شخصیت D نوع و نتایج روانی سه ماه در میان بیماران مبتلا به انفارکتوس میوکارد

Objective Type D personality has been proposed as a risk factor for poor prognosis in cardiac patients. Recent studies which have adopted a dimensional approach to Type D (negative affectivity × social inhibition) found no effect of Type D on mortality, after controlling for its constituent elements. To-date, no study has determined if Type D is associated with psychosocial outcomes in post-myocardial infarction (MI) patients when conceptualised as a dimensional variable. Methods Participants were 192 MI patients (138 males, 54 females, mean age 66.0 years) who provided demographic and clinical information, and completed measures of Type D one-week post-MI. Three months later, 131 of these MI patients completed measures of disability and quality of life. Results Using regression analyses, adjusted for demographic and clinical data, Type D emerged as a significant predictor of disability and quality of life in MI patients, when analysed using the traditional categorical approach. However, Type D did not predict disability and quality of life when it was analysed using the interaction of negative affectivity and social inhibition. Negative affect emerged as a significant predictor of both disability (β=.433, t(130) = 3.53, p < .01), and quality of life (β= − .624, t(130) = − 5.68, p < .001). Conclusions The results suggest that Type D is not associated with short-term psychosocial outcome in MI patients, after controlling for its constituent elements. However, negative affect was significantly associated with both disability and quality of life. Future research should conceptualise Type D as the interaction between negative affectivity and social inhibition, rather than as a typology.

The Type D construct describes individuals who simultaneously experience high levels of negative affectivity and high levels of social inhibition [1]. Type D individuals are, therefore, thought to experience negative emotions (such as anxiety, sadness, anger etc.) across time and situations and inhibit the expression of these emotions in social interactions due to fears of how others may react. Crucially, it is the synergistic effect of high scores on both stable personality traits, negative affectivity and social inhibition, which has been proposed as the key feature of the Type D construct, suggesting that it is not merely the presence of negative emotions that should be considered as a risk factor but also how an individual copes with these negative emotions [2]. The first studies carried out on the Type D construct [1], [3] and [4] demonstrated that Type D is associated with a four-fold increased risk of mortality in coronary heart disease (CHD) patients, independent of traditional biomedical risk factors. In addition, a further study demonstrated that Type D CHD patients had a four-fold risk of major cardiac events over five years, independent of disease severity [5]. Similar findings were demonstrated in recent studies which demonstrated a comparable relationship between Type D and mortality in patients with chronic heart failure (CHF) [6] and peripheral arterial disease (PAD) [7]. A further study found that Type D predicts death and recurrent MI in patients with acute MI after controlling for both disease and depression severity [8]. However, these studies have recently been criticised [9] on the basis of their small sample sizes and over fitted regression equations (given the relatively small number of deaths). Three recent studies have failed to find an association between the Type D typology and outcome [10], [11] and [12]. However, these studies are also limited by small sample sizes, and the number of deaths being predicted. The vast majority of research on Type D has utilised Type D as a dichotomous typology. Traditionally, individuals have been defined as Type D if they score ≥ 10 on both the NA and SI subscales of Type D [13]. Recently, a taxometric analysis of Type D [14] has suggested that Type D is better represented as a continuous rather than dichotomous construct. Accordingly, the most appropriate test of the predictive utility of Type D is to determine if the multiplicative interaction of negative affectivity and social inhibition predicts outcome after controlling for the main effects of the negative affectivity and social inhibition constituent elements in a regression analysis. Denollet has proposed that the Type D construct is more than just the presence of negative emotions and that social inhibition is a moderator of the effects of negative affectivity on clinical outcome [1].