Type-D personality mechanisms of effect: the role of health-related behavior and social support

Association of type-D personality and left-ventricular remodelling in patients treated with primary percutaneous intervention after ST-segment elevation myocardial infarction

BACKGROUND

Type-D personality is an established predisposing factor for various diseases. Type-D traits have been shown to pose a 26% increased risk of coronary artery disease after controlling for other confounding factors. Significant associations have been reported between type-D personality traits and dyslipidaemia, impaired endothelial function, coronary heart disease (CAD), acute myocardial infarction, and other adverse cardiovascular events.

OBJECTIVE

To assess the association between type-D personality and left-ventricular adverse remodelling in patients treated with percutaneous coronary intervention following index ST-segment elevation myocardial infarction.

METHODS

All patients hospitalized and treated with percutaneous coronary intervention (PCI) after their index ST-segment elevation myocardial infarction (STEMI) between 1 January 2022 to 31 December 2023 were prospectively enrolled. Type-D personality traits in the study population were determined at baseline using type-D Scale-14 (DS14) instrument, whereas any positive change in left ventricular end diastolic volume (LVEDV) ≥ 20% at follow up period of 12-months from baseline was defined as left-ventricular adverse remodelling (LVAR). Univariate and multivariate analysis was done to establish the independent predictors of LVAR. The area under receiver-operating characteristic curve (AUROC) was employed to assess the sensitivity and specificity of the identified independent predictors.

RESULTS

A total of 124 patients were enrolled in the study. The mean age of the study population was 67 ± 10 years and the overall incidence of LVAR was found to be 25%. Multivariate regression analysis revealed that type-D personality is a significant independent predictor of LVAR [Formula: see text] apart from the already established independent predictors Killip Class[Formula: see text], baseline Global Longitudinal strain (GLS)[Formula: see text], and 3-vessel CAD[Formula: see text]. In ROC curve analysis type-D personality as an independent predictor of LVAR achieved a sensitivity of 41.4% and a specificity of 87.1%, p < 0.02.

CONCLUSION

Type-D personality trait is a significant independent predictor of LVAR in patients treated with PCI after their index-STEMI.

Ageism and Type D Personality: The Protective Role of Self-Esteem and Perceived Social Support

Background: This study examined the relationship between Type D personality and ageism in young adults, and evaluated the role of protective and risk factors. Methods: Two hundred and forty-seven community volunteers (M age = 31.8 years) reported online on age-related attitudes, Type D personality, and on measures of well-being. Results: A significant correlation was found between ageist attitudes and the tendency toward Type D personality. Both Type D personality and ageism correlated negatively with all the well-being measures. Perceived social support (PSS) partially down-mediated the association between Type D personality and ageism. A three-way interaction was found among individuals with Type D personality. Low PSS and low self-esteem were associated with an elevation of ageism compared to those with low PSS and high self-esteem. Discussion: The current research suggests that self-esteem and PSS are protective against ageism, and might be good targets for psychological interventions in order to mitigate ageism, particularly among individuals with Type D personality.

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.

Risk of recurrent cardiovascular events in coronary artery disease patients with Type D personality

Introduction

Data on the association between Type D personality, its traits negative affectivity (NA) and social inhibition (SI), and risk of major adverse cardiac events (MACE) in coronary outpatients is sparse. Furthermore, the associations between Type D subgroups and cardiovascular risk factors are largely unknown.

Methods

We investigated i) Type D personality, NA and SI and risk of recurrent MACE, and ii) the relationship between Type D subgroups and risk factors in a coronary population. This prospective cohort study included 1083 patients` median 16 months after a myocardial infarction and/or a revascularization procedure who were followed-up for 4.2 (SD 0.4) years. Type D personality was assessed by DS14. Anxiety and depression, statin adherence, and risk factors were assessed by patients' self-report and a clinical examination with blood samples. MACE, defined as cardiovascular death, myocardial infarction, revascularization, stroke or heart failure, were obtained from hospital records from index event to end of study lasting 5.7 years. Data were analyzed by Cox proportional hazard regression.

Results

In all, 352 MACE occurred in 230 patients after average 4.2 years follow-up. Higher NA score was associated with MACE after adjustment for age, risk factors and comorbidity (HR 1.02 per unit increase, 95% CI 1.00-1.05), whereas we found a weaker, not statistically significant estimated effect of higher SI score. After additional adjustment for symptoms of anxiety and depression, we found a weaker, not statistically significant association between NA and MACE (HR 1.01 per unit increase, 95% CI 0.98-1.05). Low statin adherence and smoking were more prevalent in the Type D and high NA group.

Discussion

Our results indicate that the NA trait is related to worse prognosis in outpatients with coronary artery disease.

Personality as a Predictor of Disability in Multiple Sclerosis

OBJECTIVE

As personality changes and personality disorders are frequently observed in multiple sclerosis (MS), personality may be a prognostic factor for this disease. The present study investigated the influence of personality on disability, progression, and treatment adherence in MS.

METHOD

Personality was assessed in 41 patients with Relapsing-Remitting MS (30 females; mean age = 42.63 years) using the NEO Personality Inventory-3rd edition. Disability was measured with the Expanded Disability Status Scale, and treatment adherence information was collected from the Swiss MS Cohort. Correlation, multiple linear and partial least square regressions were performed to examine relations between personality, disability, and treatment adherence in MS.

RESULTS

After accounting for age and time since disease onset, our analysis revealed that Neuroticism (β = 0.32, p = 0.01) and its Vulnerability facet (β = 0.28, p < 0.05) predicted greater disability, whereas Extraversion (β = -0.25, p = 0.04) and its Activity facet (β = -0.23, p < 0.05) predicted milder disability. Regarding disability progression, correlational analysis revealed that it was negatively correlated with Extraversion (r = -0.44, p = 0.02) and the Feelings facet of Openness (r = -0.41, p = 0.03), but regressions failed to highlight any predictive links. No significant results could be demonstrated for treatment adherence.

CONCLUSIONS

Overall, our study showed that some personality traits can impact disability in MS, indicating that these should be considered in clinical practice, as they could be used to adapt and improve patients' clinical support.

Relationship between Functional Status and Type D Personality and Psychiatric Symptoms of Patients with Chronic Obstructive Pulmonary Disease (COPD)

Emotional difficulties, adjustment difficulties, anxiety disorder, paranoid reactions and depression are among the common psychiatric disorders in patients with Chronic Obstructive Pulmonary Disease (COPD). Type D personality is characterized by social inhibition and negative affectivity. Individuals with Type D personality have difficulty in coping with chronic diseases. The aim of our study was to determine type D personality and psychiatric symptoms in patients with COPD. A patient group was formed with 44 people hospitalized with COPD in the Chest Diseases service and a control group was formed with 44 healthy people. A sociodemographic data form, the Beck Depression Inventory, State and Trait Anxiety Inventory, Somatosensory Amplification Scale, Type D Personality Scale, and BODE (Body mass index, Obstruction, Dyspnea, Exercise capacity) index, were used to. According to the results of our study, state and trait anxiety, depression and D-type personality, exaggeration of bodily sensations scale scores were statistically significantly higher in the patient group compared to the control group. Moreover, a high score on the somatosensory amplification scale and having a type D personality were correlated with the BODE index score. These results suggest that it is important for patients with COPD to be examined by a psychiatrist..

Relationship between Type D personality and adverse health outcomes in people with type 2 diabetes: The parallel mediating roles of diabetes distress and social isolation

AIM

To investigate the relationship between Type D personality and adverse health outcomes [glycated haemoglobin (HbA1c) and health-related quality of life (HRQOL)] directly, and indirectly via diabetes distress and social isolation in people with type 2 diabetes.

DESIGN

A secondary analysis of 524 participant's data derived from a cross-sectional, correlational study with people with type 2 diabetes.

METHODS

Data were analysed using the PROCESS macro of SPSS.

RESULTS

Type D personality was present in 31.3% of the participants, and exerted a direct effect on HRQOL but not on HbA1c. Type D personality indirectly affected both HbA1c and HRQOL via the mediators of diabetes distress and social isolation. Nurses need to monitor people with type 2 diabetes to determine whether Type D personality is present. Those with Type D personality should be provided with interventions to reduce diabetes distress and alleviate social isolation in order to improve HbA1c and HRQOL.

Type D Personality and Health Behaviors in People Living with Obesity

BACKGROUND

Considering that health behaviors and personality traits play an important role in the formation of health attitudes, the main objective of this study was to evaluate the relations that occur between type D personality and health behaviors in a group of obese patients.

METHODS

443 adult patients with BMI ≥ 30 kg/m2, who had been hospitalized in selected hospital facilities in the Silesian Voivodeship (Poland), participated in the study. Respondents completed three standardized questionnaires-the Multidimensional Health Locus of Control Scale, version A (MHLC-A), the Inventory of Health Behaviors (IZZ), and the Type D Scale (DS-14).

RESULTS

Patients with type D personality were characterized by the least effective mental attitudes and preventive behaviors, and differed significantly from the other personality types (intermediate and non-type D). Type D personality increased the risk of initiating improper health behaviors by more than five times. Regarding the sense of health control, patients with type D personality had significantly lower scores for the Internal Dimension subscale (21.3 ± 3.1) and higher for the Powerful Others Dimension subscale (24.0 ± 2.6), compared to patients with intermediate and non-type D personality. Proper health behaviors correlated with an internal sense of health control; the strongest correlation, defined as a medium, was with Preventive Behaviors (R = 0.42; p < 0.0001).

CONCLUSIONS

Type D personality was associated with poorer attitudes towards health. Among obese respondents with a type D personality, there was a significantly higher prevalence of those who believed that their health status was a consequence of chance events.

Distressed (Type D) personality is predicted by avoidance: evidence from a computer-based avatar task

Background

One personality type associated with poor health outcomes is distressed (Type D) personality which involves high levels of both social inhibition (SI) and negative affectivity (NA). Type D is also linked to psychopathologies such as post-traumatic stress disorder (PTSD), anxiety disorders, and depression. One mechanism through which personality temperament may result in these psychopathologies is avoidance. Recently, a computer-based measure designed to assess avoidant behaviors, in which the participant guides the behavior of an avatar interacting with strangers in social situations, has been found to be related to various forms of avoidance. In the current study, we extended this work with the avatar avoidance task to determine its relationship to distressed (Type D) personality. We hypothesized that Type D personality, along with SI, but not NA, would be positively related to avatar avoidance scores. We also hypothesized that avatar avoidance scores would be higher in Type D individuals than non-Type D individuals.

Methods

A total of 302 undergraduates completed the Distressed Type D Personality Scale (DS-14), and a computer-based avatar avoidance task.

Results

Type D and SI, and NA to a lesser degree, were positively correlated with avoidance scores on the avatar task. Furthermore, regression analyses revealed that Type D and SI scores were best predicted by a model including avoidance scores and education level while NA scores were best predicted by a model including avoidance scores. Standard cut-off scores on the DS-14 scale resulted in four groups (i.e., low SI and NA, high SI, high NA, and Type D) which significantly differed in avoidance scores. Specifically, Type D individuals had higher avoidance scores than the other three groups. Taken together these findings support a role for avoidance in Type D personality. The computer-based avatar avoidance task may be particularly relevant as an ecologically valid measure to identify avoidance in a virtual setting for use with individuals expressing Type D personality who may be unwilling or unable to accurately self-report or describe their own avoidant tendencies.

A Controlled Community Study of Distress and Resilience in Women Diagnosed with Fibromyalgia and Systemic Lupus Erythematosus

This study examines psychological and physical influences on the distress and well-being of patients with chronic rheumatic diseases. The study aims were to (1) evaluate the relative contribution of objective disease activity and psychological factors on the wellbeing of patients with systemic lupus erythematosus (SLE); (2) to compare the psychological distress of SLE patients to fibromyalgia (FM) patients and healthy controls, and to (3) characterize subgroups of patients by performing cluster analysis using psychological variables. Participants were ascertained from closed forums and social media channels resulting in 41 women with a diagnosis of SLE, 47 with a diagnosis of FM, and 77 healthy controls (HC). Hierarchical linear regression for well-being of SLE patients found that most of the variance was accounted for by social support. Cluster analysis performed on the entire sample identified two clusters, a distressed group tending to Type D personality, anxiety and depression, low in well-being and social support, and a resilient group; the proportion of resilient individuals was highest in the HC intermediate in the SLE group and lowest in the FM group. The importance of psychological variables vs disease severity in these two rheumatic diseases for wellbeing is demonstrated by these results. The results suggest that psychological interventions that enhance the experience of social support in medical settings, might benefit patients with both diseases, and be of particular importance to the well-being of patients who are more distressed.

The association of Type D personality with functional outcomes, quality of life and neuropathic pain in persons with spinal cord injury

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

This study aimed to investigate the association of Type D personality (TDP) with functional outcomes, health-related quality of life (HRQoL) and neuropathic pain in persons with spinal cord injury (SCI), using dichotomous and continuous analysis methods.

SETTING

Tertiary rehabilitation center.

METHODS

This study included 105 persons with SCI. Independence level was determined using the Functional Independence Measure (FIM)-motor subscale. The Short Form-36 questionnaire (SF-36) was used to assess HRQoL. TDP (combined existence of negative affectivity and social inhibition) was assessed using Type D Scale-14 (DS-14). Presence of chronic pain was questioned and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale was used to distinguish neuropathic pain from others.

RESULTS

In dichotomous method, the FIM-motor score was significantly lower in persons with TDP (41 persons, 39%) (p = 0.025). Persons with TDP had significantly lower scores in vitality, emotional role and mental health. There was no significant difference between the groups, regarding neuropathic pain and LANSS scores (p > 0.05 for all). Negative affectivity and total DS-14 scores had negative correlation with mental health and vitality. In continuous interaction method, TDP predicted mainly the mental health components of SF-36 (particularly, vitality and mental health). Negative affectivity was the driving factor. TDP was not associated with FIM-motor, VAS pain or LANSS scores.

CONCLUSIONS

Mental component of HRQoL is associated with Type D in persons with SCI in both analyses. Assessment of potential differences related with TDP may be beneficial to develop and apply person-specific goals in SCI rehabilitation.

Personality Type D, Level of Perceived Stress, Insomnia, and Depression Among High School Teachers in Poland

Teaching is inherently connected with specific burdens that may imply stressful situations. The goal of this study was to explore the prevalence of type D (distressed) personality in teachers. This is known to cause depressive episodes and sleep disorders, which not only have direct physical health effects, but can also impact the wellbeing of individuals and hence adversely affect their job performance. The participants consisted of 412 high school teachers from the Silesian Province, located in the south of Poland. Using the following research tools: Type D Scale (DS14), Perceived Stress Scale, Athens Insomnia Scale, and Beck Depression Inventory, it was found that type D personality was observed in a large percentage of teachers (30.1%). It was reported that teachers with distressed personality suffered from insomnia and depression significantly more often. Findings from the current study indicate the need to implement preventive activities focused on reducing psychosocial risk factors in the work environment in order to reduce the frequency of depressive disorders among teachers.

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.

A Psychophysiological Examination of the Mutability of Type D Personality in a Therapeutic Trial

Abstract. Identifying the associations between health and personality has been a focus for psychophysiological research. Type D personality is associated with predisposition to physical and psychological ill-health. This statistician-blind parallel-group controlled trial (intervention group vs. waiting list control group) examined the impact of Havening Techniques on the Type D constituents of negative affect (NA) and social inhibition (SI). One hundred twenty-five adult (18+ years) participants in the United Kingdom (72 females, 53 males) completed the Type D Scale-14 (DS14) measure of Type D personality at baseline (T1), 24-hours (T2), and at 1-month (T3). Forty participants in the treatment group received additional stress biomarker assessment of heart rate, blood pressure, and salivary cortisol. Type D caseness remained stable in the waiting list participants ( n = 57). In the treatment group ( n = 68); NA, SI, and total scores decreased from T1 to T2 ( p < .001, p < .001, and p < .001, respectively), and from T2 to T3 ( p = .004, p < .001, and p < .001, respectively), significantly transmuting to non-caseness ( p < .001 for T1 to T2; p = .025 for T2 to T3). Between T1 and T2, decreases in cortisol ( p < .001), diastolic blood pressure ( p < .001), and systolic blood pressure ( p < .001) were demonstrated. Heart rate fell nonsignificantly between T1 and T2 ( p = .063), but significantly from T1 to T3 ( p = .048). The findings of this study indicate the potential mutability of the psychophysiological illness-prone characteristics of Type D personality.

Factors Associated With Secondary Traumatic Stress Among Nurses in Regional Trauma Centers in South Korea: A Descriptive Correlational Study

INTRODUCTION

Trauma is a leading cause of death in South Korea. This study aimed to identify the factors associated with secondary traumatic stress of nurses working at regional trauma centers.

METHODS

A survey-based cross-sectional design was utilized. Data were collected through a structured questionnaire consisting of 5 rating scales and demographic data. Data were analyzed via descriptive statistics, t test, analysis of variance, Pearson's correlation, and multiple regression.

RESULTS

One hundred eighty-six nurses participated, and most (84.4%) reported moderate to severe secondary traumatic stress. Exposure to traumatic events averaged 34.33 (SD = 6.25) out of 65 points. Average problem-focused coping was 3.00 (SD = 0.37), emotion-focused coping was 2.57 (SD = 0.26), and dysfunctional coping was 2.17 (SD = 0.41) out of 4 points. Social support from family and friends averaged 5.85 (SD = 0.75), social support from coworkers was 5.78 (SD = 0.83), and social support from supervisors was 4.65 (SD = 1.18) out of 7 points. The factors affecting the respondents' secondary traumatic stress were type D personality (β = 0.39, P < .001), dysfunctional coping (β = 0.28, P < .001), problem-focused coping (β = 0.19, P < .01), desire for job rotation (β = 0.17, P < .01), and social support from supervisors (β = -0.12, P = < .05). This regression model was statistically significant and the explanatory power was 46.7% (F = 33.47, P < .001, Adj R² = 0.47).

DISCUSSION

Along with a personal effort to engage in stress management programs, administrators, managers, and supervisors should prioritize developing practical strategies for reducing secondary traumatic stress of nurses.

The mediating effect of resilience on the relationship between Type D personality and self-care behavior in patients with heart failure

AIM

There have been few studies done looking at the relationship between resilience, Type D personality, and self-care behavior in patients with heart failure. The purpose of this study was to identify the mediating effect of resilience on the relationship between Type D personality and self-care behavior in patients with heart failure.

METHODS

The subjects consisted of a sample of 90 heart failure patients aged ≥20 years who visited the cardiology outpatient clinic in the Chungbuk area of South Korea.

RESULTS

Among 90 patients, 49 subjects (54.0%) were classified as Type D personality, who exhibited statistically significant differences in resilience and self-care behavior (p < .001). A statistically significant correlation was also observed between self-care behavior score and resilience score (p < .01). The resilience had full mediation effects on the relationship between Type D personality and self-care behavior. In other words, the higher their resilience, the better their self-care behavior.

CONCLUSIONS

The study showed that resilience and Type D personality have important effects on self-care behavior.

Type D personality and cardiovascular reactivity to acute stress: The mediating effects of social support and negative social relationships

Type D personality has been consistently associated with adverse cardiovascular health with atypical cardiovascular reactions to psychological stress one potential underlying mechanism. As Type D individuals have been noted to report lower social support and greater perceptions of negativity in social interactions, this study examined if the association between Type D personality and cardiovascular reactivity was mediated by these social relationships. A sample of 195 undergraduate students (138 female) participated in this observational study, where they completed measures assessing Type D personality (DS14), social support, and perceptions of negative social relationships (National Institute of Health social relationship scales), before undergoing a traditional cardiovascular reactivity protocol. Systolic and diastolic blood pressure (SBP; DBP), heart rate (HR), cardiac output (CO), and total peripheral resistance (TPR) were monitored throughout. ANCOVAs and regressions indicated that Type D personality was associated with lower cardiovascular reactivity to a mental arithmetic stressor. Furthermore, mediation analyses (process macro) indicated that the relationship between Type D personality and cardiovascular reactivity was mediated via increased perceptions of negative social relationships, as well as lower levels of social support. Apart from a significant association between Type D personality and increased HR reactivity, all results failed to withstand adjustment for the individual effects of negative affect (NA) and social inhibition (SI) in controlled analyses. Overall, these findings suggest that the predictive utility of Type D personality on cardiovascular reactivity above and beyond the individual effects of NA and SI is limited, and may vary depending on the cardiovascular parameter of focus.

Negative Affectivity Is Associated with a Higher Systolic and Diastolic Blood Pressure in Normotensive Middle-Aged and Older Adults: A Cross-Sectional Study

Background and objectives: Type D personality, characterized by two stable traits (social inhibition and negative affectivity), is associated with adverse cardiovascular events. A possible mediating factor for this association could be hypertension. Previous research has shown that individuals with Type D personality were associated with an increased risk of hypertension. However, the association of negative affectivity and social inhibition on blood pressure in normotensive individuals has not yet been reported. Therefore, the aim of this study was to investigate whether negative affectivity and social inhibition were associated with systolic and diastolic blood pressure in normotensive middle-aged and older Taiwanese adults. Materials and Methods: A cross-sectional study design was used. Individuals attending general health examination at a regional hospital in southern Taiwan who were 40 to 75 years old were recruited. Patients with self-reported hypertension or currently receiving antihypertensive medication were excluded. Negative affectivity and social inhibition were assessed with the 14-item Type D Scale-Taiwanese version. Multiple linear regression analyses were conducted to determine the association of Z-score transformed negative affectivity and social inhibition on blood pressure. Results: A total of 92 patients with a mean age of 51.5 years were included in the study, and 15 (16.3%) were defined as having a Type D personality. The Z-score transformed negative affectivity score (p = 0.035, effect size = 0.18) and Z-score transformed social inhibition score (p = 0.054, effect size = 0.17) were significantly associated with a higher systolic blood pressure. In addition, the Z-score transformed negative affectivity score (p = 0.036, effect size = 0.28) and Z-score transformed social inhibition score (p = 0.154, effect size = 0.24) were significantly associated with a higher diastolic blood pressure. Conclusions: Negative affectivity of the Type D personality was significantly associated with higher systolic and diastolic blood pressure, with a medium effect size, in apparently healthy middle-aged and older adults. Assessment of negative affectivity may be clinically useful in identifying individuals at risk of hypertension.

Associations of eating alone with type D personality, depression and rejection sensitivity among South Korean university students

PURPOSE

To identify the associations of eating alone with type D personality, depression, and rejection sensitivity among South Korean university students.

DESIGN AND METHODS

Data were collected from 370 students recruited from five universities using a self-reported questionnaire.

FINDINGS

Eating alone had significant correlations with type D personality and depression. Significant factors affecting eating alone were age, place of residence, type D personality, and depression. These factors accounted for 17% in eating alone.

IMPLICATIONS FOR NURSING PRACTICE

There is a need for interventional programs that can reduce the negative effects of eating alone and prevent depression among students with type D personality.

Type D personality and life event stress: the mediating effects of social support and negative social relationships

Background and Objective: Type D personality has been associated with increased perceptions of stress. As Type D individuals have been noted to report lower social support and greater perceptions of negativity in social interactions, this study examined if the association between Type D personality and life events stress was mediated by these social relationships. Design: A cross-sectional design. Methods: Undergraduate students (N = 197) completed questionnaires assessing Type D personality, social support, negative social relationships, and life events stress. Results: Unadjusted analyses revealed that Type D individuals perceived their life events to be significantly more stressful than non-Type D individuals. Type D individuals also reported increased perceptions of negative social relationships and lower social support. Finally, the association between Type D personality and life events stress was mediated by perceptions of negative social relationships. However, when controlling for the main effects of negative affectivity and social inhibition, Type D was not significantly associated with social relationship or life events variables. Further, effects appeared to be primarily driven by negative affectivity. Conclusion: These results support recent findings in the Type D literature that have identified null effects of Type D when controlling for negative affectivity.

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.

Psychosocial markers of pre-hospital decision delay and psychological distress in acute coronary syndrome patients

Objectives Both pre-hospital decision delay - the time patients wait before seeking medical attention after symptoms have started - and high psychological distress after the cardiac episode predict poor prognosis of patients with acute coronary syndromes (ACS). We aimed to identify psychosocial markers of these prognostic factors. Design A cross-sectional study of 102 consecutive, clinically stable ACS survivors. Methods Participants completed a questionnaire measuring pre-hospital decision delay, psychological distress, and several known psychosocial factors related to cardiovascular health: type D personality, resilience, social support, and concerns during the cardiac event. Multiple linear regression and mediation analyses were conducted. Results Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress post-ACS, and these relationships were mediated by longer pre-hospital decision delay. In contrast, resilience was related to lower psychological distress. Social support and social concerns about help-seeking were not related to the outcome variables. Conclusions Type D personality may be a risk factor for more delayed help-seeking for an ACS and higher psychological distress after the cardiac event. Resilience, in contrast, emerged as a potential protective factor of patients' mental health after the cardiac event. Pre-hospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one's family) but not about social concerns (e.g., wasting other people's time) during the cardiac episode. Statement of Contribution What is already known on this subject? Longer pre-hospital decision delay, that is waiting longer to seek medical attention after symptoms have started, predicts poor prognosis of acute coronary syndrome patients. High psychological distress post-ACS, such as the development of anxiety and/or depression, also predicts poor prognosis of these patients. What does this study adds? This study identifies several psychosocial markers of longer prehospital decision delay and high psychological distress post-ACS. Prehospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one's family) but not about social concerns (e.g., wasting other people's time) during the cardiac episode. Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress, and these relationships were mediated by longer prehospital decision delay. Resilience was related to lower psychological distress post-ACS.

The dyadic effects of Type D personality on health in romantic couples

Objective: An individual's own personality traits are powerful predictors of their health outcomes (actor effects). However, the effect of personality on health may also occur at an interpersonal level, whereby the personalities of people close to the individual also affect his or her health outcomes (partner effects). Our objective was to examine the actor and partner effects of Type D personality on health in romantic couples for the first time.Design: Cross-sectional questionnaire-based study (N = 364), consisting of 182 romantic couples from the general population (mean age = 35.7 years).Main outcome measures: Each participant completed self-report measures of Type D personality (DS14), health behaviours (GPHB), mood (DASS-21) and quality of life (WHOQOL-BREF).Results: Data were analysed using the Actor-Partner Interdependence Model (APIM). The APIM showed no actor or partner effects of the overall Type D construct. However, there were actor effects of negative affect for both males and females on depression and quality of life, a male actor effect of social inhibition on quality of life, and a female partner effect of social inhibition on depression.Conclusions: These findings suggest that there are both actor and partner effects of the Type D components on some health outcomes.

Prevalence and Correlates of Type D Personality among Survivors following Acute Myocardial Infarction in a Tertiary Care Center in South India

Background  Type D personality, described as a consistent tendency to experience increased levels of social inhibition and negative affectivity, has a robust association with negative outcomes following myocardial infarction (MI). However, little is known about its determinants in our setting. Our aim was to assess the prevalence and correlates of Type D personality among survivors following acute MI (AMI). Methods  Two hundred participants with AMI were recruited over an 18-month period. Type D scale-14 was used to evaluate the presence of Type D personality. Apart from sociodemographic factors, depression, anxiety, stress, coping, personality, quality of life, and perceived social support were assessed using standard measures. Results  Type D personality was present in 24% of samples ( n = 48). In multivariate Poisson regression analysis, younger age (prevalence ratio [PR]: 0.950, 95% confidence intervals [CIs]: 0.927-0.974), high depression (PR: 1.372, 95% CI: 1.216-1.548), and low family support (PR: 0.898, 95% CI: 0.849-0.949) emerged as independent predictors of Type D personality in participants with AMI. Conclusion  Type D personality is seen in a significant proportion of AMI, consistent with global literature. Our findings suggest that among Indian patients with AMI, the presence or absence of Type D personality may represent two distinct subpopulations.

Cognitive Bias of Interpretation in Type D Personality: Associations with Physiological Indices of Arousal

It is argued that the Type D person experiences increased distress when encountering social situations, which results in altered stress responding. However, little is known about how Type D individuals behave or feel during social interactions. Using a within-subjects design, the present study examined the physiological arousal of Type D and non-Type D individuals when rating how they would deal with a number of hypothetical social situations. Results showed that across all social situations, Type D individuals experienced greater levels of discomfort. In clearly negative and ambiguously neutral situations, this was paired with higher pulse rate. This study shows that the Type D individual not only reports greater discomfort but also experiences changes physiologically that support the role of the cardiovascular system as a potential psychosomatic pathway to disease.

Predictive model for quality of life in patients with recurrent coronary artery disease

Background:

The aims of this study were to construct and verify a model that explains the quality of life in patients with recurrent coronary artery disease.

Methods:

Participants were 212 patients with recurrent coronary artery disease undergoing percutaneous coronary intervention. Data were collected through structured questionnaires from 21 December 2016–30 April 2017, and were analyzed using SPSS 23.0 and AMOS 23.0.

Results:

The model’s fit indices were adequate. Type D personality, symptom experience, and resilience had a direct effect on quality of life, while type D personality, cardiac function status, social support, and resilience had an indirect effect on quality of life. Type D personality, cardiac function status, social support, symptom experience, and resilience explained 55% of the total variance in quality of life. Thus, type D personality, cardiac function status, social support, symptom experience, and resilience affected the quality of life in patients with recurrent coronary artery disease.

Conclusions:

Systematic and integrated intervention programs considering factors related to quality of life may be useful for improving quality of life for patients with recurrent coronary artery disease.

Negative Affect, Type D Personality, Quality of Life, and Dysfunctional Outcomes of Total Knee Arthroplasty

Background

Type D personality (TDP) is a sign of tapered stress and compromises treatment outcomes including those of hip arthroplasty. The common dissatisfaction with total knee arthroplasty (TKA) is predicted by fear avoidance, pain catastrophizing and emotional lability, with poor quality of life (QoL) reflecting these strains. This study is the first to investigate the influence of TDP on TKA assuming (1) negative affect (NA) to be linked to fear avoidance and to increased dissatisfaction with TKA and (2) the expression of NA and social inhibition (SI) to not be stable over time.

Method

We studied 79 participants using the brief symptom inventory-18, the pain-catastrophizing scale, the Tampa scale of kinesiophobia, the SF-36, and the WOMAC preoperatively and 12 months postoperatively. T-test and regression were used to compare the variables of interest between groups built based upon outcome severity.

Result

NA at follow-up predicted knee pain (p=0.02) and knee function (p < 0.01) at follow-up. Contrarily, increased expressions of NA/SI at follow-up were predicted by NA (p=0.04) and rumination (p=0.05) at the baseline.

Conclusion

The present results suggest the postoperative increase of NA to be linked to dysfunctional outcomes of TKA due to an interaction with pain catastrophizing. Baseline self-rated physical health did not connect to the dissatisfaction with TKA 1-year postoperatively.

Mediating effect of illness perception on the relationship between Type D personality and health behaviors among coronary artery disease patients

The aim of this study was to investigate the relationship between Type D personality and health behaviors of coronary artery disease patients and to determine the mediating effect of illness perception on this relationship. The participants were 142 coronary artery disease patients who underwent percutaneous coronary intervention in a university hospital in Korea. Type D personality, illness perception, and health behaviors were surveyed using structured questionnaires. The collected data were analyzed by a series of hierarchical multiple regressions. A total of 28.9 percent patients had Type D personality. Type D Patients were observed to have low illness perception and low health behaviors. There was a positive correlation between illness perception and health behaviors. The direct effect of Type D personality on health behaviors was significant (β = -.209, p = .013). However, the indirect effect of Type D personality on health behaviors via illness perception became low and non-significant (β = .007, p = .934). Based on the above results, it can be concluded that illness perception has a complete mediating effect on the relationship between Type D personality and health behaviors. The development of interventions that can improve illness perception is needed to improve health behaviors of Type D coronary artery disease patients.

Role of personality in cardiovascular diseases: An issue that needs to be focused too!

This review provides a broad overview of the relationship of personality with cardiovascular diseases (CVDs). There has been a sustained interest over the last half a century on the issue of relationship between personality traits and CVDs. Type A behavior was the initial focus of inquiry as it was observed that individuals who were competitive, hostile, and excessively driven were overrepresented among patients seeking treatment for CVDs and also were prone to develop coronary artery disease/syndrome. However, the research gradually expanded to assess the relationship of cardiac morbidity with various other personality facets. Furthermore, studies found out that negative effects (including anger and hostility) were also associated with adverse cardiovascular outcomes. Subsequently, a new personality entity named as the type D ‘distressed’ personality, which combined negative affectivity and social inhibition. type D personality then became the area of research and was demonstrated to be related with poorer cardiac outcomes. Interestingly, the results of various research studies are not equivocal, and hence, there are several critiques related to the current understanding of the link between personality construct and the risk of development as well as the outcome of CVDs. Furthermore, few personality traits such as optimism, conscientiousness, openness to experience, and curiosity have been found to be protective factors against development of CVDs and therefore are called ‘cardioprotective’ personality traits. A detailed discussion on the various aspects of personality in relation to CVDs along with a critical appraisal has been presented in this review.

Effect of Type D Personality on Short-Term Cardiac Rehabilitation in Patients With Coronary Artery Disease

Objective

To investigate the effect of type D personality on cardiac rehabilitation (CR) participation rates and the effect of a short-term CR program.

Methods

Study participants included patients diagnosed with acute coronary syndrome who underwent percutaneous coronary intervention. Patients completed the Type D personality Scale (DS-14) and the Hospital Anxiety and Depression Scale (HADS) at program entry. Subjects were recommended participation in 6 weeks of CR exercise training. Cardiopulmonary exercise test (CPET) was conducted before and after completion of the training. CR participation refers to completion of the 6-week CR exercise program and performance of the secondary CPET. Drop-out refers to the subjects who were unable to participate in the 6-week CR exercise program or to perform the secondary CPET.

Results

At baseline, type D personality was evident in 21 of 63 patients (33.3%). Type D patients were more often depressed (57.1%) and anxious (38.1%) than non-type D patients (31.0% and 9.5%, respectively). At baseline, participants with type D personality showed a decreased body mass index (24.6 vs. 26.1 kg/m², p=0.025). The type D group displayed a lower CR participation rate (5/21, 23.8%) compared with the non-type D group of (22/42, 52.4%). Logistic regression analysis revealed the association of type D personality with CR drop-out rate (odds ratio=3.87; 95% confidence interval, 1.2–12.5; p<0.05).

Conclusion

Type D personality was independently associated with drop-out from CR program and with significantly higher levels of anxiety and depressive mood.

Type D personality and social relations in adults with diabetes: results from diabetes MILES - The Netherlands

OBJECTIVE

To examine whether individual differences in Type D personality (combination of negative affectivity (NA) and social inhibition (SI)) could explain heterogeneity in perceived social support and relationship adjustment (intimate partner relationship) among people living with diabetes.

DESIGN

In the Diabetes MILES-The Netherlands survey, 621 adults with type 1 or type 2 diabetes (54% female, age: 56 ± 14 years) completed measures of Type D personality (DS14), perceived social support and relationship adjustment. We used established DS14 cut-off scores to indicate Type D personality, high NA only, high SI only and reference groups.

RESULTS

Participants from the Type D and NA only groups perceived lower levels of social support (Welch[3,259] = 37.27, p < 0.001), and relationship adjustment (Welch[3,191] = 14.74; p < 0.01) than those from the SI only and reference groups. Type D was associated with lower social support (lowest quartile; adjusted OR = 8.73; 95%CI = 5.05 ∼ 15.09; p < 0.001) and lower relationship adjustment (lowest quartile; adjusted OR = 3.70; 95%CI = 2.10 ∼ 6.53; p < 0.001). Type D was also associated with increased levels of loneliness.

CONCLUSION

Participants with Type D and participants with high NA only tend to experience less social support and less relationship adjustment. Type D personality was also associated with more loneliness. Experiencing lower social support and relationship adjustment may complicate coping and self-management in people with diabetes.

Impact of type D personality on clinical outcomes in Asian patients with stable coronary artery disease

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.

Type D personality is associated with increased desire for alcohol in response to acute stress

Type D personality (the combination of negative affectivity and social inhibition) is associated with high levels of alcohol consumption. We examined if Type D was associated with higher levels of alcohol use, and if Type D was associated with desire for alcohol in response to a social stressor. In an experimental study, participants (n = 138) completed measures of Type D, stress, and alcohol use. They also took part in a stress-inducing public speaking task and provided measures of desire for alcohol at baseline, stressor, and recovery. Type D was associated with higher levels of alcohol use, stress, and desire for alcohol at stressor and recovery. Mixed measures analysis of variance demonstrated that there was a significant group effect of Type D (F(1, 136) = 6.86, p < .05) and a significant time × Type D interaction (F(1.50, 204.49) = 3.44, p < .05) on desire for alcohol. Type D individuals exhibited significantly higher levels of desire for alcohol during the stressor and recovery phases, compared to non-Type D individuals suggesting that Type D individuals may be motivated to consume alcohol in order to cope with stressful situations.

The physical and psychological health benefits of positive emotional writing: Investigating the moderating role of Type D (distressed) personality

OBJECTIVES

Type D personality is associated with psychological and physical ill-health. However, there has been limited investigation of the role of Type D personality in interventions designed to enhance well-being. This study investigated associations between Type D personality and the efficacy of positive emotional writing for reducing stress, anxiety, and physical symptoms.

DESIGN

A between-subjects longitudinal design was employed.

METHOD

Participants (N = 71, M_age  = 28.2, SD_age  = 12.4) completed self-report measures of Type D personality, physical symptoms, perceived stress, and trait anxiety, before completing either (1) positive emotional writing or (2) a non-emotive control writing task, for 20 min per day over three consecutive days. State anxiety was measured immediately before and after each writing session, and self-report questionnaires were again administered 4 weeks post-writing.

RESULTS

Participants in the positive emotional writing condition showed significantly greater reductions in (1) state anxiety and (2) both trait anxiety and perceived stress over the 4-week follow-up period, compared to the control group. While these effects were not moderated by Type D personality, a decrease in trait anxiety was particularly evident in participants who reported both high levels of social inhibition and low negative affectivity. Linguistic analysis of the writing diaries showed that Type D personality was positively associated with swear word use, but not any other linguistic categories.

CONCLUSION

These findings support the efficacy of positive emotional writing for alleviating stress and anxiety, but not perceived physical symptoms. Swearing may be a coping strategy employed by high Type D individuals. Statement of contribution What is already known on this subject? Type D (distressed) personality is characterized by high levels of both negative affectivity and social inhibition, and has been associated with adverse physical and psychological health. Positive emotional writing is known to reduce subjectively reported physical symptoms and increase positive affect. What does this study add? Positive emotional writing was shown to attenuate (1) state anxiety immediately post-writing, and (2) trait anxiety and perceived stress 4 weeks post-writing. The findings demonstrate that positive writing might be a useful intervention for attenuating the adverse psychological effects of Type D personality in the general population. Type D personality was associated with more frequent use of swear words, which may be a coping mechanism used by high Type D individuals.

Type D personality and coronary atherosclerotic plaque vulnerability: The potential mediating effect of health behavior

OBJECTIVE

The association between type D personality and coronary plaque vulnerability has been suggested. The objective of the study was to evaluate the potential mediating effects of health behavior on the association between type D personality and plaque vulnerability in coronary artery disease (CAD) patients.

METHODS

A total of 319 CAD patients were assessed for type D personality and health behavior via self-administered questionnaires. The plaque vulnerability, evaluated according to characteristics, accompaniment, and outcomes of plaque, was assessed by optical coherence tomography.

RESULTS

Regression analysis showed that type D personality was independently associated with lipid plaque (odds ratio [OR] = 2.387, p = 0.001), thin cap fibroatheroma (TCFA) (OR = 2.366, p = 0.001), rupture (OR = 2.153, p = 0.002), and lipid arc (β = -0.291, p < 0.001). Mediation analyses showed that aspects of health behavior were significant mediators of the relationship between type D personality and plaque vulnerability. Psychological stress mediated the relationship between type D and lipid plaque (p = 0.030), TCFA (p = 0.034), and rupture (p = 0.013). Living habits significantly mediated the relationship between type D and lipid plaque (p = 0.028), TCFA (p = 0.036), but not rupture (p = 0.066). Participating in activities was not a significant mediator of the relationship between type D personality and lipid plaque (p = 0.115), TCFA (p = 0.115), or rupture (p = 0.077).

CONCLUSIONS

Health behaviors (psychological stress and living habits) may be mediators of the association between type D personality and plaque vulnerability.

Effect of type D personality on smoking status and their combined impact on outcome after acute myocardial infarction

BACKGROUND

Smoking cessation is correlated with several psychological, social, biological, and pharmacological aspects. The combined tendency to experience negative emotions and to inhibit the expression of these emotions is indicated as "type D personality," an independent risk marker for clinical outcome in cardiac disease. Despite this effect of type D personality on cardiovascular disease, it is still unclear whether this personality trait may influence smoking cessation after a myocardial infarction.

HYPOTHESIS

we hypothesized that there is a relationship between type D personality and smoking persistence in acute coronary syndrome patients, and this association may predict a worse long-term prognosis.

METHODS

The study enrolled 231 patients with ST-segment elevation myocardial infarction, treated with primary percutaneous coronary intervention. Type D scale 14 (ds 14) was administered upon admission to the hospital.

RESULTS

After controlling for demographic and clinical confounders, non-type D patients reported statistically significant higher frequencies of smoking cessation when compared with the type D group. In addition, the presence of this psychological factor anticipates significantly the onset of smoking during adolescence. Furthermore, current type D smokers had a higher incidence of cardiovascular events during long-term follow-up.

CONCLUSIONS

Type D personality and smoking status increase the risk of cardiac events. An emotionally stressed personality and persistence of smoking after the first cardiac event, and mostly their mutual influence, indicate a population at high cardiovascular risk.

An exploratory study of adolescent response to fluoxetine using psychological and biological predictors

Background

Not enough is known about predicting therapeutic response to serotonin-specific reuptake inhibitors, and specifically to fluoxetine. This exploratory study used psychological and biological markers for (retrospective) prediction of treatment-response to fluoxetine in depressed and/or anxious adolescents.

Methods

Forty-one consecutive adolescent outpatients with a primary diagnosis of severe affective and/or anxiety disorders were assessed and treated with an open-label 8-week trial of fluoxetine. Type D personality was assessed with the 14-item questionnaire, the DS14. In addition, TNFα, IL-6, and IL-1b were measured pre- and post-treatment.

Results

There was an elevation of Type D personality in patients, compared to the adolescent population rate. Post-treatment, 44% of patients were classified as non-responders; the relative risk of non-response for Type D personality patients was 2.8. Binary logistic regression predicting response vs. non-response showed a contribution of initial TNFα levels as well as Type D personality to non-response.

Conclusions

In this exploratory study, the most significant contributor to non-response was Type D personality. However, the measurement of Type D was not prospective, and thus may be confounded with psychiatric morbidity. The measurement of personality in psychiatric settings may contribute to the understanding of treatment response and have clinical utility.

Prognostic Value of Type D Personality for In-stent Restenosis in Coronary Artery Disease Patients Treated With Drug-Eluting Stent

OBJECTIVE

To evaluate the predictive value of Type D personality on in-stent restenosis (ISR) rates at 1 and 2 years post-percutaneous coronary intervention (PCI) in patients with coronary artery disease.

METHODS

Consecutive patients with coronary artery disease who underwent PCI for drug-eluting stents (n = 173) completed the Type D Scale-14 (DS14) at baseline. Follow-up coronary angiographic evaluation was routinely planned at 1 and 2 years after the procedure.

RESULTS

Follow-up coronary angiography was performed in 159 and 112 patients at 1 and 2 years post-PCI, respectively. On multivariate analysis, Type D personality was found to be an independent predictor of ISR at 1 year (odds ratio [OR] = 2.67, 95% confidence interval [CI] = 1.16-6.14, p = .021) and 2 years (OR = 4.92, 95% CI = 1.82-9.60, p = .017) after adjusting for cardiovascular risk factors. However, Type D did not predict ISR when the analysis was performed using the interaction between negative affectivity and social inhibition. The main effect of negative affectivity emerged as a significant risk factor for 1-years (OR = 4.22, 95% CI = 1.18-7.86, p = .034) and 2-year ISR (OR = 6.93, 95% CI = 2.25-11.50, p = .016).

CONCLUSIONS

In this study, Type D personality was an independent predictor of ISR at 1 and 2 years post-PCI; the association strengthened with time. The negative affectivity component seems to drive the relationship between Type D and ISR over time. Our findings provide new insights into the mechanisms involved in the association between Type D and adverse clinical outcomes of PCI.

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.

Spirit or Fleeting Apparition? Why Spirituality's Link with Social Support Might Be Incrementally Invalid

Previously published path models apparently confirm the belief-as-benefit perspective that spirituality boosts well-being via social support. The broad acceptance of such findings has motivated recommendations that clinical psychologists and psychiatrists routinely assess their patients' spiritual status. Skeptics retort that past findings are statistically confounded and that numinous beliefs and well-being are unrelated. A multivariate regression analysis testing whether spirituality explains variance in social support after personality traits are simultaneously included is reported. Although spirituality displays a significant positive correlation and partial correlation (after controlling for socio-demographics) with social support, regression analysis specifying agreeableness and conscientiousness-individual differences related to both spirituality and social support-as predictors renders spirituality nonsignificant. In summary, spirituality's correlation with social support appears spurious; demonstrating the hazards of relying on simple associations and highlighting the urgent need for researchers to utilize statistical methods capable of establishing cause and parsing effects across rival theoretical explanations.