Type D Personality and All-Cause Mortality in Cardiac Patients-Data From a German Cohort Study

Grande, Gesine; Romppel, Matthias; Vesper, Jana-Marie; Schubmann, Rainer; Glaesmer, Heide; Herrmann‐Lingen, Christoph

doi:10.1097/psy.0b013e318227a9bc

Cited by 92 publications

(79 citation statements)

References 54 publications

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“…The two larger studies conducted outside the Tilburg group [17,18] had analyzed Type D personality data using both the scoring procedure of the original investigator group, but also by preserving NA and SI as continuous variables and examining their interaction effect, and in neither instance found a significant bivariate or multivariate prediction of mortality. Could claims about Type D personality's independent prognostic value nonetheless be revived by reanalysis of the data from the earlier studies that preserved the continuous nature of component variables?…”

Section: Rescuing Type D Personality As An Interaction Term In a Regrmentioning

confidence: 99%

“…The first one failed to find a prognostic value for Type D, but was underpowered to do so, with only 11 deaths being explained [16]. Then, another two more studies from outside the original investigator group were published, with larger numbers of deaths to be explained than most of the previous studies, but neither found evidence for a prognostic value of Type D personality in unadjusted or adjusted models, despite one having 172 deaths among 977 patients with CVD [17] and the other study having 192 deaths at 18 months follow-up of 706 HF patients [18]. Both of the studies relied on all cause, rather than cardiac-specific mortality as the primary outcome.…”

Section: Introductionmentioning

confidence: 99%

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Are we witnessing the decline effect in the Type D personality literature? What can be learned?

Coyne¹,

Voogd²

2012

Journal of Psychosomatic Research

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a b s t r a c t a r t i c l e i n f oAfter an unbroken series of positive, but underpowered studies seemed to demonstrate Type D personality predicting mortality in cardiovascular disease patients, initial claims now appear at least exaggerated and probably false. Larger studies with consistently null findings are accumulating. Conceptual, methodological, and statistical issues can be raised concerning the construction of Type D personality as a categorical variable, whether Type D is sufficiently distinct from other negative affect variables, and if it could be plausibly assumed to predict mortality independent of depressive symptoms and known biomedical factors, including disease severity. The existing literature concerning negative affect and health suggests a low likelihood of discovering a new negative affect variable that independently predicts mortality better than its many rivals. The apparent decline effect in the Type D literature is discussed in terms of the need to reduce the persistence of false positive findings in the psychosomatic medicine literature, even while preserving a context allowing risk-taking and discovery. Recommendations include greater transparency concerning research design and analytic strategy; insistence on replication with larger samples before accepting "discoveries" from small samples; reduced confirmatory bias; and availability of all relevant data. Such changes would take time to implement, face practical difficulties, and run counter to established practices. An interim solution is for readers to maintain a sense of pre-discovery probabilities, to be sensitized to the pervasiveness of the decline effect, and to be skeptical of claims based on findings reaching significance in small-scale studies that have not been independently replicated.© 2012 Elsevier Inc. All rights reserved. IntroductionMany "discoveries" turn out to be exaggerated or simply false across diverse research areas and disciplines. John Ioannidis [1] provoked concern with his demonstration that of the 49 most cited clinical research studies in major journals, replications of 34 had been attempted, and 41% of key findings had been refuted or shown to be substantially diminished. In a subsequent paper [2] he offered evidence that "most claimed research findings are false" and he and others [3-6] have since identified some mechanisms by which discoveries appear in the literature and then undergo a decline or refutation. Claims of breakthrough discoveries frequently arise in small positive studies that would seem to be too underpowered to detect an effect, and the inadequate sample size makes findings all the more attention grabbing.Yet, portrayals in the literature of such "discoveries" ignore the larger context of a strong confirmatory bias in published research papers, with unknown numbers of negative findings not being published and findings being declared discoveries simply because of having achieved an arbitrary level of significance. Moreover, statistically significant findings in small studies are nece...

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Section: Rescuing Type D Personality As An Interaction Term In a Regrmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Are we witnessing the decline effect in the Type D personality literature? What can be learned?

Coyne¹,

Voogd²

2012

Journal of Psychosomatic Research

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“…Coyne et al [15] investigated the prognostic value of Type D on mortality in a large sample of Chronic Heart Failure (CHF) patients, and found that Type D did not predict mortality at 18-month follow-up. Similarly, Grande et al [16] found no association between Type D and allcause-mortality in a large sample of German cardiac patients at 6-year follow-up. These studies have the advantage over previous research on Type D in terms of their large samples.…”

Section: Introductionmentioning

confidence: 99%

“…In doing so, two large-scale studies [15,16] failed to find an association between Type D and mortality in cardiac patients. Coyne et al [15] investigated the prognostic value of Type D on mortality in a large sample of Chronic Heart Failure (CHF) patients, and found that Type D did not predict mortality at 18-month follow-up.…”

Section: Introductionmentioning

confidence: 99%

Type D personality and three-month psychosocial outcomes among patients post-myocardial infarction

Williams

O’Connor

Grubb

et al. 2012

Journal of Psychosomatic Research

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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 b .01), and quality of life (β= − .624, t(130) = − 5.68, p b .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.© 2012 Elsevier Inc. All rights reserved. IntroductionThe 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 [1,3,4] 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 ...

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“…These traits are thought to operate synergistically [39], and Type D cardiac patients have been found to be less adherent to cardioprotective medications, to view their heart condition more negatively, experience higher levels of depressive symptoms over time, and gain fewer benefits from CR [40][41][42][43][44]. While a number of meta-analyses have also shown Type D personality to predict worsened prognosis in persons with CHD [45,46], recent studies have failed to replicate these results [47][48][49][50], which has generated considerable critique. Critics of Type D highlight that the majority of these studies included small samples, were conducted by a single investigator group, and statistically analysed Type D personality as a dichotomized variable instead of an interaction term, thereby increasing the risk of spurious results [50][51][52].…”

Section: Anger and Hostilitymentioning

confidence: 86%

Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep?

2015

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Psychological aspects of cardiac care & rehabilitation: Time to wake up to sleep? Abstract:Psychological and psychosocial factors have long been linked to cardiovascular disease. These psychosocial factors, including low socioeconomic status, social support/isolation, stress and distress, personality and sleep disturbance increase risk of cardiovascular events and negatively impact on quality of life. These factors may have direct effects on cardiovascular disease via immune or neuroendocrine pathways, or more indirect effects, by for example limiting adherence to recommended therapies and cardiac rehabilitation. Most psychosocial risk factors can be assessed relatively easily using standardised tools. Sleep disturbance, in particular, is gaining evidence for its importance, and may be crucial to address. While the management of certain psychosocial risk factors is an ethical requirement for care and improves quality of life, unfortunately there is little evidence that such strategies impact on 'hard' endpoints such as recurrent myocardial infarction. A comprehensive biopsychosocial approach to management of these psychosocial factors is required to maximise the benefits patients derive from cardiac care.

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Type D Personality and All-Cause Mortality in Cardiac Patients-Data From a German Cohort Study

Abstract: In the present study, Type D personality and its constituents are not associated with increased mortality in patients with heart disease. The discrepancies with previous results deserve further investigation.

Cited by 92 publications

References 54 publications

Are we witnessing the decline effect in the Type D personality literature? What can be learned?

Are we witnessing the decline effect in the Type D personality literature? What can be learned?

Type D personality and three-month psychosocial outcomes among patients post-myocardial infarction

Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep?

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