression symptoms nor type D personality was associated with an increased risk for all-cause or cardiac mortality. Future studies with adequate power and a longer follow-up duration are needed to further elucidate the role of psychological distress in chronic heart failure.
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Affiliation(s)
- Aline J Pelle
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
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Abstract
OBJECTIVE To test the dimensionality of Type-D personality, using taxometric procedures, to assess if Type-D personality is taxonic or dimensional. Type-D personality is treated as a categorical variable and caseness has been shown to be a risk factor for poor prognosis in coronary heart disease. However, at present, there is no direct evidence to support the assumption that Type D is categorical and able to differentiate true cases from noncases. METHODS In total, 1012 healthy young adults from across the United Kingdom and Ireland completed the DS14, the standard index of Type D, and scores were submitted to two taxometric procedures MAMBAC and MAXCOV. RESULTS Graphical representations (comparing actual with simulated data) and fit indices indicated that Type D is more accurately represented as a dimensional rather than categorical construct. CONCLUSION Type D is better represented as a dimensional construct. Implications for theory development and clinical practice with respect to Type D are examined as well as the wider use of taxometrics within psychosomatic medicine (e.g., to investigate if there are medically unexplained syndrome taxons, such as a Gulf War Syndrome taxon).
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Denollet J, de Jonge P, Kuyper A, Schene AH, van Melle JP, Ormel J, Honig A. Depression and Type D personality represent different forms of distress in the Myocardial INfarction and Depression - Intervention Trial (MIND-IT). Psychol Med 2009; 39:749-756. [PMID: 18694538 DOI: 10.1017/s0033291708004157] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We investigated whether depressive disorder and Type D personality refer to different forms of distress in the Myocardial INfarction and Depression - Intervention Trial (MIND-IT). METHOD A total of 1205 myocardial infarction (MI) patients were screened at 3, 6, 9 and 12 months post-MI; those with a Beck Depression Inventory (BDI) score 10 underwent the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Patients completed the DS14 measure of Type D personality at 12 months and were stratified to one of four subgroups: depressed/Type D, depressed/non-Type D, non-depressed/Type D, or non-distressed. RESULTS Two hundred and six (17%) patients were diagnosed with depression and 224 (19%) with Type D. Only 7% (n=90) had both forms of distress, and 60% of Type D patients were free of depression in the first year post-MI. Type D moderated the relationship between depressive and cardiac disorder. Depressed patients without Type D had the worst clinical status (left ventricular dysfunction, heart failure, Killip class 2) as compared to other patients, whereas depressed patients with a Type D personality did not differ in clinical status from non-distressed patients. Contrasting 'pure' Type D and depression subgroups showed that Type D patients without depression were less likely to have left ventricular dysfunction [odds ratio (OR) 0.47, 95% confidence interval (CI) 0.35-0.65, p<0.0001] than depressed patients without Type D. CONCLUSIONS Depression and Type D refer to different forms of distress in post-MI patients; most Type D patients display non-psychiatric levels of distress and Type D moderates the relationship between depressive and cardiac disorder. Different depression/Type D subgroups may be involved in the prediction of cardiac prognosis.
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Affiliation(s)
- J Denollet
- CoRPS - Center of Research on Psychology in Somatic diseases, Tilburg University, The Netherlands.
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Schiffer AA, Smith ORF, Pedersen SS, Widdershoven JW, Denollet J. Type D personality and cardiac mortality in patients with chronic heart failure. Int J Cardiol 2009; 142:230-5. [PMID: 19162343 DOI: 10.1016/j.ijcard.2008.12.090] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 12/13/2008] [Indexed: 12/29/2022]
Abstract
BACKGROUND Clinical predictors of cardiac mortality in chronic heart failure (CHF) are established, but less is known about chronic psychological predictors. Therefore, we examined the prognostic value of Type D personality (tendency to experience negative feelings and inhibit self-expression) in CHF patients. METHODS AND RESULTS Consecutive systolic CHF outpatients (n=232) filled in the Type D Scale (DS14) at baseline. Socio-demographic and clinical data were obtained from the medical record/cardiologist. The primary endpoint was total cardiac mortality (follow-up=30.7+/-11.1 months). Late (>6 months) cardiac mortality was the secondary endpoint. Type D patients had a higher incidence of total cardiac mortality (15/48=31.3%) as compared to non Type D patients (32/184=17.4%), OR=2.16;95%CI:1.05-4.43, p=.04. Type D personality was a near significant independent predictor of total cardiac mortality (OR=1.40;95%CI:0.93-4.29, p=.08), and a significant independent predictor of late cardiac mortality, adjusting for sex, age and left ventricular ejection fraction (OR=2.34;95%CI:1.05-5.26, p=.04). CONCLUSIONS Type D personality was a near-significant independent predictor of total cardiac mortality, and a significant independent predictor of late cardiac mortality, adjusting for socio-demographics and disease-severity. These findings suggest that Type D personality, a chronic psychological risk factor, is of importance in long-term prognosis in CHF.
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Affiliation(s)
- Angélique A Schiffer
- Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands
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Yu XN, Zhang J, Liu X. Application of the Type D Scale (DS14) in Chinese coronary heart disease patients and healthy controls. J Psychosom Res 2008; 65:595-601. [PMID: 19027450 DOI: 10.1016/j.jpsychores.2008.06.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 03/19/2008] [Accepted: 06/27/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the psychometric properties of the Type D Scale (DS14) in mainland China. METHODS One hundred and seventy-eight coronary heart disease (CHD) patients and 376 healthy controls were recruited. They completed the Chinese version of the DS14, the Zung Self-Rating Depression Scale, the Positive Affect and Negative Affect Scale, the Perceived Social Support Scale, and the Social Avoidance and Distress Scale. Thirty-five of the patients were also rated by their family members on the DS14. RESULTS The two-factor structure of the DS14 was replicated. The Cronbach's alpha coefficients for the negative affectivity (NA) and social inhibition (SI) subscales were 0.90 and 0.85, respectively, for the CHD patients and 0.87 and 0.69, respectively, for the healthy subjects. The correlations between the self-reports and the observer ratings (r(NA)=0.56, r(SI)=0.69) supported satisfactory consensual validity. Good convergent validity was shown by the expected correlations and the scale-level factor analyses of NA with depression and negative affect, and SI with perceived social support and social avoidance and distress. With the standardized cut-off of NA >or=10 and SI >or=10, 31.4% of the CHD patients and 31.9% of the healthy controls in China were defined as having a Type D personality. CONCLUSIONS The results indicate that the Type D construct is valid and reliable in Chinese populations. The Chinese version of the DS14 shows good psychometric properties. The prevalence of Type D personality in China falls within the range of what has been found in Western countries, at least for CHD patients. This study indicates that it is possible to use the DS14 among Chinese populations in future cross-cultural studies.
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Affiliation(s)
- Xiao-nan Yu
- Centre for Epidemiology and Biostatistics, School of Public Health Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Denollet J, Vrints CJ, Conraads VM. Comparing Type D personality and older age as correlates of tumor necrosis factor-alpha dysregulation in chronic heart failure. Brain Behav Immun 2008; 22:736-43. [PMID: 18068948 DOI: 10.1016/j.bbi.2007.10.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 10/26/2007] [Accepted: 10/27/2007] [Indexed: 10/22/2022] Open
Abstract
Tumor necrosis factor-alpha (TNF-alpha) and its soluble receptors 1 (sTNFR1) and 2 (sTNFR2) have been shown to be implicated in the pathogenesis of chronic heart failure (CHF). Ageing is accompanied by increased plasma levels of pro-inflammatory cytokines. We hypothesized that Type D personality (joint tendency to experience negative emotions and to inhibit self-expression) and age may have similar pro-inflammatory effects in the context of CHF. Participants in this study were 130 consecutive outpatients with CHF (76% men); there were 70 relatively younger (<or=59 years) and 60 relatively older (>or=60 years) patients. They all completed the 14-item Type D Scale (DS14); 43 patients (33%) had a Type D personality. A multivariate model of cytokine levels indicated an independent overall effect of both older age [F(1,128)=9.11, p=.003] and Type D personality [F(1,128)=8.28, p=.005]. Stratifying patients in age/personality subgroups showed that younger non-Type D patients had the lowest and older Type D patients the highest sTNFR1 and sTNFR2 levels (986+/-318 vs 1661+/-1128 pg/ml and 1838+/-777 vs 2823+/-1439 pg/ml, p<.0001). Importantly, the mean sTNFR1 level in younger Type D patients (1359+/-660 pg/ml) was equivalent to that in older non-Type D patients (1360+/-440 pg/ml, p=.99) who were on average 18 years older. Younger Type D and older non-Type D patients also had similar sTNFR2 levels (2406+/-1329 vs 2448+/-812 pg/ml, p=.88). Only older Type D patients had a higher mean TNF-alpha level as compared to patients who were younger or who were not Type D (5.4+/-2.9 vs 3.9+/-2.4 pg/ml, p=.008). A logistic regression model including sex, severity of CHF, systolic heart failure and ischemic etiology indicated that the combined risk category of older age or Type D was independently associated with substantially increased sTNFR1 and sTNFR2 levels. Hence, Type D personality was associated with increased TNF-alpha activity. This disease-promoting effect of Type D matched the pro-inflammatory effect of ageing.
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Affiliation(s)
- Johan Denollet
- CoRPS-Centre of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands.
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Decreased differential activity in the amygdala in response to fearful expressions in Type D personality. Neurophysiol Clin 2008; 38:163-9. [DOI: 10.1016/j.neucli.2008.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 03/09/2008] [Indexed: 11/22/2022] Open
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SCHIFFER ANGÉLIQUEA, DENOLLET JOHAN, PEDERSEN SUSANNES, BROERS HERMAN, WIDDERSHOVEN JOSW. Health Status in Patients Treated with Cardiac Resynchronization Therapy: Modulating Effects of Personality. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 31:28-37. [DOI: 10.1111/j.1540-8159.2007.00922.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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van den Broek KC, Martens EJ, Nyklícek I, van der Voort PH, Pedersen SS. Increased emotional distress in type-D cardiac patients without a partner. J Psychosom Res 2007; 63:41-9. [PMID: 17586336 DOI: 10.1016/j.jpsychores.2007.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 03/06/2007] [Accepted: 03/20/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The distressed (type D) personality is an emerging risk factor in coronary artery disease that has been associated with adverse prognosis, impaired health status, and emotional distress. Little is known about factors that may influence the impact of type-D personality on health outcomes. Therefore, the aim of this study was to determine the combined effect of type-D and not having a partner on symptoms of anxiety and depression. METHODS Patients (n=554) hospitalized for acute myocardial infarction or implantable cardioverter defibrillator implantation completed the 14-item type-D Scale (DS14) during hospitalization and the State-Trait Anxiety Inventory and Beck Depression Inventory at 2 months follow-up. RESULTS Stratifying by personality and partner status showed that type-D patients without a partner had a higher risk of both anxiety [odds ratio (OR)=8.27; 95% confidence interval (CI)=2.50-27.32] and depressive symptoms (OR=6.74; 95% CI=2.19-20.76) followed by type-D patients with a partner (OR=3.73; 95% CI=2.16-6.45 and OR=3.81; 95% CI=2.08-6.99, respectively) and non-type-D patients without a partner (OR=2.04; 95% CI=1.05-3.96 and OR=3.03; 95% CI=1.46-6.31, respectively) compared to non-type-D patients with a partner, adjusting for demographic and clinical baseline characteristics, indicating a dose-response relationship. CONCLUSION Lack of a partner further exacerbated the risk of symptoms of anxiety and depression in the already distressed type-D patients. In clinical practice, it is important to identify type-D patients without a partner and carefully monitor them, as they may be less likely to alter health-related behaviors due to their increased levels of distress.
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Affiliation(s)
- Krista C van den Broek
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, and Department of Cardiology, Catharina Hospital Eindhoven, The Netherlands.
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Denollet J, Kupper N. Type-D personality, depression, and cardiac prognosis: cortisol dysregulation as a mediating mechanism. J Psychosom Res 2007; 62:607-9. [PMID: 17540217 DOI: 10.1016/j.jpsychores.2007.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Johan Denollet
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
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