Does type-D personality predict outcomes among patients with cardiovascular disease? A meta-analytic review

Should presurgical psychological evaluations still be a mandated requirement for metabolic and bariatric surgery? A critique of the literature and thoughts on future directions

For more than 30 years, clinical practice guidelines for the perioperative support of patients who undergo metabolic and bariatric surgery have recommended a formal psychological evaluation before surgery. However, the predictive utility of the evaluation in determining future outcomes has been mixed, leading to controversy regarding whether such evaluations should be required for all potential patients. This empirically based commentary will review the utility and value of the psychological evaluation in addition to the limitations in the extant literature that reduce predictive validity and provide recommendations on how to improve quality of the empirical literature and refinements to increase the utility of preoperative evaluations. Pre-metabolic and bariatric surgery psychological evaluation conducted by an appropriately trained clinician and properly reimbursed by the payor that includes time for psychological testing, integration of data, report writing, medical record review, and feedback to the patient and surgical team, should continue to be the standard of care as it benefits all stakeholders.

Association between personality traits and psychological distress among postmenopausal women with coronary heart disease: A cross-sectional survey and mediation analysis

Postmenopausal women with negative personality characteristics are at an increased risk of psychological disorders, yet little is known about the mechanism underlying the relationship between type D personality and psychological distress in postmenopausal women with coronary disease. This study assessed the mediating roles of perceived social support and self-perceived burden in the relationship between type D and psychological distress based on the equity theory and stress-buffering model. Demographic characteristics, type D, psychological distress, perceived social support, and self-perceived burden were completed by 335 participants with self-reported questionnaires using a cross-sectional design in Southeast China. The results revealed that perceived social support and self-perceived burden both separately and serially mediated the relationship between type D personality and psychological distress. Effective intervention strategies aimed at improving perceived social support or reducing self-perceived burden may be beneficial in reducing psychological distress.

Type D personality is associated with lower cardiovascular reactivity to stress in women

OBJECTIVE

This study examines if Type D personality is (1) associated with cardiovascular reactivity to acute stress in a healthy sample, and (2) has predictive utility for cardiovascular reactivity above its individual subcomponents (negative affect; NA, social inhibition; SI), as well as anxiety and depression.

DESIGN

Undergraduate students (n = 173) competed a standardised cardiovascular reactivity experimental protocol consisting of resting baseline and stressor phase (mental arithmetic), with systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) monitored throughout.

MAIN OUTCOME MEASURES

The main outcome measures were cardiovascular reactivity to the stressor, which was operationalised as the difference between resting baseline and the stressor phase for SBP, DBP and HR.

RESULTS

The continuous Type D interaction term (NA × SI) significantly predicted lower SBP reactivity to the mental arithmetic stressor amongst women, independent of NA, SI and confounding variables. Moreover, this remained significant after adjustment for anxiety and depressive symptoms. Depression, NA and SI were also significant independent predictors of SBP reactivity amongst women.

CONCLUSION

Type D personality is associated with lower SBP reactivity to acute stress in women, which may be indicative of blunted cardiovascular reactivity. This association was independent of NA, SI, Anxiety and Depression.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

The negative affectivity dimension of Type D personality associated with increased risk for acute ischemic stroke and white matter hyperintensity

OBJECTIVE

This study was conducted to examine the relationship among type D personality, acute ischemic stroke (AIS), and white matter hyperintensity (WMH).

METHODS

In a cross-sectional study conducted between September 2020 and June 2021, 235 patients aged 50-85 years with first-ever ischemic cerebrovascular disease, including 146 males and 89 females, were enrolled. All participants underwent the Type D Scale-14 test containing negative affectivity (NA) and social inhibition (SI) subscales. Clinical and laboratory data were also collected for analysis. The patients were divided into the AIS group (n = 148) and the transient ischemic attack (TIA) group (n = 87) according to whether there was an acute lesion.

RESULTS

Patients with type D personality had a higher frequency of AIS and LAA and a higher level of WMH. Multiple logistic regression showed that the NA score was related to a 1.11-fold increase in the odds of AIS (95% CI: 1.03-1.19). Neither NA nor SI showed a clear association with a higher frequency of LAA. Higher scores of NA (OR = 1.07, 95% CI: 1.01-1.15), SI (OR = 1.11, 95% CI: 1.03-1.19), and the interaction between the two dimensions (OR = 1.03, 95% CI: 1.01-1.05) were independently associated with an increased load of WMH.

CONCLUSION

Type D personality was related to AIS and WMH. In particular, it was NA, not SI, affected the occurrence of AIS. Our findings may provide new insights regarding behavioral vulnerability for the development of cerebrovascular disorders.

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

AIMS

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

METHODS AND RESULTS

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

CONCLUSION

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

[Evaluation of the efficacy of a psychological intervention program in a Cardiac Rehabilitation Unit after acute coronary syndrome]

INTRODUCTION

Psychosocial factors influence the prognosis of cardiovascular disease. The improvement of these variables through cardiac rehabilitation programs showed inconclusive results. Our objective was to evaluate the benefits of a psychological intervention program in heart disease patients participating in a cardiac rehabilitation program.

MATERIAL AND METHODS

Quasi-experimental retrospective study that included 157 consecutive patients referred to the Cardiac Rehabilitation Unit from September 2017 to May 2018. Participants completed a battery of questionnaires at the beginning and at the end of the rehabilitation program in order to evaluate 9 psychosocial variables. Five of these variables were reevaluated at 12months. Finally, a comparative analysis was carried out between the group that performed a specific psychological intervention and the control group.

RESULTS

Average age 55±8 years. 77% (n=122) were male. 72% (n=113) carried out a specific psychological intervention program. After completing the program, the psychological intervention group improved statistically significantly in 8of the 9variables analyzed compared to only 2in the control group and with a higher effect size (medium or large size: Cohen's d> 0.5). Furthermore, this benefit was maintained at one year for the psychological intervention group.

CONCLUSIONS

Overall, face-to-face cardiac rehabilitation programs improve the psychological sphere of the patient with acute coronary syndrome. In addition, those patients who complete a specific psychological intervention program significantly improve a greater number of psychological variables and to a greater extent compared to those who do not.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

PATIENTS AND METHODS

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

RESULTS

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

CONCLUSION

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

Type D personality and blunted cardiovascular stress reactivity: Role of task engagement

OBJECTIVE

The underlying mechanisms for linking Type D personality to cardiovascular stress reactivity remain unknown. The present study explored the possible mediating role of cognitive appraisals of stress and/or motivational levels involved in stress in the association between Type D personality and cardiovascular stress reactivity.

DESIGN

Cross-sectional.

METHODS

Chinese version of Type D Scale-14 was administered to 154 undergraduate students who underwent psychosocial stress during which the physiological data were continuously monitored, and cognitive appraisals indexed by a ratio of perceived stress demands to perceived personal resources and motivational levels engaged in stress indexed by self-reported stress task engagement were immediately assessed after the stress exposure.

RESULTS

Results indicated that Type D personality was related to blunted HR, SBP, and DBP reactivity to stress. Self-reported stress task engagement mediated the relation between Type D personality and blunted cardiovascular stress reactivity. The mediation effect of cognitive appraisals on this link was non-significant.

CONCLUSIONS

These findings suggest that motivational disengagement in the psychosocial stress task might be an important pathway linking Type D personality to blunted cardiovascular stress reactivity.

Impact of type D personality on major adverse cardiac events in patients undergoing percutaneous coronary intervention: The mediating role of cognitive appraisal and coping style

OBJECTIVE

Individuals with type D personality are characterized by maladaptive cognitive appraisal and coping styles, but it remains unclear whether cognitive appraisal and coping style mediate the interaction between type D personality and major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI). This gap was investigated in this study.

METHODS

A prospective study was conducted on a cohort of 392 individuals after undergoing PCI. All participants completed questionnaires meant to collect information about type D personality, cognitive appraisal, coping styles and demographic characteristics. They were then prospectively followed for up to 1 year for occurrence of MACE after PCI. Path analyses were performed to assess mediating effects of cognitive appraisal and coping styles.

RESULTS

The path analysis revealed that type D personality and negative affectivity (NA) had a direct positive effect on MACE (odds ratio [OR] = 1.056, 95% confidence interval [CI] = 1.023, 1.089，p = .031; OR = 1.118, 95% CI = 1.031, 1.205, p = .001), but indirect effects on MACE through negative appraisal, positive appraisal and acceptance-resignation coping (P < .001). MACE was not significantly associated with social inhibition (SI), the interaction of NA and SI (both p > .05).

CONCLUSIONS

This study revealed that type D personality and NA dimension increased the likelihood of developing MACE after PCI. Cognitive appraisal and coping styles mediated the association between type D personality and MACE. These findings may provide factors that lead to poor prognosis of patients with type D personality undergoing in PCI.

Type D Personality and Health-Related Quality of Life in Vascular Surgery Patients

BACKGROUND

This study evaluated the association of type D personality and health-related quality of life (HRQoL) and assessed the stability of type D personality in vascular surgery patients during the year after surgery.

METHOD

In a prospective cohort study between 2008 and 2014, 294 patients were assessed with validated questionnaires preoperatively and at 1, 6, and 12 months after surgery. Associations between type D personality, depression, and HRQoL were analyzed by generalized estimating equation models. Type D personality was analyzed in its standard dichotomous form as well as continuous (z) scores of its two components, negative affectivity (NA) and social inhibition (SI), and their interaction term.

RESULTS

Prevalence of type D personality varied between 18% and 25%. However, only 9% of the complete responders were classified as type D personality at all four assessments, whereas one third changed between type D classifications. Continuous scores showed greater stability over time. Dichotomized type D personality measured over time was significantly associated with impaired HRQoL, but this was not the case if measured once at baseline, like in general use. The continuous NA score and depression were also significantly associated with impaired HRQoL over time.

CONCLUSION

Type D personality was not a stable trait over time. Preoperative assessment of type D personality did not predict improvement in HRQoL after vascular surgery. However, the study revealed associations between the NA component of type D personality, depression, and lower HRQoL. This indicates that measures of overall negative affect should be taken into account when assessing HRQoL patient-reported outcomes in vascular surgery patients.

[Type D personality in patients with coronary heart disease underwent coronary stenting: a prospective study]

AIM

To evaluate the type D personality relation with clinical and instrumental parameters in patients with coronary heart disease (CHD) underwent coronary stenting (CS) and to determine the influence of the personality type D on the prognosis in these patients within one year after CS. Material and methods. Into prospective study we included 977 patients (740 men and 237 women) aged 33 to 86 years (mean age 58.7±9.4) who underwent CS. The Cox proportional hazard regression model was used to estimate the relative risk (RR) with a 95% confidence interval (CI) of the end point. The end points included death from all causes, death from cardiovas- cular disease (CVD), myocardial infarction (fatal + non-fatal) (MI), non-fatal myocardial infarction (non-fatal MI), unstable angina (UA), and stroke. Results. Type D personality was found in 31.8% patients. These did not differ from the others in terms of age, gender, main cardiovascular risk factors. Patients of D-type had tendency to the increase of diabetes diagnosed - 25.1% vs 20.3% (p=0.09). At the same time D-type patients had more prevalent ≥2 myocardial infarction in anamnesis - 9.0% vs 4.5% (p=0,006) among those with post infarction cardiosclerosis. There was no difference between the groups according to echocardiography and the short-term outcomes of CS. During the prospective study period (12±1.8 months) 24 patients (2.4%) died from all causes, 21 patients (2.1%) died from CVD. MI developed in 47 patients (4.8%) of whom, 23 patients (2.4%) underwent non-fatal MI. In 50 patients (5.1%) ischemic heart disease in a prospective period complicated UA. In 8 patients (0.8%) developed a stroke. There was no effect of personality type D on the prognosis in patients with CHD who underwent CS for 1 year after surgery. Conclusion. Among CHD patients underwent CS, type D personality was found in 31.8%. There is no link for type D personality and severity of CHD clinically as well as the short-term and long-term outcomes of CS.

Modeling Interactions Between Latent Variables in Research on Type D Personality: A Monte Carlo Simulation and Clinical Study of Depression and Anxiety

Several approaches exist to model interactions between latent variables. However, it is unclear how these perform when item scores are skewed and ordinal. Research on Type D personality serves as a good case study for that matter. In Study 1, we fitted a multivariate interaction model to predict depression and anxiety with Type D personality, operationalized as an interaction between its two subcomponents negative affectivity (NA) and social inhibition (SI). We constructed this interaction according to four approaches: (1) sum score product; (2) single product indicator; (3) matched product indicators; and (4) latent moderated structural equations (LMS). In Study 2, we compared these interaction models in a simulation study by assessing for each method the bias and precision of the estimated interaction effect under varying conditions. In Study 1, all methods showed a significant Type D effect on both depression and anxiety, although this effect diminished after including the NA and SI quadratic effects. Study 2 showed that the LMS approach performed best with respect to minimizing bias and maximizing power, even when item scores were ordinal and skewed. However, when latent traits were skewed LMS resulted in more false-positive conclusions, while the Matched PI approach adequately controlled the false-positive rate.

The negative affectivity dimension of Type D personality is associated with in-stent neoatherosclerosis in coronary patients with percutaneous coronary intervention: An optical coherence tomography study

OBJECTIVE

In-stent neoatherosclerosis (ISNA) is involved in the pathogenesis of in-stent restenosis and major adverse cardiac events (MACE) in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). We aimed to explore the association between Type D personality and ISNA via in vivo optical coherence tomography (OCT).

METHODS

One hundred and fifty-six patients with CAD completed the Type D Scale-14 and underwent in vivo measurement of in-stent neoatherosclerosis by OCT. The Type D construct was analyzed as both the dichotomous and the dimension constructs.

RESULTS

After adjusting for demographic and clinical factors and presenting as a dichotomous construct, Type D personality was independently associated with the presence of in-stent neoatherosclerosis (odds ratio [OR] = 2.99, 95% confidence interval [CI] = 1.35-6.63, p = 0.007) and in-stent thin-cap fibroatheroma (OR = 2.81, 95% CI = 1.27-6.23, p = 0.01). Meanwhile, the multiple logistic regression also showed that the main effect of negative affectivity was an independent risk factor of in-stent neoatherosclerosis (OR = 1.85, 95% CI = 1.25-2.75, p = 0.002) and in-stent thin-cap fibroatheroma (OR = 1.77, 95% CI = 1.18-2.67, p = 0.006). However, the main effects of social inhibition with in-stent neoatherosclerosis and in-stent thin-cap fibroatheroma (OR = 0.98, 95% CI = 0.64-1.52, p = 0.94; OR = 0.94, 95% CI = 0.63-1.39, p = 0.75, respectively) as well as the interaction of negative affectivity and social inhibition were not significant (OR = 0.71, 95% CI = 0.69-1.81, p = 0.11; OR = 0.72, 95% CI = 0.47-1.08, p = 0.12, respectively).

CONCLUSIONS

Type D personality was found to be independently associated with in-stent neoatherosclerosis via OCT in patients with CAD after PCI. It was negative affectivity, not social inhibition, that affected the occurrence of the in-stent neoatherosclerosis, these results challenged the usefulness of the Type D construct. Our findings may provide new insights regarding the mechanisms of the association between Type D personality and MACE after PCI.

The Physical Burden of Immunoperception

The previous chapter introduced the ImmunoEmotional Regulatory System (IMMERS). Also, there was a brief discussion about psychological states/psychiatric disorders that so far have been linked to the IMMERS. The present chapter considers another aspect of the IMMERS in which physiological states/physical diseases can be fit to the IMMERS.

Type D personality affects health-related quality of life in patients with lone atrial fibrillation by increasing symptoms related to sympathetic activation

BACKGROUND

Health-related quality of life (HRQoL) is impaired in patients with atrial fibrillation (AF), and even more so in patients with a Distressed personality type (Type D). It is unknown whether this extends to patients with 'lone AF'. Since chronic stress is associated with increased arousal, it might affect recurrences and thus HRQoL. The current study examined the influence of Type D on the trajectory of disease-specific and generic HRQoL, compared it with HRQoL in the general population, and assessed the mediating role of arousal symptoms (e.g., tachycardia, sweating).

METHODS

159 patients with 'lone AF' (age: 61.6±0.8, 63% men, 3.3±5.0 years since diagnosis) filled out a survey on personality (Type D: DS14), quality of life (SF-36, AFQoL) and symptoms (ATSSS) of AF at inclusion, and 6, 12, and 18 months later. Linear mixed modeling was used.

RESULTS

Generic HRQoL was reduced as compared to the general population, and all HRQoL scales remained stable across time. Type D personality was a significant predictor of worse disease-specific (estimate= -17.1 ; 95%CI:-23.9 - -10.2; p<.001), and generic HRQoL (estimate_PCS=-5.5; 95%CI:-9.3 - -1.8; p=.004; estimate_MCS=-14.8; 95%CI:-18.9- -10.6; p<.001), with arousal symptoms accounting for substantial change in the Type D estimate, suggesting partially shared variance between Type D and arousal symptoms in predicting HRQoL.

CONCLUSION

HRQoL was stable across time, and systematically poorer in distressed 'lone AF' patients. Arousal symptoms partly explained the relation between Type D and HRQoL. Chronic distress may affect AF patients' HRQoL through sympathetic activation and accompanying complaints.

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.

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

PURPOSE OF THE REVIEW

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

RECENT FINDINGS

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

Effect of Stress, Depression and Type D Personality on Immune System in the Incidence of Coronary Artery Disease

BACKGROUND:

Psychoneuroimmunology (PNI) is the study of the interaction between psychological processes and the nervous and immune systems of the human body. The impact of psychological factors on the immune system and the role of this system in Coronary Artery Disease (CAD) are confirmed. Coronary Heart Disease (CHD) is arisen due to the failure of blood and oxygen to the heart tissues.

AIM:

The present study aimed to describe psychoneuroimmunological processes which contribute to CAD and CHD progression.

METHOD:

Such psychological risk factors like stress, depression and type D personality were investigated here. Psychoneuroimmunological pathways of all three mentioned risk factors were described for CAD.

RESULTS:

The studies review indicated that stress could be accompanied with myocardial ischemia and help to rupture. The depression involves in the transfer of stable atherosclerotic plaque to unstable, and type D personality is effective in the initial stages of a CAD.

CONCLUSION:

As more information on cardiovascular immunity becomes available, this will provide a better understanding and thus act as the foundation for the potential development of new treatment strategies for treatment of cardiovascular disorders.

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.

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.

Type D personality, stress, coping and performance on a novel sport task

We investigated (1) the relationship between Type D personality, stress intensity appraisal of a self-selected stressor, coping, and perceived coping effectiveness and (2) the relationship between Type D personality and performance. In study one, 482 athletes completed the Type D personality questionnaire (DS14), stress thermometer and MCOPE in relation to a recently experienced sport stressor. Type D was associated with increased levels of perceived stress and selection of coping strategies (more emotion and avoidance coping) as well as perceptions of their effectiveness. In study two, 32 participants completed a rugby league circuit task and were assessed on pre-performance anxiety, post-performance affect and coping. Type D was associated with poorer performance (reduced distance; more errors), decreases in pre-performance self-confidence and more use of maladaptive resignation/withdrawal coping. Findings suggest that Type D is associated with maladaptive coping and reduced performance. Type D individuals would benefit from interventions related to mood modification or enhancing interpersonal functioning.

Type-D Personality and Elevated Psychological Symptoms In Early Adjustment of Severe Burn Injury Patients

Severe burn injuries are highly traumatic requiring lengthy recovery. High levels of distress in the early stages of treatment have been associated with poor physical and psychosocial recovery outcomes. Identifying traits relating to distress and personal coping styles may aid screening. Type-D, or 'distressed', personality may be such a trait. Type-D personality refers to an ongoing personality organization defined by a tendency to experience greater negative emotions and thoughts while simultaneously socially inhibiting their expression (Denollet et al., 1996 . Type-D has been linked to poor health outcomes in those with cardiovascular disease as well as other populations and has been found to be associated with elevated psychological symptoms. Currently, there are no investigations in the literature looking at Type-D in the severe burns injury population. This study aimed to investigate Type-D in severe burn injury patients, specifically regarding the presence of psychological symptoms in early treatment, using data gathered during a pilot study conducted at a severe burn injury unit. The DS-16, Davidson Trauma scale and Depression Anxiety and Stress Scale scores were analysed along with demographic and clinical data in 54 participants (40 males, 14 females). Participants who were found to have Type-D displayed significantly higher levels of psychopathology. Additionally, Type-D was found to be a significant predictor of psychological symptoms.

Does Type D Personality Impact on the Prognosis of Patients Who Underwent Catheter Ablation for Atrial Fibrillation? A 1-Year Follow-Up Study

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.

Cardiovascular co-morbidity in cancer patients: the role of psychological distress

Due to aging of the population and cardiotoxic cancer treatment, there is an increasing group of patients with cancer and co-morbid cardiovascular disease (CVD). In order to find a balance between the risk of undertreating the malignancy on the one hand and inducing CVD on the other hand, CVD risk stratification at the time of cancer diagnosis and knowledge on the pathway for developing incident CVD in cancer patients is vital. In this paper, we propose an adapted multiple-hit hypothesis for developing CVD in cancer patients describing that patients with cancer are exposed to a series of sequential or concurrent events that together make them more vulnerable to reduced cardiovascular reserves, development of incident CVD and ultimately death. We highlight the possible impact of psychological distress secondary to a cancer diagnosis and/or treatment, which in turn may increase the risk of incident CVD in patients diagnosed with cancer. Furthermore, we discuss potential behavioral and pathophysiological mechanisms underlying the link between psychological distress and the pathophysiology of incident CVD. In addition, key unanswered questions for future research are posed. In the future, researching the adapted multiple-hit hypothesis for developing CVD among cancer patients will hopefully advance the care of cancer patients by finding some of the missing pieces of the puzzle. To do so, we need to focus on minimizing cardiovascular risk and promoting cardiovascular health in cancer patients by addressing the knowledge gaps formulated in this paper.

Ideal cardiovascular health and psychosocial risk factors among Finnish female municipal workers

Aims: Ideal cardiovascular health has been defined by the American Heart Association as the absence of disease and the presence of seven key health factors and behaviours. However, little is known about the mental aspects associated with ideal cardiovascular health metrics. The objective of this study was to assess the relationships between psychosocial risk factors and ideal cardiovascular health metrics among Finnish women at municipal work units. Method: A cross-sectional study was conducted in Finland among 732 female employees (mean±SD age 48±10 years) from ten work units in 2014. Ideal cardiovascular health metrics were evaluated with a physical examination, laboratory tests, medical history and self-administrated questionnaires. Psychosocial risk factors (social isolation, stress, depressive symptoms, anxiety, hostility and type D personality) were assessed with core questions as suggested by the European Society of Cardiology. Results: The prevalence of having 5–7 ideal cardiovascular health metrics was 183 (25.0%), of whom 54.1% had at least one psychosocial risk factor. Anxiety (31.3%), work stress (30.7%) and type D personality (26.1%) were the most prevalent of the psychosocial risk factors. The prevalence of depressive symptoms ( p<0.001) and type D personality ( p=0.049) decreased linearly according to the sum of ideal cardiovascular health metrics after adjustment for age and years of education. Conclusions: Even women with good cardiovascular health are affected by psychosocial risk factors at municipal work units. Although the association is possibly bidirectional, screening and treating depression and dealing with type D personality might be crucial in improving cardiovascular health among women.

Explaining heterogeneity in the predictive value of Type D personality for cardiac events and mortality

BACKGROUND

Type D personality has been associated with adverse outcomes in patients with coronary artery disease (CAD). However, large heterogeneity exists between Type D studies, including some studies reporting null-findings.

OBJECTIVES

The aim of this study was to examine i) choice of endpoint and ii) age as two study characteristics that may partly explain this large heterogeneity in the Type D associated prognostic effect.

METHODS

We used four existing data cohorts of 1503 CAD patients (89% male, mean age=57.2±9.1) with baseline measures of Type D and endpoints >5years follow-up: major adverse cardiac events (MACE), cardiac death/MI, and non-cardiac death. Patients were classified in 4 age categories: <50y, 50-59y, 60-69y and ≥70y. Multiple logistic regression models included age, sex, and clinical covariates.

RESULTS

At follow-up, there were 295 events, including 116 cardiac death/MI, and 37 non-cardiac deaths. Both continuous and categorical measures of Type D predicted adverse events. Type D was independently associated with MACE (OR=1.82; 95%CI 1.33-2.50) and cardiac death/MI (OR=2.49; 95%CI 1.55-3.99). However, Type D was not associated with non-cardiac death (OR=1.23; 95%CI 0.57-2.69). Regarding age, Type D consistently predicted MACE in the lower age groups (all ORs≥2.20, all ps≤.004), but not in patients aged ≥70y (OR=1.43, p=.57).

CONCLUSIONS

Choice of endpoint and age modulated the risk conferred by Type D personality. Type D was associated with an increased risk of cardiac events, but not with non-cardiac death, or with events in patients aged ≥70y. Research on psychosocial risk in CAD should account for different sources of heterogeneity in study characteristics.

The Effect of Type D Personality on Quality of Life in Patients with Multiple Sclerosis

INTRODUCTION

The Type D personality was reported as an important indicator of adverse clinical outcomes and quality of life in various diseases. The objective of this study was to investigate the relationships between the Type D personality and clinical features and the effect of Type D personality on quality of life in patients with multiple sclerosis (MS).

METHODS

Seventy-four patients with MS participated in this study. Clinical parameters of the patients were recorded and disability was assessed using the Expanded Disability Status Scale (EDSS). Patients were examined with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Type D Scale (DS14), and 36-Item Short-Form Health Survey (SF-36).

RESULTS

BDI and BAI scores were significantly higher and mental subscale of the SF-36 scores were significantly lower in Type D compared to nonType D (p<0.001, p=0.001, and p<0.001, respectively). The total DS14 scores were found to be positively correlated with EDSS, BDI, and BAI and negatively correlated with SF-36 mental subscale (p=0.02, p<0.001, p<0.001, and p<0.001, respectively). Multivariate linear regression analysis indicated that the total DS14 score was independently associated with the mental component of SF-36 (p<0.001).

CONCLUSION

The Type D personality traits may worsen the quality of life, particularly the mental component, in patients with MS. Consequently, the assessment of MS patients by brief and valid DS14 may be valuable for clinical practice.

The relationship between childhood trauma and type D personality in university students

AIM

There has been increasing evidence that childhood traumas are related to reduced health-related quality of life, neurobiological changes and long-term adverse effects, such as an increase in the likelihood of psychiatric disorders in adulthoods. The aim of this study was to investigate the relationships between childhood traumas and type D personality.

SUBJECTS AND METHODS

In total, 187 university students (64 males and 123 females; mean age = 21.69 ± 2.00) were included in the study. All participants were evaluated using the Type D Personality Scale (DS-14), Childhood Trauma Questionnaire (CTQ-28) and Beck Depression Inventory (BDI). The participants were divided into the two groups according to the presence of type D personality. Then, statistical analyses were performed.

RESULTS

The frequency of type D personality in participants was 43.3% (n = 81). The emotional neglect, physical neglect, emotional abuse component of the CTQ-28, total CTQ-28 scores and BDI scores were higher in the group with type D personality than in the group without type D personality (p < .001, p = .003, p = .001, p < .001 and p < .001, respectively). There were significantly positive correlations between the type D personality scores and BDI scores, emotional neglect, physical neglect, emotional abuse and childhood trauma total scores (p < .05, for all). Linear regression analyses showed that the significant and independent predictors of the score of DS-14 were total score of CTQ-28 and BDI score.

CONCLUSION

Childhood trauma may be associated with type D personality, and there is predictive value of the childhood trauma on the scores of type D personality.

Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study

CONTEXT AND OBJECTIVE

: Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression.

DESIGN AND SETTING

: We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil.

METHODS

:Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale.

RESULTS

: The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02-11.47; P < 0.05) and had a marginal trend toward significance with more advanced phases of stress (OR 4.7; CI: 0.99-22.51; P = 0.053).

CONCLUSION

:Stress and coping strategies may have implications for understanding and managing nonadherent behavior among transplantation patients and should be considered among the strategies for reducing nonadherence.

Higher macrophage superoxide anion production in coronary artery disease (CAD) patients with Type D personality

BACKGROUND

Type D personality (Type D) is an independent psychosocial risk factor for poor cardiac prognosis and increased mortality in patients with cardiovascular disease (CVD), but the involved mechanisms are poorly understood. Macrophages play a pivotal role in atherosclerosis, the process underlying coronary artery disease (CAD). We investigated macrophage superoxide anion production in production in CAD patients with and without Type D.

METHODS AND RESULTS

We studied 20 male CAD patients with Type D (M:66.7±9.9years) and 20 age-matched male CAD patients without Type D (M:67.7±8.5years). Type D was measured using the DS14 questionnaire with the two subscales 'negative affectivity' and 'social inhibition'. We assessed macrophage superoxide anion production using the WST-1 assay. All analyses were controlled for potential confounders. CAD patients with Type D showed higher superoxide anion production compared to CAD patients without Type D (F(1,38)=15.57, p<0.001). Complementary analyses using the Type D subscales 'negative affectivity' and 'social inhibition', and their interaction as continuous measures, showed that both Type D subscales (negative affectivity: (ß=0.48, p=0.002, R(2)=0.227); social inhibition: (ß=0.46, p=0.003, R(2)=0.208)) and their interaction (ß=0.36, p=0.022, R(2)=0.130) were associated with higher WST-1 reduction scores. Results remained significant when controlling for classical CVD risk factors (i.e. body mass index, mean arterial blood pressure), atherosclerosis severity (i.e. intima media thickness, presence of carotid plaques), and psychological factors (depressive symptom severity, chronic stress).

CONCLUSIONS

Our results indicate higher macrophage superoxide anion production in CAD patients with Type D compared to those without Type D. This may suggest a mechanism contributing to increased morbidity and mortality in CAD patients with Type D.

Type D personality is related to severity of acute coronary syndrome in patients with recurrent cardiovascular disease

OBJECTIVES

To investigate the relationship between Type D (distressed) personality and cardiac biomarkers of disease severity in patients with acute coronary syndrome. To identify potential mechanisms behind the effect of Type D personality on cardiovascular disease (CVD).

DESIGN

Cross-sectional.

METHODS

Patients (N = 215) with acute coronary syndrome completed a survey including a measure of Type D personality. Blood samples including a lipid profile and cardiac enzymes were taken within 3 days after the cardiovascular event. Data were analysed using simple correlations, multiple regressions, and mediation analyses.

RESULTS

Type D personality was more predictive of severity of the acute coronary syndrome among patients with previous CVD compared to patients without previous CVD. Among patients with previous CVD, Type D personality was associated with the presence of ST elevation (R(2)  =.07) and more damage to the myocardium as indicated by higher troponin-I (R(2)  = .05) and myoglobin (R(2)  = .07) levels. These effects were independent from demographics, CV risk factors, and depression. Lower HDL cholesterol levels mediated the relationship between Type D personality and disease severity (Κ(2)  = .12 [95% CI 0.02, 0.28]) for myoglobin and Κ(2)  = .08 [95% CI 0.01, 0.21] for troponin-I).

CONCLUSION

Type D personality was related to a worse lipid profile and more severe acute coronary syndrome in patients with previous history of CVD. Given the strong relationship between disease severity and subsequent mortality, these results suggest that severity of the myocardial infarction may be a potential mechanism explaining increased mortality in Type D patients with recurrent CVD. Statement of contribution What is already known on this subject? Type D personality has been related to worse outcomes in cardiac patients. However, recent studies show mixed results, suggesting the need to clarify potential mechanisms. What does this study add? Type D personality is related to severity of acute coronary syndrome in patients with previous history of cardiovascular disease. This effect is partially accounted for by lower HDL levels in Type D patients. Disease severity is a potential mechanism by which Type D personality may affect cardiovascular health of patients with recurrent CVD.

Type D personality and dietary intake: The mediating effects of coping style

This study aimed to investigate the relationship between Type D and dietary intake and to determine whether this relationship is mediated by coping. In a cross-sectional study, 187 healthy participants completed a self-report questionnaire measuring Type D personality, dietary intake and coping. Results showed that Type D was associated with maladaptive coping and significantly less healthy food intake, including more consumption of fat and sugar, and significantly less consumption of fruit and vegetables. Regression analyses showed that this relationship was partially mediated by coping. The results suggest that Type D personality may represent a risk factor for unhealthy eating.

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

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

Psychological and personality factors in type 2 diabetes mellitus, presenting the rationale and exploratory results from The Maastricht Study, a population-based cohort study

BACKGROUND

Strong longitudinal evidence exists that psychological distress is associated with a high morbidity and mortality risk in type 2 diabetes. Little is known about the biological and behavioral mechanisms that may explain this association. Moreover, the role of personality traits in these associations is still unclear. In this paper, we first describe the design of the psychological part of The Maastricht Study that aims to elucidate these mechanisms. Next, we present exploratory results on the prevalence of depression, anxiety and personality traits in type 2 diabetes. Finally, we briefly discuss the importance of these findings for clinical research and practice.

METHODS

We measured psychological distress and depression using the MINI diagnostic interview, the PHQ-9 and GAD-7 questionnaires in the first 864 participants of The Maastricht Study, a large, population-based cohort study. Personality traits were measured by the DS14 and Big Five personality questionnaires. Type 2 diabetes was assessed by an oral glucose tolerance test. Logistic regression analyses were used to estimate the associations of depression, anxiety and personality with type 2 diabetes, adjusted for age, sex and education level.

RESULTS

Individuals with type 2 diabetes had higher levels of depressive and anxiety symptoms, odds ratios (95 % CI) were 3.15 (1.49; 6.67), 1.73 (0.83-3.60), 1.50 (0.72-3.12), for PHQ-9 ≥ 10, current depressive disorder and GAD-7 ≥ 10, respectively. Type D personality, social inhibition and negative affectivity were more prevalent in type 2 diabetes, odds ratios were 1.95 (1.23-3.10), 1.35 (0.93-1.94) and 1.70 (1.14-2.51), respectively. Individuals with type 2 diabetes were less extraverted, less conscientious, less agreeable and less emotionally stable, and similar in openness to individuals without type 2 diabetes, although effect sizes were small.

CONCLUSIONS

Individuals with type 2 diabetes experience more psychological distress and have different personality traits compared to individuals without type 2 diabetes. Future longitudinal analyses within The Maastricht Study will increase our understanding of biological and behavioral mechanisms that link psychological distress to morbidity and mortality in type 2 diabetes.

Psychological and Work Stress Assessment of Patients following Angioplasty or Heart Surgery: Results of 1-year Follow-up Study

The aim of this study was to explore changes in subjective psychological health and perceived work stress among patients who returned to work (RTW) after a multidisciplinary cardiac rehabilitation (CR) following cardiac interventions. A total of 108 patients were evaluated at the beginning of their CR, at 6 and 12 months after discharge. Self-report questionnaires were used to assess depression, anxiety, illness perception and work stress at each time stage. Results showed reports of depressive symptoms significantly decreased (p < 0.05) and subjective mental (p = 0.001) and physical health (p < 0.001) improved over time. Patients revealed a decrease in Type A behaviour pattern (p < 0.001) and in job satisfaction levels (p = 0.01), greater internal locus of control (p < 0.01) and increased use of the coping strategy 'Involvement' (p < 0.01). Major findings are that cardiac patients had an improvement in subjective psychological health and did not perceive increased work stress after their RTW. Patients' psychological health and work stress need to be assessed during the CR and should be also carefully monitored after the RTW in order to identify patients' psychological and work-related barriers and facilitate a safe and successful work reintegration.

The Relationship between Type D Personality and Heart Rate Variability in Community Mental Health Center Users

OBJECTIVE

Type D personality can be regarded as a promising cardiovascular risk marker that has been repeatedly linked to relevant indicators of mental health, quality of life, morbidity, and mortality in cardiac patients. Heart rate variability (HRV) is a non-invasive technology that can provide information regarding a patient's sympathetic/parasympathetic balance and the control mechanisms of the autonomic systems in the cardiovascular system. As both type D personality and HRV are parameters related to the cardiovascular system, we assumed a relationship between type D personality and HRV. This study set out to identify the relationship between type D and HRV and the differences in HRV variables between type D and non-type D personalities.

METHODS

Patients who visited Guro Community Mental Health Center from January 2011 to December 2012 were surveyed. They were evaluated using both the Korean version of the Type D Personality-14 for type D personality and HRV. During the survey, those who reported major cardiovascular disease that can affect heart rate variability were excluded from the study.

RESULTS

Our analysis included 559 participants, 249 of whom were classified as type D personality. No significant differences were found in the HRV variables between the type D group and the non-type D group. There were also no clinically meaningful correlations between HRV variables and type D total/subscale scores when controlled for patient age.

CONCLUSION

A relationship between HRV and type D personality was not identified using short-term HRV measurements in non-clinical patients with no definitive cardiovascular disease. Further studies using long-term HRV measurements in patients with cardiovascular disease are necessary to conclude an association between HRV and type D personality.

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

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

The Relationship between Type D Personality and Suicidality in Low-Income, Middle-Aged Adults

OBJECTIVE

Low-income adults are considered to be a group at high risk for suicide. We sought to examine the effect of type D personality and other socio-demographic factors on suicidality in low-income, middle-aged Koreans.

METHODS

In total, 306 low-income, middle-aged Koreans [age: 49.16±5.24 (40-59) years, 156 males, 150 females] were enrolled from the Korean National Basic Livelihood Security System. Socio-demographic data, including employment status, income, health, marital status, and educational attainment, were gathered. Beck's 19-item Scale for Suicidal Ideation (SSI) was applied to evaluate suicidality, and the DS14 was used to assess type D personality.

RESULTS

Unemployment (p<0.01) and absence of spouse (p=0.03) predicted higher SSI scores independent of other socioeconomic factors. All type D personality scores [i.e., negative affectivity (NA), social inhibition (SI), and total score] predicted higher SSI scores independent of all socioeconomic factors (all, p<0.001). Subjects with type D personality had higher SSI scores (p<0.001), and the association between suicidality and socio-demographic factors (employment or physical health) could be found only in subjects without type D personality.

CONCLUSION

Type D personality was a risk factor for suicide in low-income Koreans, independently from socio-economic factors. In addition, the socio-demographic factors were less prominently associated with suicidality in those with type D personality.

Is there any association of personality traits with vascular endothelial function or systemic inflammation?

Background:

Evidences showed association of some personality traits with increased risk of cardiovascular diseases, but mediated mechanisms are not entirely described. In this study, we investigated the association of different personality traits with systemic inflammation and endothelial function as probable mediators.

Methods:

This cross-sectional study was conducted in 2011 on 40-60 years old employees of an industrial company located in Isfahan city (central Iran). Participants were selected through simple random sampling. Personality types were evaluated using the neuroticism-extroversion-openness personality inventory and systemic inflammatory status was determined with high sensitive C-reactive protein (hs-CRP) level. To evaluate endothelial function flow mediated dilation (FMD) were measured. The obtained data were analyzed with univariate correlation and multiple linear regression tests.

Results:

A total of 254 cases with mean age of 51.4 ± 6.1 years were evaluated. There was no significant relationship between hs-CRP level and FMD with the personality traits in univariate analysis. In multivariate analysis, no association was found between the scores of personality traits and FMD with controlling the factors such as age, body mass index dyslipidemia, hypertension and diabetes. Only there was an inverse association between conscientiousness score and hs-CRP (β = −0.241, P = 0.013).

Conclusions:

In our population who were the employees of an industrial company, no relationship was found between specific personality trait and endothelial dysfunction. However, we found that the personality trait of responsibility (conscientiousness) is negatively associated with inflammation. Further multi-center studies and also cohort studies are recommended in this regard.

Type D personality is associated with social anxiety in the general population

BACKGROUND

Research on the emotional processes associated with Type D personality is important for its further conceptualization. We examined the associations of Type D personality with social and general anxiety symptoms in a large community sample.

PURPOSE

The aim of the current study was to disentangle the associations of Type D personality and its components with social anxiety and general anxiety in a large sample from the general population.

METHODS

A random sample of 2,475 adults from the general population filled out questionnaires to assess Type D personality (DS-14), social anxiety (SIAS(10), SPS(11), BFNE-II), and general anxiety (HADS-A, GAD-7).

RESULTS

Type D individuals were characterized by increased levels of both social and general anxiety. The social inhibition (SI) component of Type D personality was most strongly associated with social interaction anxiety (r = .63), while negative affectivity (NA) was strongly associated with general anxiety (GAD-7: r = .70; HADS-A: r = .66). Within social anxiety, SI was more strongly associated with facets of social interaction anxiety than with social phobia. Multiple regression analysis showed that the synergistic interaction of NA and SI was a predictor of social anxiety (SIAS(10): β = .32, p < .0005; SPS(11): β = .27, p < .0005; BFNE-II: β = .11, p = .007) independent of demographics and the scores on the individual Type D components. This interaction was not a significant predictor of general anxiety. Logistic regression using the dichotomous Type D classification demonstrated a 9.1-fold (95%CI, 7.0-11.8) increased odds of a score in the highest quartile of social interaction anxiety and a 7.6-fold (95%CI, 5.8-9.8) increased odds of high social phobia. Odds ratios for clinically relevant levels of general anxiety were 8.3 (95%CI, 5.5-12.5) for GAD-7 and 6.5 (95%CI, 3.4-12.6) for HADS-A.

CONCLUSION

In the general population, Type D individuals were characterized by both social and general anxiety. The SI component of Type D is strongly associated with social interaction anxiety and the synergistic interaction of NA and SI was associated with high social anxiety, above and beyond the main NA and SI effects.

Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

Impact of psychological factors on objective ambulatory measures in patients with intermittent claudication

OBJECTIVE

The purpose of this study was to evaluate the difference in objective measures of ambulation and psychosocial factors in patients with intermittent claudication (IC) stratified by type D personality, which incorporates elements of social inhibition and negative affectivity.

METHODS

During a 1-year period, routine history and physical examination, ankle-brachial index, and pulse volume recording were performed on IC patients. Questionnaires assessing type D personality and psychosocial factors were also collected. The 6-minute walk test (6MWT) was performed, assessing symptoms and distance walked. Univariate and multivariate methods were used to assess the association between ambulation and type D personality.

RESULTS

Seventy-one patients were enrolled (mean age, 62.5 ± 1.1 years; mean ankle-brachial index, 0.55 ± 0.03). Mean distance to symptoms and total distance walked were 83.7 ± 80.1 m and 206.5 ± 126.3 m, respectively. Type D personality was present in 29.6% of the population (n = 21). On 6MWT, 83.1% of all patients developed symptoms, and 57.4% quit because of symptoms. Univariate analysis of objective measures of ambulation demonstrated lower distance to symptoms in the type D group and trends toward lower total distance walked and quitting the 6MWT. Multivariate models showed increased odds of quitting the 6MWT (odds ratio, 7.71; P = .01) and less total distance walked by an average of 33.2 ± 13.3 m (P = .02) for the type D group.

CONCLUSIONS

Despite equivalent demographic, medical, and psychosocial factors, the type D group was limited in ambulation, suggesting that type D personality is a strong predictor of disease impact in patients with IC.