Interventions for Cardiovascular Patients with Type D Personality: A Systematic Review

An Educational Intervention for Coronary Heart Disease Patients With Type D Personality: A Randomized Controlled Trial

BACKGROUND

Type D personality, a newly specified personality type defined as the interaction of high levels of negative affectivity and social inhibition, is associated with poor health outcomes. Few interventional studies have been performed to improve health outcomes in this subpopulation.

PURPOSE

This study was developed to examine the effects of an educational intervention on psychological health, health-promoting behaviors, and quality of life in coronary heart disease (CHD) patients with type D personality in China.

METHODS

A randomized controlled trial was adopted. One hundred twenty-eight patients with CHD and type D personality were randomly assigned. The intervention group received the 12-week educational intervention in addition to usual care, whereas the control group received usual care only. Data on anxiety and depression, health-promoting behaviors, and quality of life were collected at baseline and at 1 and 3 months after enrollment. After controlling for the covariates, the generalized estimating equation model was used to examine the intervention effects.

RESULTS

The mean age of the participants was 61.02 years, and more than 70% were male. Results of the generalized estimating equation analysis showed significantly greater improvements in anxiety, depression, and health-promoting behaviors in the intervention group than in the control group. In addition, quality of life, the domains of angina limitation, angina stability, and treatment satisfaction were found to have improved more significantly in the intervention group than the control group, whereas the posttest changes in angina frequency and disease perception were found to be similar in both groups.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The educational intervention was shown to be effective in improving psychological health, health-promoting behaviors, and certain domains of quality of life in patients with CHD and type D personality. Nurses should identify patients with this personality type and provide tailored care to improve their health outcomes in clinical practice.

Primary care patients with cardiovascular disease eligible for nurse-led internet-based cognitive behavioural therapy for insomnia: Characteristics and motives for participation

AIM

To describe demographic, physical and psychological characteristics associated with insomnia in patients with cardiovascular disease (CVD) participating in nurse-led Internet-based cognitive behavioural therapy for insomnia (I-CBTI), and their motives and expectations regarding participation in I-CBTI.

DESIGN

A mixed method design was applied, including primary care patients with angina pectoris, myocardial infarction, heart failure, atrial fibrillation and atrial flutter or arrhythmia in southern Sweden.

METHODS

Data on demographics, insomnia severity and physical and psychological characteristics were collected through self-rated validated questionnaires (n = 126). Motives and expectations were collected through interviews (n = 19) and analysed using the 'personas' model.

RESULTS

Physical symptoms and psychological characteristics were associated with insomnia. Three personas were identified: the pragmatist (a curious and optimistic persona), the philosopher (a problem-solving persona) and the philanthropist (an altruistic persona). Expectations were positive among the three personas, but comorbid conditions reduced the perceived ability to make necessary behavioural changes.

Relationships among Symptoms, Disability, Type D Personality, and Quality of Life in Patients with Migraine: A Cross-Sectional Study in South Korea

BACKGROUND

Type D personality as a personality vulnerable to stress consists of negative affectivity and social inhibition, and it is related to symptoms and decreased quality of life in patients with chronic illness.

AIM

This study aimed to explore the relationships among migraine symptoms, disability, type D personality, and quality of life in patients with migraine.

METHODS

A convenience sample of 135 patients with migraine was collected at the neurologic outpatient clinics of two tertiary hospitals in South Korea. Frequency and severity of migraine symptoms, Migraine Disability Assessment, type D personality, and quality of life were investigated using a structured questionnaire. A descriptive cross-sectional design was used.

RESULTS

Sixty-one (45.2%) were classified as type D personality. The intensity of the most severe migraine and Migraine Disability Assessment scores in subjects with type D personality were significantly higher than those in subjects without type D personality. In addition, the quality of life score of subjects with type D personality was significantly lower than in subjects without type D personality. The intensity of the migraine, Migraine Disability Assessment score, and type D personality were significant factors influencing quality of life on stepwise multiple regression analysis.

CONCLUSIONS

Type D personality was related to migraine symptoms, disability, and quality of life in patients with migraine.

Predictive Model for Quality of Life in Patients 1 Year After First Stroke

BACKGROUND

Because the recurrence rate of stroke increases 1 year after its initial occurrence, it is important to predict quality of life at this stage, although most functions are likely recovered.

OBJECTIVES

We aimed to construct and verify a model of quality of life in patients 1 year post stroke by considering their characteristics at the time of the stroke based on the Wilson and Cleary model and previous literature.

METHODS

Participants comprised 288 patients who had experienced their first ischemic stroke and were enrolled in 3 regional stroke centers in South Korea. Data were analyzed using path analysis to identify a model of patients' quality of life 1 year post stroke.

RESULTS

Age, National Institutes of Health Stroke Scale score, the modified Rankin Scale score, and anxiety had a direct effect on quality of life, whereas type D personality and social support had an indirect effect. Type D personality, age, National Institutes of Health Stroke Scale score, social support, the modified Rankin Scale score, and anxiety explained 32.9% of the total variance in quality of life.

CONCLUSIONS

When predicting quality of life in a patient 1 year after a stroke, it is important to consider variables such as type D personality, age, National Institutes of Health Stroke Scale score, social support, the modified Rankin Scale score, and anxiety at the time of the first stroke. Interventions to improve the quality of life of patients with stroke should consider these factors.

Type-D personality and quality of life in patients with primary brain tumours

OBJECTIVE

To investigate the influence of type-D personality on quality of life (QoL) in patients with primary brain tumours.

METHODS

We performed descriptive cross-sectional study between July 2018 and March 2019. A convenience sample of 293 patients was recruited from an outpatient neurosurgery clinic.

RESULTS

Type-D personality was identified in 34.1% of subjects. Type-D patients had poorer QoL and experienced more severe symptoms and interference with life. Poor QoL was associated with lower education, no spouse and lower family income. Symptoms were the most significant factor affecting QoL, followed by type-D personality, income and education.

CONCLUSION

Symptoms, type-D personality and demographic factors should be considered when assessing QoL in patients with primary brain tumours. Interventions that reflect these characteristics, including type-D personality, may help improve QoL for patients with primary brain tumours.

Type D Personality Associated With Increased Risk for Mortality in Adults With Congenital Heart Disease

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Type D personality has been previously shown to increase the risk for mortality in patients with acquired heart disease.

Effects of a Lifestyle Intervention Based on Type D Personality in Overweight and Obese Middle-Aged Women: A Feasibility Study

BACKGROUND

Obesity is an important public health problem, particularly among middle-aged women. Type D personality, characterized by negative affectivity and social inhibition, is prevalent among obese and overweight middle-aged women and has been linked to maladaptive health-related behaviors and unhealthy lifestyle. Lifestyle interventions based on type D personality could be a first step in combatting obesity in middle-aged women.

AIM

To identify the effects of a lifestyle intervention based on type D personality on health-promoting lifestyle behaviors, psychological distress, type D personality, and body composition in overweight and obese middle-aged women.

METHODS

A total of 36 overweight and obese middle-aged women participated in a quasi-experimental design using a non-equivalent control group pretest-posttest. The experimental group received a total of eight sessions of a lifestyle intervention program based on type D personality over the course of four weeks. Outcomes were measured health-promoting lifestyle behaviors, psychological distress, type D personality, and body composition (body weight, body mass index, body fat, and abdominal fat).

RESULTS

Following the intervention, the experimental group scored significantly higher than the control group for health-promoting lifestyle behaviors, and significantly lower than the control group for psychological distress and type D personality. Body weight and body mass index decreased significantly in the experimental group compared to the control group.

LINKING EVIDENCE TO ACTION

Further research on various intervention programs for overweight and obese middle-aged women is warranted, including lifestyle interventions based on type D personality.

Prevalence and Correlates of Type D Personality among Survivors following Acute Myocardial Infarction in a Tertiary Care Center in South India

Background  Type D personality, described as a consistent tendency to experience increased levels of social inhibition and negative affectivity, has a robust association with negative outcomes following myocardial infarction (MI). However, little is known about its determinants in our setting. Our aim was to assess the prevalence and correlates of Type D personality among survivors following acute MI (AMI). Methods  Two hundred participants with AMI were recruited over an 18-month period. Type D scale-14 was used to evaluate the presence of Type D personality. Apart from sociodemographic factors, depression, anxiety, stress, coping, personality, quality of life, and perceived social support were assessed using standard measures. Results  Type D personality was present in 24% of samples ( n = 48). In multivariate Poisson regression analysis, younger age (prevalence ratio [PR]: 0.950, 95% confidence intervals [CIs]: 0.927-0.974), high depression (PR: 1.372, 95% CI: 1.216-1.548), and low family support (PR: 0.898, 95% CI: 0.849-0.949) emerged as independent predictors of Type D personality in participants with AMI. Conclusion  Type D personality is seen in a significant proportion of AMI, consistent with global literature. Our findings suggest that among Indian patients with AMI, the presence or absence of Type D personality may represent two distinct subpopulations.

Predictive model for quality of life in patients with recurrent coronary artery disease

Background:

The aims of this study were to construct and verify a model that explains the quality of life in patients with recurrent coronary artery disease.

Methods:

Participants were 212 patients with recurrent coronary artery disease undergoing percutaneous coronary intervention. Data were collected through structured questionnaires from 21 December 2016–30 April 2017, and were analyzed using SPSS 23.0 and AMOS 23.0.

Results:

The model’s fit indices were adequate. Type D personality, symptom experience, and resilience had a direct effect on quality of life, while type D personality, cardiac function status, social support, and resilience had an indirect effect on quality of life. Type D personality, cardiac function status, social support, symptom experience, and resilience explained 55% of the total variance in quality of life. Thus, type D personality, cardiac function status, social support, symptom experience, and resilience affected the quality of life in patients with recurrent coronary artery disease.

Conclusions:

Systematic and integrated intervention programs considering factors related to quality of life may be useful for improving quality of life for patients with recurrent coronary artery disease.

Mediating effect of illness perception on the relationship between Type D personality and health behaviors among coronary artery disease patients

The aim of this study was to investigate the relationship between Type D personality and health behaviors of coronary artery disease patients and to determine the mediating effect of illness perception on this relationship. The participants were 142 coronary artery disease patients who underwent percutaneous coronary intervention in a university hospital in Korea. Type D personality, illness perception, and health behaviors were surveyed using structured questionnaires. The collected data were analyzed by a series of hierarchical multiple regressions. A total of 28.9 percent patients had Type D personality. Type D Patients were observed to have low illness perception and low health behaviors. There was a positive correlation between illness perception and health behaviors. The direct effect of Type D personality on health behaviors was significant (β = -.209, p = .013). However, the indirect effect of Type D personality on health behaviors via illness perception became low and non-significant (β = .007, p = .934). Based on the above results, it can be concluded that illness perception has a complete mediating effect on the relationship between Type D personality and health behaviors. The development of interventions that can improve illness perception is needed to improve health behaviors of Type D coronary artery disease patients.

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.

Effect of Type D Personality on Short-Term Cardiac Rehabilitation in Patients With Coronary Artery Disease

Objective

To investigate the effect of type D personality on cardiac rehabilitation (CR) participation rates and the effect of a short-term CR program.

Methods

Study participants included patients diagnosed with acute coronary syndrome who underwent percutaneous coronary intervention. Patients completed the Type D personality Scale (DS-14) and the Hospital Anxiety and Depression Scale (HADS) at program entry. Subjects were recommended participation in 6 weeks of CR exercise training. Cardiopulmonary exercise test (CPET) was conducted before and after completion of the training. CR participation refers to completion of the 6-week CR exercise program and performance of the secondary CPET. Drop-out refers to the subjects who were unable to participate in the 6-week CR exercise program or to perform the secondary CPET.

Results

At baseline, type D personality was evident in 21 of 63 patients (33.3%). Type D patients were more often depressed (57.1%) and anxious (38.1%) than non-type D patients (31.0% and 9.5%, respectively). At baseline, participants with type D personality showed a decreased body mass index (24.6 vs. 26.1 kg/m², p=0.025). The type D group displayed a lower CR participation rate (5/21, 23.8%) compared with the non-type D group of (22/42, 52.4%). Logistic regression analysis revealed the association of type D personality with CR drop-out rate (odds ratio=3.87; 95% confidence interval, 1.2–12.5; p<0.05).

Conclusion

Type D personality was independently associated with drop-out from CR program and with significantly higher levels of anxiety and depressive mood.