Type D (distressed) personality in primary care patients with type 2 diabetes: validation and clinical correlates of the DS14 assessment

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.

Personality and weight management in adults with type 2 diabetes: A systematic review

Aims

Managing weight in the context of type 2 diabetes presents unique hormonal, medicinal, behavioural and psychological challenges. The relationship between weight management and personality has previously been reviewed for general and cardiovascular disease populations but is less well understood in diabetes. This systematic review investigated the relationship between personality constructs and weight management outcomes and behaviours among adults with type 2 diabetes.

Methods

Medline, PubMed, Embase, PsycINFO and SPORTDiscus databases were searched to July 2021. Eligibility: empirical quantitative studies; English language; adults with type 2 diabetes; investigation of personality-weight management association. Search terms included variants of: diabetes, physical activity, diet, body mass index (BMI), adiposity, personality constructs and validated scales. A narrative synthesis, with quality assessment, was conducted.

Results

Seventeen studies were identified: nine cross-sectional, six cohort and two randomised controlled trials (N=6,672 participants, range: 30-1,553). Three studies had a low risk of bias. Personality measurement varied. The Big Five and Type D personality constructs were the most common measures. Higher emotional instability (neuroticism, negative affect, anxiety, unmitigated communion and external locus of control) was negatively associated with healthy diet and physical activity, and positively associated with BMI. Conscientiousness had positive associations with healthy diet and physical activity and negative associations with BMI and anthropometric indices.

Conclusions

Among adults with type 2 diabetes, evidence exists of a relationship between weight management and personality, specifically, negative emotionality and conscientiousness. Consideration of personality may be important for optimising weight management and further research is warranted.

Systematic review registration

www.crd.york.ac.uk/prospero/, identifier CRD42019111002.

Effect of personality on blood glucose control in patients with type 1 diabetes

OBJECTIVE

The diagnosis of type 1 diabetes mellitus (DM1) has a major impact on young people and their families. Psychosocial factors, patient motivation, participation and acceptance of the disease are essential to achieve good blood glucose control. Our aims were to analyse personality traits and how they are related to blood glucose control in patients with DM1.

METHODS

Sixty-two patients with DM1 over 18 years of age, with at least one-year disease duration and absence of advanced chronic complications were studied. Clinical, biological and personality parameters were measured. The Millon Index of Personality Styles was administered for personality assessment.

RESULTS

Significant correlations between different personality variables and glycated haemoglobin (HbA1c) values were found. Individuals with poor blood glucose control had significantly higher scores on the Feeling-guided (53.6±25.7 vs 36.2±26.8, p=0.021), Innovation-seeking (36.7±24.1 vs 21.9±21.4, p=0.025), Dissenting (41.1±24.4 vs 15.6±16.6, p=0.001), Submissive (41.5±25.1 vs 28.3±14.7, p=0.038) and Dissatisfied (37.5±27.5 vs 19.5±20.2, p=0.015) scales. This psychological profile is characterised by greater focus on emotions and personal values (feeling-guided), the tendency to reject conventional ideas (innovation-seeking), an aversion to complying with norms and a preference for autonomy (unconventional/dissenting), labile self-confidence (submissive/yielding) and expressed disagreement with others (dissatisfied/complaining). Factor analysis based on the main components of the variance yielded four factors. Factor characterised as related to rebelliousness or independent judgement and action was correlated with poor blood glucose control (r=0.402, p<0.05).

CONCLUSION

The rebellious or non-conformist personality type is closely associated with poor blood glucose control in patients with DM1.

Type D Personality Is an Independent Predictor of Lower Urinary Tract Symptoms in Young Men

This cross-sectional study, which included men aged 20-40 years, aimed to determine the relationships among type D personality, depressive symptoms and lower urinary tract symptoms in young men. An internet-based questionnaire was administered, and General demographics, International Prostate Symptom Scores, Type D Scale-14 scores, and Depression and Somatic Symptom Scale scores were analyzed. A total of 3,127 men were included; of these, 762 (24.4%) reported moderate/severe lower urinary tract symptoms, and 1,565 (50.05%) met the criteria for type D personality. Men with type D personality had significantly higher body mass index and total and sub-scores for the International Prostate Symptom Score and Depression and Somatic Symptom Scale. Furthermore, the type D personality group had a higher prevalence of lower urinary tract symptoms, particularly voiding symptoms. Univariate analysis revealed that all parameters, except for body mass index, were significant predictors of moderate/severe lower urinary tract symptoms. Multivariate analysis showed that age >30 years, type D personality, and depressive and somatic Depression and Somatic Symptom Scale sub-scores were independent predictors of moderate/severe lower urinary tract symptoms. Regarding Type D Scale-14 subscales, social inhibition, rather than negative affectivity, impacted moderate/severe lower urinary tract symptoms. Mediation analysis revealed that depressive symptoms mediated the relationship between type D personality and lower urinary tract symptoms. This study established correlations between type D personality, depressive symptoms, and lower urinary tract symptoms. As previous studies suggested that patients with type D personality are less likely to consult and adhere to treatment, and are at higher risk for depression, urologists should therefore actively recognize patients with TDP.

Loneliness and functional limitations among older adults with diabetes: Comparing directional models

OBJECTIVE

Middle-aged and older adults with diabetes are at increased risk for loneliness and functional limitations. Cross-sectional and longitudinal associations between loneliness and functional limitations have been demonstrated among the general population, but have not been established among those with diabetes. The purpose of this study was to directly compare the following models describing the direction of the association between loneliness and functional limitations among people with diabetes: (1) loneliness leads to functional limitations, (2) functional limitations lead to loneliness, and (3) a bidirectional association between loneliness and functional limitations.

METHODS

Data came from the Health and Retirement Study. Participants were middle-aged and older individuals with diabetes in the United States (n = 2934). Loneliness and functional limitations were measured at baseline, 4-year follow-up, and 8-year follow-up. Path models for each of the three models, as well as a stability model, were created. Model fit was compared using Akaike's Information Criteria (AIC).

RESULTS

Participants were 54.6% female, 74.98% White, had a mean age of 69.66 years, had an average of 1.48 comorbid chronic conditions, and had diabetes for an average of 10.40 years. The bidirectional model best fit the data as evidenced by the lowest AIC value (AIC = 171,162.81). ∆AIC between the bidirectional model and the next best fitting model was 16.19, indicating strong support for selecting the bidirectional model. Higher levels of loneliness were associated with subsequent higher levels of functional limitations at some time points (βs = 0.07, 0.02) and higher levels of functional limitations were associated with subsequent higher levels of loneliness (βs = 0.13, 0.06) at all time points.

CONCLUSION

Results suggest that the association between loneliness and functional limitations among individuals with diabetes is bidirectional. This study demonstrates the value of directly comparing directional models.

Type D personality is associated with depressive symptoms and clinical activity in inflammatory bowel disease

BACKGROUND

Inflammatory bowel disease (IBD) can be exacerbated by stress and depression. Type D personality, characterised by high negative affectivity and social inhibition, represents a vulnerability towards stressors and is associated with adverse outcomes in coronary heart disease.

AIMS

To assess the prevalence of Type D personality in IBD patients and investigate potential associations with disease course.

METHODS

We tested for associations between Type D (Type D Scale-14), depressive symptoms (Hospital Anxiety and Depression Scale's depression subscore ≥11) and recurrent IBD amongst Swiss IBD cohort patients. We built regression models for cross-sectional and Cox proportional hazards models for time-to-event analyses. IBD disease course was assessed by the future occurrence of active disease (Crohn's Disease Activity Index ≥150/Modified Truelove & Witts activity index ≥10) and several IBD-relevant endpoints.

RESULTS

Amongst 2275 patients (1005 ulcerative colitis, 1270 Crohn's disease), 672 (29.5%) had Type D. Type D was a significant risk factor for future active disease (adjusted hazard ratio, aHR: 1.60, corrected P value, q = 0.007) and predicted the future presence of depressive symptoms (aHR: 3.30, P < 0.001). The combination of Type D and depressive symptoms further increased the risk for active disease (aHR: 3.98, q < 0.001). However, Type D associated depressive symptoms seemed to be the main contributor to this effect as Type D's predictive power decreased considerably in models corrected for depressive symptoms (aHR: 1.32, CI: 0.97-1.79, q = 0.292).

CONCLUSIONS

Type D personality's prevalence amongst IBD patients was comparable with its prevalence in the general population. Type D was strongly associated with depressive symptoms and showed modest independent associations with IBD prognosis.

The impact of type D personality on self-care of patients with type 2 diabetes: the mediating role of coping strategies

PURPOSE

As a chronic disease, Diabetes requires special self-care behaviors until the end of life. Psychological factors play an important role in following the self-care plans among patients with diabetes. The present study was designed to examine the relationship between type D personality and self-care with the mediating role of coping strategies in patients with type 2 diabetes.

METHODS

This cross-sectional study was carried out on a sample of 361 patients with type 2 diabetes from Ale-Ebrahim Diabetes Charity Center in Isfahan, Iran. Type D personality, coping strategies and self-care were measured by validated questionnaires. The data were analyzed through Structural Equation Modeling (SEM).

RESULTS

The results indicated that type D personality affects the self-care behaviors indirectly via emotion-oriented coping. Problem and avoidant oriented coping strategies did not significantly mediate the effect of type D personality on self-care.

CONCLUSION

In general, assessing psychological background (such as personality traits and coping strategies) can facilitate the treatment of patients with diabetes by means of self-care enhancement.

The association of type D personality and depression with infertility in women

Purpose: Type D personality-defined as the presence of two personality characters, namely negative affectivity (NA) and social inhibition (SI)-is associated with various disorders. The 14-item Type D Scale (DS14), which consists of NA and SI subscales, can be used for the detection of the presence of Type D personality. The aim of our study was to investigate the association of Type D personality and depression with infertility in women.Method: A total of 324 women, 168 primary unexplained infertile women (92 patients undergoing in vitro fertilization (IVF) treatment and 76 undergoing intrauterine insemination (IUI) treatment) and 156 fertile controls were recruited. The 21-item Beck Depression Inventory (BDI-21) and DS14 were completed by all participants. The study was approved by Local Ethics Committee with the protocol number 72867572-050-218.Results: Depression and Type D personality were found to be significantly more prevalent in the infertile group than the fertile group. Type D was positively associated with infertility (OR = 2.34, 95% CI = 1.45-3.78, p < .0001), especially in the younger-aged (<35 years) population (OR = 2.59, 95% CI = 1.48-4.5, p = .001). After adjusting for the duration of marriage, age, obesity, educational level, and the same characteristics of the partner, the association between Type D personality and infertility persisted (OR = 2.56, 95% CI = 1.52-4.29, p < .001). The scores of the BDI-21 and NA subscale were found to be negatively correlated with age and partner's age. The BDI and SI scores, and the NA, SI, and Type D personality rates were similar between the IUI and the IVF groups; however, the NA score was higher, and depression was found to be more prevalent and severe in the IUI group than the IVF group.Conclusions: Type D personality could be positively associated with infertility, especially in younger-aged women.

Type D Personality Is Associated with Glycemic Control and Socio-Psychological Factors on Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Purpose

Type D personality (TDP) has been recognized as a risk factor for many diseases. The aims of our study were to estimate the prevalence of TDP and glycemic control on the patients with type 2 diabetes mellitus (T2DM) and to assess their relationship between TDP and socio-psychological factors, such as perceived stress, self-efficacy, self-care behaviors, and psychological distress.

Patients and Methods

A total of 198 T2DM patients (male 62.6%, mean age 51.2±11.0, mean HbA1c 7.3±1.8%) were recruited consecutively from the Department of Endocrinology of a regional hospital in Taipei, Taiwan, from December 2017 to April 2018. They completed questionnaires that contain questions about sociodemographic characteristics, TDP, illness-related stress, self-efficacy, execution of diabetes management and emotional distress. Their medical records were reviewed for biomedical data.

Results

Of the 198 patients, 82 (41.4%) had TDP. Controlling for sociodemographic factors, patients with TDP were reported significantly poorer on glycemic control than those without TDP (mean HbA1c (%) 7.6±1.9 vs 7.1±1.8, P<0.05). Compared to those without TDP, the results showed significantly higher levels of perceived stress (P<0.001) and psychological distress (anxiety and depression) (P<0.001), as well as significantly lower levels of self-efficacy (P<0.001) and self-care behaviors (P<0.001) on patients with TDP. TDP was positively correlated with perceived stress and psychological distress and negatively correlated with self-efficacy and self-care behaviors scores.

Discussion

This study provides the evidence linking TDP with poor glycemic control, low levels of self-efficacy and self-care behaviors, as well as high levels of perceived stress and psychological distress, which highlights the screening of TDP and the tailored needs for the care among T2DM patients with TDP.

Loneliness and its correlates amongst elderly attending non-communicable disease rural clinic attached to a tertiary care centre of North India

BACKGROUND

Psychological and sociological factors like loneliness have a noteworthy influence on the aging. Very less is known about loneliness amongst the elderly populations living with various Non-communicable diseases.

AIM

The present study aimed to evaluate the prevalence and correlates of loneliness among elderly patients with Non-communicable diseases.

METHODOLOGY

296 patients attending the chronic disease clinic of two Community Health Centres were evaluated on University of California, Los Angeles Loneliness Scale (UCLA LS), Geriatric Depression Scale, Generalized Anxiety Disorder (GAD-7 scale) and Vulnerability to Abuse Screening Scale.

RESULTS

More than half (55.4%) of the participants experienced loneliness as per the three item UCLA LS. When the total scores of UCLA scale were used to evaluate the severity of loneliness, half of the study participants had either moderate (N = 39; 13.2%), moderately high (N = 52; 17.6%) and high (N = 55; 18.6%) level of loneliness. Higher proportion of patients experiencing loneliness had anxiety and reported abuse. Significant predictors of loneliness included presence of diabetes mellitus or hypertension, generalized anxiety disorder and abuse.

CONCLUSION

Older adults living with non-communicable diseases are at a higher risk for loneliness. Mutual help groups kind of models can be developed to help in "re-peopling" elderly. Primary health centres should help in improving the overall health and morale amongst the elderly by stamping down their apprehensions and anxieties.

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.

Negative Affectivity Predicts Lower Quality of Life and Metabolic Control in Type 2 Diabetes Patients: A Structural Equation Modeling Approach

Introduction: It is essential to consider the clinical assessment of psychological aspects in patients with Diabetes Mellitus (DM), in order to prevent potentially adverse self-management care behaviors leading to diabetes-related complications, including declining levels of Quality of Life (QoL) and negative metabolic control. Purpose: In the framework of Structural Equation Modeling (SEM), the specific aim of this study is to evaluate the influence of distressed personality factors as Negative Affectivity (NA) and Social Inhibition (SI) on diabetes-related clinical variables (i.e., QoL and glycemic control). Methods: The total sample consists of a clinical sample, including 159 outpatients with Type 2 Diabetes Mellitus (T2DM), and a control group composed of 102 healthy respondents. All participants completed the following self- rating scales: The Type D Scale (DS14) and the World Health Organization QoL Scale (WHOQOLBREF). Furthermore, the participants of the clinical group were assessed for HbA1c, disease duration, and BMI. The observed covariates were BMI, gender, and disease duration, while HbA1c was considered an observed variable. Results: SEM analysis revealed significant differences between groups in regards to the latent construct of NA and the Environmental dimension of QoL. For the clinical sample, SEM showed that NA had a negative impact on both QoL dimensions and metabolic control. Conclusions: Clinical interventions aiming to improve medication adherence in patients with T2DM should include the psychological evaluation of Type D Personality traits, by focusing especially on its component of NA as a significant risk factor leading to negative health outcomes.

Type D personality as a predictor of self-efficacy and social support in patients with type 2 diabetes mellitus

OBJECTIVE

The aim of this study was to estimate the prevalence of Type D personality and assess the relationship between this personality type and self-efficacy/social support in Chinese patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

From January 1, 2014, to July 31, 2014, 532 consecutive patients with T2DM were recruited from two hospitals in Guangzhou, China. The participants completed questionnaires containing questions about sociodemographic characteristics, Type D personality, self-efficacy, and social support scales, and their medical records were reviewed for additional data.

RESULTS

Of the 532 patients, 18.2% had Type D personality. Patients with this personality type reported significantly lower levels of self-efficacy (P<0.001), total social support (P<0.001), subjective support (P<0.001), and support utilization (P=0.003), but similar level of objective support (P=0.314), compared to those of patients without Type D personality. Negative affectivity and social inhibition, two intrinsic traits of Type D personality, negatively correlated with self-efficacy and social support scores. Type D personality was significantly associated with less self-efficacy and social support (P<0.001), controlling for other sociodemographic factors. Glycosylated hemoglobin (HbA1c) levels were significantly higher in T2DM patients with Type D personality than in patients with non-Type D personality.

CONCLUSION

This study provides new evidence linking Type D personality with self-efficacy, social support, and poor glycemic control, highlighting the special need for care among T2DM patients with Type D personality.

Type D personality and periodontal disease in university students: A prospective cohort study

The purpose of this prospective cohort study was to investigate whether Type D personality was related to periodontal disease in Japanese university students. Among students ( n = 600) who were interested in receiving oral health examinations, logistic regression analysis showed that the risk of developing periodontal disease during a 3-year period was associated with body mass index ⩾ 25 (odds ratio: 2.543; 95% confidence interval: 1.297-4.989; p = 0.007) and Type D personality (odds ratio: 1.473; 95% confidence interval: 1.027-2.111; p = 0.035). In this short-term prospective cohort study, a significant association between periodontal disease and Type D personality was observed in Japanese university students.

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.

The Clinical Link between Type D Personality and Diabetes

INTRODUCTION

Type D personality consists of a mixture of high levels of negative affectivity and social inhibition, resulting in a stable tendency to experience negative emotions, by inhibiting the expression of these emotions. We have reanalyzed the clinically relevant studies examining the role of this personality profile in diabetes, by providing a qualitative synthesis of the data. In this regard, the aim of this study is to provide a systematic review by evaluating the clinical link between Type D personality and diabetes.

METHOD

When focusing on PRISMA guidelines, we have performed a comprehensive research of the literature on PubMed, Scopus, ScienceDirect, ISI Web of Science, PsycINFO, and Google Scholar by using search terms as "distressed personality" OR (i.e., Boolean operator) "Type D personality" combined with the Boolean "AND" operator with "diabetes."

RESULTS

A total of seven research studies were identified and included in the review. Type D was found to be more prevalent in diabetes patients than controls. As regards the specific association with diabetes variables, Type D personality is a significant predictor of both poor medication adherence and unhealthy behaviors, by predicting negative mental health consequences also (i.e., depressed mood, anhedonia, and anxiety).

CONCLUSION

Our review emphasized for the first time that Type D personality affects clinical factors in patients with diabetes by provoking adverse outcomes. The core implication of the study comprises the clinical relevance to detect, from a clinimetric point of view, Type D personality in diabetes in order to prevent potentially negative clinical outcomes.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Type D personality, anxiety, depression and personality traits in patients with isolated itching of the external auditory canal

Objective:

This study evaluated type D personality, anxiety, depression and personality traits in patients with isolated itching of the external auditory canal.

Method:

A hundred consecutive out-patients with isolated itching of the external auditory canal and 100 controls were enrolled in the study. The Type D Scale, the abbreviated form of the Eysenck Personality Questionnaire Revised and the Hospital Anxiety and Depression Scale were used for data collection. Patients were also evaluated using the Modified Itch Severity Scale.

Results:

In all, 43 per cent of patients and 15 per cent of controls met the criteria for a type D personality. Patients with a type D personality had higher anxiety and itching severity but lower extraversion compared with those without a type D personality. Multiple linear regression analysis showed that extraversion and type D personality were independently associated with itch severity.

Conclusion:

These data suggest that clinicians should consider psychological and personality features when evaluating and treating patients with isolated itching of the external auditory canal.

Fear of hypoglycaemia in adults with Type 1 diabetes: results from Diabetes MILES - The Netherlands

AIMS

To examine sociodemographic, clinical and psychological factors associated with fear of hypoglycaemia in adults with Type 1 diabetes.

METHODS

Data were obtained from Diabetes MILES - The Netherlands, an online self-report national survey. This cross-sectional analysis focused on participants with Type 1 diabetes who completed the 18-item Hypoglycaemia Fear Survey - Second Version Worry subscale (HFS-II-W; possible total score range 0-72, higher scores indicating higher fear) (n = 288). To explore correlates of fear of hypoglycaemia, a hierarchical linear regression analysis was performed in participants with full data on sociodemographic, clinical and psychological factors (n = 232; younger and more highly educated than those excluded).

RESULTS

HFS-II-W mean score was 11.1 ± 11.1. Gender, age, education and having a partner (model 1) were not associated with fear of hypoglycaemia. In model 2, history of severe hypoglycaemia (irrespective of number of events) was associated with (greater) fear of hypoglycaemia, whereas diabetes duration, pump therapy and HbA1c were not. Type D personality was positively correlated (model 3), as were symptoms of depression, but not anxiety (model 4). Adding loneliness (model 5) did not improve the model. The fully adjusted analysis showed that fear of hypoglycaemia was associated with depressive symptoms (β = 0.38, P < 0.001) and history of hypoglycaemia (1-2 events: β = 0.30, P < 0.001; ≥ 3 events: β = 0.19, P = 0.002). Total explained variance was 23%.

CONCLUSIONS

Depressive symptoms and history of hypoglycaemia are associated with fear of hypoglycaemia in adults with Type 1 diabetes. These factors may help to identify people with excessive fear, who may particularly benefit from interventions to reduce hypoglycaemia risk and worries.

Subjective sleep impairment in adults with type 1 or type 2 diabetes: Results from Diabetes MILES--The Netherlands

AIMS

Despite growing recognition of the impact of sleep on diabetes, a clear profile of people with diabetes regarding subjective sleep impairment has yet to be established. This study examines: (1) subjective sleep characteristics in adults with type 1 and type 2 diabetes; (2) the relationship of poor subjective sleep quality with glycaemic control, self-care and daytime functioning; (3) possible risk markers for poor sleep quality.

METHODS

In a cross-sectional study, Dutch adults with type 1 (n=267) or type 2 diabetes (n=361) completed an online survey, including the Pittsburgh Sleep Quality Index (PSQI), socio-demographic, clinical, self-care and psychological measures.

RESULTS

Poor sleep quality (PSQI-score >5) was reported by 31% of adults with type 1 and 42% of adults with type 2 diabetes. Participants with good and poor sleep quality did not differ in self-reported HbA1c or the frequency of meeting lifestyle recommendations. Poor sleep quality was related to a higher self-care burden and higher levels of daytime sleepiness, fatigue, depressive and anxiety symptoms, and diabetes-specific distress. In multivariable logistic regression analyses examining risk markers, poor sleep quality was associated with depressive symptoms in adults with type 1 (OR=1.39, 95% CI 1.25-1.54) and type 2 diabetes (OR=1.31, 1.16-1.47), and with being female in those with type 2 diabetes (OR=2.72, 1.42-5.20).

CONCLUSIONS

Poor subjective sleep quality is prevalent both in adults with type 1 and type 2 diabetes, and is related to poor daytime functioning and higher self-care burden. The temporal relation with depression and merits of therapy should be explored.

A Systematic Review of Loneliness and Common Chronic Physical Conditions in Adults

Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Anhedonia: a concept analysis

Anhedonia presents itself in a myriad of disease processes. To further develop our understanding of anhedonia and effective ways to manage it, the concept requires clear boundaries. This paper critically examined the current scientific literature and conducted a concept analysis of anhedonia to provide a more accurate and lucid understanding of the concept. As part of the concept analysis, this paper also provides model, borderline, related, and contrary examples of anhedonia.

Diabetes MILES--The Netherlands: rationale, design and sample characteristics of a national survey examining the psychosocial aspects of living with diabetes in Dutch adults

BACKGROUND

As the number of people with diabetes is increasing rapidly worldwide, a more thorough understanding of the psychosocial aspects of living with this condition has become an important health care priority. While our knowledge has grown substantially over the past two decades with respect to the physical, emotional and social difficulties that people with diabetes may encounter, many important issues remain to be elucidated. Under the umbrella of the Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study International Collaborative, Diabetes MILES--The Netherlands aims to examine how Dutch adults with diabetes manage their condition and how it affects their lives. Topics of special interest in Diabetes MILES--The Netherlands include subtypes of depression, Type D personality, mindfulness, sleep and sexual functioning.

METHODS/DESIGN

Diabetes MILES--The Netherlands was designed as a national online observational study among adults with diabetes. In addition to a main set of self-report measures, the survey consisted of five complementary modules to which participants were allocated randomly. From September to October 2011, a total of 3,960 individuals with diabetes (40% type 1, 53% type 2) completed the battery of questionnaires covering a broad range of topics, including general health, self-management, emotional well-being and contact with health care providers. People with self-reported type 1 diabetes (specifically those on insulin pump therapy) were over-represented, as were those using insulin among respondents with self-reported type 2 diabetes. People from ethnic minorities were under-represented. The sex distribution was fairly equal in the total sample, participants spanned a broad age range (19-90 years), and diabetes duration ranged from recent diagnosis to living with the condition for over fifty years.

DISCUSSION

The Diabetes MILES Study enables detailed investigation of the psychosocial aspects of living with diabetes and an opportunity to put these findings in an international context. With several papers planned resulting from a pooled Australian-Dutch dataset and data collections planned in other countries, the Diabetes MILES Study International Collaborative will contribute substantially to identifying potentially unmet needs of those living with diabetes and to inform clinical research and care across the globe.