1
|
Gomes AP, Costa B, Marques R, Nunes V, Coelho C. Kaplan-Meier Survival Analysis: Practical Insights for Clinicians. ACTA MEDICA PORT 2024; 37:280-285. [PMID: 38631048 DOI: 10.20344/amp.21080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/06/2024] [Indexed: 04/19/2024]
Abstract
This article aims to provide a guide that will help healthcare professionals and clinical researchers from all fields that deal with Kaplan-Meier curves. Survival analysis methods are among the most frequently used in the medical sciences and in clinical research. Overall survival, progression free survival, time to recurrence, or any other clinically relevant parameter represented by a Kaplan-Meier curve will be discussed. We will present a practical and straightforward interpretation of these curves, setting aside intricate mathematical considerations. Our focus will be on essential concepts that interface with biological sciences and medicine in order to guarantee proficiency in one of the most popular yet frequently misunderstood methods in clinical research. Being familiar with these concepts is not only essential for designing new clinical studies but also for critically assessing and interpreting published data.
Collapse
Affiliation(s)
- António Pedro Gomes
- Surgery Department. Hospital de Vila Franca de Xira. Vila Franca de Xira. Portugal
| | - Bruna Costa
- Champalimaud Centre for the Unknown. Lisbon. Portugal
| | - Rita Marques
- Surgery Department. Unidade de Caldas da Rainha. Centro Hospitalar do Oeste. Caldas da Rainha. Portugal
| | - Vitor Nunes
- Surgery Department. Hospital de Vila Franca de Xira. Vila Franca de Xira. Portugal
| | - Constança Coelho
- Genetics Laboratory. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| |
Collapse
|
2
|
Torgersen KS, Sverre ECB, Weedon-Fekjær H, Andreassen OA, Munkhaugen J, Dammen T. Risk of recurrent cardiovascular events in coronary artery disease patients with Type D personality. Front Psychol 2023; 14:1119146. [PMID: 37057178 PMCID: PMC10088369 DOI: 10.3389/fpsyg.2023.1119146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionData on the association between Type D personality, its traits negative affectivity (NA) and social inhibition (SI), and risk of major adverse cardiac events (MACE) in coronary outpatients is sparse. Furthermore, the associations between Type D subgroups and cardiovascular risk factors are largely unknown.MethodsWe investigated i) Type D personality, NA and SI and risk of recurrent MACE, and ii) the relationship between Type D subgroups and risk factors in a coronary population. This prospective cohort study included 1083 patients` median 16 months after a myocardial infarction and/or a revascularization procedure who were followed-up for 4.2 (SD 0.4) years. Type D personality was assessed by DS14. Anxiety and depression, statin adherence, and risk factors were assessed by patients’ self-report and a clinical examination with blood samples. MACE, defined as cardiovascular death, myocardial infarction, revascularization, stroke or heart failure, were obtained from hospital records from index event to end of study lasting 5.7 years. Data were analyzed by Cox proportional hazard regression.ResultsIn all, 352 MACE occurred in 230 patients after average 4.2 years follow-up. Higher NA score was associated with MACE after adjustment for age, risk factors and comorbidity (HR 1.02 per unit increase, 95% CI 1.00-1.05), whereas we found a weaker, not statistically significant estimated effect of higher SI score. After additional adjustment for symptoms of anxiety and depression, we found a weaker, not statistically significant association between NA and MACE (HR 1.01 per unit increase, 95% CI 0.98-1.05). Low statin adherence and smoking were more prevalent in the Type D and high NA group.DiscussionOur results indicate that the NA trait is related to worse prognosis in outpatients with coronary artery disease.
Collapse
Affiliation(s)
- Kristin Stensland Torgersen
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elise Christine Bjørkholen Sverre
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Harald Weedon-Fekjær
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT: Norwegian Centre for Mental Disorders Research, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - John Munkhaugen
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Toril Dammen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section of Psychiatric Treatment Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
3
|
Wang Y, Gao X, Zhao Z, Li L, Liu G, Tao H, Yu X, Yu B, Lin P. The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction. Psychol Med 2023; 53:1379-1389. [PMID: 35775401 DOI: 10.1017/s0033291721002932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI). METHODS This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period. RESULTS A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (-) groups had a higher risk of MACE [95% confidence interval (CI) 1.74-6.07] (95% CI 1.25-2.96) and ISR (95% CI 3.09-8.28) (95% CI 1.85-6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (-) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients. CONCLUSIONS These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.
Collapse
Affiliation(s)
- Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xueqin Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhenjuan Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ling Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guojie Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Tao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xi Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ping Lin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
4
|
Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Meta-analysis. Psychosom Med 2023; 85:188-202. [PMID: 36640440 DOI: 10.1097/psy.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Type D personality, a joint tendency toward negative affectivity and social inhibition, has been linked to adverse events in patients with heart disease, although with inconsistent findings. Here, we apply an individual patient-data meta-analysis to data from 19 prospective cohort studies ( N = 11,151) to investigate the prediction of adverse outcomes by type D personality in patients with acquired cardiovascular disease. METHOD For each outcome (all-cause mortality, cardiac mortality, myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, major adverse cardiac event, any adverse event), we estimated type D's prognostic influence and the moderation by age, sex, and disease type. RESULTS In patients with cardiovascular disease, evidence for a type D effect in terms of the Bayes factor (BF) was strong for major adverse cardiac event (BF = 42.5; odds ratio [OR] = 1.14) and any adverse event (BF = 129.4; OR = 1.15). Evidence for the null hypothesis was found for all-cause mortality (BF = 45.9; OR = 1.03), cardiac mortality (BF = 23.7; OR = 0.99), and myocardial infarction (BF = 16.9; OR = 1.12), suggesting that type D had no effect on these outcomes. This evidence was similar in the subset of patients with coronary artery disease (CAD), but inconclusive for patients with heart failure (HF). Positive effects were found for negative affectivity on cardiac and all-cause mortality, with the latter being more pronounced in male than female patients. CONCLUSION Across 19 prospective cohort studies, type D predicts adverse events in patients with CAD, whereas evidence in patients with HF was inconclusive. In both patients with CAD and HF, we found evidence for a null effect of type D on cardiac and all-cause mortality.
Collapse
|
5
|
Skau E, Wagner P, Leppert J, Ärnlöv J, Hedberg P. Are the results from a multiplex proteomic assay and a conventional immunoassay for NT-proBNP and GDF-15 comparable? Clin Proteomics 2023; 20:5. [PMID: 36694116 PMCID: PMC9872369 DOI: 10.1186/s12014-023-09393-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND We aimed to compare absolute plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) obtained by a conventional immunoassay with the corresponding relative concentrations from a proximity extension assay (PEA) and compare the prognostic impact of the protein levels obtained from these assays. METHODS We evaluated 437 patients with peripheral arterial disease (PAD) and a population-based cohort of 643 individuals without PAD. Correlations were calculated using Spearman's rank correlation coefficients (rho). The discriminatory accuracy of the protein levels to predict future cardiovascular events was analyzed with Cox regression and presented as time-dependent areas under the receiver-operator-characteristic curves (tdAUCs). RESULTS For NT-proBNP, the two assays correlated with rho 0.93 and 0.93 in the respective cohort. The PEA values leveled off at higher values in both cohorts. The corresponding correlations for GDF-15 were 0.91 and 0.89. At 5 years follow-up, the tdAUCs in the patient cohort were similar for NT-proBNP and GDF-15 regardless of assay used (0.65-0.66). The corresponding tdAUCs in the population-based cohort were between 0.72 and 0.77. CONCLUSION Except for the highest levels of NT-proBNP, we suggest that PEA data for NT-proBNP and GDF-15 reliably reflects absolute plasma levels and contains similar prognostic information.
Collapse
Affiliation(s)
- Emma Skau
- grid.8993.b0000 0004 1936 9457Centre for Clinical Research, Västmanland County Hospital, Uppsala University, SE-72 189 Västerås, Sweden ,grid.412154.70000 0004 0636 5158Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Philippe Wagner
- grid.8993.b0000 0004 1936 9457Centre for Clinical Research, Västmanland County Hospital, Uppsala University, SE-72 189 Västerås, Sweden
| | - Jerzy Leppert
- grid.8993.b0000 0004 1936 9457Centre for Clinical Research, Västmanland County Hospital, Uppsala University, SE-72 189 Västerås, Sweden
| | - Johan Ärnlöv
- grid.411953.b0000 0001 0304 6002School of Health and Social Studies, Dalarna University, Falun, Sweden ,grid.4714.60000 0004 1937 0626Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
| | - Pär Hedberg
- grid.8993.b0000 0004 1936 9457Centre for Clinical Research, Västmanland County Hospital, Uppsala University, SE-72 189 Västerås, Sweden ,Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden
| |
Collapse
|
6
|
SÁNCHEZ-DÍAZ M, MONTERO-VÍLCHEZ T, QUIÑONES-VICO MI, SIERRA-SÁNCHEZ Á, UBAGO-RODRÍGUEZ A, SANABRIA-DE LA TORRE R, MOLINA-LEYVA A, ARIAS-SANTIAGO S. Type D Personality as a Marker of Poorer Quality of Life and Mood Status Disturbances in Patients with Skin Diseases: A Systematic Review. Acta Derm Venereol 2023; 103:adv00846. [PMID: 36625209 PMCID: PMC9885290 DOI: 10.2340/actadv.v103.2741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Type D personality is characterized by social inhibition and negative affectivity. Poorer outcomes and worse quality of life have been linked to type D personality in patients with a variety of non-dermatological diseases. Despite increasing evidence of the importance of type D personality in skin diseases, there are no reviews on this subject. The aim of this review is to summarize the current evidence regarding type D personality and skin diseases. A systematic search was performed using Medline and Web of Science databases from inception to 11 October 2022. Studies addressing the presence of type D personality, its associated factors, its impact on the outcomes of the disease or the quality of life of the patients were included in the systematic review. A total of 20 studies, including 3,124 participants, met the eligibility criteria and were included in the review. Acne, hidradenitis suppurativa, psoriasis, melanoma, atopic dermatitis, chronic spontaneous urticaria and pruritic disorders were the main diseases assessed. Type D personality was more frequent among patients with skin diseases than among controls. Type D personality was found to be associated with poorer quality of life and higher rates of psychological comorbidities in patients with skin diseases. In conclusion, type D personality appears to be a marker of patients with increased risk of poorer quality of life and higher rates of psychological comorbidities. Screening for type D personality in specialized dermatology units might be beneficial to identify patients who are more psychologically vulnerable to the consequences of chronic skin diseases.
Collapse
Affiliation(s)
- Manuel SÁNCHEZ-DÍAZ
- Dermatology Department, Hospital Universitario Virgen de las Nieves, Ibs.Granada
| | | | - María I. QUIÑONES-VICO
- Cell Production and Tissue Engineering Unit, Hospital Universitario Virgen de las Nieves, Ibs.Granada,School of Medicine, University of Granada, Granada, Spain
| | - Álvaro SIERRA-SÁNCHEZ
- Cell Production and Tissue Engineering Unit, Hospital Universitario Virgen de las Nieves, Ibs.Granada
| | - Ana UBAGO-RODRÍGUEZ
- Cell Production and Tissue Engineering Unit, Hospital Universitario Virgen de las Nieves, Ibs.Granada,School of Medicine, University of Granada, Granada, Spain
| | - Raquel SANABRIA-DE LA TORRE
- Cell Production and Tissue Engineering Unit, Hospital Universitario Virgen de las Nieves, Ibs.Granada,School of Medicine, University of Granada, Granada, Spain
| | | | - Salvador ARIAS-SANTIAGO
- Dermatology Department, Hospital Universitario Virgen de las Nieves, Ibs.Granada,Cell Production and Tissue Engineering Unit, Hospital Universitario Virgen de las Nieves, Ibs.Granada,School of Medicine, University of Granada, Granada, Spain
| |
Collapse
|
7
|
Tunheim K, Dammen T, Baardstu S, Moum T, Munkhaugen J, Papageorgiou C. Relationships between depression, anxiety, type D personality, and worry and rumination in patients with coronary heart disease. Front Psychol 2022; 13:929410. [PMID: 36186321 PMCID: PMC9517376 DOI: 10.3389/fpsyg.2022.929410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Psychological distress, including depression and anxiety, and Type-D personality are prevalent in patients with coronary heart disease (CHD) and associated with poor cardiovascular outcomes. Worry and rumination may be among the core features responsible for driving psychological distress in these patients. However, the nature of associations between these constructs remains to be delineated, yet they may have implications for the assessment and treatment of CHD patients. This study aimed to (1) explore the factorial structure and potential overlap between measures of depression, anxiety and the Type-D personality factors known as negative affectivity and social inhibition, and (2) examine how these constructs relate to worry and rumination in a sample of 1,042 CHD outpatients who participated in the in the cross-sectional NORwegian CORonary Prevention study. We conducted confirmatory factor analyses (n = 1,042) and regression analyses (n = 904) within a structural equation modeling framework. Results showed all constructs to have acceptable factor structure and indicated an overlap between the constructs of depression and negative affectivity. Worry was most strongly associated with anxiety, whereas rumination was most strongly associated with depression and negative affectivity. The results suggest conceptual similarities across the measures of depression and negative affectivity. They further suggest that intervention efforts could benefit from targeting worry and/or rumination in the treatment of CHD outpatients presenting with symptoms of psychological distress.
Collapse
Affiliation(s)
- Kristoffer Tunheim
- The Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | - Toril Dammen
- The Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Department for Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Silje Baardstu
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Torbjørn Moum
- Department of Behavioral Medicine, The Medical Faculty, University of Oslo, Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
- Department of Behavioral Medicine, The Medical Faculty, University of Oslo, Oslo, Norway
| | - Costas Papageorgiou
- Department of Psychology, University of Oslo, Oslo, Norway
- Priory Hospital Altrincham, Cheshire, United Kingdom
| |
Collapse
|
8
|
Ganz FD, Raanan O, Shafir G, Levy D, Klempfner R, Beigel R, Iakobishvili Z. Distress among hospitalized patients with acute coronary syndrome. Nurs Crit Care 2021; 27:165-171. [PMID: 34766409 DOI: 10.1111/nicc.12730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have demonstrated that those suffering from acute coronary syndrome (ACS) experience various physical and psychological symptoms. Few studies have investigated the multi-factorial, holistic, unpleasant experience of distress that includes physical, psychological, social, and spiritual factors among this patient population while still hospitalized. AIM To describe the level of distress among patients hospitalized with ACS and its association with demographic and clinical factors and mortality. STUDY DESIGN The study conducted a descriptive, cross-sectional survey. METHODS The Acute Coronary Syndrome Israel Study is a national, biennial registry, enrolling all patients with ACS admitted to cardiac intensive care or cardiology wards in Israel within a 2-month period. Demographic and clinical data were retrieved from an electronic database. Distress was measured by the Distress Thermometer. Nurses collected distress data directly from patients before discharge. RESULTS Nine hundred ninety participants (50.6% response rate) were surveyed. Mean age was 62.8 (SD = 12.5). Mean distress level was 4.8 (SD = 3.45) out of 10. The most frequently reported area of distress was physical, followed by emotional. Practical and family problems were less frequent. Emotional distress was found to differ based on educational level, marital status, smoking history, and previous medical history. Distress did not predict 7- or 30-day mortality. CONCLUSIONS Respondents with ACS were in moderate distress. It is recommended that those at increased risk receive increased monitoring of emotional distress while still in hospital. Further studies should investigate this holistic view of distress among the ACS population using a variety of methods and methodologies.
Collapse
Affiliation(s)
- Freda DeKeyser Ganz
- Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel.,Hadassah-Hebrew University School of Nursing, Jerusalem, Israel
| | - Ofra Raanan
- Sheba Medical Center School of Nursing, Tel Hashomer, Israel
| | - Gennady Shafir
- Cardiac Intensive Care Unit, Haemek Medical Center, Afula, Israel
| | - Dassy Levy
- Division of Cardiology, Rambam Medical Center, Haifa, Israel
| | - Robert Klempfner
- Department of Cardiology, Sheba Medical Center, Cardiac Rehabilitation Institute, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beigel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Zaza Iakobishvili
- Department of Community Cardiology, Clalit Health Services, Tel Aviv, Israel.,Department of Cardiology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| |
Collapse
|
9
|
Lodder P, Kupper N, Antens M, Wicherts JM. A systematic review comparing two popular methods to assess a Type D personality effect. Gen Hosp Psychiatry 2021; 71:62-75. [PMID: 33962138 DOI: 10.1016/j.genhosppsych.2021.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/04/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Type D personality, operationalized as high scores on negative affectivity (NA) and social inhibition (SI), has been associated with various medical and psychosocial outcomes. The recent failure to replicate several earlier findings could result from the various methods used to assess the Type D effect. Despite recommendations to analyze the continuous NA and SI scores, a popular approach groups people as having Type D personality or not. This method does not adequately detect a Type D effect as it is also sensitive to main effects of NA or SI only, suggesting the literature contains false positive Type D effects. Here, we systematically assess the extent of this problem. METHOD We conducted a systematic review including 44 published studies assessing a Type D effect with both a continuous and dichotomous operationalization. RESULTS The dichotomous method showed poor agreement with the continuous Type D effect. Of the 89 significant dichotomous method effects, 37 (41.6%) were Type D effects according to the continuous method. The remaining 52 (58.4%) are therefore likely not Type D effects based on the continuous method, as 42 (47.2%) were main effects of NA or SI only. CONCLUSION Half of the published Type D effect according to the dichotomous method may be false positives, with only NA or SI driving the outcome.
Collapse
Affiliation(s)
- Paul Lodder
- Department of Methodology and Statistics, Tilburg University, the Netherlands; Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands.
| | - Nina Kupper
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Marijn Antens
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Jelte M Wicherts
- Department of Methodology and Statistics, Tilburg University, the Netherlands
| |
Collapse
|
10
|
Zhang Y, Wu S, Pan J, Hoschar S, Wang Z, Tu R, Ladwig KH, Ma W. The impact of the Type D Personality pattern on prehospital delay in patients suffering from acute myocardial infarction. J Thorac Dis 2020; 12:4680-4689. [PMID: 33145041 PMCID: PMC7578491 DOI: 10.21037/jtd-20-1546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The Type D Personality (TDP) has been specifically linked to acute myocardial infarction (AMI). However, the impact on prehospital delay of AMI patients is unclear. The aim of this study was to assess the relationship between TDP and pre-hospital delay time (PHT) in a Chinese population. Methods A total of 256 AMI patients (47 women and 209 men) were taken from the Multicenter Delay in Patients Experiencing AMI in Shanghai (MEDEA FAR-EAST) study. Sociodemographic and psycho-behavioral characteristics were assessed by bedside interviews and questionnaires. TDP was evaluated according to the Type D Personality Scale (DS14) subdivided in social inhibition (SI) and negative affectivity (NA). Based on a significant interaction analysis of TDP and sex on PHT, all analyses were stratified by sex. Results PHT of female patients with TDP were substantially shorter compared to non-TDP female patients (108 vs. 281 min, P=0.029). In male patients, no effect of TDT on PHT was found. Spearman correlation analysis suggests that NA was negatively correlated with PHT (r=−0.358, P=0.014). Further age-adjusted logistic regression analyses showed that female patients with TDP were generally less likely to prehospital delay compared with non-TDP patients (OR =0.28; 95% CI, 0.08–0.98) and had a lower risk of PHT >360 minutes (OR =0.10; 95% CI, 0.01–0.91). However, statistical significance disappeared after adjustment for psychological factors (anxiety, depression, suboptimal wellbeing, cardiac denial and stress event). Conclusions TDP is associated with less prehospital delay in female patients during AMI—an effect which may be particularly mediated by NA.
Collapse
Affiliation(s)
- Youyang Zhang
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shihao Wu
- Department of Geriatrics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiangqi Pan
- Department of Cardiology, Gongli Hospital, Navy Military Medical University, Shanghai, China
| | - Sophia Hoschar
- Institute of Epidemiology, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health (HMGU), Neuherberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Zhen Wang
- Department of General Practice, Jiangning Hospital, Nanjing Medical University, Nanjing, China
| | - Rongxiang Tu
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technische Univerität Munich (TUM), Munich, Germany
| | - Wenlin Ma
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Geriatrics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
11
|
Lodder P. Modeling synergy: How to assess a Type D personality effect. J Psychosom Res 2020; 132:109990. [PMID: 32151819 DOI: 10.1016/j.jpsychores.2020.109990] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In research on Type D personality, its subcomponents negative affectivity (NA) and social inhibition (SI) are hypothesized to have a synergistic effect on various medical and psychosocial outcomes. As some methods to analyze Type D personality have been criticized, this study investigated whether these methods adequately detect a Type D effect. METHOD We used a simulation and two empirical illustrations to investigate each method's performance (bias, power and false positives) in detecting the Type D effect. RESULTS Our simulation showed that the two most commonly used methods to assess the Type D effect (subgroup methods) were primarily picking up the presence of NA or SI main effects, indicating that these methods might falsely suggest synergistic Type D effects. Moreover, these methods failed to detect the combined presence of the NA and SI main effects, resulting in significant Type D effects when only one of the NA/SI main effects was present. The method that best detected Type D effects modeled the continuous NA/SI main effects and their statistical interaction in a regression analysis. Reanalysis of two empirical Type D personality datasets confirmed the patterns found in our simulation. CONCLUSION This study showed that Type D effects should be modeled with a continuous interaction approach. Other approaches showed either more bias, more false positive findings or lower power. We recommend against using subgroup approaches to operationalize Type D personality, as these methods are biased, regardless of whether the Type D effect is synergistic or additive in nature.
Collapse
Affiliation(s)
- Paul Lodder
- Department of Methodology and Statistics, Tilburg University, the Netherlands; Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, the Netherlands.
| |
Collapse
|
12
|
Sex and gender-stratified risks of psychological factors for adverse clinical outcomes in patients with ischemic heart disease: A systematic review and meta-analysis. Int J Cardiol 2020; 302:21-29. [DOI: 10.1016/j.ijcard.2019.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/20/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022]
|
13
|
Association between Type D personality and outcomes in patients with non-ischemic heart failure. Qual Life Res 2019; 28:2901-2908. [DOI: 10.1007/s11136-019-02241-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
|
14
|
Pushkarev G, Denollet J, Kuznetsov V, Spek V, Yaroslavskaya E. Type D personality in Russian patients with cardiovascular disease: validity of the Russian DS14 (DS14-RU). BMC Cardiovasc Disord 2019; 19:78. [PMID: 30940075 PMCID: PMC6444517 DOI: 10.1186/s12872-019-1056-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 03/21/2019] [Indexed: 12/24/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Georgiy Pushkarev
- Laboratory of Instrumental Diagnostics, Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, 111, Melnikaite Str, 625026 Tyumen, Russia
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Johan Denollet
- Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| | - Vadim Kuznetsov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Viola Spek
- Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| | - Elena Yaroslavskaya
- Laboratory of Instrumental Diagnostics, Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, 111, Melnikaite Str, 625026 Tyumen, Russia
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| |
Collapse
|
15
|
Abstract
PURPOSE OF THE REVIEW This review article synthesizes recent research findings on the psychological context of Type D personality and the mechanisms through which Type D affects disease progression and prognosis among patients with coronary heart disease (CHD). RECENT FINDINGS One in four patients with CHD has a Distressed (Type D) personality, which is characterized by two stable traits: social inhibition and negative affectivity. Type D personality predicts increased mortality and morbidity burden, and poorer health-related quality of life. Type D is part of a family of psychosocial risk factors that affect CHD prognosis. The pattern of co-occurrence of these psychosocial factors and intra-individual differences in psychosocial profiles may affect risk prediction accuracy. Multiple biological and behavioral processes have been associated with Type D personality. Identifying pathways explaining the observed associations between Type D personality and CHD is important to improve etiological and pathophysiological knowledge and to design personalized interventions, and targeting specific risk-associated pathways.
Collapse
|
16
|
Type D personality and the degree of control of bronchial asthma. Postepy Dermatol Alergol 2018; 35:387-391. [PMID: 30206452 PMCID: PMC6130135 DOI: 10.5114/ada.2018.77670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/20/2017] [Indexed: 12/27/2022] Open
Abstract
Introduction Poor asthma control is probably associated with both biological and psychological factors. Type D pattern of behavior is characterized by negative emotionality and inhibition in social relationships. It was previously found to be associated with cardiovascular diseases. Aim To evaluate the correlation between the degree of asthma control and the severity of the components of type D behavior pattern. Material and methods The research was conducted on a group of 117 subjects with bronchial asthma. The control group consisted of 32 healthy subjects. The degree of bronchial asthma control was determined using the Asthma Control Test. The D pattern of behavior was measured using the DS-14 questionnaire. Results The risk of type D behavior pattern, defined as scoring at least 10 points in both scales (Negative Emotionality and Social Inhibition), was higher in subjects with uncontrolled asthma than in healthy individuals (OR = 5.19; 95% CI: 1.74–15.44), those with partial control of asthma (OR = 6.04; 95% CI: 1.87–19.52) and subjects with good control of asthma (OR = 8.46; 95% CI: 3.09–23.16). The severity of depressiveness correlated positively with the number of infections in the past year. Negative emotionality correlated positively with the number of infections and social inhibition. Conclusions Type D pattern of behavior may be associated with diagnosis and severity of asthma. Due to its link to poor control of asthma symptoms, a high level of negative emotionality among patients with asthma might be of particular interest to the clinicians.
Collapse
|
17
|
Prognostic Value of Type D Personality for In-stent Restenosis in Coronary Artery Disease Patients Treated With Drug-Eluting Stent. Psychosom Med 2018; 80:95-102. [PMID: 28938244 DOI: 10.1097/psy.0000000000000532] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the predictive value of Type D personality on in-stent restenosis (ISR) rates at 1 and 2 years post-percutaneous coronary intervention (PCI) in patients with coronary artery disease. METHODS Consecutive patients with coronary artery disease who underwent PCI for drug-eluting stents (n = 173) completed the Type D Scale-14 (DS14) at baseline. Follow-up coronary angiographic evaluation was routinely planned at 1 and 2 years after the procedure. RESULTS Follow-up coronary angiography was performed in 159 and 112 patients at 1 and 2 years post-PCI, respectively. On multivariate analysis, Type D personality was found to be an independent predictor of ISR at 1 year (odds ratio [OR] = 2.67, 95% confidence interval [CI] = 1.16-6.14, p = .021) and 2 years (OR = 4.92, 95% CI = 1.82-9.60, p = .017) after adjusting for cardiovascular risk factors. However, Type D did not predict ISR when the analysis was performed using the interaction between negative affectivity and social inhibition. The main effect of negative affectivity emerged as a significant risk factor for 1-years (OR = 4.22, 95% CI = 1.18-7.86, p = .034) and 2-year ISR (OR = 6.93, 95% CI = 2.25-11.50, p = .016). CONCLUSIONS In this study, Type D personality was an independent predictor of ISR at 1 and 2 years post-PCI; the association strengthened with time. The negative affectivity component seems to drive the relationship between Type D and ISR over time. Our findings provide new insights into the mechanisms involved in the association between Type D and adverse clinical outcomes of PCI.
Collapse
|
18
|
Skau E, Henriksen E, Wagner P, Hedberg P, Siegbahn A, Leppert J. GDF-15 and TRAIL-R2 are powerful predictors of long-term mortality in patients with acute myocardial infarction. Eur J Prev Cardiol 2017; 24:1576-1583. [DOI: 10.1177/2047487317725017] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emma Skau
- Department of Clinical Physiology, Hospital of Västmanland Västerås, Sweden
- Region Västmanland – Uppsala University, Centre for Clinical Research, Hospital of Västmanland Västerås, Sweden
| | - Egil Henriksen
- Department of Clinical Physiology, Hospital of Västmanland Västerås, Sweden
- Region Västmanland – Uppsala University, Centre for Clinical Research, Hospital of Västmanland Västerås, Sweden
| | - Philippe Wagner
- Region Västmanland – Uppsala University, Centre for Clinical Research, Hospital of Västmanland Västerås, Sweden
| | - Pär Hedberg
- Department of Clinical Physiology, Hospital of Västmanland Västerås, Sweden
- Region Västmanland – Uppsala University, Centre for Clinical Research, Hospital of Västmanland Västerås, Sweden
| | - Agneta Siegbahn
- Uppsala Clinical Research Centre, Sweden
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Sweden
| | - Jerzy Leppert
- Region Västmanland – Uppsala University, Centre for Clinical Research, Hospital of Västmanland Västerås, Sweden
| |
Collapse
|