Psychiatric disorders, rumination, and metacognitions in patients with type D personality and coronary heart disease

BACKGROUND

Little is known regarding the prevalence of psychiatric disorders in patients with both coronary heart disease (CHD) and type D personality, and whether these patients may benefit from psychotherapy that modifies metacognitive beliefs implicated in disorder maintenance. This study explored prevalence rates among these patients and associations between type D characteristics, rumination and metacognitions.

METHODS

Forty-seven consecutive patients with CHD who scored positive for type D personality were included in this pre-planned study. Participants underwent structured clinical interviews for mental and personality disorders and completed questionnaires assessing rumination and metacognitions.

RESULTS

Mean age was 53.8 (SD 8.1) years and 21.3% were female. At least one mood disorder or anxiety disorder was found in 70.2% and 61.7% of the patients. The most common disorders were major depressive disorder (59.6%), social phobia (40.4%), and generalized anxiety disorder (29.8%). At least one personality disorder was detected in 42.6%. Only 21% reported ongoing treatment with psychotropic medication whereas none had psychotherapy. Metacognitions and rumination were significantly associated with negative affectivity (0.53-0.72, p < .001) but not social inhibition.

CONCLUSION

Mood and anxiety disorders were highly prevalent and relatively untreated among these patients. Future studies should test the metacognitive model for type D personality.

The problem of distressed personality in a group of female footballers representing a club in the women’s first football league in Poland

Purpose. One of the keys to identifying health problems from the holistic perspective is the knowledge of Type D personality (distressed personality). Diagnosing this personality disorder among female football players may help sports psychologists, coaches, parents/caregivers, and all those engaged in training new sports entrants develop guidelines on how to resolve the problem. Methods. The study involved female footballers representing a Polish Ekstraliga football club, AZS-PSW Biała Podlaska, and was conducted with the use of the Polish adaptation of the DS14 scale. Results. In a group of 21 footballers, 7 (33.3%) were diagnosed with Type D personality. Besides, a negative correlation was noted between the level of satisfaction with playing football and one of the dimensions of Type D personality - negative emotionality. Conclusions. The results of the study may be applicable in formulating practical recommendations while preparing mental training programmes.

Social inhibition and emotional distress in patients with coronary artery disease: The Type D personality construct

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.

Spirit or Fleeting Apparition? Why Spirituality's Link with Social Support Might Be Incrementally Invalid

Previously published path models apparently confirm the belief-as-benefit perspective that spirituality boosts well-being via social support. The broad acceptance of such findings has motivated recommendations that clinical psychologists and psychiatrists routinely assess their patients' spiritual status. Skeptics retort that past findings are statistically confounded and that numinous beliefs and well-being are unrelated. A multivariate regression analysis testing whether spirituality explains variance in social support after personality traits are simultaneously included is reported. Although spirituality displays a significant positive correlation and partial correlation (after controlling for socio-demographics) with social support, regression analysis specifying agreeableness and conscientiousness-individual differences related to both spirituality and social support-as predictors renders spirituality nonsignificant. In summary, spirituality's correlation with social support appears spurious; demonstrating the hazards of relying on simple associations and highlighting the urgent need for researchers to utilize statistical methods capable of establishing cause and parsing effects across rival theoretical explanations.

Type D personality is associated with social anxiety in the general population

BACKGROUND

Research on the emotional processes associated with Type D personality is important for its further conceptualization. We examined the associations of Type D personality with social and general anxiety symptoms in a large community sample.

PURPOSE

The aim of the current study was to disentangle the associations of Type D personality and its components with social anxiety and general anxiety in a large sample from the general population.

METHODS

A random sample of 2,475 adults from the general population filled out questionnaires to assess Type D personality (DS-14), social anxiety (SIAS(10), SPS(11), BFNE-II), and general anxiety (HADS-A, GAD-7).

RESULTS

Type D individuals were characterized by increased levels of both social and general anxiety. The social inhibition (SI) component of Type D personality was most strongly associated with social interaction anxiety (r = .63), while negative affectivity (NA) was strongly associated with general anxiety (GAD-7: r = .70; HADS-A: r = .66). Within social anxiety, SI was more strongly associated with facets of social interaction anxiety than with social phobia. Multiple regression analysis showed that the synergistic interaction of NA and SI was a predictor of social anxiety (SIAS(10): β = .32, p < .0005; SPS(11): β = .27, p < .0005; BFNE-II: β = .11, p = .007) independent of demographics and the scores on the individual Type D components. This interaction was not a significant predictor of general anxiety. Logistic regression using the dichotomous Type D classification demonstrated a 9.1-fold (95%CI, 7.0-11.8) increased odds of a score in the highest quartile of social interaction anxiety and a 7.6-fold (95%CI, 5.8-9.8) increased odds of high social phobia. Odds ratios for clinically relevant levels of general anxiety were 8.3 (95%CI, 5.5-12.5) for GAD-7 and 6.5 (95%CI, 3.4-12.6) for HADS-A.

CONCLUSION

In the general population, Type D individuals were characterized by both social and general anxiety. The SI component of Type D is strongly associated with social interaction anxiety and the synergistic interaction of NA and SI was associated with high social anxiety, above and beyond the main NA and SI effects.

The Type D Construct

The interaction of negative affectivity (NA) and social inhibition (SI), known as the Type D personality, is associated with a worse prognosis in cardiac patients. Until now, causal models have been speculative, and this is partly due to a lack of clarity related to the validity of SI, its role in emotion regulation, and the postulated independence of social and emotional functioning. To examine the construct validity of the Type D personality, we analyzed associations of NA and SI with different measures of affectivity, social anxiety, and social competencies in a German population-based representative sample (n = 2,495). Both NA and SI were associated with all other measures of social functioning and negative affect (all rs > .30) and showed considerable cross-loadings (NA: a 1 = .39, a 2 = .63; SI: a1 = .73 and a2 = .34) in a two-factor solution with the factors labeled as Social Functioning and Negative Affectivity. The SI subscale did not properly differentiate between social fears and social competencies, which emerged as rather different aspects of social functioning. Further studies should examine the effect of broader dimensions of social orientation and competencies and their interaction with NA on cardiac prognosis.

Health specific traits beyond the Five Factor Model, cognitive processes and trait expression: replies to Watson (2012), Matthews (2012) and Haslam, Jetten, Reynolds, and Reicher (2012)

In this article we reply to the issues raised by the three commentaries on Ferguson's (2012) article. Watson argues that the four traits identified by Ferguson (2012) – health anxiety, alexithymia, empathy and Type D – do not lie outside the Five Factor Model (FFM). We present factor analytic data showing that health anxiety forms a separate factor from positive and negative affectivity, alexithymia forms a factor outside the FFM and while emotional empathy loads with agreeableness, cognitive empathy forms a separate factor outside the FFM. Across these analyses there was no evidence for a general factor of personality. We also show that health anxiety, empathic facets and alexithymia show incremental validity over FFM traits. However, the evidence that Type D lies outside the FFM is less clear. Matthews (2012) argues that traits have a more distributed influence on cognitions and that attention is not part of Ferguson's framework. We agree; but Ferguson's original statement concerned where traits have their maximal effect. Finally, Haslam et al. suggest that traits should be viewed from a dynamic interactionist perspective. This is in fact what Ferguson (2012) suggested and we go on to highlight that traits can also influence group processes.

The validity of the Type D construct and its assessment in Taiwan

BACKGROUND

Type D (distressed) personality, defined by negative affectivity and social inhibition, is related to cardiovascular outcomes. Little is known about Type D in non-Western cultures. We examined the validity of this construct and its assessment in Taiwanese patients with coronary artery disease (CAD) and adults from the general population.

METHODS

CAD patients (N = 87) and adults from the general population (N = 421) completed the 14-item Type D Scale- Taiwanese version (DS14-T), State-Trait Anxiety Inventory, Beck Depression Inventory-II, and Chinese Hostility Inventory Short-Form.

RESULTS

Based on the psychometric examination, item #3 of the original DS14, "I often talk to strangers" was replaced by "I don't like to have a lot of people around me" which comes from the "Withdrawal" facet of social inhibition of DS-24. The reliability of Type D assessment in Taiwan was good, with Cronbach's α for negative affectivity and social inhibition of .86 and .79. Factor analyses confirmed the two-factor model of the Type D construct. The prevalence rate of Type D personality in Taiwan was 20% in CAD patients and 16% in the general population. Negative affectivity was positively associated with anxiety, depression and hostility, and social inhibition was positively associated with suppressive hostility and negatively associated with expressive hostility after controlling for the total hostility. Furthermore, Taiwanese individuals with a Type D personality displayed elevated levels of anxiety, depression and hostility.

CONCLUSIONS

The Type D construct and its assessment with the DS14-T is generalizable to an Asian setting, Taiwan. The DS14-T showed good psychometric properties, and the prevalence of Type D personality in Taiwan was similar to the prevalence rates in Western countries and Mainland China, and Type D was associated with anxiety, depression and hostility.

Type D (distressed) personality and its assessment with the DS14 in Lithuanian patients with coronary artery disease

We examined Type D personality (combination of negative affectivity with social inhibition) and its assessment with the DS14 in 543 Lithuanian coronary patients. Psychometric analyses confirmed the two-factor structure, internal consistency (α = 0.84/α = 0.75), and test-retest reliability (r = 0.69/0.81) of the DS14 negative affectivity and inhibition components. Negative affectivity correlated (r = -0.58) with emotional stability and social inhibition (r = -0.46) with extraversion; correlations with other Big-Five traits ranged between r = -0.11 and -0.19. Type D patients (34%) had a ninefold increased odds of depression (95% confidence interval = 5.01-17.36) and a fivefold increased odds of anxiety (95% confidence interval = 3.47-7.97). These findings support the validity of the Type D construct in Lithuania.

Multi-method analysis of the internal structure of the Type D Scale-14 (DS14)

OBJECTIVE

The Type D Scale-14 (DS14) measures distressed (also, Type D) personality by assessing the medium-level trait negative affectivity that encompasses the low-level traits dysphoria, anxiety, and irritability, and the medium-level trait social inhibition that encompasses the low-level traits social discomfort, reticence, and lack of social poise. The literature discusses three different structural models of the DS14. The goal of this study was to investigate which of the three models best describes the internal structure of the DS14.

METHOD

We used three methods to investigate the internal structure of the DS14 items using data collected in representative samples from the Dutch general population (N=3,181). The methods were exploratory factor analysis, confirmatory factor analysis, and Mokken scale analysis.

RESULTS

Exploratory factor analysis suggested a two-factor structure without evidence of the low-level factors, and the other two methods showed evidence of a three-level structure including the low-level factors.

CONCLUSIONS

A two-factor model with correlated errors for items defining low-level traits adequately describes the data. The results support the three-level hierarchical model as a conceptual model for Type D personality, and support the interpretation of DS14 scores on item subsets representing medium-level traits and low-level traits.

Type D personality and persistence of depressive symptoms in a German cohort of cardiac patients

BACKGROUND

Depression is associated with a negative prognosis in coronary heart disease and heart failure patients. Type D personality has been shown to predict the persistence of depressive symptoms over 12 months. Data on longer follow-up periods and on the effectiveness of Type D as a screening tool compared to established measures of depressive symptoms are missing.

METHODS

Type D personality and depressive mood were assessed with the DS14 and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) in 679 consecutive cardiac patients (22.2% female, mean age 62.4±10.2 years) over a period of 6 years. Latent class and growth mixture models with Type D, comorbidity, age, and sex as covariates were used to model individual depression trajectory classes and to predict trajectories and class membership. Estimates of specificity and sensitivity were calculated for Type D and the HADS-D baseline cut-off point.

RESULTS

In a model with four latent classes (mild symptoms, moderate and increasing symptoms, significant but decreasing symptoms, and significant and increasing symptoms), Type D predicted the membership in the class with significant and increasing symptoms (OR=10.94, 4.93, and 3.15). Sensitivity and specificity were 59% and 78% for Type D and 47% and 80% for the HADS-D.

LIMITATIONS

Some possible confounders might be missing. With just two measurement points only linear trajectories could be modeled.

CONCLUSIONS

Type D personality is a stronger predictor for persistent depressive symptoms than the baseline HADS-D score, but the predictive power seems low for clinical practice.

Cross-cultural analysis of type D (distressed) personality in 6222 patients with ischemic heart disease: a study from the International HeartQoL Project

BACKGROUND

Type D (distressed) personality, the conjoint effect of negative affectivity (NA) and social inhibition (SI), predicts adverse cardiovascular outcomes, and is assessed with the 14-item Type D Scale (DS14). However, potential cross-cultural differences in Type D have not been examined yet in a direct comparison of countries.

AIM

To examine the cross-cultural validity of the Type D construct and its relation with cardiovascular risk factors, cardiac symptom severity, and depression/anxiety.

METHODS

In 22 countries, 6222 patients with ischemic heart disease (angina, 33%; myocardial infarction, 37%; or heart failure, 30%) completed the DS14 as part of the International HeartQoL Project.

RESULTS

Type D personality was assessed reliably across countries (αNA>.80; αSI>.74; except Russia, which was excluded from further analysis). Cross-cultural measurement equivalence was established for Type D personality at all measurement levels, as the factor-item configuration, factor loadings, and error structure were not different across countries (fit: CFI=.91; NFI=.88; RMSEA=.018), as well as across gender and diagnostic subgroups. Type D personality was more prevalent in Southern (37%) and Eastern (35%) European countries compared to Northern (24%) and Western European and English-speaking (both 27%) countries (p<.001). Type D was not confounded by cardiac symptom severity, but was associated with a higher prevalence of hypertension, smoking, sedentary lifestyle, and depression.

CONCLUSION

Cross-cultural measurement equivalence was demonstrated for the Type D scale in 21 countries. There is a pan-cultural relationship between Type D personality and some cardiovascular risk factors, supporting the role of Type D personality across countries and cardiac conditions.

Type D personality and all-cause mortality in cardiac patients--data from a German cohort study

OBJECTIVE

Type D personality has been established as a predictor of adverse clinical events in patients with cardiovascular diseases. To date, all studies except one have been conducted by a single research group. Thus, the aim of our study was to provide an independent replication of the results regarding the prognostic validity of Type D personality in a German sample of cardiac patients.

METHODS

Cardiac patients (n = 1040) were recruited from cardiac rehabilitation centers (n = 484), an outpatient clinic (n = 249), and a university hospital (n = 307). Main analyses were based on the combined data from these three subsamples. Cardiac health status, medical risk factors, sociodemographic characteristics, psychological symptoms, and Type D personality were assessed at baseline. The primary end point was all-cause mortality. The Cox proportional hazards regression model was used to estimate the relative risk of death.

RESULTS

Vital status was known for 977 patients (22.5% women; mean [standard deviation] = 63.3 [10.7] years). Within the follow-up time (mean [standard deviation] = 71.5 [3.6] months), 172 patients died. Type D personality was found in 25.2% of survivors and in 22.2% of nonsurvivors (χ²= 0.78, p = .38). Depressive symptoms (p = .13) and anxiety (p = .27) were also not predictive of mortality. In the multivariate analyses, neither Type D (p = .95) nor negative affectivity (p = .71) and social inhibition (p = .59), as well as their interaction (p = .88), were associated with all-cause mortality.

CONCLUSIONS

In the present study, Type D personality and its constituents are not associated with increased mortality in patients with heart disease. The discrepancies with previous results deserve further investigation.

Validity of Type D personality in Iceland: association with disease severity and risk markers in cardiac patients

Type D personality has been associated with poor prognosis in cardiac patients. This study investigated the validity of the Type D construct in Iceland and its association with disease severity and health-related risk markers in cardiac patients. A sample of 1,452 cardiac patients completed the Type D scale (DS14), and a subgroup of 161 patients completed measurements for the five-factor model of personality, emotional control, anxiety, depression, stress and lifestyle factors. The Icelandic DS14 had good psychometric properties and its construct validity was confirmed. Prevalence of Type D was 26–29%, and assessment of Type D personality was not confounded by severity of underlying coronary artery disease. Regarding risk markers, Type D patients reported more psychopharmacological medication use and smoking, but frequency of previous mental problems was similar across groups. Type D is a valid personality construct in Iceland, and is associated with health-related risk markers, but not cardiac disease severity.