Association between type D personality, depression, and oxidative stress in patients with chronic heart failure

Depressive symptoms and oxidative DNA damage in Japanese municipal employees

We sought to explore the relationship between depressive symptoms and urinary 8-hydroxydeoxyguanine (8-OHdG), a biomarker of systemic oxidative DNA damage and repair, among 301 men and 210 women aged 21-67 years working in two municipal offices. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D). The geometric mean and its 95% confidence interval (CI) of urinary 8-OHdG concentrations were calculated according to the quartile of CES-D score. The prevalence of depressive symptoms, defined as having CES_D of ≥16, was 35.9% in men and 35.2% in women. There was no significant difference in geometric mean of urinary 8-OHdG concentrations according to the levels of depressive symptoms. In men, the multivariable-adjusted geometric mean of urinary 8-OHdG concentrations (95% CIs) in the first, second, third, and fourth category of depressive symptoms was 1.09 (1.02-1.16), 1.16 (1.08-1.24), 1.15 (1.07-1.24), and 1.10 (1.02-1.18), respectively (p for trend=0.86). Similarly, no significant association was found in the analyses among women, nonsmoking men, and smoking men. The lack of association between depressive symptoms and urinary 8-OHdG concentrations may indicate the absence or more complex interactions between milder forms of depression and systemic oxidative DNA damage and repair in well-functioning population.

Racial discrimination is associated with a measure of red blood cell oxidative stress: a potential pathway for racial health disparities

BACKGROUND

There are racial health disparities in many conditions for which oxidative stress is hypothesized to be a precursor. These include cardiovascular disease, diabetes, and premature aging. Small clinical studies suggest that psychological stress may increase oxidative stress. However, confirmation of this association in epidemiological studies has been limited by homogenous populations and unmeasured potential confounders.

PURPOSE

We tested the cross-sectional association between self-reported racial discrimination and red blood cell (RBC) oxidative stress in a biracial, socioeconomically heterogeneous population with well-measured confounders.

METHODS

We performed a cross-sectional analysis of a consecutive series of 629 participants enrolled in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Conducted by the National Institute on Aging Intramural Research Program, HANDLS is a prospective epidemiological study of a socioeconomically diverse cohort of 3,721 Whites and African Americans aged 30-64 years. Racial discrimination was based on self-report. RBC oxidative stress was measured by fluorescent heme degradation products. Potential confounders were age, smoking status, obesity, and C-reactive protein.

RESULTS

Participants had a mean age of 49 years (SD = 9.27). In multivariable linear regression models, racial discrimination was significantly associated with RBC oxidative stress (Beta = 0.55, P < 0.05) after adjustment for age, smoking, C-reactive protein level, and obesity. When stratified by race, discrimination was not associated with RBC oxidative stress in Whites but was associated significantly for African Americans (Beta = 0.36, P < 0.05).

CONCLUSIONS

These findings suggest that there may be identifiable cellular pathways by which racial discrimination amplifies cardiovascular and other age-related disease risks.

Type D personality as a cardiovascular risk marker in the general population: results from the Gutenberg health study

BACKGROUND

Type D personality is considered as an independent risk factor for morbidity and mortality in cardiovascular patients and a vulnerability factor for distress in the general population. Because representative community studies are rare, we sought to determine the prevalence of type D personality and its relationship with demographic characteristics, different features of mental disorders, cardiovascular risk factors, health behavior, endothelial function and cardiovascular biomarkers in the general population.

METHODS

The prevalence of type D personality and its correlates were analyzed cross-sectionally in a population-based sample of 5,000 Mid-Europeans aged 35-74 years from the Gutenberg Health Study.

RESULTS

The prevalence of type D personality was 22.2% without remarkable differences in sex distribution. Type D subjects were characterized by lower socioeconomic status, lack of a partnership, increased depression, anxiety, depersonalization and health care utilization. Despite its strong association with mental disorders, type D personality emerged as psychometrically distinct. Although type D personality was independently associated with coronary heart disease (OR = 1.54, p = 0.044), no associations with traditional cardiovascular risk factors were found independently from depression or anxiety.

CONCLUSIONS

Although type D personality is strongly associated with depression, anxiety, impaired mental and somatic health status, and increased health care utilization, the type D construct seems to comprise dysfunctional personality patterns not covered by depression and anxiety scales. Beyond these associations, the pathways of the cardiotoxic impact of type D personality remain to be elucidated. There is a need for prospective population studies on potential links between type D personality and cardiac disease.

Type D personality and course of health status over 18 months in outpatients with heart failure: multiple mediating inflammatory biomarkers

BACKGROUND

The distressed (Type D) personality is associated with poor health status (HS) and increased inflammatory activation in heart failure (HF). We tested whether multiple inflammatory biomarkers mediated the association between Type D personality and the course of self-reported HS over 18 months.

METHODS

HF outpatients (n=228, 80% male, mean age 67.0±8.7 years), filled out the Type D questionnaire (DS14) at inclusion and the Short Form-12 (SF12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 0, 6, 12, and 18 months. Blood samples at inclusion were analyzed for high sensitive C-reactive protein (hsCRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and its soluble receptors (sTNFr1, sTNFr2). A multiple mediation latent growth model was tested using structural equation modeling.

RESULTS

Type D personality (prevalence=21%) was associated with poorer HS (all scales p<0.001), deterioration of mental HS (p<0.001), and higher TNF-α and sTNFr2 levels in the full mediation model. A higher inflammatory burden was associated with a poorer baseline level and a deterioration of generic physical, mental and disease-specific HS. No mediating effects were found for the multiple inflammatory biomarkers on the association between Type D and baseline self-reported HS, whereas change in physical HS was significantly mediated by the group of five inflammatory biomarkers (p=0.026).

CONCLUSIONS

Only the association between Type D personality and change in self-reported physical health status was significantly mediated by inflammatory biomarkers. Future research should investigate whether the association between Type D personality and poor health status may be explained by other biological or behavioral factors.

Self care in patients with chronic heart failure

'Heart failure self care' refers to the practices in which patients engage to maintain their own health, and to the decisions that they make about managing signs or symptoms. In this article, we base our discussion of self care in chronic heart failure on the classification of patients as being 'expert', inconsistent', or 'novice' in heart failure self-care behaviors. The available literature on factors predicting heart failure self care and its outcomes are reviewed within this context. Factors known to influence heart failure self care include experience with the illness, physical functioning, depression and anxiety, social support, daytime sleepiness, and attitudes such as confidence. Further research is needed to understand the contributions of comorbidities, patient sex, and health disparities on heart failure self care. The evidence to support a link between heart failure self care and health outcomes is limited, but early evidence suggests that adequate self care is associated with an improvement in health status, a decrease in the number and duration of hospitalizations, and a decline in levels of biomarkers of stress and inflammation, and in intrathoracic impedance. Implications of heart failure self care for clinical practice, policy, and public health are also described.

Personality and longevity: knowns, unknowns, and implications for public health and personalized medicine

We review evidence for links between personality traits and longevity. We provide an overview of personality for health scientists, using the primary organizing framework used in the study of personality and longevity. We then review data on various aspects of personality linked to longevity. In general, there is good evidence that higher level of conscientiousness and lower levels of hostility and Type D or "distressed" personality are associated with greater longevity. Limited evidence suggests that extraversion, openness, perceived control, and low levels of emotional suppression may be associated with longer lifespan. Findings regarding neuroticism are mixed, supporting the notion that many component(s) of neuroticism detract from life expectancy, but some components at some levels may be healthy or protective. Overall, evidence suggests various personality traits are significant predictors of longevity and points to several promising directions for further study. We conclude by discussing the implications of these links for epidemiologic research and personalized medicine and lay out a translational research agenda for integrating the psychology of individual differences into public health and medicine.

Nine-year stability of type D personality: contributions of genes and environment

OBJECTIVE

To assess longitudinal changes in genetic and environmental influences on Type D personality and its subcomponents negative affectivity (NA) and social inhibition (SI) over a 9-year period. Most personality constructs have good retest reliability over long periods, with stability attributed to genes, and changes to environmental factors. Type D personality is stable across an 18-month period and is influenced by genetic factors. However, there is no knowledge on long-term stability, and the contributions of genes and environment to that stability.

METHODS

Type D personality was determined from survey data collected in 1991 (n = 3235; mean age = 17.3 years), 1997 (n = 3133; mean age = 25.3 years), and 2000 (n = 4456; mean age = 29.6 years) in a population sample of healthy twins. Multivariate structural equation modeling was employed.

RESULTS

Type D heritability ranged from 50% in 1997 to 34% in 2000, with the same genetic factor affecting Type D at all time points. Heritability of SI ranged from 49% (1991) to 42% (2000), with the same genetic factor influencing SI at all times. Heritability estimates for NA ranged from 45% (1991) to 40% (2000), with one genetic factor influencing NA at all times, and one genetic factor influencing NA at the second and third occasions. Different environmental factors acted on Type D, NA, and SI at each of the three measurement occasions.

CONCLUSION

Type D personality and both subcomponents are stable over time, which is largely due to genetic factors. Different unique environmental factors influence the Type D components at different occasions.

Type D personality in the general population: a systematic review of health status, mechanisms of disease, and work-related problems

Background

The objective was to review all available literature concerning Type D (distressed) personality among the general population and to discuss its implications for research on health status, disease-promoting mechanisms and work-related problems in non-clinical populations.

Methods

A computerized search of the literature was performed independently and in duplicate by both investigators on December 21^st, 2009. Published research reports were included if they studied Type D personality among the general population. Nineteen articles were selected and they were subjected to an 11-item standardised quality checklist by both investigators.

Results

The methodological quality of the selected studies was adequate to high. The studies included in this review showed that the presence of Type D characteristics had a negative impact on mental health status (more symptoms of depression, anxiety, post-traumatic stress disorder, mental distress, passive coping, and less social support) and physical health status (more somatic complaints, lower health status, more influenza-like illness reporting). Other studies reported on behavioral and biological mechanisms of disease in apparently healthy individuals with a Type D personality. Finally, some studies also showed a negative effect of Type D personality on work-related problems (higher absence-leave, higher levels of vital exhaustion and burnout, and more work-related stress).

Conclusions

Type D personality is a vulnerability factor for general psychological distress that affects mental and physical health status and is associated with disease-promoting mechanisms and work-related problems in apparently healthy individuals.

Type D personality among noncardiovascular patient populations: a systematic review

OBJECTIVE

This article reviews all available literature concerning the implications of Type D personality (the conjoint effects of negative affectivity and social inhibition) among patients with noncardiovascular conditions.

METHODS

Published papers were included if they studied Type D personality among noncardiovascular patient populations. Twelve articles met our inclusion criteria and were subjected to a methodological quality checklist (e.g., sample size, response rate, Type D measurement).

RESULTS

The methodological quality of the selected studies was quite good. The noncardiovascular patient populations included chronic pain, asthma, tinnitus, sleep apnea, primary care patients, vulvovaginal candidiasis, mild traumatic brain injury, vertigo, melanoma and diabetic foot syndrome. Type D personality was associated with an increased number or severity of reported health complaints, heightened the perception of negative emotions (e.g., depression and anxiety), had an adverse effect on health-related behaviors, was associated with poor adherence to treatment and significantly reduced effort to perform during diagnostic testing.

CONCLUSION

Type D is a vulnerability factor that not only affects people with cardiovascular conditions but also those with other medical conditions. Type D was associated with poor physical and mental health status and poor self-management of the disease. Consequently, including Type D in future studies seems warranted.