اعتبارسنجی ایجاد تیپ شخصیتی نوع D در بیماران چینی با بیماری عروق کرونر قلب

Objective Type D personality predicts poor prognosis in coronary heart disease (CHD) but little is known about Type D in non-Western cultures. We examined the (a) validity of the Type D construct and its assessment with the DS14 scale in the Chinese culture, (b) prevalence of Type D, and (c) gender vs. Type D discrepancies in depression/anxiety, among Chinese patients with CHD. Method Patients with CHD (N=326) completed the Chinese version of the DS14. The NEO Five Factor Inventory (NEO-FFI), Hospital Anxiety and Depression Scale (HADS), and Stress Symptom Checklist (SSC) were administered to subsamples to establish construct and discriminant validity. Administration of the DS14, HADS, and SSC was repeated at 1 month after hospital discharge in 66 patients, and stability of the DS14 was examined in another subsample of 100 patients. Results The theoretical structure of the Type D construct in the Chinese culture was supported (χ2/df=2.89, root mean square error of approximation=0.08, normal fit index=0.91, non-normal fit index=0.91, comparative fit index=0.93). The Negative Affectivity (NA) and Social Inhibition (SI) subscales of the DS14 in the entire sample were internally consistent (Cronbach's alpha=0.89/0.81), measured stable traits (3-month test–retest ICC=0.76/0.74), and correlated significantly with the neuroticism (NA/neuroticism, r=0.78, P<.001) and extraversion subscales (SI/extraversion, r=−0.64, P<.001) of the NEO-FFI, respectively. The prevalence of Type D personality was 31%. Type D was not related to transient emotional states. However, Chinese patients with a Type D personality were at increased concurrent risk of anxiety (P=.002) and depression (P=.016). Conclusion Type D personality is a cross-culturally valid construct, is associated with an increased risk of anxiety and depression, and deserves prompt attention in estimating the prognostic risk of Chinese CHD patients.

The potentially deleterious effects of psychological distress on the etiology and prognosis of coronary heart disease (CHD) are well recognized [1], [2] and [3]. Independent of disease severity, a high level of psychological distress is a risk factor for recurrent cardiac events, prolonged recovery, and increased mortality. Attention has also been given to the role of personality in predicting health outcomes in CHD patients, although this became less fashionable following inconsistent findings related to the prognostic role of the Type A Behavior Pattern [4] and [5]. Hence, cardiovascular research tends to focus more on gender to explain individual differences in health status [6], [7] and [8]. With the introduction of the “distressed” or Type D personality [9], the role of personality factors in explaining individual differences in psychological sequelae, morbidity, and mortality in CHD may see a revival.