اعتبار ایجاد شخصیت نوع D در بیماران پس از سکته و افراد سالم دانمارکی

Objective Type D personality has been associated with increased risk of depression, vital exhaustion, social alienation, a higher number of reinfarctions, and higher mortality rates in patients with established coronary artery disease (CAD) independent of traditional biomedical risk factors. The construct was developed in Belgian cardiac patients, but little is known about its applicability in other nationalities. The objectives of the present article were to cross-validate the Type D Personality Scale-16 (DS16) in a Danish sample of patients with a first myocardial infarction and a random sample of healthy controls, and to investigate whether Type D is associated with posttraumatic stress disorder (PTSD). Methods A questionnaire was given to 112 consecutive patients with a first myocardial infarction 4 to 6 weeks post infarction, and to 115 healthy controls selected randomly from the general population. Results The two-factor structure of the DS16 and the internal consistency of the Negative Affectivity (α=.83) and Social Inhibition (α=.76) subscales were confirmed. The construct validity of the DS16 was confirmed against scales that measure similar constructs, and the discriminant validity of the DS16 against measures of psychopathology. In a pooled sample of patients and healthy controls, comparison of both groups confirmed that Type D may be conceptualised as a marker of general emotional distress, with Type D persons scoring higher on depression, anxiety, and the PTSD symptom clusters arousal and avoidance compared with non-Type D persons. A regression analysis run in two steps showed that the inclusion of Type D in the model lead to an improvement in the level of prediction of PTSD above and beyond a model that included gender, age, MI, neuroticism, and extroversion. Type D (OR=4.46; 95% CI: 1.36 to 14.64), diagnosis of MI (OR=4.03; 95% CI: 1.43 to 11.35), and neuroticism (OR=1.32; 95% CI: 1.13 to 1.53) were independently associated with PTSD, adjusting for all other variables. Conclusion These findings indicate that the Type D construct is equally applicable in Danish patients with CAD, and that Type D is associated with PTSD.

Studies have shown that approximately 20% of cardiac patients suffer from psychological sequelae following a cardiac event, including poor perceived health, anxiety, depression, and posttraumatic stress disorder (PTSD) [1], [2], [3], [4] and [5]. In turn, these sequelae have been shown to have negative prognostic impact independent of disease severity [3], [6] and [7]. However, the role of individual differences in risk has to a great extent been overlooked, in particular since the controversy surrounding the Type A behaviour pattern emerged [8] and [9]. Personality traits may be able to explain individual differences in distress, morbidity, and mortality in cardiac patients. Personality traits or the interaction of traits may also exert a more stable influence on outcome in cardiac patients than other individual difference variables, e.g., gender, routinely included in cardiovascular research [10] and [11]. In addition, traits may impede the development of social contacts and, hence, the availability of social support [12] and [13]. Lack of social support has been related to increased morbidity and mortality [14] and [6], and increased cardiac symptoms [15] and [16].