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Sumin AN, Prokashko IY, Shcheglova AV. The Influence of Personality Type D and Coping Strategies on Cognitive Functioning in Students. Behav Sci (Basel) 2024; 14:382. [PMID: 38785873 PMCID: PMC11118174 DOI: 10.3390/bs14050382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Academic and emotional challenges faced by medical students can affect their psychological well-being and health. Personal characteristics may also predispose one to the manifestation of distress reactions. Individuals with type D personality have an increased tendency to develop depressive reactions and somatic diseases, including the presence of cognitive dysfunction. In students, the presence of cognitive dysfunction may additionally adversely affect academic and psycho-emotional problems. The purpose of this study was to examine the influence of type D personality and coping strategies on cognitive functioning in medical students. METHODS A cross-sectional study included 258 medical students (age 19 ± 1.2 years, 79 men). All participants completed psychological questionnaires (DS-14 to identify type D personality, and The Coping Strategy Indication, CSI-to determine coping strategies), as well as extensive neuropsychological testing of cognitive functions. RESULTS Among the medical students examined, the frequency of identification of type D personality was 44%. In persons with personality type D, according to psychometric testing, a decrease in the level of functional mobility of nervous processes (FMNP) was noted, which was manifested in an increase in the test completion time (p < 0.001) and an increase in the number of errors (p < 0.001) during the FMNP test, and an increase in the test completion time in the attention concentration test. In addition, in type D participants, an increase in the test execution time during the attention test was noted (p = 0.007). Personality type D was an independent risk factor for cognitive decline in students in multiple linear regression analysis, when type D was analyzed as a dichotomous construct. CONCLUSIONS Assessing personal characteristics and identifying personality type D is advisable for medical students, to develop subsequent programs to increase their resistance to academic challenges, improve cognitive function, and also to prepare for future stress loads during professional activities in the field of healthcare.
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Affiliation(s)
- Alexey N. Sumin
- Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Disease”, Blvd. Named Academician L.S. Barbarasha, 6, Kemerovo 650002, Russia;
| | - Ingrid Yu. Prokashko
- Federal State-Funded Educational Institution of Higher Education, Kemerovo State Medical University, Ministry of Health of the Russian Federation, Voroshilova Str., 22a, Kemerovo 650029, Russia;
| | - Anna V. Shcheglova
- Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Disease”, Blvd. Named Academician L.S. Barbarasha, 6, Kemerovo 650002, Russia;
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Sumin AN, Shcheglova AV. Pathogenetic Mechanisms Underlying Major Adverse Cardiac Events in Personality Type D Patients after Percutaneous Coronary Intervention: The Roles of Cognitive Appraisal and Coping Strategies. Diagnostics (Basel) 2023; 13:3374. [PMID: 37958270 PMCID: PMC10648350 DOI: 10.3390/diagnostics13213374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND This paper aimed to study the association of type D personality, coping strategies, and cognitive appraisal with annual prognosis after a percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). METHODS The prospective study included 111 CAD patients who underwent a PCI. All participants, before the PCI, completed questionnaires designed to collect information about type D personality, cognitive appraisal, and coping styles. Information was also collected on the clinical and demographic characteristics of the patients. After 1 year of follow-up, the presence of major adverse cardiac events (MACEs) was assessed. RESULTS The presence of a MACE was noted in 38 patients, and the absence of a MACE was noted in 53 patients. In patients with type D personality, higher incidences of MACEs (54.1% versus 33.3%; p = 0.0489) and hospitalization rates (29.7% versus 7.4%; p = 0.004) were revealed. Patients with poor prognoses preferred a moderate use of the confrontation strategy than patients without a MACE (78.4% vs. 50.9%; p = 0.0082). Patients with MACEs had statistically significantly lower indicators of strong emotions (11.92 ± 5.32 versus 14.62 ± 4.83 points; p = 0.005) and future prospects (11.36 ± 3.81 versus 13.21 ± 3.41 points; p = 0.015) than patients without a MACE. In a multiple binary logistic regression model, the following factors had significant associations with MACE development: type D, moderate use of confrontation coping, moderate use of self-control coping, and strong emotions in cognitive appraisal. CONCLUSION This study showed that not only personality type D, but also certain coping strategies and cognitive appraisals increase the likelihood of developing a MACE after a PCI. This provides a theoretical basis for understanding the mechanism underlying type D personality and MACEs in patients after a PCI.
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Affiliation(s)
- Alexey N. Sumin
- Laboratory of Comorbidity in Cardiovascular Diseases, Department of Clinical Cardiology, Research Institute of Complex Problems of Cardiovascular Diseases, 6, Sosnovy Blvd., 650002 Kemerovo, Russia;
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Torgersen KS, Sverre ECB, Weedon-Fekjær H, Andreassen OA, Munkhaugen J, Dammen T. Risk of recurrent cardiovascular events in coronary artery disease patients with Type D personality. Front Psychol 2023; 14:1119146. [PMID: 37057178 PMCID: PMC10088369 DOI: 10.3389/fpsyg.2023.1119146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction Data on the association between Type D personality, its traits negative affectivity (NA) and social inhibition (SI), and risk of major adverse cardiac events (MACE) in coronary outpatients is sparse. Furthermore, the associations between Type D subgroups and cardiovascular risk factors are largely unknown. Methods We investigated i) Type D personality, NA and SI and risk of recurrent MACE, and ii) the relationship between Type D subgroups and risk factors in a coronary population. This prospective cohort study included 1083 patients` median 16 months after a myocardial infarction and/or a revascularization procedure who were followed-up for 4.2 (SD 0.4) years. Type D personality was assessed by DS14. Anxiety and depression, statin adherence, and risk factors were assessed by patients' self-report and a clinical examination with blood samples. MACE, defined as cardiovascular death, myocardial infarction, revascularization, stroke or heart failure, were obtained from hospital records from index event to end of study lasting 5.7 years. Data were analyzed by Cox proportional hazard regression. Results In all, 352 MACE occurred in 230 patients after average 4.2 years follow-up. Higher NA score was associated with MACE after adjustment for age, risk factors and comorbidity (HR 1.02 per unit increase, 95% CI 1.00-1.05), whereas we found a weaker, not statistically significant estimated effect of higher SI score. After additional adjustment for symptoms of anxiety and depression, we found a weaker, not statistically significant association between NA and MACE (HR 1.01 per unit increase, 95% CI 0.98-1.05). Low statin adherence and smoking were more prevalent in the Type D and high NA group. Discussion Our results indicate that the NA trait is related to worse prognosis in outpatients with coronary artery disease.
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Affiliation(s)
- Kristin Stensland Torgersen
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elise Christine Bjørkholen Sverre
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Harald Weedon-Fekjær
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Ole A. Andreassen
- NORMENT: Norwegian Centre for Mental Disorders Research, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - John Munkhaugen
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Toril Dammen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section of Psychiatric Treatment Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Meta-analysis. Psychosom Med 2023; 85:188-202. [PMID: 36640440 DOI: 10.1097/psy.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Type D personality, a joint tendency toward negative affectivity and social inhibition, has been linked to adverse events in patients with heart disease, although with inconsistent findings. Here, we apply an individual patient-data meta-analysis to data from 19 prospective cohort studies ( N = 11,151) to investigate the prediction of adverse outcomes by type D personality in patients with acquired cardiovascular disease. METHOD For each outcome (all-cause mortality, cardiac mortality, myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, major adverse cardiac event, any adverse event), we estimated type D's prognostic influence and the moderation by age, sex, and disease type. RESULTS In patients with cardiovascular disease, evidence for a type D effect in terms of the Bayes factor (BF) was strong for major adverse cardiac event (BF = 42.5; odds ratio [OR] = 1.14) and any adverse event (BF = 129.4; OR = 1.15). Evidence for the null hypothesis was found for all-cause mortality (BF = 45.9; OR = 1.03), cardiac mortality (BF = 23.7; OR = 0.99), and myocardial infarction (BF = 16.9; OR = 1.12), suggesting that type D had no effect on these outcomes. This evidence was similar in the subset of patients with coronary artery disease (CAD), but inconclusive for patients with heart failure (HF). Positive effects were found for negative affectivity on cardiac and all-cause mortality, with the latter being more pronounced in male than female patients. CONCLUSION Across 19 prospective cohort studies, type D predicts adverse events in patients with CAD, whereas evidence in patients with HF was inconclusive. In both patients with CAD and HF, we found evidence for a null effect of type D on cardiac and all-cause mortality.
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Sumin AN, Prokashko IY, Shcheglova AV. Evaluation of Coping Strategies among Students with Type D Personality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084918. [PMID: 35457785 PMCID: PMC9029841 DOI: 10.3390/ijerph19084918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 12/04/2022]
Abstract
Objective: Personality type D may be associated with a predisposition to develop stress under external adverse influences, for example, in the COVID-19 pandemic. Likewise, type D personality is associated with higher burnout levels; thus, it may contribute to the development of diseases symptoms. The current study was designed to examine the coping strategies in young healthy persons with personality type D. Methods: The study included 98 medical students, with 30 being males. The participants completed questionnaires to identify personality type D (DS-14) and the coping strategies. Depending on the results of the DS-14 questionnaire, four subgroups were distinguished with different levels of points on the NA and SI subscales. Results: For persons with type D personality, the escape–avoidance strategy was used more often, the accepting responsibility and self-controlling strategies were less common compared with non-type-D individuals. When type D was adjusted for the NA and SI subscales, the correlation remained only with escape–avoidance strategy. We did not find a synergistic effect of the NA and SI subscales in regard to coping. Conclusions: This study demonstrated a link between personality type D and maladaptive coping strategies. The predominance of the maladaptive coping strategy in type D is a possible point of application for psychosocial training in such individuals that requires further research.
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Affiliation(s)
- Alexey N. Sumin
- Laboratory of Comorbidity in Cardiovascular Deseases, Federal State Budgetary Scientific Institution “Research Institute for Complex Issues of Cardiovascular Disease”, Sosnovy Blvd., 6, 650002 Kemerovo, Russia;
- Correspondence: ; Tel.: +7-(3842)-64-44-61 or +7-903940-8668
| | - Ingrid Yu. Prokashko
- Federal State-Funded Educational Institution of Higher Education “Kemerovo State Medical University”, Voroshilova Str., 22a, 650029 Kemerovo, Russia;
| | - Anna V. Shcheglova
- Laboratory of Comorbidity in Cardiovascular Deseases, Federal State Budgetary Scientific Institution “Research Institute for Complex Issues of Cardiovascular Disease”, Sosnovy Blvd., 6, 650002 Kemerovo, Russia;
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Lodder P, Kupper N, Antens M, Wicherts JM. A systematic review comparing two popular methods to assess a Type D personality effect. Gen Hosp Psychiatry 2021; 71:62-75. [PMID: 33962138 DOI: 10.1016/j.genhosppsych.2021.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/04/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Paul Lodder
- Department of Methodology and Statistics, Tilburg University, the Netherlands; Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands.
| | - Nina Kupper
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Marijn Antens
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Jelte M Wicherts
- Department of Methodology and Statistics, Tilburg University, the Netherlands
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Raykh OI, Sumin AN, Korok EV. The Influence of Personality Type D on Cardiovascular Prognosis in Patients After Coronary Artery Bypass Grafting: Data from a 5-Year-Follow-up Study. Int J Behav Med 2021; 29:46-56. [PMID: 33954890 PMCID: PMC8099536 DOI: 10.1007/s12529-021-09992-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Type D personality is accompanied by a set of negative behavioral patterns: low physical activity, high levels of psychological distress, low adherence to treatment. However, studies regarding predictive value of the type D personality remain inconclusive: the results varied depending on the examined cohort, age, and ethnicity. The aim of the study was to evaluate the influence of type D personality on the 5-year prognosis in patients undergoing coronary artery bypass grafting (CABG) in Russian population. METHODS The study included 602 patients with stable coronary artery disease (490 males, 57.7 ± 7.3 years) who had received CABG and were divided into two groups: patients with type D personality (n = 134) and patients without type D (n = 468). The risk of fatal and nonfatal events within 5 years after CABG was assessed. RESULTS There was no difference in total mortality in patients with type D and without type D (7.9% and 7.7%, respectively) over the 5-year period. The absence of cardiac events was detected much less frequently in patients with type D (28%) compared with patients without type D (82%; p = 0.021). Multivariate analysis found independent association between the unfavorable outcome and presence of diabetes mellitus (p = 0.021), type D personality (p = 0.039), and multifocal atherosclerosis (p = 0.033) regardless of gender, age, previous myocardial infarction, and stroke. CONCLUSIONS Type D patients had a greater risk for cardiac events over 5 years after CABG compared with non-type D patients. Obtained data indicates that it is reasonable to consider personality type while detecting patients at risk of development of stress induced cardiac complications after CABG.
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Affiliation(s)
- Olga Igorevna Raykh
- Researcher of Laboratory of Circulation Pathology, FSBI Research Institute of Complex Problems of Cardiovascular Disease, Kemerovo, Russian Federation
| | - Alexei Nikolayevich Sumin
- Head of Department of Polyvascular Disease, FSBI Research Institute of Complex Problems of Cardiovascular Disease, Kemerovo, Russian Federation.
| | - Ekaterina Victorovna Korok
- Researcher of laboratory of Circulation Pathology, FSBI Research Institute of Complex Problems of cardiovascular disease, Kemerovo, Russian Federation
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Wang Y, Zhang S, Zhang G, Yu B, Gao X, Dai Z, Yang X, Qiu X, Qiao Z, Zhou J, Lin P, Fang D, Yang Y. Association between type D personality and in-stent restenosis in patients treated with percutaneous coronary intervention: A mediation analysis of dietary patterns. J Psychosom Res 2020; 138:110244. [PMID: 33002810 DOI: 10.1016/j.jpsychores.2020.110244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Type D personality is a psychosocial risk factor for cardiovascular events and in-stent restenosis (ISR), but the mechanisms involved are not well understood. This study aimed to evaluate the effects of dietary patterns on the association between Type D personality and ISR in patients with coronary artery disease treated with percutaneous coronary intervention (PCI). METHODS This cross-sectional study comprised a total of 230 post-PCI patients who were assessed for Type D personality, depression, dietary patterns, physical activity and medication adherence via self-administered questionnaires. ISR was assessed by coronary angiography. RESULTS Type D personality (odds ratio [OR], 3.35; 95% confidence interval [CI], 1.05-10.71, p=0.042), low fruit intake (OR, 0.30; 95% CI, 0.12-0.68, p=0.008) and low vegetable intake (OR, 0.48, 95% CI, 0.27-0.91, p=0.021) were independent risk factors for ISR after adjustment for psychosocial, lifestyle and cardiovascular risk factors. Mediation analyses revealed that Type D personality had a significant direct effect on the development of ISR (p<0.05). In addition, nutrients in fruits and vegetables, including vitamin C, vitamin E and fiber, were important mediators of the relationship between Type D personality and ISR (p<0.05), the percentage of total indirect effect was 24.65%. CONCLUSIONS These findings suggested that the low intake of fruit and vegetables in Type D patients can predict ISR. The healthy dietary interventions to supply vitamin C, vitamin E and fiber may help to improve the prognosis in post-PCI patients with Type D personality.
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Affiliation(s)
- Yini Wang
- Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sijia Zhang
- Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Gai Zhang
- Department of Orthopaedics, Guangdong Hospital of Traditional Chinese Medicine, Guangdong, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xueqin Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhenguo Dai
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiuxian Yang
- Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Xiaohui Qiu
- Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Zhengxue Qiao
- Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Jiawei Zhou
- Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China
| | - Ping Lin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Deyu Fang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Yanjie Yang
- Psychology Department of the Public Health Institute of Harbin Medical University, Harbin, China.
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Lv H, Tao H, Wang Y, Zhao Z, Liu G, Li L, Yu B, Gao X, Lin P. Impact of type D personality on major adverse cardiac events in patients undergoing percutaneous coronary intervention: The mediating role of cognitive appraisal and coping style. J Psychosom Res 2020; 136:110192. [PMID: 32721776 DOI: 10.1016/j.jpsychores.2020.110192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/04/2020] [Accepted: 07/05/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Individuals with type D personality are characterized by maladaptive cognitive appraisal and coping styles, but it remains unclear whether cognitive appraisal and coping style mediate the interaction between type D personality and major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI). This gap was investigated in this study. METHODS A prospective study was conducted on a cohort of 392 individuals after undergoing PCI. All participants completed questionnaires meant to collect information about type D personality, cognitive appraisal, coping styles and demographic characteristics. They were then prospectively followed for up to 1 year for occurrence of MACE after PCI. Path analyses were performed to assess mediating effects of cognitive appraisal and coping styles. RESULTS The path analysis revealed that type D personality and negative affectivity (NA) had a direct positive effect on MACE (odds ratio [OR] = 1.056, 95% confidence interval [CI] = 1.023, 1.089,p = .031; OR = 1.118, 95% CI = 1.031, 1.205, p = .001), but indirect effects on MACE through negative appraisal, positive appraisal and acceptance-resignation coping (P < .001). MACE was not significantly associated with social inhibition (SI), the interaction of NA and SI (both p > .05). CONCLUSIONS This study revealed that type D personality and NA dimension increased the likelihood of developing MACE after PCI. Cognitive appraisal and coping styles mediated the association between type D personality and MACE. These findings may provide factors that lead to poor prognosis of patients with type D personality undergoing in PCI.
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Affiliation(s)
- Han Lv
- College of Nursing of Harbin Medical University, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Tao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhenjuan Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guojie Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ling Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xueqin Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Ping Lin
- College of Nursing of Harbin Medical University, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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Lodder P. Modeling synergy: How to assess a Type D personality effect. J Psychosom Res 2020; 132:109990. [PMID: 32151819 DOI: 10.1016/j.jpsychores.2020.109990] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Paul Lodder
- Department of Methodology and Statistics, Tilburg University, the Netherlands; Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands.
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Howard S, O'Riordan A, Nolan M. Cognitive Bias of Interpretation in Type D Personality: Associations with Physiological Indices of Arousal. Appl Psychophysiol Biofeedback 2019; 43:193-201. [PMID: 29915960 DOI: 10.1007/s10484-018-9397-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Siobhán Howard
- Department of Psychology, University of Limerick, Limerick, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Adam O'Riordan
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Michelle Nolan
- Department of Psychology, Mary Immaculate College, University of Limerick, Limerick, Ireland
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Association between Type D personality and outcomes in patients with non-ischemic heart failure. Qual Life Res 2019; 28:2901-2908. [DOI: 10.1007/s11136-019-02241-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
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Cayanan EA, Bartlett DJ, Chapman JL, Hoyos C, Phillips CL, Grunstein RR. A review of psychosocial factors and personality in the treatment of obstructive sleep apnoea. Eur Respir Rev 2019; 28:28/152/190005. [DOI: 10.1183/16000617.0005-2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023] Open
Abstract
Effective treatment of obstructive sleep apnoea (OSA) is primarily determined by adherence to the selected intervention. The most common treatment pathways are mechanical devices such as continuous positive airway pressure (CPAP) or a mandibular advancement device, often combined with weight loss therapy. Weight reduction is usually an adjunct therapy but may be used as a secondary treatment in mild-to-moderate OSA when mechanical treatments cannot be tolerated. To enhance the uptake and adherence to treatment, clinicians may assess patient's personality profiles and psychological readiness. There is a paucity of evidence related to these aspects of patient care and this article outlines the current research in relation to patient presentation, treatment uptake and barriers, and methods to enhance treatment adherence.This article disseminates personality traits observed in patients with OSA and identifies vulnerable groups who may require additional support to increase treatment adherence. It summarises the current evidence for treatment barriers in patients with OSA. Low self-efficacy in relation to CPAP and weight loss adherence will be explored as well as the potential to predict treatment responders and enhance therapeutic uptake and adherence. Extending personality traits into research and clinical practice could potentially result in more successful CPAP therapy and weight loss treatment outcomes.
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Lee R, Yu H, Gao X, Cao J, Tao H, Yu B, Wang Y, Lin P. 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. J Psychosom Res 2019; 120:20-28. [PMID: 30929704 DOI: 10.1016/j.jpsychores.2019.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Ruxue Lee
- College of Nursing of Harbin Medical University, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huai Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xueqin Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianqin Cao
- College of Nursing of Harbin Medical University, Daqing, China
| | - Hui Tao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Ping Lin
- College of Nursing of Harbin Medical University, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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Negative affectivity and social inhibition are associated with increased cardiac readmission in patients with heart failure: A preliminary observation study. PLoS One 2019; 14:e0215726. [PMID: 31002696 PMCID: PMC6474614 DOI: 10.1371/journal.pone.0215726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/09/2019] [Indexed: 12/20/2022] Open
Abstract
Background Type D personality was hypothesized to influence clinical and patient-centered outcomes patients with heart failure. The aim of this study was to investigate the association between negative affectivity and social inhibition components of Type D personality and cardiac readmission in patients with heart failure. Methods A prospective observational study design was used. A total of 222 patients with heart failure were recruited from the department of cardiology in two regional hospitals in Taiwan. The 14-item Type D Scale-Taiwanese version was used to assess negative affectivity and social inhibition of the patients. Logistic regression analyses were conducted to determine the association of both Z-score transformed and dichotomized negative affectivity and social inhibition with 6-month and 18-month cardiac readmissions. Results A total of 55 patients (24.8%) and 89 patients (40.1%) had cardiac readmissions within 6 months and 18 months, respectively. Multiple logistic regression analyses of Z-score transformed negative affectivity and social inhibition were significantly associated with (1) 6-month cardiac readmission with odds ratios of 1.62 (P = 0.003) and 1.48 (P = 0.014), respectively and (2) 18-month cardiac readmission with odds ratios of 1.45 (P = 0.013) and 1.38 (P = 0.031), respectively. Similar findings were obtained when negative affectivity and social inhibition were analyzed as dichotomized scores. Conclusions Negative affectivity and social inhibition components of the Type D personality were significantly associated with a higher risk of cardiac readmission in both 6 months and 18 months after the initial hospitalization in patients with heart failure.
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Spek V, Nefs G, Mommersteeg PMC, Speight J, Pouwer F, Denollet J. Type D personality and social relations in adults with diabetes: results from diabetes MILES - The Netherlands. Psychol Health 2018; 33:1456-1471. [PMID: 30295085 DOI: 10.1080/08870446.2018.1508684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Viola Spek
- a CoRPS , Tilburg University , Tilburg , The Netherlands
| | - Giesje Nefs
- a CoRPS , Tilburg University , Tilburg , The Netherlands.,b Department of Medical Psychology , Radboud University Medical Center , Nijmegen , The Netherlands.,c Diabeter, National diabetes treatment center for children, adolescents and young adults , Rotterdam , The Netherlands
| | | | - Jane Speight
- d School of Psychology , Deakin University , Geelong , VIC , Australia.,e The Australian Centre for Behavioural Research in Diabetes , Melbourne VIC , Australia
| | - Frans Pouwer
- e The Australian Centre for Behavioural Research in Diabetes , Melbourne VIC , Australia.,f University of Southern Denmark , Odense , Denmark
| | - Johan Denollet
- a CoRPS , Tilburg University , Tilburg , The Netherlands
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Abstract
PURPOSE OF THE REVIEW This review article synthesizes recent research findings on the psychological context of Type D personality and the mechanisms through which Type D affects disease progression and prognosis among patients with coronary heart disease (CHD). RECENT FINDINGS One in four patients with CHD has a Distressed (Type D) personality, which is characterized by two stable traits: social inhibition and negative affectivity. Type D personality predicts increased mortality and morbidity burden, and poorer health-related quality of life. Type D is part of a family of psychosocial risk factors that affect CHD prognosis. The pattern of co-occurrence of these psychosocial factors and intra-individual differences in psychosocial profiles may affect risk prediction accuracy. Multiple biological and behavioral processes have been associated with Type D personality. Identifying pathways explaining the observed associations between Type D personality and CHD is important to improve etiological and pathophysiological knowledge and to design personalized interventions, and targeting specific risk-associated pathways.
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Timmermans I, Versteeg H, Duijndam S, Graafmans C, Polak P, Denollet J. Social inhibition and emotional distress in patients with coronary artery disease: The Type D personality construct. J Health Psychol 2017; 24:1929-1944. [PMID: 28810489 PMCID: PMC6749748 DOI: 10.1177/1359105317709513] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We examined the validity of the social inhibition component of Type D, its distinctiveness from negative affectivity, and value regarding emotional distress as measured with the DS14 in 173 coronary artery disease patients. In dimensional analysis, social inhibition and negative affectivity emerged as distinct traits. Analysis of continuous negative affectivity and social inhibition measures showed main effects for several emotional and inhibition markers and an interaction effect for social anxiety. Categorical analysis indicated that Type D patients reported more depression, negative mood, social anxiety, and less positive mood. Social inhibition is not a redundant trait, but has additional conceptual value.
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Affiliation(s)
- Ivy Timmermans
- Tilburg University, The Netherlands.,University Medical Center Utrecht, The Netherlands
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Jandackova VK, Koenig J, Jarczok MN, Fischer JE, Thayer JF. Potential biological pathways linking Type-D personality and poor health: A cross-sectional investigation. PLoS One 2017; 12:e0176014. [PMID: 28453522 PMCID: PMC5409166 DOI: 10.1371/journal.pone.0176014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/04/2017] [Indexed: 01/08/2023] Open
Abstract
Background Type-D personality, defined as a combination of high negative affect and high social isolation, has been associated with poor health outcomes. However, pathways underlying this association are largely unknown. We investigated the relationship between Type-D personality and several biological and behavioral pathways including the autonomic nervous system, the immune system, glucose regulation and sleep in a large, apparently healthy sample. Methods Data from a total of 646 respondents (age 41.6±11.5, 12,2% women) were available for analysis. Persons with Type-D (negative affect and social isolation score ≥10) were contrasted with those without Type-D. Measures of plasma fibrinogen levels, white blood cell count, high sensitivity C-reactive protein, fasting plasma glucose (FPG), cholesterol, high-density and low-density lipoprotein, glycated hemoglobin (HbA1c), creatinine, triglycerides, and albumin were derived from fasting blood samples. Urine norepinephrine and free cortisol were determined by high-performance liquid chromatography. Time-domain heart rate variability (HRV) measures were calculated for the 24hr recording period and for nighttime separately. Results Persons with Type-D had higher HbA1c, FPG, and fibrinogen, and lower nighttime HRV than those without Type-D, suggesting worse glycemic control, systemic inflammation and poorer autonomic nervous system modulation in Type-D persons. In addition, those with Type-D reported less social support and greater sleep difficulties while no group differences were observed for alcohol and cigarette consumption, physical activity and body mass index. Conclusions Findings provide some of the first evidence for multiple possible biological and behavioral pathways between Type-D personality and increased morbidity and mortality.
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Affiliation(s)
- Vera K. Jandackova
- Department of Internal Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Human Movement Studies, Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - Julian Koenig
- Department of Psychology, The Ohio State University, Columbus, Ohio, United States of America
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Marc N. Jarczok
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Joachim E. Fischer
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Julian F. Thayer
- Department of Psychology, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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Condén E, Rosenblad A, Wagner P, Leppert J, Ekselius L, Åslund C. Is type D personality an independent risk factor for recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients? Eur J Prev Cardiol 2017; 24:522-533. [PMID: 28071958 DOI: 10.1177/2047487316687427] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Type D personality refers to a combination of simultaneously high levels of negative affectivity and social inhibition. The present study aimed to examine whether type D personality was independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality. Design This was a prospective cohort study. Methods Utilising data from the Västmanland Myocardial Infarction Study, 946 post-acute myocardial infarction patients having data on the DS14 instrument used to measure type D personality were followed-up for recurrent myocardial infarction and all-cause mortality until 9 December 2015. Data were analysed using Cox regression, adjusted for established risk factors. Results In total, 133 (14.1%) patients suffered from type D personality. During a mean follow-up time for recurrent myocardial infarction of 5.7 (3.2) years, 166 (17.5%) patients were affected by recurrent myocardial infarction, of which 26 (15.7%) had type D personality, while during a mean follow-up time for all-cause mortality of 6.3 (2.9) years, 321 (33.9%) patients died, of which 42 (13.1%) had type D personality. After adjusting for established risk factors, type D personality was not significantly associated with recurrent myocardial infarction or all-cause mortality using any of the previously proposed methods for measuring type D personality. A weak association was found between the social inhibition part of type D personality and a decreased risk of all-cause mortality, but this association was not significant after taking missing data into account in a multiple imputation analysis. Conclusions No support was found for type D personality being independently associated with recurrent myocardial infarction or all-cause mortality in post-acute myocardial infarction patients, using any of the previously proposed methods for measuring type D personality.
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Affiliation(s)
- Emelie Condén
- 1 Centre for Clinical Research, Uppsala University, Sweden.,2 School of Health, Care and Social Welfare, Malardalen University, Sweden
| | | | | | - Jerzy Leppert
- 1 Centre for Clinical Research, Uppsala University, Sweden
| | - Lisa Ekselius
- 3 Department of Neuroscience, Uppsala University, Sweden
| | - Cecilia Åslund
- 1 Centre for Clinical Research, Uppsala University, Sweden
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Du J, Zhang D, Yin Y, Zhang X, Li J, Liu D, Pan F, Chen W. The Personality and Psychological Stress Predict Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention for Five Years. Medicine (Baltimore) 2016; 95:e3364. [PMID: 27082597 PMCID: PMC4839841 DOI: 10.1097/md.0000000000003364] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
To investigate the effects of personality type and psychological stress on the occurrence of major adverse cardiovascular events (MACEs) at 5 years in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). Two hundred twenty patients with stable angina (SA) or non-ST segment elevation acute coronary syndrome (NSTE-ACS) treated with PCI completed type A behavioral questionnaire, type D personality questionnaire, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Trait Coping Style Questionnaire (TCSQ), and Symptom Checklist 90 (SCL-90) at 3 days after PCI operation. Meanwhile, biomedical markers (cTnI, CK-MB, LDH, LDH1) were assayed. MACEs were monitored over a 5-year follow-up. NSTE-ACS group had higher ratio of type A behavior, type A/D behavior, and higher single factor scores of type A personality and type D personality than control group and SAP group. NSTE-ACS patients had more anxiety, depression, lower level of mental health (P < 0.05; P < 0.01), more negative coping styles and less positive coping styles. The plasma levels of biomedical predictors had positive relation with anxiety, depression, and lower level of mental health. Type D patients were at a cumulative increased risk of adverse outcome compared with non-type D patients (P < 0.05). Patients treated with PCI were more likely to have type A and type D personality and this tendency was associated with myocardial injury. They also had obvious anxiety, depression emotion, and lower level of mental health, which were related to personality and coping style. Type D personality was an independent predictor of adverse events.
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Affiliation(s)
- Jinling Du
- From the Key Laboratory of Cardiovascular Remodeling and Function Research (JD, DZ, YY, XZ, JL, WC), Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong; and Institute of Medical Psychology School of Medicine (DL, FP), Shandong University, Jinan, China
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