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Wellekens S, Vanderhelst E, Verbanck S, De Weerdt S. REM-predominant obstructive sleep apnea: an unmet clinical need. Sleep Breath 2025; 29:97. [PMID: 39934482 DOI: 10.1007/s11325-025-03268-5] [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: 11/28/2024] [Revised: 01/16/2025] [Accepted: 01/29/2025] [Indexed: 02/13/2025]
Abstract
PURPOSE Obstructive sleep apnea (OSA) and rapid eye movement (REM) sleep fragmentation are associated with increased fatigue, sleepiness, anxiety and depressive symptoms. However, the clinical significance of REM-predominant OSA (REM-OSA) remains less clear. AIM To determine any differences in symptom-burden between REM-OSA and non-REM (NREM) OSA. METHODS Patients diagnosed with OSA at a University Hospital in Brussels between 25-11-2019 and 19-09-2020 were eligible. REM-OSA was defined as an apnea hypopnea index REM/NREM ratio of at least 2 with a minimum REM-time of 30 min. Severe OSA was excluded due to the expectedly lower prevalence of REM-OSA in this group. All patients completed the Hospital Anxiety and Depression Scale, Big Five Inventory-2, DS-14 questionnaire, SF-36 Health Survey Questionnaire, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Fatigue Assessment Scale, Checklist Individual Strength, Epworth Sleepiness Scale and Stanford Sleepiness Scale at diagnosis. RESULTS 209 patients with REM-OSA (112 mild and 97 moderate) and 132 with NREM-OSA (48 mild and 84 moderate) were included. Patients with mild REM-OSA were twice as likely to have a SSS score of 3 or more (defined as excessive daytime sleepiness) compared to NREM-OSA (odds ratio 2.1591, p-value 0.0359). There was no significant difference in anxiety, depression, personality traits, fatigue or sleep quality. CONCLUSION For mild OSA, a predominance of obstructive respiratory events during the REM phase results in a greater impact on excessive daytime sleepiness. To address this symptom, a lower treatment threshold to include symptomatic mild REM-OSA patients may be warranted.
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Affiliation(s)
- Shauni Wellekens
- Department of Respiratory Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Brussels, Belgium.
| | - Eef Vanderhelst
- Department of Respiratory Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Brussels, Belgium
| | - Sylvia Verbanck
- Department of Respiratory Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Brussels, Belgium
| | - Sonia De Weerdt
- Sleep Laboratory, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Brussels, Belgium
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2
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Li-Gao R, Bot M, Kurilshikov A, Willemsen G, van Greevenbroek MMJ, Schram MMT, Stehouwer CDA, Fu J, Zhernakova A, Penninx BWJH, De Geus EJC, Boomsma DI, Kupper N. Metabolomics profiling of Type D personality traits. J Psychosom Res 2025; 188:111994. [PMID: 39577138 DOI: 10.1016/j.jpsychores.2024.111994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 08/30/2024] [Accepted: 11/17/2024] [Indexed: 11/24/2024]
Abstract
OBJECTIVE Type D (Distressed) personality combines negative affectivity (NA) and social inhibition (SI) and is associated with an increased risk of cardiometabolic diseases. Here, we examined the association of Type D traits with 230 (predominantly) lipid metabolites and metabolite ratios. METHODS Four Dutch cohorts were included, comprising 10,834 individuals. Type D personality traits were measured by self-report questionnaires. A proton nuclear magnetic resonance (NMR) metabolomics platform provided 149 absolute measures (98 belonging to lipoprotein subclasses) and 81 derived ratios. For all, linear regression analyses were performed within each cohort, followed by random-effects meta-analyses. A per-measure FDR q-value<0.05 was set as a study-wise significant association. RESULTS SI was significantly associated with a lower omega-3 fatty acids to total fatty acids (FAw3.FA%) ratio, and a lower free cholesterol to total lipids ratio in very small VLDL (XS.VLDL.FC%). FAw3.FA% was also associated to NA (no study-wise significance though). NA showed a suggestive replication (p-value<.05) of the previous reported associations with depression for 5 out of 18 metabolites from the same metabolomics platform: triglycerides in HDL, serum total triglycerides, VLDL cholesterol, mean diameter for VLDL particles and VLDL triglycerides. CONCLUSIONS In this large meta-analysis, SI was associated with omega-3 fatty acids to total fatty acids ratio, which is suggestive of lower omega-3 fatty acid intake. Only some metabolite biomarkers showed tentative links to Type D and NA. In sum, it seems that there are no major alterations in lipid metabolism associated with Type D traits.
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Affiliation(s)
- Ruifang Li-Gao
- CoRPS Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands; Department of Biological Psychology, Vrije Universiteit, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Mariska Bot
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute and Amsterdam Neuroscience, the Netherlands
| | - Alexander Kurilshikov
- Department of Genetics, University Medical Center Groningen, Groningen, the Netherlands
| | - Gonneke Willemsen
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marleen M J van Greevenbroek
- School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands; Internal Medicine, MUMC+, Maastricht, the Netherlands
| | - Miranda M T Schram
- School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands; Internal Medicine, MUMC+, Maastricht, the Netherlands; MHeNs School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands; Internal Medicine, MUMC+, Maastricht, the Netherlands
| | - Jingyuan Fu
- Department of Genetics, University Medical Center Groningen, Groningen, the Netherlands; Department of Pediatrics, University Medical Center Groningen, Groningen, the Netherlands
| | - Alexandra Zhernakova
- Department of Genetics, University Medical Center Groningen, Groningen, the Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute and Amsterdam Neuroscience, the Netherlands
| | - Eco J C De Geus
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, the Netherlands; Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, the Netherlands
| | - Nina Kupper
- CoRPS Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
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De Weerdt S, Schotte C, Barbé K, Verbanck S, Verbraecken J. The DS-14 questionnaire: psychometric characteristics and utility in patients with obstructive sleep apnea. Sleep Breath 2024; 28:69-78. [PMID: 37418222 DOI: 10.1007/s11325-023-02859-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
Little is known about type D personality in patients with obstructive sleep apnea (OSA). The DS-14 questionnaire is the standard tool to assess this personality type, but it has not been properly validated in patients with OSA, nor has it been correlated with clinical features in these patients. PURPOSE To determine the internal consistency and test-retest reliability of the DS-14 questionnaire, as well as the prevalence of type D personality in the overall OSA sample and subgroups. We assessed the influence of type D on perceived symptoms and its congruence with self-reported measures of personality, depression, fatigue, anxiety, quality of life, and quality of sleep. METHODS Patients with OSA completed the DS-14 questionnaire, Big Five Inventory-2 questionnaire, Hospital Anxiety and Depression Scale, SF-36 Health Survey Questionnaire, Epworth Sleepiness Scale and Stanford Sleepiness Scale, Pittsburgh Sleep Quality Index and Insomnia Severity Index, Fatigue Assessment Scale, and Checklist Individual Strength. After 1 month, the DS-14 questionnaire was repeated. RESULTS The overall prevalence of type D personality was 32%. Internal consistency (negative affectivity: α = 0.880, social inhibition: α = 0.851) and diagnostic test-retest reliability (kappa value = 0.664) of the DS-14 questionnaire were high. Significantly more symptoms of anxiety, depression, poor sleep quality, fatigue, and a worse health perception were found in OSA with type D. Neither OSA severity nor REM predominance altered these observations. CONCLUSION The DS-14 questionnaire showed excellent psychometric properties in patients with OSA. The prevalence of type D personality in patients with OSA was higher than in the general population. The presence of type D personality was associated with higher symptom burden.
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Affiliation(s)
- Sonia De Weerdt
- Sleep Laboratory, UZ Brussels, Laarbeeklaan 101, 1090, Jette, Belgium.
| | - Christiaan Schotte
- Faculty of Psychology and al Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kurt Barbé
- Research Group Biostatistics and Medical Informatics (BISI), Free University of Brussels (VUB), Brussels, Belgium
| | - Sylvia Verbanck
- Respiratory Division, UZ Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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Association between behavioral phenotypes and sustained use of smartphones and wearable devices to remotely monitor physical activity. Sci Rep 2021; 11:21501. [PMID: 34728746 PMCID: PMC8563736 DOI: 10.1038/s41598-021-01021-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Smartphones and wearable devices can be used to remotely monitor health behaviors, but little is known about how individual characteristics influence sustained use of these devices. Leveraging data on baseline activity levels and demographic, behavioral, and psychosocial traits, we used latent class analysis to identify behavioral phenotypes among participants randomized to track physical activity using a smartphone or wearable device for 6 months following hospital discharge. Four phenotypes were identified: (1) more agreeable and conscientious; (2) more active, social, and motivated; (3) more risk-taking and less supported; and (4) less active, social, and risk-taking. We found that duration and consistency of device use differed by phenotype for wearables, but not smartphones. Additionally, "at-risk" phenotypes 3 and 4 were more likely to discontinue use of a wearable device than a smartphone, while activity monitoring in phenotypes 1 and 2 did not differ by device type. These findings could help to better target remote-monitoring interventions for hospitalized patients.
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Aguayo-Carreras P, Ruiz-Carrascosa JC, Ruiz-Villaverde R, Molina-Leyva A. Four years stability of type D personality in patients with moderate to severe psoriasis and its implications for psychological impairment. An Bras Dermatol 2021; 96:558-564. [PMID: 34274184 PMCID: PMC8441460 DOI: 10.1016/j.abd.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background Psoriasis is a systemic auto-inflammatory disease that is related to an increased risk of organic and psychological comorbidities. Type D is a stable personality trait in healthy subjects but there is no data regarding its stability in patients with moderate-severe psoriasis. Objectives To assess the stability of type D personality in patients with moderate to severe psoriasis as well as assessing the influence of type D personality on anxiety and depression. Methods Prospective cohort study. Forty psoriasis patients with type D personality and sixty-six patients with psoriasis without type D personality were included in the study. Participants completed the DS14 test and HADS at baseline and four years later. Results At baseline, the prevalence of type D personality was 37.7% and at week 208 it was 27.3%. The stability of type D personality was higher in patients with an incomplete education level and in those who were separated/divorced or windowed. During follow-up, 15% of patients developed type D personality. Male sex, having topical treatment, the presence of previous depression, anxiety, and high levels of negative affectivity at baseline increase the risk of developing type D personality. Study limitations Sample size, psoriasis severity restricted to moderate and severe and all patients being under treatment for psoriasis. Conclusions The presence of type D personality varies over time in psoriasis patients. Therefore, type D personality is possibly more a state than a trait phenomenon, modified by environmental factors. Type D personality is associated with a higher risk of anxiety.
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Majaluoma S, Seppälä T, Kautiainen H, Korhonen P. Type D personality and metabolic syndrome among Finnish female municipal workers. BMC WOMENS HEALTH 2020; 20:202. [PMID: 32928173 PMCID: PMC7489202 DOI: 10.1186/s12905-020-01052-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 08/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Type D personality is a combination of high negative affectivity (NA) and high social inhibition (SI). This personality trait is suspected to impair cardiovascular patients' recovery. The 2016 European Guidelines on cardiovascular disease prevention in clinical practice recommend screening of psychosocial risk factors as Type D personality. The aim of this study was to assess the relationship between Type D personality and Metabolic syndrome (MetS) in working-age female population. METHODS Six hundred thirty-four female employees with mean age of 48 ± 10 years were evaluated. Type D personality and its components (NA) and (SI) were screened with DS14 questionnaire. The definition of MetS was based on measurements done by trained medical staff. We investigated the relationship between Mets and Type D personality, NA and SI using the logistic regression models adjusting for age, education years, leisure-time physical activity, smoking, alcohol use and depressive symptoms. RESULTS The prevalence of Type D personality was 10.6% (n = 67) [95% CI: 8.3 to 13.2] and MetS 34.7% (n = 220). Type D personality or its subcomponents were not associated with MetS. Women with Type D personality had significantly worse quality of sleep and lower LTPA. They were also more often unsatisfied with their economic situation, they had more often depressive symptoms and psychiatric disorders than non-D type persons. There were no differences in risk factors for cardiovascular diseases. CONCLUSION Screening for Type D personality among working- age, reasonably healthy female population seems not to be practical method for finding persons with risk for cardiovascular disease.
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Affiliation(s)
- Susa Majaluoma
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital University of Turku, 20500, Turku, Finland. .,University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland. .,Health Center of Pori, Siltapuistokatu 2, 28100, Pori, Finland.
| | - Tellervo Seppälä
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital University of Turku, 20500, Turku, Finland.,University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland.,Health Center of Pori, Siltapuistokatu 2, 28100, Pori, Finland
| | - Hannu Kautiainen
- Department of General practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, University of Helsinki, Yliopistonkatu 4, 00100, Helsinki, Finland.,Helsinki University Hospital, Helsingin ja Uudenmaan sairaanhoitopiiri, Stenbäckinkatu 9, PL 100, 00029 HUS, Helsinki, Finland.,Folkhälsan Research Center, Haartmaninkatu 8, 00290, Helsinki, Finland.,Unit of Primary Health Care, University of Kuopio, University Hospital Kuopio. University of Kuopio, Yliopistonranta 1, 70210, Kuopio, Finland.,University Hospital of Kuopio, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Päivi Korhonen
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital University of Turku, 20500, Turku, Finland.,University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland.,Unit of Primary Health Care, University of Kuopio, University Hospital Kuopio. University of Kuopio, Yliopistonranta 1, 70210, Kuopio, Finland.,University Hospital of Kuopio, Puijonlaaksontie 2, 70210, Kuopio, Finland.,Central Satakunta Health Federation of Municipalities, Koulukatu 2, 29200, Harjavalta, Finland
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7
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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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Canonical Correlation between Behavioral-Psychological Variables and Predictors of Coronary Artery Disease Prognosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051608. [PMID: 32131511 PMCID: PMC7084809 DOI: 10.3390/ijerph17051608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/06/2020] [Accepted: 02/28/2020] [Indexed: 12/16/2022]
Abstract
Metabolic syndrome (MetS) and severity of coronary artery disease (CAD) are considered predictors of CAD prognosis. Unhealthy lifestyles and type-D personality are associated with MetS and are potential causes of primary and secondary CAD. In this cross-sectional descriptive study, we aimed to investigate the relationship between behavioral-psychological variables and predictors of CAD prognosis. The behavioral-psychological variable set contained six lifestyle categories and two type-D personality categories. Descriptive analyses, t-tests, analysis of variance, Pearson’s correlation, and canonical correlation were used. The behavioral-psychological variable set was related to the predictor set for CAD prognosis, with a significant canonical variate of 0.67 (45% overlapping variance). Significant pairs of canonical variates indicated that poor physical activity and weight control (−0.77), poor dietary habits (−0.78), alcohol consumption and cigarette smoking (−0.37), lack of sleep and rest (−0.40), stress (−0.64) in the lifestyle set, higher negative affectivity (0.52), and social inhibition (0.71) in the type-D personality set were associated with a high MetS score (0.59) and severity of CAD (0.91). A combination of behavioral and psychological variables was found to be important in predicting the prognosis of CAD; therefore, interventions aimed at preventing combinations of these variables may be effective in improving CAD prognosis.
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Haalen FM, Dijk EH, Andela CD, Dijkman G, Biermasz NR, Pereira AM, Boon CJ. Maladaptive personality traits, psychological morbidity and coping strategies in chronic central serous chorioretinopathy. Acta Ophthalmol 2019; 97:e572-e579. [PMID: 30378259 DOI: 10.1111/aos.13952] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/26/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE 'Type A' behavioural characteristics and psychosocial stress have traditionally been associated with chronic central serous chorioretinopathy (cCSC). However, a characteristical personality profile could not be identified in these patients and the presumed association with stress is subject to controversy, due to a lack of convincing studies using validated measuring instruments. In this study, we aimed to assess maladaptive personality traits, psychological morbidity and coping strategies in patients with cCSC, in order to identify potentially modifiable psychosocial aspects which could be used in support to current standard treatment. METHODS A cross-sectional study in a cohort of 86 patients with cCSC using validated questionnaires. Findings were compared to both Dutch population reference data and reference data from patients treated for Cushing's disease. RESULTS Maladaptive personality traits were not more prevalent in patients with cCSC than in the general population, and psychological morbidity was not increased. Patients with cCSC were shown to make more use of passive coping, active coping and seeking social support. Interestingly, personality, psychological morbidity and coping characteristics of patients with cCSC were more comparable to features of patients treated for Cushing's disease than to population-based data. CONCLUSION Maladaptive personality traits such as type A behavioural characteristics are not more prevalent in patients with cCSC. Patients with cCSC make more use of certain coping strategies, which could be addressed by psychosocial care to improve self-management. Further research is needed establish whether the course of disease can be improved by altering coping and reducing 'stress'.
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Affiliation(s)
- Femke M. Haalen
- Department of Medicine Division of Endocrinology and Center for Endocrine Tumors Leiden University Medical Center Leiden the Netherlands
| | - Elon H.C. Dijk
- Department of Ophthalmology Leiden University Medical Center Leiden the Netherlands
| | - Cornelie D. Andela
- Department of Medicine Division of Endocrinology and Center for Endocrine Tumors Leiden University Medical Center Leiden the Netherlands
| | - Greet Dijkman
- Department of Ophthalmology Leiden University Medical Center Leiden the Netherlands
| | - Nienke R. Biermasz
- Department of Medicine Division of Endocrinology and Center for Endocrine Tumors Leiden University Medical Center Leiden the Netherlands
| | - Alberto M. Pereira
- Department of Medicine Division of Endocrinology and Center for Endocrine Tumors Leiden University Medical Center Leiden the Netherlands
| | - Camiel J.F. Boon
- Department of Ophthalmology Leiden University Medical Center Leiden the Netherlands
- Department of Ophthalmology Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
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Zainal NH, Newman MG. Relation between cognitive and behavioral strategies and future change in common mental health problems across 18 years. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 128:295-304. [PMID: 31045412 PMCID: PMC6707366 DOI: 10.1037/abn0000428] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD), constitute common mental disorders that may have chronic and disabling courses. Cognitive and behavioral theories posit that lack of engagement in certain strategies (goal persistence, self-mastery, positive reappraisal) increases vulnerability toward these disorders. Further, scar effect theories assert that experiencing more of these disorders may diminish engagement in such strategies within individuals across time. However, dynamic longitudinal associations between cognitive-behavioral strategies (CBS) and disorder counts across adulthood are not well understood. Using bivariate latent difference score models, this study aimed to test the dynamic trajectories between disorder counts and each CBS across 18 years. Participants were 3,294 community-dwelling adults ages 45.62 years (SD = 11.41, range = 20-74; 54.61% female) who took part in 3 waves of measurement spaced 9 years apart. Self-mastery, disorder counts, and their change were not significantly related. However, higher within-subject increase in goal persistence (but not self-mastery or positive reappraisal) led to greater future decline in disorder counts, but not vice versa. Last, within individuals, greater prior levels of goal persistence and positive reappraisal predicted larger subsequent reduction in disorder counts, and vice versa. The reciprocal, bidirectional associations between specific CBS (goal persistence, positive reappraisal) and disorder counts support both vulnerability and scar models of depression and anxiety. Treatments for MDD, GAD, and PD should attempt to enhance perseverance and optimism. Theoretical and clinical implications are further discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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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: 0.3] [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.
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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
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12
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Allen SF, Wetherell MA, Smith MA. A one-year prospective investigation of Type D personality and self-reported physical health. Psychol Health 2019; 34:773-795. [DOI: 10.1080/08870446.2019.1568431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Sarah F. Allen
- Department of Health Sciences, Faculty of Science, University of York, York, UK
| | - Mark A. Wetherell
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Michael A. Smith
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
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Lee SJ, Koh S, Kim BO, Kim B, Kim C. Effect of Type D Personality on Short-Term Cardiac Rehabilitation in Patients With Coronary Artery Disease. Ann Rehabil Med 2018; 42:748-757. [PMID: 30404424 PMCID: PMC6246854 DOI: 10.5535/arm.2018.42.5.748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/13/2018] [Indexed: 01/20/2023] Open
Abstract
Objective To investigate the effect of type D personality on cardiac rehabilitation (CR) participation rates and the effect of a short-term CR program. Methods Study participants included patients diagnosed with acute coronary syndrome who underwent percutaneous coronary intervention. Patients completed the Type D personality Scale (DS-14) and the Hospital Anxiety and Depression Scale (HADS) at program entry. Subjects were recommended participation in 6 weeks of CR exercise training. Cardiopulmonary exercise test (CPET) was conducted before and after completion of the training. CR participation refers to completion of the 6-week CR exercise program and performance of the secondary CPET. Drop-out refers to the subjects who were unable to participate in the 6-week CR exercise program or to perform the secondary CPET. Results At baseline, type D personality was evident in 21 of 63 patients (33.3%). Type D patients were more often depressed (57.1%) and anxious (38.1%) than non-type D patients (31.0% and 9.5%, respectively). At baseline, participants with type D personality showed a decreased body mass index (24.6 vs. 26.1 kg/m2, p=0.025). The type D group displayed a lower CR participation rate (5/21, 23.8%) compared with the non-type D group of (22/42, 52.4%). Logistic regression analysis revealed the association of type D personality with CR drop-out rate (odds ratio=3.87; 95% confidence interval, 1.2–12.5; p<0.05). Conclusion Type D personality was independently associated with drop-out from CR program and with significantly higher levels of anxiety and depressive mood.
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Affiliation(s)
- Sang Jae Lee
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sunghoon Koh
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Bongseog Kim
- Department of Psychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
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14
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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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Leu HB, Yin WH, Tseng WK, Wu YW, Lin TH, Yeh HI, Cheng Chang K, Wang JH, Wu CC, Chen JW. Impact of type D personality on clinical outcomes in Asian patients with stable coronary artery disease. J Formos Med Assoc 2018; 118:721-729. [PMID: 30243505 DOI: 10.1016/j.jfma.2018.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 08/16/2018] [Accepted: 08/24/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Some personality types are associated with cardiovascular (CV) diseases and may be related to clinical outcomes in coronary artery disease (CAD). This study investigates the association between type D personality and clinical outcomes in stable CAD patients in an Asian cohort. METHODS Stable CAD patients were enrolled and prospectively followed up for at least 1 year in Taiwan. The inclusion criteria were at least one successful percutaneous coronary intervention (PCI) and stable medical treatment for at least 1 month before enrollment. Vulnerability to psychological distress was measured by the Type D Personality Scale (DS14) after enrollment. The end point was the occurrence of total CV events. Cox regression models of CV events were used to investigate the role of type D personality in clinical outcomes. RESULTS The study included 777 patients, among which 122 (15.77%) had type D personality. Forty-two CV events were identified: 3 cardiac deaths, 5 nonfatal myocardial infarctions, 1 stroke, 4 congestive heart failures (CHF), 6 peripheral arterial occlusive disorder cases, and 23 readmissions for angina/revascularization treatment. Patients with type D personality had significantly higher incidence of future CV events (9.84% vs. 4.58%, p = 0.018%) and admission for angina/revascularization (5.74% vs. 2.44%, p = 0.049). Patients with subsequent CV events were more likely to have type D personality (28.57% vs. 14.97%, p=0.018). After proportional Cox regression analysis, type D personality remained an independent predictor of future CV events (HR: 3.21, 95% CI: 1.06-9.69). In subgroup analyses, type D personality was especially associated with higher risk of total CV events among females, the elderly, hypertension patients, diabetes patients, and non-smokers. CONCLUSION Type D personality was an independent predictor of CV outcomes in an Asian cohort of stable CAD patients. This personality type may be identified in risk stratification for secondary prevention after PCI.
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Affiliation(s)
- Hsin-Bang Leu
- Heath Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Kung Tseng
- Department of Medical Imaging and Radiological Sciences, I-Shou University and Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
| | - Kuan- Cheng Chang
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Taiwan Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Ji-Hung Wang
- Department of Cardiology, Buddhist Tzu-Chi General Hospital, Tzu-Chi University, Hualien, Taiwan
| | - Chau-Chung Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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van Montfort E, Mommersteeg P, Spek V, Kupper N. Latent profiles of early trauma & Type D personality: sex differences in cardiovascular risk markers. Compr Psychiatry 2018; 83:38-45. [PMID: 29549878 DOI: 10.1016/j.comppsych.2018.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/05/2018] [Accepted: 02/24/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Both adverse early life-events and distressed personality are associated with an increased cardiovascular risk. As there is an important link between these psychological factors, we investigated how these might cluster in sex-specific psychological profiles. We further examined the association of these profiles with cardiovascular risk markers. METHOD 446 women (mean age = 49.8 ± 17.9 years) and 431 men (mean age = 49.4 ± 17.5 years) from the Dutch general population completed questionnaires on demographics, adverse early life-events (ETI), Type D personality (DS14), anxiety (GAD-7) and depressive (PHQ-9) symptoms, and traditional cardiovascular risk markers. RESULTS A step-3 latent profile analysis identified three profiles in women (Reference, Type D & trauma, and Type D/no trauma) and four in men (Reference, Type D & trauma, Type D/no trauma, and Physical abuse). In women, the Type D/no trauma was associated with highest levels of emotional symptoms (OR = 2.47; 95% CI: 2.11-2.89), lipid abnormalities (OR = 3.69; 95% CI: 1.47-9.27), and increased levels of alcohol use (OR = 3.63; 95% CI: 1.42-9.30). The Type D & trauma profile was associated with increased levels of emotional symptoms (OR = 2.03; 95% CI: 1.70-2.42), highest levels of smoking (OR = 3.30; 95% CI: 1.21-8.97) and alcohol use (OR = 7.63; 95% CI: 2.86-20.33). Women in both profiles were older as compared to the Reference group (OR = 1.03; 95% CI: 1.01-1.05). In men, the Type D & trauma profile was associated with increased levels of emotional symptoms (OR = 1.11; 95% CI: 1.03-1.20). There were no significant differences between the profiles in lifestyle factors and cardiometabolic factors. CONCLUSIONS In women, the Type D/no trauma profile and the Type D & trauma profile were associated with a specific combination of cardiovascular risk markers. In men, the Type D & trauma profile was associated with an increased level of emotional symptoms.
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Affiliation(s)
- Eveline van Montfort
- Center of Research on Psychological and Somatic Diseases, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
| | - Paula Mommersteeg
- Center of Research on Psychological and Somatic Diseases, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
| | - Viola Spek
- Center of Research on Psychological and Somatic Diseases, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
| | - Nina Kupper
- Center of Research on Psychological and Somatic Diseases, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands.
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Guerrero Rodríguez C, Palmero Cantero F, Gómez-Íñiguez C. Blood pressure responses of defensive hostile women when facing a real stress task. Psychol Health 2018. [PMID: 29532686 DOI: 10.1080/08870446.2018.1449952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This study investigated the importance of the combination of the hostility and defensiveness variables as psychosocial factors that predict the risk of cardiovascular dysfunction. We examined the impact of a stressful situation on blood pressure responses, using a continuous psychophysiological assessment approach. DESIGN We measured the evolution of these responses over three experimental phases (adaptation, task and recovery), also considering a minute-by-minute analysis within each phase. MAIN OUTCOME MEASURES We used the Cook-Medley Hostility Scale and the Social Desirability Questionnaire to form four groups (high hostility and high defensiveness, high hostility and low defensiveness, low hostility and high defensiveness, and low hostility and low defensiveness). RESULTS We expected the group of hostile defensive women to record higher activation (task phase: an academic exam) and slower habituation (recovery phase) compared to the other groups. The results confirmed our hypothesis, as the profile of the hostile defensive individuals was one of constant or sensitization during the task phase, while during the recovery phase those individuals underwent a slow recovery. CONCLUSION Therefore, it can be indicated that the low hostility and low defensive group is the most adaptive, as recorded very little activation in response, and rapid recovery.
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Affiliation(s)
| | - Francisco Palmero Cantero
- b Department of Psychology, Clinic and Psychobiology , University Jaume I of Castellón , Castellón de la Plana , Spain
| | - Consuelo Gómez-Íñiguez
- b Department of Psychology, Clinic and Psychobiology , University Jaume I of Castellón , Castellón de la Plana , Spain
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18
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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: 2.4] [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.
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19
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Wichmann HE. Epidemiology in Germany-general development and personal experience. Eur J Epidemiol 2017; 32:635-656. [PMID: 28815360 DOI: 10.1007/s10654-017-0290-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022]
Abstract
Did you ever hear about epidemiology in Germany? Starting from an epidemiological desert the discipline has grown remarkably, especially during the last 10-15 years: research institutes have been established, research funding has improved, multiple curriculae in Epidemiology and Public Health are offered. This increase has been quite steep, and now the epidemiological infrastructure is much better. Several medium-sized and even big population cohorts are ongoing, and the number and quality of publications from German epidemiologists has reached a respectable level. My own career in epidemiology started in the field of environmental health. After German reunification I concentrated for many years on environmental problems in East Germany and observed the health benefits after improvement of the situation. Later, I concentrated on population-based cohorts in newborns (GINI/LISA) and adults (KORA, German National Cohort), and on biobanking. This Essay describes the development in Germany after worldwar 2, illustrated by examples of research results and build-up of epidemiological infractructures worth mentioning.
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Affiliation(s)
- Heinz-Erich Wichmann
- Institute of Epidemiology, 2, Helmholtz Center Munich, Munich, Germany.
- Chair of Epidemiology, University of Munich, Munich, Germany.
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20
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Donisan T, Bojincă VC, Dobrin MA, Bălănescu DV, Predețeanu D, Bojincă M, Berghea F, Opriș D, Groșeanu L, Borangiu A, Constantinescu CL, Ionescu R, Bălănescu AR. The relationship between disease activity, quality of life, and personality types in rheumatoid arthritis and ankylosing spondylitis patients. Clin Rheumatol 2017; 36:1511-1519. [PMID: 28451872 DOI: 10.1007/s10067-017-3654-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/07/2017] [Accepted: 04/20/2017] [Indexed: 01/26/2023]
Abstract
We hypothesized that clinical outcomes might be influenced by personality type (A, B, C, D) in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). One hundred ninety-four patients (104 with RA, 90 with AS) participated in a questionnaire study. We evaluated health-related quality of life (HRQoL) using the Medical Outcome Study Short-Form 36 (SF-36), personality type A/B with the Jenkins Activity Survey, type C with the State-Trait Anger Expression Inventory Anger-in Scale, type D with the Type D Personality Scale, and disease activity with Disease Activity Score with 28 joints for RA and Bath Ankylosing Spondylitis Disease Activity Index for AS. We used Pearson's correlation coefficient, independent samples t tests, and multivariate analyses of variance. In the RA group, type D personality was significantly correlated with 7/12 SF-36 components. AS patients with type D personality had deficits in all SF-36 subscales. Type D was related with higher disease activity in RA and AS. Both RA and AS type C patients had more active disease forms and negatively affected HRQoL subscales. In the RA group, type A personality did not correlate with HRQoL, but it positively influenced pain visual analog scale scores. In AS patients, type A personality was linked with higher HRQoL and with less active disease. Type C and type D personality types were correlated with decreased HRQoL and higher disease activity in RA and AS patients. Type A personality was associated with less active disease and higher HRQoL in AS patients and with less pain in RA patients.
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Affiliation(s)
- T Donisan
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania
| | - V C Bojincă
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania. .,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania.
| | - M A Dobrin
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania
| | - D V Bălănescu
- "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania
| | - D Predețeanu
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania
| | - M Bojincă
- "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania.,Department of Internal Medicine and Rheumatology "Dr. I. Cantacuzino" Hospital, 5-7 Ion Movilă Str, Bucharest, Romania
| | - F Berghea
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania
| | - D Opriș
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania
| | - L Groșeanu
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania
| | - A Borangiu
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania
| | - C L Constantinescu
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania
| | - R Ionescu
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania
| | - A R Bălănescu
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, 37-39 Ion Mihalache Bd, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, Bucharest, Romania
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Li J, Wu X, Lin J, Zou D, Yang X, Cheng S, Guo Q. Type D personality, illness perception, social support and quality of life in continuous ambulatory peritoneal dialysis patients. PSYCHOL HEALTH MED 2016; 22:196-204. [PMID: 27550710 DOI: 10.1080/13548506.2016.1224371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The previous studies reported Type D was associated with poor quality of life (QoL), increased psychological distress, and impaired health status in cardiac patients. The aim of this study is to assess the relationships among Type D personality, illness perception, social support, and investigate the impact of Type D personality on QoL in continuous ambulatory peritoneal dialysis (CAPD) patients. Type D personality was assessed by the Chinese 14-item Type D Personality Scale (DS14). Illness perceptions were assessed using the Chinese version of the Brief Illness Perception Questionnaire (B-IPQ). Social support status was assessed by the well-validated social support rating scale (SSRS). Patients' QoL was assessed by using Medical Outcomes Short Form 36 (SF-36), respectively. The Type Ds had significantly lower objective support score (8.18 ± 2.56 vs. 9.67 ± 3.28, p = 0.0001), subjective support score (6.71 ± 2.0 vs. 7.62 ± 1.93, p = 0.0001) and utilization of social support score (6.76 ± 2.0 vs. 7.61 ± 1.94, p = 0.0001) than that of the non-type Ds. Type Ds believed their illness had much more serious consequences (7.67 ± 2.64 vs. 6.27 ± 3.45, p < 0.001), and experience much more symptoms that they attributed to their illness (6.65 ± 2.54 vs. 7.31 ± 2.36, p = 0.023). Significant differences were found between Type Ds and non-Type Ds in PCS (40.53 ± 6.42 vs. 48.54 ± 6.21 p < 0.001) and MCS (41.7 1 ± 10.20 vs. 46.35 ± 9.31, p = 0.012). The correlation analysis demonstrated that Type D was negatively associated with physical component score (PCS) (r = -0.29, p < 0.01), mental component score (MCS) (r = -0.31, p < 0.01), and social support (r = -0.24, p < 0.001). Using multiple linear regression analysis, we found that Type D personality was independently associated with PCS (β = -0.32, p < 0.001) and MCS (β = -0.24, p < 0.001). Type D personality was a predictor of poor QoL in CAPD patients. The current study is the first to identify a strong association among Type D, illness perceptions, social support and QoL in CAPD patients. The worse illness perceptions and lower social support level therefore represent possible mechanisms to explain the link between Type D and poor QoL in CAPD patients.
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Affiliation(s)
- Jianying Li
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Xiaofeng Wu
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Jianxiong Lin
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Dongmei Zou
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Xiao Yang
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Shouzhen Cheng
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China.,b Department of Nursing , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Qunying Guo
- a Department of Nephrology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
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22
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Gawda B. Type D Personality Associated With Health and Mental Health Problems: A Comment on Lussier and Loas (2015). Psychol Rep 2016; 118:1039-43. [PMID: 27173852 DOI: 10.1177/0033294116649156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Lussier and Loas examined relationship between anhedonia, depression, and type D personality. The aim of this commentary is to extend the discussion to four aspects not considered in the original article: association of type D personality with problems other than those of cardiovascular health, inconsistent findings in these associations, data on association between type D personality and mental problems, and an attempt to interpret their main findings. The proposed interpretation refers to trait anxiety as is partially incorporated into the type D personality.
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Affiliation(s)
- Barbara Gawda
- Department of Psychology, Maria Curie-Sklodowska University, Poland
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23
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The Association of Social Inhibition and Posttraumatic Stress Disorder: A Vicious Circle?: Results From the Population-Based KORA F4 Study With 1232 Participants With Trauma Exposure. J Nerv Ment Dis 2016; 204:261-6. [PMID: 26807881 DOI: 10.1097/nmd.0000000000000468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This cross-sectional analysis investigated the association between posttraumatic stress disorder (PTSD) and social inhibition (SI). A total of 1232 individuals aged 32-71 years with a history of traumatic experience were identified from the population-based Cooperative Health Research in the Region of Augsburg F4 study conducted in 2006-2008. PTSD was assessed by the Impact of Event Scale, Posttraumatic Diagnostic Scale, and interview data. SI was measured by the SI subscale of the German version of the Type-D scale and dichotomized in a high (score of ≥10) and nonhigh group. Even in the fully adjusted multinomial logistic regression model (adjusted for age, sex, sociodemographic and metabolic risk factors, anxiety, depression), high levels of SI were significantly associated with PTSD (partial: odds ratio, 1.58; 95% confidence interval, 1.19-2.09; p = 0.002; full: odds ratio, 2.45; 95% confidence interval, 1.25-4.82; p = 0.009). Our findings suggest a dose-response relationship between PTSD and SI and should be integrated in individual therapy plans, especially of patients with interpersonal violence experience.
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Cao X, Wong EML, Chow Choi K, Cheng L, Ying Chair S. Interventions for Cardiovascular Patients with Type D Personality: A Systematic Review. Worldviews Evid Based Nurs 2016; 13:314-23. [DOI: 10.1111/wvn.12153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Xi Cao
- Doctoral candidate, the Nethersole School of Nursing; the Chinese University of Hong Kong; Hong Kong
| | - Eliza M. L. Wong
- Assistant Professor, the Nethersole School of Nursing; the Chinese University of Hong Kong; Hong Kong
| | - Kai Chow Choi
- Assistant Professor, the Nethersole School of Nursing; the Chinese University of Hong Kong; Hong Kong
| | - Li Cheng
- Doctoral candidate, the Nethersole School of Nursing; the Chinese University of Hong Kong; Hong Kong
| | - Sek Ying Chair
- Professor and Director, the Nethersole School of Nursing; the Chinese University of Hong Kong; Hong Kong
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Prata J, Quelhas Martins A, Ramos S, Rocha-Gonçalves F, Coelho R. Gender differences in quality of life perception and cardiovascular risk in a community sample. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Prata J, Quelhas Martins A, Ramos S, Rocha-Gonçalves F, Coelho R. Gender differences in quality of life perception and cardiovascular risk in a community sample. Rev Port Cardiol 2016; 35:153-60. [PMID: 26923365 DOI: 10.1016/j.repc.2015.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/13/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Self-reported heath and quality of life is an independent predictor of overall and cardiovascular morbidity and mortality, and incident coronary heart disease. However, less is known regarding how gender differences in cardiovascular risk factors impact quality of life perception. METHODS Primary healthcare users (n=261, 158 women) were screened for cardiovascular risk factors and completed the Medical Outcomes Study Short Form (SF-36). RESULTS Women had significantly lower alcohol consumption, body mass index and exercise frequency than men, but more prevalent psychiatric history, depressive and anxiety symptoms, and negative affectivity. Prevalences of hypertension, diabetes, dyslipidemia and type D personality were similar between genders. Women reported significantly worse quality of life on most SF-36 subscales and gender differences were apparent in predictors of quality of life. Moreover, high negative affectivity was an independent predictor of worse general health for women, whereas high social inhibition and high anxiety had a comparable role for men. CONCLUSION Gender specifics in cardiovascular risk factors should be considered in prevention strategies. Women reported significantly worse quality of life, putting them at higher risk for cardiovascular morbidity and mortality. Therefore, gender differences in predictors of quality of life warrant further investigation.
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Affiliation(s)
- Joana Prata
- Unidade de Investigação & Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Amadeu Quelhas Martins
- Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Sónia Ramos
- Unidade de Investigação & Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Francisco Rocha-Gonçalves
- Unidade de Investigação & Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui Coelho
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; Departamento de Neurociências Clínicas e Saúde Mental, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Batselé E, Denollet J, Lussier A, Loas G, Vanden Eynde S, Van de Borne P, Fantini-Hauwel C. Type D personality: Application of DS14 French version in general and clinical populations. J Health Psychol 2016; 22:1075-1083. [PMID: 26826169 DOI: 10.1177/1359105315624499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to validate the French-language version of the Type D personality scale-14 among general and clinical populations (acute coronary syndrome and breast cancer patients). The two-factor structure of the Type D personality scale-14 was confirmed by factorial and confirmatory analyses. Internal consistency for both subdimensions of Type D personality scale-14 (negative affectivity and social inhibition) was very good with α = .87 for each. Contrary to our expectations, the Type D prevalence was much higher in the breast cancer group than in the acute coronary syndrome patients. In conclusion, the French-language Type D personality scale-14 showed good psychometric properties among general and clinical populations.
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van Dooren FEP, Verhey FRJ, Pouwer F, Schalkwijk CG, Sep SJS, Stehouwer CDA, Henry RMA, Dagnelie PC, Schaper NC, van der Kallen CJH, Koster A, Schram MT, Denollet J. Association of Type D personality with increased vulnerability to depression: Is there a role for inflammation or endothelial dysfunction? - The Maastricht Study. J Affect Disord 2016; 189:118-25. [PMID: 26433759 DOI: 10.1016/j.jad.2015.09.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Type D personality - the combination of negative affectivity (NA) and social inhibition (SI) - has been associated with depression but little is known about underlying mechanisms. We examined whether (1) Type D is a vulnerability factor for depression in general, (2) Type D is associated with inflammation or endothelial dysfunction, and (3) these biomarkers alter the possible association between Type D and depression. METHODS In the Maastricht Study, 712 subjects underwent assessment of NA, SI and Type D personality (DS14), depressive disorder (Mini-International Neuropsychiatric Interview) and depressive symptoms (Patient Health Questionnaire-9). Plasma biomarkers of inflammation (hsCRP, SAA, sICAM-1, IL-6, IL-8, TNF-α) and endothelial dysfunction (sVCAM-1, sICAM-1, E-selectin, vWF) were measured with sandwich immunoassays or ELISA and combined into standardized sumscores. RESULTS Regarding personality, 49% of the study population was low in NA and SI, 22% had SI only, 12% NA only and 17% had Type D. Depressive disorder and depressive symptoms were significantly more prevalent in Type D versus the other three personality subgroups. Multivariable regression analyses showed that Type D was associated with inflammation (β=0.228, p=0.014) and endothelial dysfunction (β=0.216, p=0.022). After adjustment for these biomarkers, Type D remained independently associated with increased vulnerability to depressive disorder (OR=13.20, p<0.001) and depressive symptoms (β=3.87, p<0.001). LIMITATIONS The cross-sectional design restrained us to draw any conclusions on causality. The relatively low prevalence of depressive disorder restrained us to adjust for more potential confounders. CONCLUSIONS Type D personality may be a vulnerability factor for depression, irrespective of levels of inflammation or endothelial dysfunction. Future research should examine possible underlying mechanisms.
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Affiliation(s)
- Fleur E P van Dooren
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; MHeNS - Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Frans R J Verhey
- MHeNS - Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Frans Pouwer
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Pieter C Dagnelie
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Johan Denollet
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
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Geuens N, Braspenning M, Van Bogaert P, Franck E. Individual vulnerability to burnout in nurses: The role of Type D personality within different nursing specialty areas. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.burn.2015.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Albarqouni L, von Eisenhart Rothe A, Ronel J, Meinertz T, Ladwig KH. Frequency and covariates of fear of death during myocardial infarction and its impact on prehospital delay: findings from the multicentre MEDEA Study. Clin Res Cardiol 2015. [PMID: 26210771 DOI: 10.1007/s00392-015-0895-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fear of death (FoD) is an exceptionally stressful symptom of ST-elevation myocardial infarction (STEMI), which received little scientific attention in recent years. We aimed to describe the prevalence and factors contributing to FoD among STEMI patients and assess the impact of FoD on prehospital delay. METHODS This investigation was based on 592 STEMI patients who participated in the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. Multivariate logistic regression models were used to identify factors associated with FoD. RESULTS A total of 15% of STEMI patients reported FoD (n = 88), no significant gender difference was found. STEMI pain strength [OR = 2.3 (1.4-3.9)], STEMI symptom severity [OR = 3.7 (2-6.8)], risk perception pre-STEMI [OR = 1.9 (1.2-3.2)] and negative affectivity [OR = 1.9 (1.2-3.1)] were independently associated with FoD. The median delay for those who experienced FoD was 139 min compared to 218 min for those who did not (p = 0.005). Male patients with FoD were significantly more likely to delay less than 120 min [OR = 2.11(1.25-3.57); p = 0.005], whereas in women, this association was not significant. Additionally, a clear dose-response relationship between fear severity and delay was observed. Male FoD patients significantly more often used emergency services to reach the hospital (p = 0.003). CONCLUSIONS FoD is experienced by a clinically meaningful minority of vulnerable STEMI patients and is strongly associated with shorter delay times in men but not in women. Patients' uses of emergency services play an important role in reducing the delay in male FoD patients.
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Affiliation(s)
- L Albarqouni
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - A von Eisenhart Rothe
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - J Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - T Meinertz
- Department of Cardiology, University Heart Center Hamburg Eppendorf, Klinikum Stephansplatz, Hamburg, Germany
| | - K H Ladwig
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Bhochhibhoya A, Collado M, Branscum P, Sharma M. The Role of Global Mental Health and Type-D Personality in Predicting Alcohol Use Among a Sample of College Students. ALCOHOLISM TREATMENT QUARTERLY 2015. [DOI: 10.1080/07347324.2015.1050932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mommersteeg PMC, Widdershoven JW, Aarnoudse W, Denollet J. Personality subtypes and chest pain in patients with nonobstructive coronary artery disease from the TweeSteden Mild Stenosis study: mediating effect of anxiety and depression. Eur J Pain 2015; 20:427-37. [PMID: 26105088 DOI: 10.1002/ejp.743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients presenting with chest pain in nonobstructive coronary artery disease (CAD, luminal narrowing <60%) are at risk for emotional distress and future events. We aimed to examine the association of personality subtypes with persistent chest pain, and investigated the potential mediating effects of negative mood states. METHODS Any chest pain in the past month was the primary outcome measure reported by 523 patients with nonobstructive CAD (mean age 61.4 years, SD = 9.4; 48% men), who participate in the TweeSteden Mild Stenosis (TWIST) observational cohort. Personality was categorized into a 'reference group', a high social inhibition ('SI only'), a high negative affectivity ('NA only') and a 'Type D' (NA and SI) group. Negative mood states included symptoms of depression and anxiety (Hospital Anxiety and Depression Scale) and cognitive and somatic depression (Beck Depression Inventory). The PROCESS macro was used to examine the relation between personality subtypes and chest pain presence, with the negative mood states as potential mediators. RESULTS Persistent chest pain was present in 44% of the patients with nonobstructive CAD. Type D personality (OR = 1.91, 95% CI 1.24-2.95), but not the 'NA only' (OR = 1.48, 95% CI 0.89-2.44) or the 'SI only' (OR = 0.93, 95% CI 0.53-1.64) group was associated with chest pain, adjusted for age and sex. Negative mood states mediated the association between personality and chest pain. CONCLUSIONS Type D personality, but not negative affectivity or social inhibition, was related to chest pain in nonobstructive CAD, which was mediated by negative mood states.
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Affiliation(s)
- P M C Mommersteeg
- CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| | - J W Widdershoven
- CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands.,Department of Cardiology, Tweesteden Hospital, Tilburg, The Netherlands
| | - W Aarnoudse
- Department of Cardiology, Tweesteden Hospital, Tilburg, The Netherlands
| | - J Denollet
- CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
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Nefs G, Speight J, Pouwer F, Pop V, Bot M, Denollet J. Type D personality, suboptimal health behaviors and emotional distress in adults with diabetes: results from Diabetes MILES-The Netherlands. Diabetes Res Clin Pract 2015; 108:94-105. [PMID: 25686507 DOI: 10.1016/j.diabres.2015.01.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/24/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
AIMS Type D personality - defined as high negative affectivity (NA) and high social inhibition (SI) - has been associated with adverse cardiovascular prognosis. We explored the differential associations of Type D personality and its constituent components with health behaviors, emotional distress and standard biomedical risk factors as potential risk mechanisms in adults with diabetes. METHODS 3314 Dutch adults with self-reported type 1 or 2 diabetes completed an online survey, including the DS14 Type D Scale. AN(C)OVAs and X(2) tests were used to compare participants scoring (i) low on NA and SI; (ii) high on SI only; (iii) high on NA only; (iv) high on NA and SI (Type D). RESULTS Participants with Type D personality (29%) were less likely to follow a healthy diet or to consult healthcare professionals in case of problems with diabetes management than those scoring high on neither or only one component. They also reported more barriers surrounding medication use, diabetes-specific social anxiety, loneliness and symptoms of depression and anxiety. There were no differences in standard biomedical risk factors (body mass index, blood pressure, cholesterol, HbA1c). After adjustment for demographics, clinical characteristics, NA, and SI in multivariable logistic regression analyses, Type D personality was independently associated with 2 to 3-fold increased odds of suboptimal health behaviors and over 15-fold increased odds of general emotional distress. CONCLUSIONS Type D personality was not related to standard biomedical risk factors, but was associated with unhealthy behaviors and negative emotions that are likely to have adverse impact on adults with diabetes.
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Affiliation(s)
- G Nefs
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
| | - J Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia-Vic, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia; AHP Research, 16 Walden Way, Hornchurch, UK
| | - F Pouwer
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - V Pop
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - M Bot
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands; Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, and GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - J Denollet
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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Molina-Leyva A, Caparros-delMoral I, Ruiz-Carrascosa J, Naranjo-Sintes R, Jimenez-Moleon J. Elevated prevalence of Type D (distressed) personality in moderate to severe psoriasis is associated with mood status and quality of life impairment: a comparative pilot study. J Eur Acad Dermatol Venereol 2015; 29:1710-7. [DOI: 10.1111/jdv.12960] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/09/2014] [Indexed: 01/09/2023]
Affiliation(s)
- A. Molina-Leyva
- Department of Dermatology; Hospital Torrecardenas; Almería Spain
| | | | | | | | - J.J. Jimenez-Moleon
- CIBER de Epidemiología y Salud Pública (CIBERESP); Granada Spain
- Dpto. de Medicina Preventiva y Salud Pública; Instituto de Investigación Biosanitaria ibs; Hospitales Universitarios de Granada/Universidad de Granada; Granada Spain
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Marchesi C, Ossola P, Scagnelli F, Paglia F, Aprile S, Monici A, Tonna M, Conte G, Masini F, De Panfilis C, Ardissino D. Type D personality in never-depressed patients and the development of major and minor depression after acute coronary syndrome. J Affect Disord 2014; 155:194-9. [PMID: 24274964 DOI: 10.1016/j.jad.2013.10.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Type D personality (TDP) has been proposed as a risk factor for the development of depressive symptoms after an acute coronary syndrome (ACS). However, contrasting findings emerged about its predicting power on the onset of depression, since an overlap between TDP and depressive symptoms has been proposed. The present study was aimed to verify whether TDP predicts the development of a depressive disorder in the 6 months after the discharge from hospital. METHODS Two hundred fifty consecutive patients were recruited, at the Coronary Intensive Care Unit at the University Hospital of Parma, who were both presenting their first ACS and had no history of depression. The presence and the severity of major (MD) and minor (md) depression were evaluated with the Primary Care Evaluation of Mental Disorders (PRIME-MD) and the Hospital Anxiety and Depression Scale (HADS) respectively. Type D Personality was assessed with the DS14, both at baseline and at 1, 2, 4 and 6 month follow ups. RESULTS Out of 250 subjects (81.2% males), MD was diagnosed in 12 patients (4.8%) and md in 18 patients (7.2%). At baseline risk factors for a post-ACS depressive disorder were HADS depression scores, whereas TDP, or its subscales, did not showed any effect. LIMITATION The small amount of patients with incidence of depression, due to highly selective inclusion criteria, tempers the reliability of our results. CONCLUSION Our data suggests that TDP does not predict the development of depressive disorders in never-depressed patients at their first ACS, when the baseline depression severity was controlled.
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Affiliation(s)
- Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy.
| | - Paolo Ossola
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
| | - Francesca Scagnelli
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
| | - Francesca Paglia
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
| | - Sonja Aprile
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
| | | | | | - Giulio Conte
- Department of Cardiology, University Hospital, Parma, Italy
| | - Franco Masini
- Department of Cardiology, University Hospital, Parma, Italy
| | - Chiara De Panfilis
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
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Lee HB, Offidani E, Ziegelstein RC, Bienvenu OJ, Samuels J, Eaton WW, Nestadt G. Five-factor model personality traits as predictors of incident coronary heart disease in the community: a 10.5-year cohort study based on the Baltimore epidemiologic catchment area follow-up study. PSYCHOSOMATICS 2013; 55:352-361. [PMID: 24751113 DOI: 10.1016/j.psym.2013.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 11/11/2013] [Accepted: 11/19/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Certain personality and behavioral traits (e.g., type A and type D) have been reported to be associated with development and progression of coronary heart disease (CHD), but few have examined the relationship using a comprehensive assessment of personality along with a structured assessment of psychiatric disorders. METHODS Based on participants (age: 47.3 ± 12.8; female: 62.6%) of the Baltimore Epidemiologic Catchment Area follow-up study, we examined the relationship between the 5 major domains of personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and incident CHD between Wave III (1993-1996) and Wave IV (2004-2005). RESULTS Incident CHD developed in 65 participants during the follow-up. Those with incident CHD had lower on openness (44.06 ± 9.29 vs. 47.18 ± 8.80; p = 0.007) and extraversion (45.98 ± 9.25 vs. 49.12 ± 8.92; p = 0.007) scores than those without. Logistic regression models revealed an inverse association (OR = 0.73; 95% CI = 0.54-0.98) between openness factor z-scores and incident CHD after adjusting for putative confounding factors, including DSM III-R Major Depressive Disorder. CONCLUSION High openness appears to be an independent protective factor for incident CHD in the community. Future studies should examine behavioral and pathophysiologic mechanisms underlying this association.
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Affiliation(s)
| | | | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Oscar Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Mental Health, the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Jack Samuels
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - William W Eaton
- Department of Mental Health, the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Mental Health, the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Predictive value of social inhibition and negative affectivity for cardiovascular events and mortality in patients with coronary artery disease: the type D personality construct. Psychosom Med 2013; 75:873-81. [PMID: 24163388 DOI: 10.1097/psy.0000000000000001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Methodological considerations and selected null findings indicate the need to reexamine the Type D construct. We investigated whether associations with cardiac events in patients with coronary artery disease (CAD) involve the specific combination of negative affectivity (NA) and social inhibition (SI), or rather the main effect of either trait alone. METHODS In this 5-year follow-up of 541 patients with CAD, the Type D construct (14-item Type D Scale) was tested by examining a) the interaction of continuous NA and SI z scores and b) a four-group classification defined by low/high trait scores. End points were major adverse cardiac events (MACEs; death, myocardial infarction [MI], coronary revascularization) and cardiac death/MI. RESULTS At follow-up, 113 patients had a MACE, including 47 patients with cardiac death/MI. After adjustment for disease severity, age, sex, and main trait effects, the interaction of NA and SI z scores was associated with MACE (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.11-1.67). This continuous measure of Type D was also associated with cardiac death/MI (OR = 1.48, 95% CI = 1.11-1.96) and remained an independent predictor of events after adjustment for depressive symptoms. Using a cutoff of 10 on both NA and SI scales, Type D was associated with an adjusted OR of 1.74 (95% CI = 1.11-2.73) for MACE and an OR of 2.35 (95% CI = 1.26-4.38) for death/MI but was unrelated to noncardiac death. Patients with high NA or SI alone were not at increased risk. CONCLUSIONS Continuous (NA × SI interaction) and dichotomized measures of Type D were associated with cardiovascular events in patients with CAD. Research is needed to explore moderating factors that may alter this association.
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Altmaier E, Emeny RT, Krumsiek J, Lacruz ME, Lukaschek K, Häfner S, Kastenmüller G, Römisch-Margl W, Prehn C, Mohney RP, Evans AM, Milburn MV, Illig T, Adamski J, Theis F, Suhre K, Ladwig KH. Metabolomic profiles in individuals with negative affectivity and social inhibition: a population-based study of Type D personality. Psychoneuroendocrinology 2013; 38:1299-309. [PMID: 23237813 DOI: 10.1016/j.psyneuen.2012.11.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 11/09/2012] [Accepted: 11/10/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Individuals with negative affectivity who are inhibited in social situations are characterized as distressed, or Type D, and have an increased risk of cardiovascular disease (CVD). The underlying biomechanisms that link this psychological affect to a pathological state are not well understood. This study applied a metabolomic approach to explore biochemical pathways that may contribute to the Type D personality. METHODS Type D personality was determined by the Type D Scale-14. Small molecule biochemicals were measured using two complementary mass-spectrometry based metabolomics platforms. Metabolic profiles of Type D and non-Type D participants within a population-based study in Southern Germany were compared in cross-sectional regression analyses. The PHQ-9 and GAD-7 instruments were also used to assess symptoms of depression and anxiety, respectively, within this metabolomic study. RESULTS 668 metabolites were identified in the serum of 1502 participants (age 32-77); 386 of these individuals were classified as Type D. While demographic and biomedical characteristics were equally distributed between the groups, a higher level of depression and anxiety was observed in Type D individuals. Significantly lower levels of the tryptophan metabolite kynurenine were associated with Type D (p-value corrected for multiple testing=0.042), while no significant associations could be found for depression and anxiety. A Gaussian graphical model analysis enabled the identification of four potentially interesting metabolite networks that are enriched in metabolites (androsterone sulfate, tyrosine, indoxyl sulfate or caffeine) that associate nominally with Type D personality. CONCLUSIONS This study identified novel biochemical pathways associated with Type D personality and demonstrates that the application of metabolomic approaches in population studies can reveal mechanisms that may contribute to psychological health and disease.
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Affiliation(s)
- Elisabeth Altmaier
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
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The distressed (Type D) and Five-Factor Models of personality in young, healthy adults and their association with emotional inhibition and distress. PERSONALITY AND INDIVIDUAL DIFFERENCES 2013. [DOI: 10.1016/j.paid.2013.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Compare A, Bigi R, Orrego PS, Proietti R, Grossi E, Steptoe A. Type D personality is associated with the development of stress cardiomyopathy following emotional triggers. Ann Behav Med 2013; 45:299-307. [PMID: 23494256 DOI: 10.1007/s12160-013-9474-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Stress cardiomyopathy (SCM) can be triggered by emotional events. Recently, type D personality has been established as an independent predictor of acute cardiac adverse events. PURPOSE We sought to examine whether type D personality can be identified in SCM patients. METHODS A case-control study with 37 SCM patients, 37 myocardial infarction (AMI) patients, who both experienced emotional triggering, and 37 SCM patients without emotional triggers was performed. The DS14 and Interview for Recent Life Events were administered. RESULTS Twenty-eight (76 %) SCM emotional trigger patients were categorized as type D compared with 13 (43 %) SCM patients without emotional trigger and 12 (32 %) AMI patients (p < 0.001). SCM patients with emotional triggers had higher scores on the social inhibition subscale than the other patient groups. CONCLUSIONS The present study highlights the possible link between type D, with a specific key role for social inhibition component, and increased biological reactivity to acute emotional stress.
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Association of mental distress with smoking status in the community: Results from the Gutenberg Health Study. J Affect Disord 2013; 146:355-60. [PMID: 23063238 DOI: 10.1016/j.jad.2012.09.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 09/19/2012] [Accepted: 09/20/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Exposition to tobacco smoke is among the major modifiable risk factors in the general population. There is strong evidence for a close association between smoking exposure and mental disorders. METHODS Cross-sectional associations of different conditions of smoking status (former, current, and second hand smoking (SHS)) with indicators of mental distress were analyzed in a sample of N=5000 participants (aged 35-74 years) of the population-based survey "Gutenberg Health Study". RESULTS In the general population clinically significant depression (OR 1.59, 95%CI 1.17-2.17) and a previous diagnosis of depression (OR 1.50, 95%CI 1.16-1.94) were associated with current smoking. Each cigarette per day was associated with a 3% increase for the likelihood of clinically significant depression. We did not find a decreased prevalence for current first and second hand exposure in persons with established cardiovascular or lung disease. In this subgroup mental distress was strongly associated with SHS at home. LIMITATIONS Main limitations of the study pertain to the reliance on self-report of distress and smoking status and the cross-sectional nature of the data. CONCLUSIONS Despite public health efforts, smoke exposure is still alarmingly high in the general population, especially in persons with mental distress and with established cardiovascular or lung disease. In the management of persons with chronic cardiovascular and lung disease, enquiry of the medical history should include exposure to SHS at home and offer special counseling.
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Condén E, Ekselius L, Aslund C. Type D personality is associated with sleep problems in adolescents. Results from a population-based cohort study of Swedish adolescents. J Psychosom Res 2013; 74:290-5. [PMID: 23497829 DOI: 10.1016/j.jpsychores.2012.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Sleep problems are associated with an increased risk of psychiatric and somatic diseases. Type D personality, or the distressed personality, refers to the joint tendency to experience negative emotions and to inhibit self-expression in social interaction. Type D personality is associated with an increased number of health complaints including cardiovascular diseases. The present study investigated whether type D personality was associated with sleep problems among adolescents. METHODS The study was part of the Survey of Adolescent Life in Västmanland 2008 (SALVe 2008). A total of 5012 adolescents (age 15-18 years old) completed a questionnaire including the type D measurement DS14 and questions on sleep disturbances, sleep hours during school nights, and sleep hours during weekend nights. RESULTS Adolescents with a type D personality had an approximately four times increased risk of having sleep disturbances. Moreover, type D personality was associated with sleeping fewer hours. CONCLUSION As adolescence represents a formative period for development it is critical to identify sleep disorders early. The presence of type D personality associated with poor sleep demands attention because sleep problems may be an early stage in the development of later diseases.
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Affiliation(s)
- Emelie Condén
- Centre for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden.
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Parruti G, Vadini F, Sozio F, Mazzott E, Ursini T, Polill E, Di Stefano P, Tontodonati M, Verrocchio MC, Fulcheri M, Calella G, Santilli F, Manzoli L. Psychological factors, including alexithymia, in the prediction of cardiovascular risk in HIV infected patients: results of a cohort study. PLoS One 2013; 8:e54555. [PMID: 23349927 PMCID: PMC3551818 DOI: 10.1371/journal.pone.0054555] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 12/12/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Psychological factors are known predictors of cardiovascular disease in many clinical settings, but data are lacking for HIV infection. We carried out a prospective cohort study to evaluate potential psychological predictors of preclinical and clinical vascular disease in HIV patients. METHODOLOGY/PRINCIPAL FINDINGS HIV patients were consecutively enrolled. Demographics, viral and immune parameters and traditional cardiovascular predictors were considered; Intima-Media Thickness (c-IMT, continuous measure) and Carotid Plaques (CPs, focal thickening ≥1.5 mm) were investigated by B-mode ultrasonography; depressive symptoms by the Beck Depression Inventory (BDI-II), Type D personality (Distressed Personality or Type D) by the DS14, alexithymia by the Toronto Alexithymia Scale (TAS-20). Vascular outcomes included transient ischemic attacks or stroke, acute coronary syndrome, myocardial or other organ infarction. We enrolled 232 HIV subjects, 73.9% males, aged 44.5±9.9 y, 38.2% with AIDS diagnosis, 18.3% untreated. Mean Nadir CD4 T-cell counts were 237.5±186.2/mmc. Of them, 224 (96.5%) attended IMT measurements; 201 (86.6%) attended both IMT assessment and psychological profiling. Mean follow-up was 782±308 days. Fifty-nine patients (29.4%) had CPs at baseline. Nineteen patients (9.5%) had ≥1 vascular event; 12 (6.0%) died due to such events (n = 4) or any cause. At baseline cross-sectional multivariate analysis, increasing age, total cholesterol, current smoking and Alexithymia score≥50 were significantly associated with both increased cIMT (linear regression) and CPs (logistic regression). At follow-up analysis, log-rank tests and Cox's regression revealed that only older age (p = 0.001), current smoking (p = 0.019) and alexithymia score≥50 (p = 0.013) were independently associated with vascular events. CONCLUSIONS/SIGNIFICANCE In HIV-infected subjects, the Alexithymic trait emerges as a strong predictor of increased IMT, presence of CPs and vascular events. Such results are preliminary and require confirmation from studies with larger sample size and longer follow-up.
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Affiliation(s)
- Giustino Parruti
- Unit of Infectious Diseases, Pescara General Hospital, Pescara, Italy.
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Type D personality and patient-perceived health in nonsignificant coronary artery disease: the TWeesteden mIld STenosis (TWIST) study. Qual Life Res 2012; 22:2041-50. [DOI: 10.1007/s11136-012-0340-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 01/09/2023]
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Nefs G, Bot M, Browne JL, Speight J, Pouwer F. Diabetes MILES--The Netherlands: rationale, design and sample characteristics of a national survey examining the psychosocial aspects of living with diabetes in Dutch adults. BMC Public Health 2012; 12:925. [PMID: 23110382 PMCID: PMC3560187 DOI: 10.1186/1471-2458-12-925] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/14/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND As the number of people with diabetes is increasing rapidly worldwide, a more thorough understanding of the psychosocial aspects of living with this condition has become an important health care priority. While our knowledge has grown substantially over the past two decades with respect to the physical, emotional and social difficulties that people with diabetes may encounter, many important issues remain to be elucidated. Under the umbrella of the Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study International Collaborative, Diabetes MILES--The Netherlands aims to examine how Dutch adults with diabetes manage their condition and how it affects their lives. Topics of special interest in Diabetes MILES--The Netherlands include subtypes of depression, Type D personality, mindfulness, sleep and sexual functioning. METHODS/DESIGN Diabetes MILES--The Netherlands was designed as a national online observational study among adults with diabetes. In addition to a main set of self-report measures, the survey consisted of five complementary modules to which participants were allocated randomly. From September to October 2011, a total of 3,960 individuals with diabetes (40% type 1, 53% type 2) completed the battery of questionnaires covering a broad range of topics, including general health, self-management, emotional well-being and contact with health care providers. People with self-reported type 1 diabetes (specifically those on insulin pump therapy) were over-represented, as were those using insulin among respondents with self-reported type 2 diabetes. People from ethnic minorities were under-represented. The sex distribution was fairly equal in the total sample, participants spanned a broad age range (19-90 years), and diabetes duration ranged from recent diagnosis to living with the condition for over fifty years. DISCUSSION The Diabetes MILES Study enables detailed investigation of the psychosocial aspects of living with diabetes and an opportunity to put these findings in an international context. With several papers planned resulting from a pooled Australian-Dutch dataset and data collections planned in other countries, the Diabetes MILES Study International Collaborative will contribute substantially to identifying potentially unmet needs of those living with diabetes and to inform clinical research and care across the globe.
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Affiliation(s)
- Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO BOX 90153 5000, LE, Tilburg, The Netherlands
| | - Mariska Bot
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO BOX 90153 5000, LE, Tilburg, The Netherlands
- Department of Psychiatry, VU University Medical Center and GGZ in Geest, Amsterdam, The Netherlands
| | - Jessica L Browne
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia – Vic, Melbourne, VIC, Australia
- Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia – Vic, Melbourne, VIC, Australia
- Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia
- AHP Research, Hornchurch, Essex, UK
| | - François Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO BOX 90153 5000, LE, Tilburg, The Netherlands
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Sumin AN, Sumina LY, Barbarash NA. Stress-related hemodynamic response in healthy young individuals with Type D personality. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2012. [DOI: 10.15829/1728-8800-2012-3-70-76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To investigate the association between the stress-related hemodynamic response during the mental calculation test (MCT) and the presence of Type D personality in healthy young individuals. Material and methods. The study included 80 healthy individuals (19 men and 61 women; mean age 18,8±0,2 years). Psychological status examination included the DS-14 scale, depression scale, and Spielberger-Khanin scale. MCT was performed with simultaneous assessment of hemodynamic response. Results. Type D personality (distressed type) was observed in 32,5% of the participants. Among young students, Type D personality was associated with higher levels of trait and state anxiety (TA and SA), as well as higher depression scale scores, compared to students without Type D personality. Type D personality was also linked to a more pronounced response of systolic blood pressure (SBP) during MCT (p=0,05). There was a strong correlation between social inhibition levels and maximal heart rate (HR) during MCT (r=-0,238; p=0,034). Young men demonstrated a moderate correlation between Type D personality and HR response (r=-0,508; p=0,026), as well as between negative affectivity levels and HR response during MCT (r=0,469; p=0,043). Conclusion. Distressed personality type was observed in one-third of healthy young participants of the study. Type D personality and its subscales correlated with the hemodynamic response during MCT, with some gender-specific features observed. These findings clarify potential mechanisms of Type D personality effects on the development and prognosis of cardiovascular disease.
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Affiliation(s)
- A. N. Sumin
- Research Institute of Complex Cardiovascular Problems, Siberian Branch, Russian Academy of Medical Sciences
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Beutel ME, Wiltink J, Till Y, Wild PS, Münzel T, Ojeda FM, Zeller T, Schnabel RB, Lackner K, Blettner M, Zwiener I, Michal M. Type D personality as a cardiovascular risk marker in the general population: results from the Gutenberg health study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2012; 81:108-17. [PMID: 22262039 DOI: 10.1159/000331776] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 08/12/2011] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- M E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Straat JH, van der Ark LA, Sijtsma K. Multi-method analysis of the internal structure of the Type D Scale-14 (DS14). J Psychosom Res 2012; 72:258-65. [PMID: 22405218 DOI: 10.1016/j.jpsychores.2012.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 01/02/2012] [Accepted: 01/04/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The Type D Scale-14 (DS14) measures distressed (also, Type D) personality by assessing the medium-level trait negative affectivity that encompasses the low-level traits dysphoria, anxiety, and irritability, and the medium-level trait social inhibition that encompasses the low-level traits social discomfort, reticence, and lack of social poise. The literature discusses three different structural models of the DS14. The goal of this study was to investigate which of the three models best describes the internal structure of the DS14. METHOD We used three methods to investigate the internal structure of the DS14 items using data collected in representative samples from the Dutch general population (N=3,181). The methods were exploratory factor analysis, confirmatory factor analysis, and Mokken scale analysis. RESULTS Exploratory factor analysis suggested a two-factor structure without evidence of the low-level factors, and the other two methods showed evidence of a three-level structure including the low-level factors. CONCLUSIONS A two-factor model with correlated errors for items defining low-level traits adequately describes the data. The results support the three-level hierarchical model as a conceptual model for Type D personality, and support the interpretation of DS14 scores on item subsets representing medium-level traits and low-level traits.
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Affiliation(s)
- J Hendrik Straat
- Department of Methodology and Statistics TSB, Tilburg University, Tilburg, The Netherlands.
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Nefs G, Pouwer F, Pop V, Denollet J. Type D (distressed) personality in primary care patients with type 2 diabetes: validation and clinical correlates of the DS14 assessment. J Psychosom Res 2012; 72:251-7. [PMID: 22405217 DOI: 10.1016/j.jpsychores.2012.01.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 12/23/2011] [Accepted: 01/04/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In cardiovascular research, Type D personality (high negative affectivity and social inhibition) has been associated with a more than 3-fold increased risk of adverse health outcomes. This study examined the validity and clinical correlates of the Type D construct as assessed by the Type D Scale-14 (DS14) in type 2 diabetes patients. METHODS 1553 primary care patients with type 2 diabetes were assessed for demographic, clinical, lifestyle and psychological characteristics in 2007. A subgroup (n=1012) completed the DS14 again 1 year later. RESULTS The two-factor model of the Type D construct was confirmed in exploratory and confirmatory factor analyses; results were stable across gender. The Negative Affectivity (NA) and Social Inhibition (SI) subscales had adequate reliability in both men and women, as measured by Cronbach's alpha (NA=0.87, SI=0.83), lambda2 (NA=0.87/0.88, SI=0.84), corrected item-total correlations (NA 0.47-0.77, SI 0.34-0.72) and mean inter-item correlations (NA=0.50/0.51, SI=0.42). One year test-retest reliability using intraclass correlation coefficients was 0.64/0.63 for NA and 0.73/0.65 for SI. Type D and non-Type D patients did not differ in vascular history or physiological risk factors, but Type D women had a more sedentary lifestyle (p=.003). Type D patients experienced less social support and more stressful life events, loneliness, and more depressed mood, anhedonia and anxiety (p<.001 for most variables). These differences were clinically significant (Cohen's d>0.60 for most variables). CONCLUSION Type D personality can be reliably assessed in primary care patients with type 2 diabetes, and is associated with increased loneliness, stress and emotional distress in these patients.
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Affiliation(s)
- Giesje Nefs
- Center of Research on Psychology in Somatic Diseases-CoRPS, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands
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Svansdottir E, Denollet J, Thorsson B, Gudnason T, Halldorsdottir S, Gudnason V, den Broek KCV, Karlsson HD. Association of Type D personality with unhealthy lifestyle, and estimated risk of coronary events in the general Icelandic population. Eur J Prev Cardiol 2012; 20:322-30. [DOI: 10.1177/2047487312441723] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Erla Svansdottir
- CoRPS ⊟ Center of Research on Psychology in Somatic diseases, Tilburg, The Netherlands
| | - Johan Denollet
- CoRPS ⊟ Center of Research on Psychology in Somatic diseases, Tilburg, The Netherlands
| | | | - Thorarinn Gudnason
- Department of Cardiology, Landspitali-University Hospital, Reykjavık, Iceland
- Cardiovascular Research Institute of Landspitali and University of Iceland, Landspitali-University Hospital, Reykjavik, Iceland
| | | | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | | | - Hrobjartur D Karlsson
- Icelandic Heart Association, Kopavogur, Iceland
- Department of Cardiology, Landspitali-University Hospital, Reykjavık, Iceland
- Cardiovascular Research Institute of Landspitali and University of Iceland, Landspitali-University Hospital, Reykjavik, Iceland
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