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Dimou K, Dragioti E, Tsitsas G, Mantzoukas S, Gouva M. Association of Personality Traits and Self-Care Behaviors in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e50714. [PMID: 38234931 PMCID: PMC10792707 DOI: 10.7759/cureus.50714] [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] [Accepted: 12/16/2023] [Indexed: 01/19/2024] Open
Abstract
Diabetes self-care is critical for individuals with type 2 diabetes mellitus (T2DM), and exploring the impact of personality traits on this domain remains pivotal. This study aimed to investigate the association between personality traits and various dimensions of self-care in people with T2DM. A Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA)-guided systematic review with meta-analysis was conducted. Two reviewers independently screened articles, extracted data, and assessed the risk of bias. Estimates were pooled using random-effects meta-analysis. Twenty-three studies, that met our inclusion criteria, revealed distinct associations between certain personality traits and various aspects of self-care. Notably, traits such as openness, conscientiousness, and agreeableness showed associations with improved foot care compliance (odds ratio (OR) = 2.53, 95% CI = 1.49-4.28; OR = 1.84, 95% CI = 1.10-3.08; and OR = 2.07, 95% CI = 1.23-3.48, respectively). Openness was also linked to better overall self-care behaviors (OR = 2.00, 95% CI = 1.17-3.41), while conscientiousness correlated with reduced smoking (OR = 0.96, 95% CI = 0.93-0.99), and agreeableness was associated with improved medication adherence (OR = 1.68, 95% CI = 1.34-2.31). Conversely, traits like extraversion and neuroticism showed associations with decreased medication adherence (OR = 0.77, 95% CI = 0.61-0.96 and OR = 0.51, 95% CI = 0.40-0.65, respectively), with neuroticism additionally linked to lower overall self-care behaviors (OR = 0.67, 95% CI: 0.55-0.81). This study emphasizes the intricate role of personality traits in shaping self-care practices in individuals with T2DM, underscoring the significance of factoring these traits into tailoring and improving diabetes self-care strategies. Nevertheless, establishing definitive causal relationships mandates further in-depth longitudinal investigations and broader meta-analyses to achieve a more conclusive understanding.
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Affiliation(s)
- Konstantina Dimou
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Elena Dragioti
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Georgios Tsitsas
- Department of Economy and Sustainable Development, Harokopio University, Athens, GRC
| | - Stefanos Mantzoukas
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Mary Gouva
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, GRC
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Impact of Type D Personality, Role Strain, and Diabetes Distress on Depression in Women With Type 2 Diabetes: A Cross-Sectional Study. THE JOURNAL OF NURSING RESEARCH : JNR 2023; 31:e258. [PMID: 36692837 DOI: 10.1097/jnr.0000000000000536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Women with diabetes face a significantly elevated risk of developing depression. Clarifying the factors associated with depression is critical to designing more timely interventions for this vulnerable population. PURPOSE This study was developed to examine the impact of Type D personality, diabetes-care-related role strain, and diabetes-related distress on depression in women with Type 2 diabetes. METHODS A cross-sectional design was used. Convenience sampling was used to recruit 298 women aged 20-64 years who had been diagnosed with Type 2 diabetes for over 6 months from three outpatient endocrine clinics in Taiwan. Demographic and disease characteristics and Type D personality (negative affectivity and social inhibition), diabetes-care-related role strain, and diabetes-related distress and depression status information were collected using self-reported questionnaires and medical records. The important factors of influence on depression were examined using hierarchical multiple regression. RESULTS On the basis of the results of the hierarchical multiple regression analysis, age, negative affectivity, diabetes-care-related role strain, and diabetes-related distress were identified as significantly associated with depression, with negative affectivity explaining most (43.4%) of the variance in depression, followed by diabetes-care-related role strain and diabetes-related distress, which respectively explained 3% and 2.5% of the variance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The negative affectivity associated with the Type D personality was shown to be more significantly associated with depression than diabetes-related psychosocial factors such as diabetes-related distress and diabetes-care-related role strain. Timely assessment of negative affectivity and the provision of brief mindfulness intervention to reduce negative affectivity may be useful in preventing depression in women with Type 2 diabetes, whereas addressing diabetes-related distress and diabetes-care-related role strain should not be neglected when providing comprehensive depression-preventing interventions to young women with diabetes.
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Lee EH, Lee YW, Chae D, Kang EH, Kang HJ. Relationship between Type D personality and adverse health outcomes in people with type 2 diabetes: The parallel mediating roles of diabetes distress and social isolation. Nurs Open 2022; 10:3347-3355. [PMID: 36576733 PMCID: PMC10077398 DOI: 10.1002/nop2.1587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/17/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
AIM To investigate the relationship between Type D personality and adverse health outcomes [glycated haemoglobin (HbA1c) and health-related quality of life (HRQOL)] directly, and indirectly via diabetes distress and social isolation in people with type 2 diabetes. DESIGN A secondary analysis of 524 participant's data derived from a cross-sectional, correlational study with people with type 2 diabetes. METHODS Data were analysed using the PROCESS macro of SPSS. RESULTS Type D personality was present in 31.3% of the participants, and exerted a direct effect on HRQOL but not on HbA1c. Type D personality indirectly affected both HbA1c and HRQOL via the mediators of diabetes distress and social isolation. Nurses need to monitor people with type 2 diabetes to determine whether Type D personality is present. Those with Type D personality should be provided with interventions to reduce diabetes distress and alleviate social isolation in order to improve HbA1c and HRQOL.
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Affiliation(s)
- Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea
| | - Young Whee Lee
- Department of Nursing, Inha University, Incheon, Republic of Korea
| | - Duckhee Chae
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
| | - Eun Hee Kang
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea
| | - Hyun-Jung Kang
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea
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Geerling R, Kothe EJ, Anglim J, Emerson C, Holmes-Truscott E, Speight J. Personality and weight management in adults with type 2 diabetes: A systematic review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:1044005. [PMID: 36992758 PMCID: PMC10012143 DOI: 10.3389/fcdhc.2022.1044005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022]
Abstract
AimsManaging weight in the context of type 2 diabetes presents unique hormonal, medicinal, behavioural and psychological challenges. The relationship between weight management and personality has previously been reviewed for general and cardiovascular disease populations but is less well understood in diabetes. This systematic review investigated the relationship between personality constructs and weight management outcomes and behaviours among adults with type 2 diabetes.MethodsMedline, PubMed, Embase, PsycINFO and SPORTDiscus databases were searched to July 2021. Eligibility: empirical quantitative studies; English language; adults with type 2 diabetes; investigation of personality-weight management association. Search terms included variants of: diabetes, physical activity, diet, body mass index (BMI), adiposity, personality constructs and validated scales. A narrative synthesis, with quality assessment, was conducted.ResultsSeventeen studies were identified: nine cross-sectional, six cohort and two randomised controlled trials (N=6,672 participants, range: 30-1,553). Three studies had a low risk of bias. Personality measurement varied. The Big Five and Type D personality constructs were the most common measures. Higher emotional instability (neuroticism, negative affect, anxiety, unmitigated communion and external locus of control) was negatively associated with healthy diet and physical activity, and positively associated with BMI. Conscientiousness had positive associations with healthy diet and physical activity and negative associations with BMI and anthropometric indices.ConclusionsAmong adults with type 2 diabetes, evidence exists of a relationship between weight management and personality, specifically, negative emotionality and conscientiousness. Consideration of personality may be important for optimising weight management and further research is warranted.Systematic review registrationwww.crd.york.ac.uk/prospero/, identifier CRD42019111002.
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Affiliation(s)
- Ralph Geerling
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- *Correspondence: Ralph Geerling,
| | - Emily J. Kothe
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Jeromy Anglim
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | | | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
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Cheng WM, Liou YJ, Fan YH. Type D Personality Is an Independent Predictor of Lower Urinary Tract Symptoms in Young Men. Front Psychol 2022; 13:822490. [PMID: 35273543 PMCID: PMC8901569 DOI: 10.3389/fpsyg.2022.822490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/18/2022] [Indexed: 12/28/2022] Open
Abstract
This cross-sectional study, which included men aged 20-40 years, aimed to determine the relationships among type D personality, depressive symptoms and lower urinary tract symptoms in young men. An internet-based questionnaire was administered, and General demographics, International Prostate Symptom Scores, Type D Scale-14 scores, and Depression and Somatic Symptom Scale scores were analyzed. A total of 3,127 men were included; of these, 762 (24.4%) reported moderate/severe lower urinary tract symptoms, and 1,565 (50.05%) met the criteria for type D personality. Men with type D personality had significantly higher body mass index and total and sub-scores for the International Prostate Symptom Score and Depression and Somatic Symptom Scale. Furthermore, the type D personality group had a higher prevalence of lower urinary tract symptoms, particularly voiding symptoms. Univariate analysis revealed that all parameters, except for body mass index, were significant predictors of moderate/severe lower urinary tract symptoms. Multivariate analysis showed that age >30 years, type D personality, and depressive and somatic Depression and Somatic Symptom Scale sub-scores were independent predictors of moderate/severe lower urinary tract symptoms. Regarding Type D Scale-14 subscales, social inhibition, rather than negative affectivity, impacted moderate/severe lower urinary tract symptoms. Mediation analysis revealed that depressive symptoms mediated the relationship between type D personality and lower urinary tract symptoms. This study established correlations between type D personality, depressive symptoms, and lower urinary tract symptoms. As previous studies suggested that patients with type D personality are less likely to consult and adhere to treatment, and are at higher risk for depression, urologists should therefore actively recognize patients with TDP.
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Affiliation(s)
- Wei-Ming Cheng
- Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Biopharmaceutical Science, School of Life Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Ying-Jay Liou
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Hua Fan
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan.,Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Mendoza-Catalán G, Rodríguez-Santamaría Y, Domínguez-Chávez CJ, Juárez-Medina LL, Villa-Rueda AA, González-Ramírez J, Gutiérrez-Valverde JM. Personality Traits and Self-Care Behaviors in Adults with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:1-6. [PMID: 35018104 PMCID: PMC8742583 DOI: 10.2147/dmso.s340277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Personality traits are an important factor in health behaviors. However, personality traits and self-care in T2DM in the Mexican population are not yet explored due to this; the purpose of this work was to explore the relationship of personality traits with self-care in Mexican adults with type 2 diabetes mellitus. PATIENTS AND METHODS A cross-sectional study was carried out in a sample of 197 T2DM patients from a primary care center in Oaxaca, Mexico. The Big Five Inventory and the Summary of Diabetes Self-care Activities (SDSCA) were the tools used. Correlation models and multiple linear regression models were used for the analysis. RESULTS Most of the study participants were women (74.6%). The mean age was 53.1 years (SD = 8.4). The average years of schooling of the participants were 5.7 (SD = 4.3). The number of years lived with T2DM was 9.0 (SD = 6.5). The waist circumference was 96.3 (SD = 14.2), and the BMI was 27.5 kg/m2 (SD = 4.1). The traits of conscientiousness (r = 0.283) and openness (r = 0.259) were positively correlated with self-care activities, while neuroticism was inversely correlated (r = -0.144). In the multiple linear regression models, only the conscientiousness and openness traits were predictors of self-care; they explained 19% of the variance. CONCLUSION People with greater openness and conscientiousness were associated with greater compliance with self-care. Conversely, neuroticism was inversely associated with self-care in patients with T2DM.
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Affiliation(s)
- Geu Mendoza-Catalán
- Faculty of Nursing, Autonomous University of Baja California, Mexicali, Baja California, Mexico
| | | | | | | | | | - Javier González-Ramírez
- Faculty of Nursing, Autonomous University of Baja California, Mexicali, Baja California, Mexico
- Correspondence: Javier González-Ramírez Facultad de Enfermería, Universidad Autónoma de Baja California, Av. Álvaro Obregón y Calle “G” S/N, Col. Nueva, C.P., Mexicali, 21100, Baja California, MéxicoTel +52 686 905-8257 Email
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McCarthy M, Zhang L, Monacelli G, Ward T. Using Methods From Computational Decision-making to Predict Nonadherence to Fitness Goals: Protocol for an Observational Study. JMIR Res Protoc 2021; 10:e29758. [PMID: 34842557 PMCID: PMC8665389 DOI: 10.2196/29758] [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: 04/22/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background Can methods from computational models of decision-making be used to build a predictive model to identify individuals most likely to be nonadherent to personal fitness goals? Such a model may have significant value in the global battle against obesity. Despite growing awareness of the impact of physical inactivity on human health, sedentary behavior is increasingly linked to premature death in the developed world. The annual impact of sedentary behavior is significant, causing an estimated 2 million deaths. From a global perspective, sedentary behavior is one of the 10 leading causes of mortality and morbidity. Annually, considerable funding and countless public health initiatives are applied to promote physical fitness, with little impact on sustained behavioral change. Predictive models developed from multimodal methodologies combining data from decision-making tasks with contextual insights and objective physical activity data could be used to identify those most likely to abandon their fitness goals. This has the potential to enable development of more targeted support to ensure that those who embark on fitness programs are successful. Objective The aim of this study is to determine whether it is possible to use decision-making tasks such as the Iowa Gambling Task to help determine those most likely to abandon their fitness goals. Predictive models built using methods from computational models of decision-making, combining objective data from a fitness tracker with personality traits and modeling from decision-making games delivered via a mobile app, will be used to ascertain whether a predictive algorithm can identify digital personae most likely to be nonadherent to self-determined exercise goals. If it is possible to phenotype these individuals, it may be possible to tailor initiatives to support these individuals to continue exercising. Methods This is a siteless study design based on a bring your own device model. A total of 200 healthy adults who are novice exercisers and own a Fitbit (Fitbit Inc) physical activity tracker will be recruited via social media for this study. Participants will provide consent via the study app, which they will download from the Google Play store (Alphabet Inc) or Apple App Store (Apple Inc). They will also provide consent to share their Fitbit data. Necessary demographic information concerning age and sex will be collected as part of the recruitment process. Over 12 months, the scheduled study assessments will be pushed to the subjects to complete. The Iowa Gambling Task will be administered via a web app shared via a URL. Results Ethics approval was received from Dublin City University in December 2020. At manuscript submission, study recruitment was pending. The expected results will be published in 2022. Conclusions It is hoped that the study results will support the development of a predictive model and the study design will inform future research approaches. Trial Registration ClinicalTrials.gov NCT04783298; https://clinicaltrials.gov/ct2/show/NCT04783298
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Affiliation(s)
- Marie McCarthy
- Insight Centre For Data Analytics, Dublin City University, Dublin, Ireland
| | - Lili Zhang
- Insight Centre For Data Analytics, Dublin City University, Dublin, Ireland
| | - Greta Monacelli
- Insight Centre For Data Analytics, Dublin City University, Dublin, Ireland
| | - Tomas Ward
- Insight Centre For Data Analytics, Dublin City University, Dublin, Ireland
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Lee SF, Li CP. Personality as a predictor of HbA1c level in patients with type 2 diabetes mellitus. Medicine (Baltimore) 2021; 100:e26590. [PMID: 34232208 PMCID: PMC8270580 DOI: 10.1097/md.0000000000026590] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/17/2021] [Indexed: 01/04/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is the most common type of diabetes, accounting for around 90% of all cases worldwide. One means to strengthen the prevention and treatment of diabetes is via changes in self-management and lifestyle behaviors. However, lifestyle and personal health behaviors are strongly influenced by personality traits, and thus personality may play a significant role in such aspects as medication compliance, exercise habits, blood glucose monitoring, diet control, and maintenance of an ideal body weight.In this study, we examined whether certain personality traits of patients with T2DM are correlated with higher glycohemoglobin (HbA1c) levels.A total of 214 participants with T2DM were recruited from an outpatient setting. χ2 test and logistic regression analyses with 5 models were employed.The OR for the "neuroticism" trait was 3.199 (95% CI = 1.228-8.331, P = .017), and those with this trait were 3.199 times more likely to have higher HbA1c levels than those with the "openness-extraversion" personality trait. This strong relationship between neuroticism and a higher HbA1c level was also evident in models 2, 3, 4, and 5. One-way ANOVA also indicated that the group with the neuroticism personality trait had significantly different mean fasting glucose, HbA1c, triglyceride, and high-density lipoprotein cholesterol levels.We found that a personality characterized by neuroticism is an independent predictor of higher HbA1c level in this study. We also found that people in the pre-contemplation and contemplation stages of exercise have higher HbA1c levels.
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Affiliation(s)
- Shu-Fen Lee
- Department of Nursing, Cardinal Tien College of Healthcare and Management, New Taipei
| | - Chih-Ping Li
- Department of Health Industry Management, Kainan University, Taoyuan, Taiwan
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Structural relationship model of type D personality and depression with the mediating role of cognitive distortions and family functioning in irritable bowel syndrome patients and healthy people: A multi-group analysis. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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The impact of type D personality on self-care of patients with type 2 diabetes: the mediating role of coping strategies. J Diabetes Metab Disord 2020; 19:1191-1198. [PMID: 33553023 DOI: 10.1007/s40200-020-00624-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE As a chronic disease, Diabetes requires special self-care behaviors until the end of life. Psychological factors play an important role in following the self-care plans among patients with diabetes. The present study was designed to examine the relationship between type D personality and self-care with the mediating role of coping strategies in patients with type 2 diabetes. METHODS This cross-sectional study was carried out on a sample of 361 patients with type 2 diabetes from Ale-Ebrahim Diabetes Charity Center in Isfahan, Iran. Type D personality, coping strategies and self-care were measured by validated questionnaires. The data were analyzed through Structural Equation Modeling (SEM). RESULTS The results indicated that type D personality affects the self-care behaviors indirectly via emotion-oriented coping. Problem and avoidant oriented coping strategies did not significantly mediate the effect of type D personality on self-care. CONCLUSION In general, assessing psychological background (such as personality traits and coping strategies) can facilitate the treatment of patients with diabetes by means of self-care enhancement.
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Park C, Won MH, Son YJ. Mediating effects of social support between Type D personality and self-care behaviours among heart failure patients. J Adv Nurs 2020; 77:1315-1324. [PMID: 33249650 DOI: 10.1111/jan.14682] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 09/28/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
AIMS Patients with heart failure exhibit poor adherence to self-care behaviours. Recent studies have shown a link between Type D personality, social support, and self-care behaviours of patients with chronic diseases. However, the mechanisms underlying this relationship have received little empirical attention in those with heart failure. This study aimed to identify the mediating effects of social support in the relationship between Type D personality and self-care behaviours in patients with heart failure. DESIGN This study employed a descriptive cross-sectional design. METHODS The sample comprised 170 patients aged over 18 years who had been diagnosed with heart failure for over 6 months and visited a tertiary care university hospital in Seoul. From April-July 2019, data were collected through an interview conducted using a structured questionnaire and a review of medical records by two trained research assistants. Multiple regression models were tested using the SPSS PROCESS procedure with bootstrapping to determine the significance of the mediation. RESULTS The prevalence of Type D personality in patients with heart failure was 20.0%. Significant associations were identified among Type D personality, social support, and self-care behaviours. Results revealed an indirect effect, suggesting that the effects of Type D personality on self-care behaviours were mediated by social support. CONCLUSION Heart failure patients with Type D personality were likely to lack social support, which may have influenced their low adherence to self-care behaviours. Thus, to facilitate long-lasting self-care behaviours, it is vital to provide supportive care or educational programs for patients with Type D personality. IMPACT Providing sustainable social support can have a positive impact on the long-term self-care maintenance of patients with heart failure patients who have a Type D personality. Future studies are required to further elucidate the underlying mechanisms of the relationship between Type D personality, social support, and self-care behaviours.
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Affiliation(s)
- Chanhee Park
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Mi Hwa Won
- Department of Nursing, Wonkwang University, Iksan, South Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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12
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O'Riordan A, Howard S, Brown E, Gallagher S. Type D personality and cardiovascular reactivity to acute stress: The mediating effects of social support and negative social relationships. Psychophysiology 2020; 57:e13660. [PMID: 32767574 DOI: 10.1111/psyp.13660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
Type D personality has been consistently associated with adverse cardiovascular health with atypical cardiovascular reactions to psychological stress one potential underlying mechanism. As Type D individuals have been noted to report lower social support and greater perceptions of negativity in social interactions, this study examined if the association between Type D personality and cardiovascular reactivity was mediated by these social relationships. A sample of 195 undergraduate students (138 female) participated in this observational study, where they completed measures assessing Type D personality (DS14), social support, and perceptions of negative social relationships (National Institute of Health social relationship scales), before undergoing a traditional cardiovascular reactivity protocol. Systolic and diastolic blood pressure (SBP; DBP), heart rate (HR), cardiac output (CO), and total peripheral resistance (TPR) were monitored throughout. ANCOVAs and regressions indicated that Type D personality was associated with lower cardiovascular reactivity to a mental arithmetic stressor. Furthermore, mediation analyses (process macro) indicated that the relationship between Type D personality and cardiovascular reactivity was mediated via increased perceptions of negative social relationships, as well as lower levels of social support. Apart from a significant association between Type D personality and increased HR reactivity, all results failed to withstand adjustment for the individual effects of negative affect (NA) and social inhibition (SI) in controlled analyses. Overall, these findings suggest that the predictive utility of Type D personality on cardiovascular reactivity above and beyond the individual effects of NA and SI is limited, and may vary depending on the cardiovascular parameter of focus.
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Affiliation(s)
- Adam O'Riordan
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Siobhán Howard
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Eoin Brown
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Stephen Gallagher
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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Köbling T, Váradi Z, Katona É, Somodi S, Kempler P, Páll D, Zrínyi M. Predictors of dietary self-efficacy in high glycosylated hemoglobin A1c type 2 diabetic patients. J Int Med Res 2020; 48:300060520931284. [PMID: 32588697 PMCID: PMC7325457 DOI: 10.1177/0300060520931284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To predict dietary self-efficacy behaviors in high glycosylated hemoglobin A1c (HbA1c) patients using type D personality (TDP) and other psychosocial measures. Methods A cross-sectional, predictive research design was implemented. Participants were type 2 diabetes mellitus patients diagnosed more than 2 years prior to the study. Data were collected for demographics, dietary self-efficacy and psychological measures. Spearman’s rank-order correlation was used to test for relationships, the Mann–Whitney test was used to test for differences and multiple linear regression was used to examine predictors of dietary self-efficacy. Results Lower dietary self-efficacy was strongly correlated with greater social isolation (r = 0.93) and moderately correlated with more mental health problems (r = 0.20) and higher TDP scores (r = 0.17). Higher HbA1c was inversely related to self-reported physical health (r = −0.19). Social and emotional isolation and time since diagnosis predicted dietary self-efficacy (greater isolation was associated with more dietary management difficulties). Conclusions Regression outcomes suggested that a 10% decrease in social isolation improves dietary self-efficacy by 30%, a significant boost to therapeutic adherence. We recommend assessment of social isolation to improve dietary self-efficacy and achieve better patient adherence to therapy.
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Affiliation(s)
- Tamás Köbling
- Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zita Váradi
- Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Éva Katona
- Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sándor Somodi
- Emergency Clinic, University of Debrecen, Debrecen, Hungary
| | - Péter Kempler
- Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Dénes Páll
- Department of Medicine, University of Debrecen, Debrecen, Hungary.,Coordination Center for Drug Development, University of Debrecen, Debrecen, Hungary
| | - Miklós Zrínyi
- Coordination Center for Drug Development, University of Debrecen, Debrecen, Hungary
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14
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Associations Between Sleep and Personality Factors Among Patients Living With Coronary Artery Disease. J Cardiovasc Nurs 2020; 35:568-575. [DOI: 10.1097/jcn.0000000000000691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Lin YH, Chen DA, Lin C, Huang H. Type D Personality Is Associated with Glycemic Control and Socio-Psychological Factors on Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. Psychol Res Behav Manag 2020; 13:373-381. [PMID: 32431557 PMCID: PMC7200262 DOI: 10.2147/prbm.s245226] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/10/2020] [Indexed: 01/14/2023] Open
Abstract
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.
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Affiliation(s)
- Yi-Hsin Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan (R.O.C.)
| | - Di-An Chen
- Department of Clinic Psychology, Fu Jen Catholic University, Taipei, Taiwan (R.O.C.)
| | - Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan (R.O.C.)
| | - Hsuan Huang
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan (R.O.C.)
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16
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O'Riordan A, Howard S, Gallagher S. Type D personality and life event stress: the mediating effects of social support and negative social relationships. ANXIETY STRESS AND COPING 2020; 33:452-465. [PMID: 32223435 DOI: 10.1080/10615806.2020.1746284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background and Objective: Type D personality has been associated with increased perceptions of stress. As Type D individuals have been noted to report lower social support and greater perceptions of negativity in social interactions, this study examined if the association between Type D personality and life events stress was mediated by these social relationships. Design: A cross-sectional design. Methods: Undergraduate students (N = 197) completed questionnaires assessing Type D personality, social support, negative social relationships, and life events stress. Results: Unadjusted analyses revealed that Type D individuals perceived their life events to be significantly more stressful than non-Type D individuals. Type D individuals also reported increased perceptions of negative social relationships and lower social support. Finally, the association between Type D personality and life events stress was mediated by perceptions of negative social relationships. However, when controlling for the main effects of negative affectivity and social inhibition, Type D was not significantly associated with social relationship or life events variables. Further, effects appeared to be primarily driven by negative affectivity. Conclusion: These results support recent findings in the Type D literature that have identified null effects of Type D when controlling for negative affectivity.
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Affiliation(s)
- Adam O'Riordan
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Siobhán Howard
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Stephen Gallagher
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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17
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Yasui-Furukori N, Murakami H, Otaka H, Tanabe J, Yanagimachi M, Murabayashi M, Matsumura K, Matsuhashi Y, Nakayama H, Mizushiri S, Sugawara N, Daimon M, Shimoda K. Personality Traits Do Not Have Influence on Glycemic Control in Outpatients with Type 2 Diabetes Mellitus. Psychiatry Investig 2020; 17:78-84. [PMID: 31995975 PMCID: PMC6992853 DOI: 10.30773/pi.2019.0210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/07/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Glycemic control varies based on lifestyle factors and stress coping mechanisms, which are influenced by personality. The psychological factors associated with glycemic control have not yet been established in patients with type 2 diabetes mellitus (T2DM). The relationship between a 5-factor model of personality and glycemic control was evaluated in individuals with T2DM. METHODS The subjects were 503 Japanese outpatients with T2DM. Glycated hemoglobin A1c (HbA1c) levels, depressive status, insomnia and personality traits were assessed. Lifestyle factors of the patients, such as habitual alcohol consumption and smoking, were also included in the analyses. RESULTS Because the influence of insulin therapy on HbA1c is so strong, we stratified the patients according to insulin use. Simple regression analysis showed a significant correlation between HbA1c and neuroticism in patients who did not use insulin. After adjustment for confounders, multiple regression analyses revealed that none of the personality factors, including neuroticism, were found to be associated with HbA1c. CONCLUSION These findings suggest that personality traits do not have a large impact on glycemic control. Further studies are required to confirm the relationships between psychological factors and glycemic control using a longitudinal study design.
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Affiliation(s)
- Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Shimotuga, Tochigi, Japan.,Department of Neuropsychiaty, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroshi Murakami
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hideyuki Otaka
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Jutaro Tanabe
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Miyuki Yanagimachi
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaya Murabayashi
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koki Matsumura
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Matsuhashi
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Nakayama
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoru Mizushiri
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Norio Sugawara
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Shimotuga, Tochigi, Japan.,Department of Neuropsychiaty, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Makoto Daimon
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Shimotuga, Tochigi, Japan
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18
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He GH, Strodl E, Liu L, Ruan ZL, Yin XN, Wen GM, Sun DL, Xian DX, Jiang H, Jing J, Jin Y, Wu CA, Chen WQ. Teacher's Type D Personality and Chinese Children's Hyperactive Behaviors: Moderation Effect of Parental Type D Personality and Mediation Effect of Teacher-Student Relationship. Front Psychol 2019; 10:2517. [PMID: 31781007 PMCID: PMC6856868 DOI: 10.3389/fpsyg.2019.02517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/24/2019] [Indexed: 02/02/2023] Open
Abstract
This study aimed to explore the association between teacher’s type D personality (TDP) and children’s hyperactive behaviors, along with the moderation effect of parental TDP and the mediation effect of the teacher–student relationship. In this prospective study, a total of 25,852 children were surveyed from 2014 to 2016 in Longhua District of Shenzhen, China, and followed up 1 year later. At baseline, parents provided data on parental TDP and children’s hyperactive behaviors, while teachers reported on their TDP. At follow-up, parents provided data on children’s hyperactive behaviors again, and teachers described their relationship with each student. Two-level multilevel logistic models were conducted to assess the influence of a teacher’s TDP, parental TDP, and their interaction on children’s hyperactive behaviors. Mediation analysis was used to examine the mediating role of the teacher–student relationship. Results indicated that teachers’ TDP was not a significant predictor of children’s hyperactive behaviors after 1 year in kindergarten. Conversely, maternal and paternal TDP were prospectively and positively associated with children’s subsequent hyperactive behaviors. However, the children with a TDP teacher, a TDP mother, and/or a TDP father had higher risk of hyperactive behaviors than those with either a TDP teacher or a TDP mother or a TDP father. In addition, the teacher–student relationship was not a significant mediator between teacher’s TDP and children’s hyperactive behaviors. Further, researchers may consider the effect of the combination of teacher’s TDP, maternal TDP, and paternal TDP on hyperactive behaviors in children in further studies.
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Affiliation(s)
- Guan-Hao He
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Li Liu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zeng-Liang Ruan
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Na Yin
- Women's and Children's Hospital of Longhua District, Shenzhen, China
| | - Guo-Ming Wen
- Women's and Children's Hospital of Longhua District, Shenzhen, China
| | - Deng-Li Sun
- Women's and Children's Hospital of Longhua District, Shenzhen, China
| | - Dan-Xia Xian
- Women's and Children's Hospital of Longhua District, Shenzhen, China
| | - Hui Jiang
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jin Jing
- Department of Women and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yu Jin
- Department of Women and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chuan-An Wu
- Women's and Children's Hospital of Longhua District, Shenzhen, China
| | - Wei-Qing Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Department of Information Management, Xinhua College of Sun Yat-sen University, Guangzhou, China
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The Eysenck Personality Profile in Selected Groups of Ophthalmological Patients. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2019; 40:41-49. [PMID: 31605595 DOI: 10.2478/prilozi-2019-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Personality correlates in patients with eye diseases have bidirectional influence. It is possible that personality variables lead to behaviours that may influence the cause of eye problems, but the opposite is also possible, that eye problems could have a direct effect on personality. The aim of this study was to evaluate personality traits in patients with glaucoma, diabetic retinopathy and cataract using the Eysenck Personality Questionnaire. Obtained results showed similar personality profiles in patients with glaucoma, diabetic retinopathy and cataract. However, extraversion and neuroticism were higher in patients with diabetes, while the psychopathic traits are the highest in the group of cataract. Age and gender of patients do not influence the scores obtained on the questionnaire confirmed with one way ANOVA. Not significant difference in parameters (tested with Student t-test) was obtained between groups. It is proposed psychological evaluation to be included in the assessment of more serious eye diseases for helping patients to adjust and adapt to the condition and treatment.
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20
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Dehghani F. Type D personality and life satisfaction: The mediating role of social support. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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21
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Spek V, Nefs G, Mommersteeg PMC, Speight J, Pouwer F, Denollet J. Type D personality and social relations in adults with diabetes: results from diabetes MILES - The Netherlands. Psychol Health 2018; 33:1456-1471. [PMID: 30295085 DOI: 10.1080/08870446.2018.1508684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine whether individual differences in Type D personality (combination of negative affectivity (NA) and social inhibition (SI)) could explain heterogeneity in perceived social support and relationship adjustment (intimate partner relationship) among people living with diabetes. DESIGN In the Diabetes MILES-The Netherlands survey, 621 adults with type 1 or type 2 diabetes (54% female, age: 56 ± 14 years) completed measures of Type D personality (DS14), perceived social support and relationship adjustment. We used established DS14 cut-off scores to indicate Type D personality, high NA only, high SI only and reference groups. RESULTS Participants from the Type D and NA only groups perceived lower levels of social support (Welch[3,259] = 37.27, p < 0.001), and relationship adjustment (Welch[3,191] = 14.74; p < 0.01) than those from the SI only and reference groups. Type D was associated with lower social support (lowest quartile; adjusted OR = 8.73; 95%CI = 5.05 ∼ 15.09; p < 0.001) and lower relationship adjustment (lowest quartile; adjusted OR = 3.70; 95%CI = 2.10 ∼ 6.53; p < 0.001). Type D was also associated with increased levels of loneliness. CONCLUSION Participants with Type D and participants with high NA only tend to experience less social support and less relationship adjustment. Type D personality was also associated with more loneliness. Experiencing lower social support and relationship adjustment may complicate coping and self-management in people with diabetes.
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Affiliation(s)
- Viola Spek
- a CoRPS , Tilburg University , Tilburg , The Netherlands
| | - Giesje Nefs
- a CoRPS , Tilburg University , Tilburg , The Netherlands.,b Department of Medical Psychology , Radboud University Medical Center , Nijmegen , The Netherlands.,c Diabeter, National diabetes treatment center for children, adolescents and young adults , Rotterdam , The Netherlands
| | | | - Jane Speight
- d School of Psychology , Deakin University , Geelong , VIC , Australia.,e The Australian Centre for Behavioural Research in Diabetes , Melbourne VIC , Australia
| | - Frans Pouwer
- e The Australian Centre for Behavioural Research in Diabetes , Melbourne VIC , Australia.,f University of Southern Denmark , Odense , Denmark
| | - Johan Denollet
- a CoRPS , Tilburg University , Tilburg , The Netherlands
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22
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Liu L, Wang X, Cao X, Gu C, Yang C, OuYang Y. Self-care confidence mediates the relationship between type D personality and self-care adherence in chinese heart failure patients. Heart Lung 2018; 47:216-221. [DOI: 10.1016/j.hrtlng.2018.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 03/02/2018] [Indexed: 11/26/2022]
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