Type D personality. A potential risk factor refined

Association between personality type and patient-reported outcomes (PRO) in patients with atrial fibrillation

BACKGROUND

Atrial Fibrillation (AF) is known to be associated with a negative emotional state. Patient-reported outcomes (PROs) are important tools for evaluating the endpoints of AF management. This study aims to examine the correlation between personality types and PROs in patients with AF.

METHODS

All included subjects were newly diagnosed with AF fewer than one month, and their personality types were assessed using the Eysenck Personality Questionnaire (EPQ). Quality of life (QoL) was measured using the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire. Anxiety and depression were assessed using the General Anxiety Scale (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9), respectively. We constructed stepwise linear regression analyses for factors related to the QoL and emotional state in patients with AF.

RESULTS

A total of 531 AF patients completed the survey and were categorized into four groups based on their personality types. Of these patients (mean age: 67.12 ± 10.93 years, 50.28% male), 357 (67.23%) had paroxysmal AF, and 16.95% (n = 90) had a sanguine personality. Compared to patients with other personality types, those with a sanguine personality had the highest average AFEQT scores (P < 0.001) and the lowest scores of GAD-7 and PHQ-9 scales (P < 0.05). Furthermore, multiple linear regression analyses suggested that sanguine personality was also independently associated with better QoL and emotional states (P < 0.05).

CONCLUSION

There is a significant association between the personality types and PROs in AF patients.

The relationship between gastrointestinal symptoms in FGID patients and D-type personality and emotion regulation strategies

This study examines the relationship between gastrointestinal symptoms in patients with functional gastrointestinal disorders (FGIDs) and type D personality traits, as well as emotion regulation strategies. Analyzing a diverse group of FGID patients, we uncover significant effects of gender and age on gastrointestinal symptoms. Negative Affectivity emerges as a key predictor, positively associated with symptom severity, whereas Social Inhibition correlates negatively with Abdominal Pain. Additionally, our findings suggest that the expressive suppression strategy predicts heightened gastrointestinal symptoms, whereas cognitive reappraisal predicts lower levels of certain symptoms. These findings provide valuable insights for precise diagnosis and tailored treatments of FGIDs. Further research is warranted to explore underlying mechanisms and inform evidence-based interventions.

Moderator role of Type D personality traits between depressive symptoms and job satisfaction among teachers

Background

Type D personality is characterized by negative affect (NA) and social suppression (SI). It has been indicated Type D personality is associated with depression, anxiety, and burnout. Depressive complaints and social inhibition negatively affect job satisfaction. The aim of this study is to investigate the moderating role of Type D personality structure between the severity of depressive complaints and job satisfaction in teachers.

Methods

939 teachers, who constitute the sample of the study, completed the sociodemographic form, Type D personality scale (DS-14), Beck Depression Inventory (BDI) and Minnesota Satisfaction Scale Short Form with an online survey.

Results

While a negative relationship was found between teachers' NA scores and their intrinsic and extrinsic job satisfaction (r = -0.28 and r = -0.19, respectively), a negative relationship was detected between SI scores and intrinsic and extrinsic job satisfaction (r = -0.22 and r = -0.21, respectively). NA and SI had partial moderating roles in the relationship between BDI score and intrinsic job satisfaction. SI played a partial moderating role in the relationship between BDI and extrinsic job satisfaction.

Conclusion

It can be said Type D personality traits has a moderating role between the severity of teachers' depressive complaints and job satisfaction.

The DS-14 questionnaire: psychometric characteristics and utility in patients with obstructive sleep apnea

Little is known about type D personality in patients with obstructive sleep apnea (OSA). The DS-14 questionnaire is the standard tool to assess this personality type, but it has not been properly validated in patients with OSA, nor has it been correlated with clinical features in these patients.

PURPOSE

To determine the internal consistency and test-retest reliability of the DS-14 questionnaire, as well as the prevalence of type D personality in the overall OSA sample and subgroups. We assessed the influence of type D on perceived symptoms and its congruence with self-reported measures of personality, depression, fatigue, anxiety, quality of life, and quality of sleep.

METHODS

Patients with OSA completed the DS-14 questionnaire, Big Five Inventory-2 questionnaire, Hospital Anxiety and Depression Scale, SF-36 Health Survey Questionnaire, Epworth Sleepiness Scale and Stanford Sleepiness Scale, Pittsburgh Sleep Quality Index and Insomnia Severity Index, Fatigue Assessment Scale, and Checklist Individual Strength. After 1 month, the DS-14 questionnaire was repeated.

RESULTS

The overall prevalence of type D personality was 32%. Internal consistency (negative affectivity: α = 0.880, social inhibition: α = 0.851) and diagnostic test-retest reliability (kappa value = 0.664) of the DS-14 questionnaire were high. Significantly more symptoms of anxiety, depression, poor sleep quality, fatigue, and a worse health perception were found in OSA with type D. Neither OSA severity nor REM predominance altered these observations.

CONCLUSION

The DS-14 questionnaire showed excellent psychometric properties in patients with OSA. The prevalence of type D personality in patients with OSA was higher than in the general population. The presence of type D personality was associated with higher symptom burden.

Predictors of health-related quality of life in outpatients with coronary heart disease

Introduction

Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and is associated with poor outcomes. Therefore, it is of clinical importance to identify the key determinants of HRQoL among these patients. There is, however, limited knowledge of how a comprehensive set of psychosocial factors influence HRQoL. We aimed to determine the relative associations of clinical and psychosocial factors with mental and physical components of HRQoL in a sample of CHD outpatients.

Methods

This cross-sectional study included 1,042 patients 2-36 (mean 16) months after a CHD event recruited from two general Norwegian hospitals with a combined catchment area making up 7% of the Norwegian population, representative with regards to demographic and clinical factors. We collected data on HRQoL, demographics, comorbidities, coronary risk factors, and psychosocial factors. HRQoL was assessed using the Short Form 12 (SF12), which comprises a Mental Component Scale (MCS), and the Physical Component Scale (PCS). Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS.

Results

Mean age was 61 [standard deviation (SD) 10] years, 20% were females, 18% had type D personality, 20% significant depression symptoms, 14% significant symptoms of anxiety whereas 45% reported insomnia. The presence of type D personality (β: -0.19), significant symptoms of depression (β: -0.15), and the presence of insomnia (β: -0.13) were negatively associated with MCS, but not PCS in multi-adjusted analyses. The presence of chronic kidney disease (β: -0.11) was associated with reduced MCS, whereas the presence of chronic obstructive pulmonary disease (β: -0.08) and low physical activity (β: -0.14) were negatively associated with PCS. Younger age was associated with lower MCS, whereas older age was associated with lower PCS.

Discussion

We conclude that Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest determinants of the mental component of HRQoL. Assessing and managing these psychological factors among CHD outpatients may improve their mental HRQoL.

Does negative affectivity have an association with achieving target values in hypertensive patients: primary care perspective

OBJECTIVES

The current study aimed to seek the relationship between demographic characteristics, treatment compliance status, and type D personality characteristics to achieve target BP values.

METHODS

This cross-sectional research was conducted on HT patients at three family medicine health-care services in Ankara, Turkey, between 1 February 2021, and 31 January 2022. The sociodemographic questionnaire survey, Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCHBPTS), and Type D Scale-14 (DS-14) were applied to 317 patients. HBCHBPTS consists of 14 items with three domains. DS-14 consists of 14 items assessing negative affectivity (NA) and social inhibition (SI).

RESULTS

Patients with NA were less likely to achieve the SBP target values (62.20% vs 47.50, p = 0.011). NA scores were correlated with HBCHBPTS total scores and HBCHBPTS medication-taking domain scores. Living in a city center (β = -0.157, p = 0.017), not smoking (β = -0.114, p = 0.042), knowing the names of HT drugs (β = - 0.152, p = 0.005), having a Mediterranean-style diet (β = -0.182, p = 0.002), starting treatment immediately after diagnosis (β = -0.121, p = 0.029), older age (β = -0.164, p = 0.028), having less NA scores (β = 0.171, p = 0.029) were effective on better treatment adherence. Variables affecting the failure to achieve the SBP target values were not being in the extended family (p = 0.022, OR: 0.337), anti-HT drug side effects (p = 0.029, OR: 2.566), higher HBCHBPTS total scores (p = 0.001, OR: 1.178), higher DBP values (p < 0.001, OR: 1.141).

CONCLUSION

HBCHBPTS total and HBCHBPTS medication-taking domain indicators worsened as the NA and SI characteristics increased. Predictors, including those not living in an extended family, being affected by the side effects of anti-HT drugs, high HBCHBPTS total score, and high DBP values, were effective in failure to achieve the SBP target values.

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.

Relationships among type-D personality, fatigue, and quality of life in infertile women

PURPOSE

The objective of the present study was to investigate the prevalence of the type D personality and identify the relationship between type D personality, fatigue and quality of life (QoL) in infertile women.

METHODS

A total of 149 infertile women were recruited between October 2020 and January 2021. The participants were assessed through self-administered questionnaires using the type- D Personality Scale-14, Fatigue Severity Scale, and Fertility QoL Instrumental Questionnaire. Data were analyzed using the independent t-test, chi-square test, Pearson's correlation coefficients, and multiple regression analysis using the SPSS/WIN 25.0 program for Windows.

RESULTS

Approximately 40.9% of infertile women were classified into the type D personality group, which showed significantly higher fatigue and lower QoL than the non-type D personality group. Fatigue was the most influential factor on the QoL of infertile women (β=-.23, p=.003), followed by the duration of infertility treatment (β=-.22, p=.003), type D personality (β=-.18, p=.025), and relationship with spouse (β=-.17, p=.024). These variables account for approximately 22% of the variance.

CONCLUSIONS

Intervention programs that consider fatigue, type D personality, relationship with spouses, and treatment duration may be useful for improving QoL in infertile women.

Allostatic load index in patients with multiple sclerosis: A case-control study

Elevated allostatic load (AL) index is a cumulative measure of biological dysregulations associated with stress exposure. It has been reported that stress plays an important role in the pathophysiology of multiple sclerosis (MS). However, the AL index has not been investigated in this population so far. Therefore, we aimed to investigate the AL index in patients with MS compared to healthy controls. A total of 90 patients with relapsing-remitting MS (76.7% females) and 47 healthy controls (76.6% females) were included in the study. The AL index was computed based on percentile distributions of 18 biomarkers. The AL index was significantly higher in patients with MS compared to healthy controls (2.74 ± 0.99 vs. 1.96 ± 0.71, p < 0.001), even after adjustment for age and education. With respect to specific AL biomarkers, individuals with MS had significantly lower resting heart rate, the levels of high-density lipoproteins and dehydroepiandrosterone sulfate as well as significantly higher level of hsCRP and albumin compared to healthy controls. There were no significant correlations of the AL index with depressive and anxiety symptoms, perceived stress, type D personality traits, insomnia, the odds of using specific coping strategies as well as MS-related clinical characteristics. These findings indicate that the AL index is increased in patients with MS. However, the exact mechanisms underlying this observation remain unknown and require additional studies.

Temperament Types at Age 3 and Smartphone Overdependence at Age 10

Few studies have addressed the longitudinal links between early temperament types and later problematic smartphone use. This study aims to identify children's early temperament types at age 3 and to examine the link between the temperament types and smartphone overdependence at age 10. This study utilized a population-based data set presented by the Panel Study on Korean Children. Based on emotionality, activity, and sociability levels at age 3, children were clustered into similar temperament types. Links between the early temperament types and the risks of smartphone overdependence at age 10 were identified through analyses of covariances and binary logistic regressions. Three early temperament types were identified among Korean children: reactive (28.1%), sociable (37.2%), and cautious (34.8%). Children's smartphone dependence at age 10 differed according to the temperament types identified at age 3. Compared to children with the sociable temperament type, children with the reactive type or the cautious type had an increased risk of smartphone overdependence. The link between temperament types at age 3 and smartphone overdependence at age 10 was meaningful. The cautious children were the most vulnerable group to the risk of smartphone overdependence. Temperament type identification in early years may be a useful measure for screening groups of children who are at risk for problematic smartphone use and need proactive interventions.

Intensification of Type D Personality Traits and Coping Strategies of People Staying in Polish Penitentiary Institutions—Cross-Sectional Study

The aim of this study was to determine the intensity of the occurrence of stress-prone personality traits (type D) and the strategies of coping with stress in a group of people staying in Polish penitentiary institutions. This study was conducted in two penitentiary units in Lesser Poland Voivodeship. Participants consisted of 152 prisoners. In this cross-sectional study, two standardized research tools—Mini-COPE Inventory for Measurement Coping with Stress and the Type-D Scale (DS14)—were used. The presence of a stress-prone personality (type D) among persons serving a prison sentence concerned 42.11% of the respondents and did not correlate with their sex and age. The convicted persons were more often guided by ‘negative affectivity’ than by ‘social inhibition’. People staying in penitentiary units most often used the strategy of ‘active coping’ and ‘planning’. Types of coping strategies used by the respondents depended on their sex and the presence of type D personal characteristics. Increasing people’s social awareness of the issues of stress experienced by prisoners can contribute to reducing the phenomenon of the marginalization and stigmatization of incarcerated people.

How is type D personality associated with the major psychological outcomes in noncardiac chest pain patients?

Noncardiac chest pain (NCCP) may lead many problems on the health-care system. Having type D personality has been shown to adversely affect NCCP patients. This study aimed to determine the psychological comorbidities that type D personality is associated with, in patients with NCCP. The participants of this cross-sectional study were 360 patients diagnosed with NCCP. Patients filled out questionnaires about sociodemographic, behavioral, and clinical factors (severity of pain, somatization, cardiac anxiety, fear of body sensations, depression, and type D personality). Type D personality was more prevalent among female (p < 0.005), and those people having this personality showed lower sleep quality (p = 0.001) and sexual life satisfaction (p < 0.001) and more likely to be smoker (p < 0.001). Type D personality is strongly associated with fear of body sensations (β = 5.92, SE = 1.95, p = 0.003), pain intensity (β = 3.53, SE = 0.98, p < 0.001), depression (β = 2.91, SE = 0.62, p < 0.001), and somatization (β = 1.75, SE = 0.55, p < 0.001). Type D personality and major psychological comorbidities were strongly associated. Physicians should consider that having type D personality can be linked to NCCP in an effort to help patients receive effective psychological consultations.

Association between Type-D Personality and Affective (Anxiety, Depression, Post-traumatic Stress) Symptoms and Maladaptive Coping in Breast Cancer Patients: A Longitudinal Study

Background:

Type-D (distressed) personality has not been prospectively explored for its association with psychosocial distress symptoms in breast cancer patients.

Objective:

The objective of the study was to test the hypothesis that Type-D personality can be associated with psychosocial distress variables in cancer over a 2-point period (6 month-follow-up).

Aims:

The aim of the study was to analyze the role of Type-D personality in relation to anxiety, depression, post-traumatic stress symptoms, general distress, and maladaptive coping among cancer patients.

Methods:

145 breast cancer patients were assessed within 6 months from diagnosis (T0) and again 6 months later (T1). The Type-D personality Scale, the Hospital Anxiety and Depression Scale, Depression subscale (HAD-D), the Brief Symptom Inventory (BSI-18) Anxiety subscale, the Distress Thermometer (DT), the Post-traumatic Symptoms (PTS) Impact of Event Scale (IES), and the Mini Mental Adjustment to Cancer (Mini-MAC) Anxious Preoccupation and Hopelessness scales were individually administered at T0 and T1.

Results:

One-quarter of cancer patients met the criteria for Type-D personality, which was stable over the follow-up time. The two main constructs of Type-D personality, namely social inhibition (SI) and negative affectivity (NA), were related to anxiety, depression, PTS, BSI-general distress and maladaptive coping (Mini-MAC anxious preoccupation and hopelessness). In regression analysis, Type-D SI was the most significant factor associated with the above-mentioned psychosocial variables, both at T0 and T1.

Conclusion:

Likewise other medical disorders (especially cardiology), Type-D personality has been confirmed to be a construct significantly related to psychosocial distress conditions and maladaptive coping that are usually part of assessment and intervention in cancer care. More attention to personality issues is important in oncology.

The Importance of Type D Personality in the Development of Temporomandibular Disorders (TMDs) and Depression in Students during the COVID-19 Pandemic

Background: a type D personality is a factor in a person’s susceptibility to general mental stress, especially during the COVID-19 pandemic. Although many studies were conducted on the relationships among stressful situations, an individual’s personality, depression, and the occurrence of various diseases, e.g., cardiovascular disease or cancer, there are no analogous data on people with temporomandibular disorders (TMDs). Aim: the assessment of TMDs and depression symptoms in students with type D personality. Material and Methods: the research was carried out with the participation of 240 physiotherapy students. The study group (G1) consisted of 120 participants with type D personalities, the control group (G2) consisted of the same number of participants, without “stress” personalities. All subjects were assessed for the occurrence of TMD symptoms, as well as for depression and anxiety symptoms, using the Beck Depression Inventory (BDI), based on the proprietary questionnaire. Results: in students with type D personality symptoms, TMDs occurred significantly more often and in greater number (p = 0.00) than in those without stress personalities. The exception was the symptom of increased muscle tension, which showed no statistical difference (p = 0.22). Among the 240 respondents, depression was found in 128 people (53.3%). In the group of students with type D personalities, depression was significantly more frequent than in the group without type D personalities (p = 0.00). In participants with depression, TMD symptoms were more common, i.e., headaches, neck, and shoulder girdle pain, TMJ acoustic symptoms, increased masticatory muscle tension, teeth clenching, and teeth grinding. There was no significant difference between the incidence of depression and TMJ pain and jaw locking. There was a significant interaction between the occurrence of headaches and acoustic symptoms and the occurrence of depression. For headache and depression interactions, the OR was >1; based on the results, we may assume that a headache depends more on the occurrence of depression rather than it being a symptom of a TMJ disorder in people with type D personalities. Conclusion: type D personality and depression may contribute to the development of TMD symptoms.

Mediating effects of emotional intelligence and resilience on the relationship between type D personality and caring ability in nursing students: A cross-sectional study

BACKGROUND

Nursing students must learn about the core values of nursing care. Thus, education designed to improve their caring ability should be included in nursing curricula. Nursing students' caring ability is reportedly affected by emotional intelligence and resilience. However, no studies have explored whether these qualities have mediating effects on the relationship between nursing students' type D personality and their caring ability.

OBJECTIVES

To examine the mediating effects of emotional intelligence and resilience on the relationship between type D personality and caring ability in nursing students.

DESIGN

A cross-sectional, descriptive survey study.

SETTING

The study was conducted in South Korea.

PARTICIPANTS

278 nursing students.

METHODS

Type D personality, emotional intelligence, resilience, and caring ability were measured using questionnaires. Data were analyzed using Pearson's correlations, regression analysis, and Hayes' Process Macro using the bootstrap method.

RESULTS

Results indicated that type D personality significantly predicted emotional intelligence (B = -6.80, p < .001), resilience (B = -6.77, p < .001), and caring ability (B = -7.20, p = .001). Emotional intelligence mediated the relationship between type D personality and caring ability.

CONCLUSION

Interventions to improve the caring ability of nursing students should include an evaluation of nursing students' emotional intelligence and strategies to promote their emotional intelligence.

The Level of Stress and Coping Strategies in Patients with Multiple Sclerosis and Their Relationships with the Disease Course

Objectives: Stress is supposed to be linked with a background of multiple sclerosis (MS) and the disease course. Design: The study aimed to assess the level of stress and coping strategies in MS patients within a year of follow-up and to investigate the relationships between these aspects and factors related—or not—to MS. Methods: In 65 patients with MS, the Perceived Stress Scale (PSS-10), Type D Scale (DS14) and Coping Orientations to Problems Experienced (COPE) were performed at baseline and after a year. Baseline PSS-10, DS-14 and COPE scores were analyzed with regard to demographics, MS duration, treatment, indices of disability and self-reported stressful events (SEs). Final PSS-10 and COPE results were analyzed with reference to MS activity and SE within a year of follow-up. Results: Initially, 67% of patients reported a moderate or high level of stress and 31% met Type-D personality criteria. Diverse coping strategies were preferred, most of which were problem-focused. The negative affectivity DS-14 subscore (NEG) was correlated with disability level. Non-health-related SEs were associated with higher PSS-10 and NEG scores. After a year, the mean PSS-10 score decreased, while COPE results did not change significantly. Non-health-related SEs were associated with a higher PSS-10 score and less frequent use of acceptance and humor strategies. Those with an active vs. stable MS course during the follow-up did not differ in terms of PSS-10 and COPE results. Conclusions: MS patients experienced an increased level of stress. No significant relationships were found between stress or coping and MS course within a year. Non-health-related factors affected measures of stress more than MS-related factors.

The effect of type D personality on anxiety, depression and fear of COVID-19 disease in healthcare workers

During the pandemic, healthcare workers are at the top of the risky groups regarding mental stress. This study aimed to evaluate the relationship of type D personality traits with anxiety, depression, and fear of the SARS-CoV-2 related illness and SARS-CoV-2 virus in healthcare workers during the pandemic period. One hundred ninety-four healthcare workers (53 physicians, 19 dentists, 76 nurses, and 46 auxiliary health personnel) were included in the present study. Sociodemographic Data Form, Type D Personality Scale, Fear of Illness and Virus Evaluation Scale, Beck Depression Inventory, and Beck Anxiety Inventory were applied to the participants. The anxiety, depression, and fear of illness and virus scores were higher in healthcare workers with Type D personality than those without type D personality (respectively; p = 0.001, p = 0.001, and p = 0.001). The Fears about Contamination and Illness, Fears about Social Distancing, Behaviors Related to Virus and Illness Fears, and Impact of Illness and Virus Fears subscale scores and FIVE total scale scores were significantly higher in female healthcare workers than male ones (p = 0.001, for all). Our study results show that Type D personality traits in healthcare workers are associated with higher anxiety, depression, and fear of disease and virus.

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.

Influence of Type D Personality on Health Promoting Behaviours and Quality of Life in Stroke Patients: A Cross-Sectional Study in South Korea

OBJECTIVES

Type D personality is vulnerable to stress and is associated with high symptom severity, unhealthy behaviors, and low quality of life (QoL) in patients with chronic diseases. This study aimed to identify the influence of type D personality on health promoting behaviors and QoL in patients with ischemic stroke in South Korea.

MATERIALS AND METHODS

A descriptive, cross-sectional design was used. This study collected data from a convenience sample of 170 patients with ischemic stroke. Demographic and clinical characteristics, health promoting behaviors, and QoL were compared between the type D personality group and the non-type D group. Stepwise multiple regression analysis was performed to identify factors influencing patients' QoL.

RESULTS

Of the 170 subjects, 39 (22.9%) were classified as having type D personality. Type D personality was associated with higher National Institutes of Health Stroke Scale scores at admission and discharge, higher modified Rankin Scale (mRS) scores at 3 months after stroke, lower scores for health promoting behaviors, and lower QoL. Regression analysis showed that mRS score 3 months after stroke was the most significant factor influencing QoL, followed by health promoting behaviors, type D personality, speech deficits, and family income.

CONCLUSIONS

Type D personality should be considered together with health promoting behaviors and QoL in patients with ischemic stroke. Interventions considering type D personality may be helpful in improving health promoting behavior and QoL for the stroke patients.

Adherence to oral appliance treatment and its determinants in obstructive sleep apnoea patients

BACKGROUND AND OBJECTIVES

Treatment effectiveness, in terms of health benefits, is a composite of efficacy and adherence. Oral appliance (OA) usage is mainly based on self-reports, but nowadays, objective adherence monitoring for OAs is available. This study investigated the objective OA adherence and its determinants in obstructive sleep apnoea (OSA) patients.

MATERIALS AND METHODS

There were 29 subjects who were treated with OA; mean [SD] age 51.4 [11.1]; mean apnoea-hypopnoea index (AHI) [SD] 19.5 [10.0]. Anthropometric and sociodemographic parameters, AHI, daytime sleepiness, snoring, and adverse effects of OA as potential determinants were evaluated. Patients were classified as regular users if they wore OA at least 4 hours nightly 5-7 nights a week. Statistical analyses included the chi-square test, t-test, Mann-Whitney U-test, and linear regression analyses.

RESULTS

At the 3-month follow-up, 68% of subjects were regular users and at 12-month follow-up, 64%. AHI, sociodemographic parameters, or adverse effects were not associated with OA adherence. Snoring seemed to improve weakly adherence, whereas mandibular retrusion reduced the weekly use, and smoking the nightly use of OAs.

LIMITATIONS

The follow-up time was short, and there were a relatively small number of patients with obtainable adherence data, therefore it is difficult to establish if OA therapy alone is a successful long-term treatment option for OSA patients.

CONCLUSIONS/IMPLICATIONS

Adherence to OA therapy is mainly the outcome of patients' subjective comfort in everyday life through eliminating social disturbance of snoring. To best meet a subject's individual treatment need and to prevent suboptimal use of OA, a patient-tailored therapy including digital wear-time documentation is recommended.

Personality variable differences between disease clusters

Previous studies of personality and health have focused mainly on the influence of psychological factors on single diseases such as cancer and coronary heart disease (CHD), thereby neglecting the problem of comorbidity (i.e. the combination of different diseases). The main focus of the present study was the discrimination between single‐ and multiple‐disease conditions on the basis of personality traits. An extensive battery of personality scales implicated in health was administered to a sample of n=5133 individuals of both genders between the ages of 40 and 65. Subjects also reported their health or illness status. A factor analysis of the personality scales yielded five dimensions clearly interpretable as “Emotional Lability”, “Type A Behaviour”, “Behavioural Control”, “Locus of Control over Diseases”, and “Psychoticism”. Hierarchical cluster analyses of the subsample of participants who reported suffering from more than one disease led to eight clusters representing individuals with different combinations of diseases. Generally, there were very few significant differences between healthy and single‐disease participants with regard to personality. However, mean factor scores calculated for “Emotional Lability” were higher across the multiple‐disease groups than in the healthy and single‐disease groups. No other personality factor showed this trend. In general the results reported here show the important role negative affectivity (e.g. Emotional Lability, Neuroticism, Depression) plays in differentiating between single and multiple diseases. Copyright © 2003 John Wiley & Sons, Ltd.

Association between Satisfaction with Life and Personality Types A and D in Young Women with Acne Vulgaris

People with acne vulgaris report a lower level of satisfaction with life and are more frequently classified as having Type D personalities than those without acne. This research examined, for the first time, the moderating and mediating role of personality type in the relationship between acne severity and satisfaction with life. Among 300 female nursing and cosmetology students ranging in age from 19 to 24 years (M = 21.28, SD = 1.39), 150 individuals (50%) presented with symptoms of acne vulgaris (AV group), while the other 150 (50%) were categorized as controls without acne vulgaris (WAV sample). A cross-sectional study was conducted using three self-report questionnaires: The Satisfaction with Life Scale (SWLS), the Framingham Type A Scale (FTAS), and the Type D Scale (DS14). Acne vulgaris was clinically diagnosed using the Hellgren–Vincent Scale (HVS). The AV group scored significantly higher on the FTAS and DS14 and lower on the SWLS than the WAV sample. Life satisfaction correlated negatively with both the negative affectivity (NA) and social inhibition (SI) subscales of the DS14. The moderating role of the Type A behavioral pattern (TABP) and the mediating role of both NA and SI subscales of the DS14 were observed in the relationship between acne severity and satisfaction with life. The type of personality may explain the mechanism of the relationship between acne disease and subjective well-being. Therefore, psychological interventions and strategies focused on managing stress and mood may effectively improve satisfaction with life in people with acne.

The Heritability of Type D Personality by an Extended Twin-Pedigree Analysis in the Netherlands Twin Register

Type D (Distressed) personality combines negative affectivity (NA) and social inhibition (SI) and is associated with an increased risk of cardiovascular disease. We aimed to (1) validate a new proxy based on the Achenbach System of Empirically Based Assessment (ASEBA) for Type D personality and its NA and SI subcomponents and (2) estimate the heritability of the Type D proxy in an extended twin-pedigree design in the Netherlands Twin Register (NTR). Proxies for the dichotomous Type D classification, and continuous NA, SI, and NAxSI (the continuous measure of Type D) scales were created based on 12 ASEBA items for 30,433 NTR participants (16,449 twins and 13,984 relatives from 11,106 pedigrees) and sources of variation were analyzed in the ‘Mendel’ software package. We estimated additive and non-additive genetic variance components, shared household and unique environmental variance components and ran bivariate models to estimate the genetic and non-genetic covariance between NA and SI. The Type D proxy showed good reliability and construct validity. The best fitting genetic model included additive and non-additive genetic effects with broad-sense heritabilities for NA, SI and NAxSI estimated at 49%, 50% and 49%, respectively. Household effects showed small contributions (4–9%) to the total phenotypic variation. The genetic correlation between NA and SI was .66 (reflecting both additive and non-additive genetic components). Thus, Type D personality and its NA and SI subcomponents are heritable, with a shared genetic basis for the two subcomponents.

Type D Personality is Associated With Disease Severity and Poor Quality of Life in Turkish Patients With Fibromyalgia Syndrome: A Cross-Sectional Study

Objectives

This study aims to investigate the rate of type D personality in Turkish patients with fibromyalgia (FM) and evaluate its associations with clinical parameters of FM as well as its effects on health-related quality of life (HRQoL).

Patients and methods

The study included 100 patients with FM (14 males, 86 females; mean age 34.6±7.4 years; range, 22 to 49 years) fulfilling 1990 American College of Rheumatology diagnostic criteria and 50 healthy controls (9 males, 41 females; mean age 32.6±6.5 years; range, 21 to 50 years). Type D personality was assessed using the type D scale-14 (DS-14). FM disease severity was determined by Fibromyalgia Impact Questionnaire (FIQ), functional status by Stanford Health Assessment Questionnaire (HAQ), and HRQoL by Nottingham Health Profile (NHP). Severity of pain and fatigue were measured by visual analog scale (VAS).

Results

The frequency of type D personality was 33% in FM patients and 12% in controls (odds ratio=3.612, 95% confidence interval 1.398-9.333) (p=0.006). Type D FM patients scored higher in tender point count (TPC), FIQ, HAQ, VAS-pain and all NHP subgroups except energy (p<0.01). Type D personality was found to be correlated with FIQ, TPC, HAQ, VAS-pain and NHP subgroups except energy (p<0.01).

Conclusion

Based on our findings, assessment of personality characteristics of patients with FM may hold the key for the treatment of the disease. Besides, a better understanding of personality-related pain in FM patients may provide a more targeted approach to pain treatment.

Childhood trauma and type D personality: The endocrine and cardiovascular effects on stress reactivity

Both exaggerated and blunted cardiovascular stress reactions are associated with health problems. Moreover, early life experiences and personality traits affect stress responses. Regarding the childhood traumas and type D personality, this study aimed to compare the endocrine and cardiovascular reactions against acute laboratory stress. Results showed that the simultaneous existence of childhood traumatic experiences and type D personality leads to exaggerated stress reactivity, while each factor results in a blunted cardiovascular response. Although the cardiovascular responses are dampened in type D personality people, their endocrine reactions are exaggerated. The underlying mechanisms of blunted cardiovascular reactivity differ between childhood trauma and type D personality groups.

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

Purpose

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

Patients and Methods

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

Results

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

Discussion

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

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

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

Interaction between BDNF val66met polymorphism and personality on long-term cardiac outcomes in patients with acute coronary syndrome

Background

The prognostic role of BDNF val66met polymorphism on long-term cardiac outcomes in acute coronary syndrome (ACS) has been unclear. Environmental factors may modify the association, but these have not been investigated to date. This study aimed to investigate the potential interactive effects of BDNF val66met polymorphism and personality traits, one of the main environmental prognostic factors of ACS, on major adverse cardiac events (MACEs) in patients with ACS.

Methods

A total of 611 patients with recent ACS were recruited at a university hospital in Korea. Baseline evaluations from 2007 to 2012 assessed BDNF val66met polymorphism and personality using the Big Five Inventory, which yielded two personality clusters (resilient and vulnerable) and five dimensions (extraversion, agreeableness, conscientiousness, neuroticism, and openness). Over a 5~12 year follow-up after the index ACS, times to MACE were investigated using Cox regression models after adjustment for a range of covariates.

Results

The BDNF val66met polymorphism modified the associations between vulnerable personality type and worse long-term cardiac outcomes in ACS patients with significant interaction terms, in that the associations were statistically significant in the presence met allele. Similar findings were observed for the individual personality dimensions of agreeableness and neuroticism.

Conclusions

Gene (BDNF val66met polymorphism) x environment (personality traits) interactions on long-term cardiac outcomes were found in ACS.

Traumatic Events, Personality and Psychopathology in Takotsubo Syndrome: A Systematic Review

OBJECTIVE

Takotsubo syndrome (TTS) is a transient heart disease that has been historically related to the occurrence of psychological (emotional) factors ("broken heart" syndrome). We aimed to conduct a systematic review analyzing the role of psychological factors in TTS.

METHODS

All studies on TTS and psychological factors from January 1991 through April 2019 were scrutinized according to the Cochrane Collaboration and the PRISMA statements. Selected studies were additionally evaluated for the Risk of Bias according to the Newcastle-Ottawa Scale (NOS).

RESULTS

Fifteen case-control studies (by Mayo Clinic criteria) were finally selected. Most studies analyzed stressful life-events or trauma, although with conflicting findings, while a likely role of long-lasting psychological distress seemed to be a homogenous result. Among life-time psychopathology, only anxiety appeared to have a significant role. Some studies outlined a likely role of personality, but findings are conflicting.

CONCLUSION

Our findings do not lead to any definitive assumption on the specific role of psychological factors in TTS, also for scant strong methodology of the most part of the studies. More studies with stronger research methodology are needed to better characterize psychological elements in TTS.

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.

Alexithymia Predicts Carotid Atherosclerosis, Vascular Events, and All-Cause Mortality in Human Immunodeficiency Virus-Infected Patients: An Italian Multisite Prospective Cohort Study

Background

Psychological factors (PFs) are known predictors of cardiovascular disease (CVD) in many clinical settings, but data are lacking for human immunodeficiency virus (HIV) infection. We carried out a prospective study to evaluate (1) psychological predictors of preclinical and clinical vascular disease and (2) all-cause mortality (ACM) in HIV patients.

Methods

We conducted a cross-sectional analysis of baseline data to evaluate the predictors of carotid plaques (CPs) and a prospective analysis to explore predictors of vascular events (VEs) and ACM over 10 years. Human immunodeficiency virus patients monitored at the Infectious Disease Units of 6 Italian regions were consecutively enrolled. Traditional CVD risk factors, PFs (depressive symptoms, alexithymia, distress personality), and CPs were investigated. Vascular events and ACM after enrollment were censored at March 2018.

Results

A multicenter cohort of 712 HIV-positive patients (75.3% males, aged 46.1 ± 10.1 years) was recruited. One hundred seventy-five (31.6%) patients had CPs at baseline. At the cross-sectional analysis, alexithymia was independently associated with CPs (odds ratio, 4.93; 95% confidence interval [CI], 2.90–8.50; P < .001), after adjustment for sociodemographic, clinical, and psychological variables. After an average follow-up of 4.4 ± 2.4 years, 54 (7.6%) patients developed a VE, whereas 41 (5.68%) died. Age, current smoking, hypertension, and alexithymia (hazard ratio [HR], 3.66; 95% CI, 1.80–7.44; P < .001) were independent predictors of VE. Likewise, alexithymia was an independent predictor of ACM (HR, 3.93; 95% CI, 1.65–9.0; P = .002), regardless of other clinical predictors.

Conclusions

The present results validate our previous monocentric finding. Alexithymia may be an additional tool for the multifactorial assessment of cardiovascular risk in HIV.

Illness perceptions in people newly diagnosed with glaucoma and ocular hypertension

Background/aims

To determine whether self-reported illness perceptions in newly diagnosed patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) are more negative compared with peers who have lived with their diagnosis for more than 2 years.

Methods

A cross-sectional study of 58 newly diagnosed patients with POAG and OHT recruited at their first clinic visit. Electronic patient records were used to identify similar patients (n=58, related by age and severity of visual field loss) who had their diagnosis for >2 years. All participants completed the Brief Illness Perception Questionnaire (BIPQ), EQ5D general health measure and Type D Personality Scale (DS14).

Results

Average BIPQ scores were similar for people newly diagnosed with POAG and POAG diagnosed >2 years and were no different to newly diagnosed OHT and OHT diagnosed >2 years POAG (p=0.46). An analysis correcting for personality type (DS14) and general health (EQ5D) indicated newly diagnosed patients with POAG to have marginally better illness perceptions on individual BIPQ items quantifying impact on life in general, experience of symptoms and ‘understanding’ of their condition (all p<0.01). In contrast, patients with POAG with a diagnosis >2 years understood better their condition to be long-term (p<0.01).

Conclusions

Some illness perceptions differed between newly diagnosed people and patients living with their diagnosis for >2 years. Illness perception for people with manifest glaucoma and at risk of glaucoma (OHT) were similar; the latter might benefit from an intervention at diagnosis that highlights the better prognosis for OHT compared with POAG.

Negative affectivity and social inhibition are associated with increased cardiac readmission in patients with heart failure: A preliminary observation study

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.

Type D personality in Russian patients with cardiovascular disease: validity of the Russian DS14 (DS14-RU)

BACKGROUND

Type D personality is associated with unfavorable outcomes in patients with cardiovascular diseases (CVD). However, there is no valid Type D Scale in Russian language. The purpose of the study was to examine the factor structure of a new Russian version of 14-item Type D Scale (DS14-RU), and to evaluate the reliability and construct validity of the DS14-RU in clinical research.

METHODS

The study included 929 participants, 496 (53.4%) of which had coronary artery disease, 195 (21.0%) congestive heart failure, 84 (9.0%) arterial hypertension and 154 (16.6%) were relatively healthy volunteers. The mean age was 57.5 years, 565 (60.8%) participants were males. The respondents filled out an extended Russian version of the Type D scale and new DS14-RU, as well as the Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Reeder Stress Inventory, and State-Trait Personality Inventory.

RESULTS

The new Russian version of DS14-RU was internally consistent with Cronbach's α = .80 for both the negative affectivity and social inhibition subscales. The prevalence of Type D personality, as measured with the DS14-RU, was 21.4% among patients with CVD, and 20.0% among relatively healthy participants. The mean scores for anxiety, depression, psychosocial stress and anger were significantly higher in patients with Type D personality and they had significantly lower levels of social support and curiosity.

CONCLUSIONS

The new DS14-RU is consistent with the original DS14 in terms of reliability, factor structure and construct validity. The DS14-RU can be used for the reliable assessment of Type D in Russian-speaking respondents.

Big Five personality traits and allostatic load in midlife

Objective: To examine the cross-sectional associations of Big Five personality traits with midlife allostatic load, including the role of sex, socio-demographic factors and health-related behaviours. Design: Cross-sectional analyses of 5512 members of the Copenhagen Aging and Midlife Biobank, aged 49-63 years, 69% men. Main outcome measure: Allostatic load (AL) based on 14 biomarkers representing the inflammatory, cardiovascular and metabolic system. Results: Due to significant sex × trait interactions, analyses were stratified by sex. Openness and Conscientiousness were inversely associated with AL in both sexes, and Extraversion was positively associated with AL in men. Adjusting for socio-demographic factors significantly attenuated the association of Openness in both sexes and of Extraversion in men, for whom the inverse association of Agreeableness with AL was strengthened. Further adjusting for health-related behaviours, the Conscientiousness-AL association was attenuated but remained significant, and Agreeableness remained significantly associated with AL in men. Conclusion: Results imply that higher levels of Agreeableness (in men) and Conscientiousness are associated with lower levels of AL above and beyond socio-demographic factors and health-related behaviours. The study further contributes by demonstrating the relevance of sex × trait and trait × trait interactions in the personality-health literature.

Type D personality, anxiety sensitivity, social anxiety, and disability in patients with acne: a cross-sectional controlled study

Introduction

Acne has long been associated with many psychiatric comorbidities.

Aim

To determine anxiety and depression levels, social phobia frequency, social anxiety level, subjective stress perception, anxiety sensitivity, disability, and the frequency of type D personality in patients with acne.

Material and methods

In total, 61 patients with acne aged > 16 years and 61 age, gender, and educationally matched healthy volunteers were included in the study. The patients and healthy controls were evaluated using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for social anxiety disorder and completed the Liebowitz Social Anxiety Scale, Sheehan Disability Scale, Anxiety Sensitivity Index, Hospital Anxiety and Depression Scale, Perceived Stress Scale (PSS), and Type D Scale-14.

Results

Depression, anxiety, social anxiety, self-reported stress, anxiety sensitivity, and disability levels were significantly higher in patients with acne than in healthy controls (p < 0.05). Type D personality was more prevalent in patients with acne than in healthy controls (49% vs. 18%, p < 0.001).

Conclusions

To our knowledge, this study is the first reported in which type D personality and anxiety sensitivity, as well as social anxiety disorder according to the DSM-5 criteria, was evaluated in patients with acne compared with healthy controls. This study shows that patients with acne have higher levels of depression, anxiety, social anxiety, self-reported stress, anxiety sensitivity, and disability, and a greater prevalence of type D personality, than healthy controls. Psychiatric evaluation of patients with acne may aid the detection of mental disorders.

Adolescent type D personality and social networking sites addiction: A moderated mediation model of restorative outcomes and affective relationships

Type D personality denotes the joint tendency towards negative affectivity and social inhibition. The recent research has regarded Type D personality as a risk factor of social networking sites addiction. The current study aimed to test whether restorative outcomes would mediate the relation between Type D personality and social networking sites addiction, and whether affective relationships would moderate simultaneously the mediating process. A valid sample of 679 adolescents (mean age = 13.29 ± 0.77 years) participated in our paper-and-pencil survey. Results showed that, after controlling for age and gender, Type D personality positively correlated with social networking sites addiction, and it increased social networking sites addiction via escalating participants' restorative outcomes. Moreover, only affective relationships with friends moderated the mediating effect: for adolescents with low levels of affective relationships with friends, the indirect effect of Type D personality on social networking sites addiction was significant; contrarily, the indirect effect for high levels of affective relationships with friends was non-significant. The current study indicated that Type D personality as a risk factor interacted with other factors (e.g., affective relationships with friends) to contribute to adolescent social networking sites addiction. The limitations and practical implications were discussed.

Relationships among Type-D personality, symptoms and quality of life in patients with ovarian cancer receiving chemotherapy

PURPOSE

The objective of this study was to investigate the prevalence of Type-D personality and identify its relationships among the symptoms and quality of life in patients with ovarian cancer-receiving chemotherapy.

METHODS

A total of 150 patients with ovarian cancer undergoing chemotherapy were recruited between December 2015 and August 2016. The subjects were assessed using the Type-D Personality Scale-14, Memorial Symptom Assessment Scale - Short Form and Functional Assessment of Cancer Therapy-General questionnaire completed through a face-to-face interview.

RESULTS

About 56% of patients were classified into the Type-D personality group. This personality group showed statistically significantly higher symptoms and lower quality of life than the non-Type-D personality group. According to stepwise multiple regression, the most significant factor influencing quality of life was symptoms, followed by Type-D personality, performance status and cancer stage.

CONCLUSIONS

The prevalence of Type-D personality in patients with ovarian cancer was high, and Type-D personality was significantly associated with a high symptom score and lower quality of life. Health professionals should consider Type-D personality in the assessment and intervention of symptoms and quality of life, along with performance status and cancer stage.

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

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

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSION

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

Blood Pressure Reactivity and Recovery to Anger Recall in Hypertensive Patients with Type D Personality

Background

Type D, otherwise known as distressed personality type, has been associated with an increased risk of cardiovascular morbidity and mortality. Blood pressure reactivity and recovery to stress could be a possible underlying pathway linking type D personality and cardiovascular events.

Methods

A total of 41 patients with hypertension were recruited from a regional hospital in southern Taiwan. Demographic and clinical characteristics were obtained from all participants. Type D personality was assessed using the 14-item Type D Scale-Taiwanese version. Systolic blood pressure, diastolic blood pressure, and heart rate were measured at the end of baseline, anger recall, verbal, and recovery phases of an anger recall task. Analysis of covariance was used to examine differences in blood pressure and heart rate at the anger recall, verbal, and recovery phase between patients with or without type D personality.

Results

After adjusting for baseline measurements, sex, and age, systolic blood pressure (p = 0.002) and diastolic blood pressure (p = 0.011) at the recovery phase were significantly higher in the patients with type D personality. No significant differences in blood pressure or heart rate were observed in the anger recall or verbal phase between the two groups of patients.

Conclusions

The findings of this study support the notion that prolonged blood pressure recovery rather than high reactivity could be an underlying pathway linking type D personality and the risk of future cardiovascular events among patients with hypertension.