Are we witnessing the decline effect in the Type D personality literature? What can be learned?

Distressed personality is associated with late adverse effects in long-term survivors of Hodgkin lymphoma

BACKGROUND AND PURPOSE

There are few studies of personality traits in long-term Hodgkin lymphoma survivors (HLSs) treated according to contemporary stage-and risk-adapted approaches. The Distressed Personality (DP) Scale covers negative affectivity and social inhibition. We examined differences in self-reported late adverse effects (LAEs) between HLSs with and without DP and other explanatory variables.

MATERIAL AND METHODS

This cross-sectional questionnaire-based study included a population-based cohort of HLSs treated from 1997 to 2006, aged 8-49 years at diagnosis, and alive in 2016. Among 518 eligible HLSs, 303 responded (58%), and 294 completed the DP scale. DP was defined by scores above cut-off on both the negative affectivity and social inhibition subscales. LAEs studied were major depression, posttraumatic stress disorder, sleep problems, obesity, neuropathy, fatigue, memory problems, and general health. DP and 10 other explanatory variables were tested against LAEs as dependent variables in multivariable regression analyses.

RESULTS

The mean age at survey was 45.9 years (standard deviation [SD] 4.6), mean follow-up time 16.7 years (SD 3.0), and 48% were females. Eighty-two HLSs had DP (28%, 95% confidence interval 23% - 33%). All LAEs except obesity were significantly more common/had higher mean score in HLSs with DP. In multivariable analyses, presence of DP was significantly associated with all LAEs except obesity.

INTERPRETATION

The presence of DP is common among HLSs. The presence of DP was associated with most self-report LAEs examined. Including assessment of personality traits in the survivorship care plans of HLSs should be considered. Prospective studies assessing the influence of pretreatment DP on LAEs are warranted.

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.

The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

BACKGROUND

Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI).

METHODS

This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period.

RESULTS

A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (-) groups had a higher risk of MACE [95% confidence interval (CI) 1.74-6.07] (95% CI 1.25-2.96) and ISR (95% CI 3.09-8.28) (95% CI 1.85-6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (-) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients.

CONCLUSIONS

These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

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

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

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

SETTING

Tertiary rehabilitation center.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Facial Emotion Expression and the Inducibility of Myocardial Ischemia During Cardiac Stress Testing: The Role of Psychological Background Factors

OBJECTIVE

Negative emotional states, such as anger and anxiety, are associated with the onset of myocardial infarction and other acute clinical manifestations of ischemic heart disease. The likelihood of experiencing these short-term negative emotions has been associated with long-term psychological background factors such as depression, generalized anxiety, and personality factors. We examined the association of acute emotional states preceding cardiac stress testing (CST) with inducibility of myocardial ischemia and to what extent psychological background factors account for this association.

METHODS

Emotional states were assessed in patients undergoing CST (n = 210; mean [standard deviation] age = 66.9 [8.2] years); 91 (43%) women) using self-report measures and video recordings of facial emotion expression. Video recordings were analyzed for expressed anxiety, anger, sadness, and happiness before CST. Psychological background factors were assessed with validated questionnaires. Single-photon emission computed tomography was used to evaluate inducibility of ischemia.

RESULTS

Ischemia occurred in 72 patients (34%). Emotional states were not associated with subsequent inducibility of ischemia during CST (odds ratio between 0.93 and 1.04; p values > .50). Psychological background factors were also not associated with ischemia (odds ratio between 0.96 and 1.06 per scale unit; p values > .20) and did not account for the associations of emotional states with ischemia.

CONCLUSIONS

Emotional states immediately before CST and psychological background factors were not associated with the inducibility of ischemia. These findings indicate that the well-documented association between negative emotions with acute clinical manifestations of ischemic heart disease requires a different explanation than a reduced threshold for inducible ischemia.

A systematic review comparing two popular methods to assess a Type D personality effect

INTRODUCTION

Type D personality, operationalized as high scores on negative affectivity (NA) and social inhibition (SI), has been associated with various medical and psychosocial outcomes. The recent failure to replicate several earlier findings could result from the various methods used to assess the Type D effect. Despite recommendations to analyze the continuous NA and SI scores, a popular approach groups people as having Type D personality or not. This method does not adequately detect a Type D effect as it is also sensitive to main effects of NA or SI only, suggesting the literature contains false positive Type D effects. Here, we systematically assess the extent of this problem.

METHOD

We conducted a systematic review including 44 published studies assessing a Type D effect with both a continuous and dichotomous operationalization.

RESULTS

The dichotomous method showed poor agreement with the continuous Type D effect. Of the 89 significant dichotomous method effects, 37 (41.6%) were Type D effects according to the continuous method. The remaining 52 (58.4%) are therefore likely not Type D effects based on the continuous method, as 42 (47.2%) were main effects of NA or SI only.

CONCLUSION

Half of the published Type D effect according to the dichotomous method may be false positives, with only NA or SI driving the outcome.

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

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

Why Most Research Findings About Psi Are False: The Replicability Crisis, the Psi Paradox and the Myth of Sisyphus

The replicability crisis in psychology has been influenced by the results of nine experiments conducted by Bem (2011) and presented as supporting the existence of precognition. In this paper, we hope to show how the debate concerning these experiments could be an opportunity to develop original thinking about psychology and replicability. After a few preliminary remarks about psi and scientific epistemology, we examine how psi results lead to a paradox which questions how appropriate the scientific method is to psi research. This paradox highlights a problem in the way experiments are conducted in psi research and its potential consequence on mainstream research in psychology. Two classical experiments - the Ganzfeld protocol and the Bem studies - are then analyzed in order to illustrate this paradox and its consequences. Mainstream research is also addressed in the broader context of the replication crisis, decline effect and questionable research practices. Several perspectives for future research are proposed in conclusion and underline the heuristic value of psi studies for psychology.

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

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

Modeling synergy: How to assess a Type D personality effect

OBJECTIVE

In research on Type D personality, its subcomponents negative affectivity (NA) and social inhibition (SI) are hypothesized to have a synergistic effect on various medical and psychosocial outcomes. As some methods to analyze Type D personality have been criticized, this study investigated whether these methods adequately detect a Type D effect.

METHOD

We used a simulation and two empirical illustrations to investigate each method's performance (bias, power and false positives) in detecting the Type D effect.

RESULTS

Our simulation showed that the two most commonly used methods to assess the Type D effect (subgroup methods) were primarily picking up the presence of NA or SI main effects, indicating that these methods might falsely suggest synergistic Type D effects. Moreover, these methods failed to detect the combined presence of the NA and SI main effects, resulting in significant Type D effects when only one of the NA/SI main effects was present. The method that best detected Type D effects modeled the continuous NA/SI main effects and their statistical interaction in a regression analysis. Reanalysis of two empirical Type D personality datasets confirmed the patterns found in our simulation.

CONCLUSION

This study showed that Type D effects should be modeled with a continuous interaction approach. Other approaches showed either more bias, more false positive findings or lower power. We recommend against using subgroup approaches to operationalize Type D personality, as these methods are biased, regardless of whether the Type D effect is synergistic or additive in nature.

The association of cardiovascular reactivity during the Trier Social Stress Test with quality of life in coronary artery disease patients

OBJECTIVE

Knowledge of objective psychophysiological stress parameters and its relationship to health-related quality of life (HRQoL) is limited in patients with coronary artery disease (CAD). The aim was to investigate the association of cardiovascular reaction to psychosocial stress with HRQoL in patients with CAD.

METHODS

One-hundred and thirty-six patients (84.6% men, age 52 ± 8) within 2-3 weeks after acute coronary syndromes (ACS) during cardiac rehabilitation were recruited in this cross-sectional study. Patients were evaluated for HRQoL (SF-36 questionnaire), symptoms of anxiety and depression (Hospital Anxiety and Depression scale) and Type D personality (DS14 scale). Trier Social Stress Test (TSST) was employed to evaluate cardiovascular reactivity (systolic and diastolic blood pressure [BP], and heart rate [HR]) to psychosocial stress. Multiple linear regression analyses were performed to test for the associations between cardiovascular reactivity and HRQoL, while controlling for possible confounders.

RESULTS

After controlling for baseline levels of HR, gender, age, NYHA functional class, AH, Type D personality, symptoms of anxiety and depression, use of beta-blockers, and history of smoking, the SF-36 Social functioning scale (β = -0.182; p = .03) and SF-36 Vitality scale (β = -0.203; p = .03) was associated with prolonged HR recovery following stress evoking tasks. No associations were found between HRQoL and BP measures during the TSST.

CONCLUSION

In CAD patients who have experienced ACS, HRQoL was associated with prolonged HR recovery after mental stress, even after controlling for potential confounder. Future studies should investigate the possible role of mediating factors involved in the mechanisms relating cardiovascular stress response and HRQoL.

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

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

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.

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

Background

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

Method

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

Result

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

Conclusion

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

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.

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

OBJECTIVES

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

DESIGN

A between-subjects longitudinal design was employed.

METHOD

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

RESULTS

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

CONCLUSION

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

The relationship between Type D personality and physical health complaints is mediated by perceived stress and anxiety but not diurnal cortisol secretion

Type D personality has been associated with minor health complaints in the general population and dysregulation of basal cortisol secretion in coronary patients. The aims of the present study were to investigate (i) whether there is an association between Type D personality and basal cortisol secretion in the general population, and (ii) whether subjective measures of stress and anxiety, as well as indices of basal cortisol secretion, mediate the relationship between Type D personality and self-reported physical symptoms in this group. Self-report measures of stress, trait anxiety and physical symptoms were provided by 101 individuals aged 18-45 years. Saliva samples were also provided over two consecutive "typical" days, to enable indices of the cortisol awakening response and diurnal cortisol profile to be determined. There was a significant relationship between Type D personality and self-reported physical symptoms, which was fully mediated by subjective stress and anxiety. However, there were no significant relationships between Type D personality and the basal cortisol indices. These findings suggest that the association between Type D personality and minor health complaints in the general population can be explained by feelings of stress and anxiety, but a precise biological mechanism for this link is yet to be elucidated.

Regression away from the mean: Theory and examples

Using a standard repeated measures model with arbitrary true score distribution and normal error variables, we present some fundamental closed-form results which explicitly indicate the conditions under which regression effects towards (RTM) and away from the mean are expected. Specifically, we show that for skewed and bimodal distributions many or even most cases will show a regression effect that is in expectation away from the mean, or that is not just towards but actually beyond the mean. We illustrate our results in quantitative detail with typical examples from experimental and biometric applications, which exhibit a clear regression away from the mean ('egression from the mean') signature. We aim not to repeal cautionary advice against potential RTM effects, but to present a balanced view of regression effects, based on a clear identification of the conditions governing the form that regression effects take in repeated measures designs.

Is type D personality an independent risk factor for recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients?

Background Type D personality refers to a combination of simultaneously high levels of negative affectivity and social inhibition. The present study aimed to examine whether type D personality was independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality. Design This was a prospective cohort study. Methods Utilising data from the Västmanland Myocardial Infarction Study, 946 post-acute myocardial infarction patients having data on the DS14 instrument used to measure type D personality were followed-up for recurrent myocardial infarction and all-cause mortality until 9 December 2015. Data were analysed using Cox regression, adjusted for established risk factors. Results In total, 133 (14.1%) patients suffered from type D personality. During a mean follow-up time for recurrent myocardial infarction of 5.7 (3.2) years, 166 (17.5%) patients were affected by recurrent myocardial infarction, of which 26 (15.7%) had type D personality, while during a mean follow-up time for all-cause mortality of 6.3 (2.9) years, 321 (33.9%) patients died, of which 42 (13.1%) had type D personality. After adjusting for established risk factors, type D personality was not significantly associated with recurrent myocardial infarction or all-cause mortality using any of the previously proposed methods for measuring type D personality. A weak association was found between the social inhibition part of type D personality and a decreased risk of all-cause mortality, but this association was not significant after taking missing data into account in a multiple imputation analysis. Conclusions No support was found for type D personality being independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality.

A Type A and Type D Combined Personality Typology in Essential Hypertension and Acute Coronary Syndrome Patients: Associations with Demographic, Psychological, Clinical, and Lifestyle Indicators

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed.

Type D Personality in Gastric Cancer Survivors: Association With Poor Quality of Life, Overall Survival, and Mental Health

CONTEXT

The associations between Type D personality and poor quality of life, overall survival, and mental health in gastric cancer survivors.

OBJECTIVES

The aim of this research was to explore quality of life (QoL), mental health status, Type D personality, symptom duration, and emergency admissions of Chinese gastric cancer patients, as well as the relationship between these factors.

METHODS

Eight hundred thirty eligible Chinese patients newly diagnosed with gastric cancer between July 2009 and July 2011 were enrolled in this prospective study. Type D personality was measured with the 14-item Type D Personality Scale (DS14). Mental health status was measured with the Hospital Anxiety and Depression Scale. The QoL outcomes were assessed longitudinally using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Quality of Life Questionnaire-STO22 at baseline and six months after diagnosis.

RESULTS

The proportion of patients with symptom duration of more than one month and who were diagnosed after emergency admissions in the Type D group was significantly higher than that in the non-Type D personality group. At both of the time points, Type D patients reported statistically significant lower scores on role, emotional, cognitive, and social functioning (all Ps < 0.001) functional scales, global health status/QoL scales (P < 0.001), and worse symptom scores compared to patients without a Type D personality. During the six-month time frame, a higher percentage of patients in the Type D group demonstrated a considerable QoL deterioration. Clinically elevated levels of anxiety and depression were more prevalent in Type D than in non-Type D survivors (both Ps < 0.001). There was a statistically significant difference in three-year overall survival between the patients in the Type D group and the non-Type D personality group.

CONCLUSION

Type D personality is associated with poor QoL, three-year overall survival and mental health status among survivors of gastric cancer, even after adjustment of confounding background variables. The Type D personality group experienced increased levels of pain and fatigue compared to non-Type D patients. Type D personality might be a general vulnerability factor to screen for subgroups at risk of longer symptom duration and emergency admissions in clinical practice.

Replication initiatives will not salvage the trustworthiness of psychology

Replication initiatives in psychology continue to gather considerable attention from far outside the field, as well as controversy from within. Some accomplishments of these initiatives are noted, but this article focuses on why they do not provide a general solution for what ails psychology. There are inherent limitations to mass replications ever being conducted in many areas of psychology, both in terms of their practicality and their prospects for improving the science. Unnecessary compromises were built into the ground rules for design and publication of the Open Science Collaboration: Psychology that undermine its effectiveness. Some ground rules could actually be flipped into guidance for how not to conduct replications. Greater adherence to best publication practices, transparency in the design and publishing of research, strengthening of independent post-publication peer review and firmer enforcement of rules about data sharing and declarations of conflict of interest would make many replications unnecessary. Yet, it has been difficult to move beyond simple endorsement of these measures to consistent implementation. Given the strong institutional support for questionable publication practices, progress will depend on effective individual and collective use of social media to expose lapses and demand reform. Some recent incidents highlight the necessity of this.

Is type-D personality trait(s) or state? An examination of type-D temporal stability in older Israeli adults in the community

Background. Type D personality was suggested as a marker of poorer prognosis for patients of cardiovascular disease. It is defined by having a score of 10 or more on both sub-scales of the DS14 questionnaire, Social Inhibition (SI) and Negative Affectivity (NA). As Type D was designed to predict risk, its temporal stability is of prime importance.

Methods. Participants in the current study were 285 community volunteers, who completed the DS14, and other personality scales, at a mean interval of six years.

Results. The prevalence of Type D did not change. The component traits of Type D showed rank order stability. Type D caseness temporal stability was improved by using the sub-scales product as a criterion. Logistic hierarchical regression predicting Type D classification from Time1 demonstrated that the best predictors were Time1 scores on NA and SI, with the character trait of Cooperation, and the alexithymia score adding some predictive power.

Conclusions. The temporal stability of the component traits, and of the prevalence of Type D were excellent. Temporal stability of Type D caseness may be improved by using a product threshold, rather than the current rule. Research is required in order to formulate the optimal timing for Type D measurement for predictive purposes.

Type D personality is unrelated to major adverse cardiovascular events in patients with coronary artery disease treated by intracoronary stenting

BACKGROUND

Previous research in cardiac patients suggested that type D personality, defined as a combination of negative affectivity (NA) and social inhibition (SI), was associated with adverse outcome.

PURPOSE

The objective of this prospective study was to examine the independent prognostic value of type D in patients with coronary artery disease (CAD).

METHODS

A total of 465 patients completed the Type D Scale (DS14) questionnaire before undergoing stent implantation and were followed up for 5 years.

RESULTS

In a Cox regression model adjusted for selected confounders, we found a trend towards NA for the prediction of nonfatal major adverse cardiovascular event (MACE, hazard ratio (HR) = 1.07, 95 % confidence intervals (CIs) = 0.99-1.14, p = 0.074), while, in contrast, SI was a significant and independent predictor of better outcome (HR = 0.92, 95 % CI = 0.86-0.99, p = 0.027).

CONCLUSIONS

In a cohort of CAD patients, the type D pattern was not linked to adverse outcome, whereas SI was negatively associated with MACE.

DS14 is more likely to measure depression rather than a personality disposition in patients with acute coronary syndrome

It has been suggested that Type D Personality is a risk factor for acute coronary syndrome (ACS) and the DS14 has been developed for its assessment. However, some of the items on the DS14 seem to evaluate depressive symptoms rather than personality features. Therefore, the present study aims to verify whether an overlap exists between the constructs of Type D Personality and depression. Three-hundred-and-four consecutive patients who were both presenting their first ACS and had no history of major depression completed the Hospital Anxiety and Depression Scale (HADS) and the DS14 to assess Type D personality at baseline and have been re-evaluated at 1, 2, 4, 6, 9 and 12-month follow-ups. Out of 304 subjects (80.6% males), 40 were diagnosed as depressed. An exploratory factor analysis of HADS and the DS14 in the second month revealed that four out of seven items on the depressive subscale of HADS (HADS-D) and six out of seven items on the Negative Affectivity (NA) subscale of the DS14 segregated on the same factor. Results were verified by a Partial Confirmatory Factor Analysis performed at the twelfth month when most of the patients achieved complete remission from the depressive episode. Temporal stability was poor for NA and Type D Personality and these construct co-vary with HADS-D over time. Our data suggests that NA and depression are overlapping constructs, supporting the idea that the DS14 measures depressed features, rather than a personality disposition.

Prognostic value of type D personality for 10-year mortality and subjective health status in patients treated with percutaneous coronary intervention

OBJECTIVE

Given the debate around limitations and controversies in type D personality studies, we aimed to evaluate the prognostic value of 'synergistically' analyzed type D personality (interaction z-scores negative affectivity NA, and social inhibition SI) on 10-year mortality and on 10-year subjective health status in percutaneous coronary intervention (PCI) patients.

METHODS

This prospective study comprised a cohort of 1190 consecutive patients who underwent PCI between October 2001 and September 2002 (73% male, mean age: 62years, range [27-90]years). At baseline, type D personality (DS14), and depression/anxiety (HADS) were assessed. Primary endpoint was 10year all-cause mortality; secondary endpoint was 10-year subjective health status (SF-36).

RESULTS

After a median follow-up of 10.3years (IQR 9.8-10.8), 293 deaths of any cause (24.6%) were recorded. After adjustment for significant baseline characteristics, personality categories approached and dichotomously approached type D personality were associated with 10-year mortality, p<.05. Synergistically approached type D personality was not associated with all-cause mortality or subjective health status at 10years. In survivors, higher NA was associated with lower subjective health status. Type D was not associated with mortality after adjusting for continuous depression and anxiety in all approaches.

CONCLUSIONS

Synergistically analyzed type D was not associated with 10-year all-cause mortality in PCI patients whereas dichotomous type D was. However, after adjustment for depression most of the findings had disappeared. Depression played an important role in this. Type D was not associated with 10-year subjective health status.

Type D personality in never-depressed patients and the development of major and minor depression after acute coronary syndrome

BACKGROUND

Type D personality (TDP) has been proposed as a risk factor for the development of depressive symptoms after an acute coronary syndrome (ACS). However, contrasting findings emerged about its predicting power on the onset of depression, since an overlap between TDP and depressive symptoms has been proposed. The present study was aimed to verify whether TDP predicts the development of a depressive disorder in the 6 months after the discharge from hospital.

METHODS

Two hundred fifty consecutive patients were recruited, at the Coronary Intensive Care Unit at the University Hospital of Parma, who were both presenting their first ACS and had no history of depression. The presence and the severity of major (MD) and minor (md) depression were evaluated with the Primary Care Evaluation of Mental Disorders (PRIME-MD) and the Hospital Anxiety and Depression Scale (HADS) respectively. Type D Personality was assessed with the DS14, both at baseline and at 1, 2, 4 and 6 month follow ups.

RESULTS

Out of 250 subjects (81.2% males), MD was diagnosed in 12 patients (4.8%) and md in 18 patients (7.2%). At baseline risk factors for a post-ACS depressive disorder were HADS depression scores, whereas TDP, or its subscales, did not showed any effect.

LIMITATION

The small amount of patients with incidence of depression, due to highly selective inclusion criteria, tempers the reliability of our results.

CONCLUSION

Our data suggests that TDP does not predict the development of depressive disorders in never-depressed patients at their first ACS, when the baseline depression severity was controlled.

Prevalence of psychological distress in elderly hypertension patients in primary care

BACKGROUND

Recent guidelines on cardiovascular disease prevention advocate the importance of psychological risk factors, as they contribute to the risk of developing cardiovascular disease. However, most previous research on psychological distress and cardiovascular factors has focused on selected populations with cardiovascular disease.

AIM

The primary aim was to determine the prevalence of depression, anxiety, and Type D personality in elderly primary care patients with hypertension. Secondary aim was to examine the relation between elevated systolic blood pressure and depression, anxiety, and Type D personality.

DESIGN AND SETTING

A cross-sectional study in primary care practices located in the south of the Netherlands.

METHOD

Primary care hypertension patients (N = 605), between 60 and 85 years (45 % men, mean age = 70 ± 6.6), were recruited for this study. All patients underwent a structured interview including validated self-report questionnaires to assess depression (PHQ-9), anxiety (GAD-7), and Type D personality (DS14) as well as blood pressure assessment.

RESULTS AND CONCLUSION

Depression was prevalent in 5 %, anxiety in 5 %, and Type D personality in 8 %. None of the distress measures were associated with elevated systolic blood pressure of >160 mmHg (all p-values >0.05). This study showed no relation between psychological distress and elevated systolic blood pressure in elderly primary care patients with hypertension.

Depression and cardiac disease: epidemiology, mechanisms, and diagnosis

In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors—including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities—may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population.

Depression and incident dementia. An 8-year population-based prospective study

Aims

The aim of the study was to investigate the impact of depression (categorical diagnosis; major depression, MD) and depressive symptoms (dimensional diagnosis and symptom patterns) on incident dementia in the German general population.

Methods

Within the Leipzig Longitudinal Study of the Aged (LEILA 75+), a representative sample of 1,265 individuals aged 75 years and older were interviewed every 1.5 years over 8 years (mean observation time 4.3 years; mean number of visits 4.2). Cox proportional hazards and binary logistic regressions were used to estimate the effect of baseline depression and depressive symptoms on incident dementia.

Results

The incidence of dementia was 48 per 1,000 person-years (95% confidence interval (CI) 45–51). Depressive symptoms (Hazard ratio HR 1.03, 95% CI 1.01–1.05), and in particular mood-related symptoms (HR 1.08, 95% CI 1.03–1.14), showed a significant impact on the incidence of dementia only in univariate analysis, but not after adjustment for cognitive and functional impairment. MD showed only a significant impact on incidence of dementia in Cox proportional hazards regression, but not in binary logistic regression models.

Discussion

The present study using different diagnostic measures of depression on future dementia found no clear significant associations of depression and incident dementia. Further in-depth investigation would help to understand the nature of depression in the context of incident dementia.

Scientific inbreeding and same-team replication: type D personality as an example

Replication is essential for validating correct results, sorting out false-positive early discoveries, and improving the accuracy and precision of estimated effects. However, some types of seemingly successful replication may foster a spurious notion of increased credibility, if they are performed by the same team and propagate or extend the same errors made by the original discoveries. Besides same-team replication, replication by other teams may also succumb to inbreeding, if it cannot fiercely maintain its independence. These patterns include obedient replication and obliged replication. I discuss these replication patterns in the context of associations and effects in the psychological sciences, drawing from the criticism of Coyne and de Voogd of the proposed association between type D personality and cardiovascular mortality and other empirical examples.