Type D personality among noncardiovascular patient populations: a systematic review

Abstract

Objective

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

Methods

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

Results

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

Conclusion

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

Introduction

In recent years, a large amount of studies have appeared that investigate the effects of Type D personality on clinical and psychological outcomes in a variety of healthy and patient populations. Type D personality refers to the conjoint effect of two stable personality traits, namely, negative affectivity and social inhibition [1]. Negative affectivity refers to the tendency to experience negative emotions, while social inhibition refers to the tendency to inhibit the expression of emotions and behaviors, because of fear of rejection or disapproval by others. Persons with high levels on both traits are classified as having a Type D personality [1].

The Type D personality construct was originally developed in order to study the role of personality traits in coronary heart disease outcomes [2]. The majority of studies on Type D therefore focus on its prevalence and effects among cardiovascular populations. Results of these studies showed that the prevalence of Type D among cardiovascular patients is between 27% and 31% [3], [4], [5], [6], compared to 13% and 24% in the normative population [1], [7], [8]. Studies on Type D among cardiovascular patients have shown that Type D is an independent predictor of negative outcomes such as poor health status, (recurrent) myocardial infarction and increased risk of mortality [3], [5], [9], [10].

Although the literature on Type D personality in patients with cardiovascular conditions is mounting, less is known about the pathways that are responsible for its negative effects on clinical outcomes [11]. Type D personality may be related to biological mechanisms of disease such as immune activation [12] or to the disruption of HPA axis function [13]. Behavioral mechanisms of disease such as an unhealthy lifestyle [14] and reluctance to consult medical staff [15], [16] may be directly linked to negative clinical outcomes [11].

These studies on the possible mechanisms behind Type D personality have led to the assumption that Type D might not only be a vulnerability factor among cardiovascular patients, but can perhaps also negatively affect the clinical course of other medical conditions as well. Therefore, the aim of the present study was to review all available literature concerning Type D personality among noncardiovascular patient populations and to describe the effects of Type D among these various populations.