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What is the prevalence of Type D personality among heart disease patients?
In modern medical psychology, Type D personality is an important concept, referring to a common tendency toward negative emotions and social inhibition. People with this type often experience higher levels of negative emotions, such as worry, irritability, and frustration, but they tend not to share these feelings with others because they fear rejection or disapproval. This personality type was first proposed by Johan Denollet, a professor of medical psychology at Tilburg University in the Netherlands, based on clinical observations and empirical research on heart disease patients.
The prevalence of Type D personality in the general population is approximately 21%, while in heart disease patients its prevalence ranges from 18% to 53%.
Type D personality has again been identified as a risk factor for cardiovascular disease. Some preliminary studies have found that among patients with coronary artery disease (CAD), those with Type D personality tend to have worse outcomes after myocardial infarction (MI). These early studies indicated that people with Type D personality had a four-fold increased risk of death, recurrent myocardial infarction, or sudden cardiac death, independent of traditional risk factors such as disease severity. . However, subsequent large-scale studies have been unable to replicate these results, leading some researchers to wonder whether the conclusions of earlier small studies were exaggerated or wrong.
A large-scale meta-analysis of 19 published prospective cohort studies, including data from more than 11,000 patients with cardiovascular disease, showed that Type D personality was not a risk factor for death in patients with cardiovascular disease.
These findings suggest that Type D personality may be associated with adverse events in patients with cardiovascular disease, especially when followed up for at least 48 months. The assessment of Type D personality can be carried out through a valid and reliable 14-item questionnaire, the Type D Scale (DS14), which includes seven questions about negative emotions and seven questions about social inhibition. When the scores of both dimensions reach 10 points or above, it is classified as Type D.
The researchers believe that the dynamic responses of Type D personality can be seen as a synergy between negative emotions and social inhibition.
Previous literature has used two-group or four-group methods to analyze the relationship between Type D personality and outcomes, but this has led to some criticism, especially questions about statistical power. As research methods advanced, the continuous interaction approach began to prevail. This approach does not classify individuals into a specific personality cluster, but rather incorporates scores on negative affectivity and social inhibition as predictors into statistical models to further examine whether these two personality traits synergistically influence outcomes.
Recent simulation studies have shown that the continuous interaction approach can more clearly distinguish the influence of Type D personality and avoid conclusions based on assumptions about a single personality trait.
In addition to its effects in heart disease patients, Type D personality was also linked to physical symptoms in childhood, suggesting long-term effects of this personality trait. Many clinical experts recommend that patients with Type D characteristics need psychological support from an early stage to reduce the psychological burden on them when facing health challenges.
In-depth research on Type D personality can not only help us better understand its prevalence and impact in heart disease patients, but also trigger our thinking about the complex interaction between mental health and physical health. Faced with this problem, should we re-examine the medical community's understanding of the role of psychological factors in the treatment of heart disease?
