Gesine Grande

Association between type D personality and prognosis in patients with cardiovascular diseases: a systematic review and meta-analysis.

BackgroundSince 1995, the association of type D personality and mortality in patients with cardiovascular diseases has been increasingly investigated.PurposeThe aim of this meta-analysis was to integrate conflicting results and to examine possible moderators of this association.MethodsProspective studies assessing type D personality and hard endpoints were selected and pooled in meta-analyses. Cardiovascular diagnosis, type and quality of adjustment, and publication date were examined in moderator analyses.ResultsTwelve studies on patients with cardiovascular diseases (N = 5,341) were included. Pooled crude and adjusted effects demonstrated a significant association of type D personality and hard endpoints (odds ratio (OR) of 2.28 (95% CI [1.43–3.62]), adjusted hazard ratio (HR) of 2.24 (95% CI [1.37–3.66])). The OR decreased over time (OR 5.02 to OR 1.54). There was no association in congestive heart failure patients.ConclusionsMore recent methodologically sound studies suggest that early type D studies had overestimated the prognostic relevance.

Type D Personality and All-cause Mortality in Cardiac Patients-data From a German Cohort Study

Objective: Type D personality has been established as a predictor of adverse clinical events in patients with cardiovascular diseases. To date, all studies except one have been conducted by a single research group. Thus, the aim of our study was to provide an independent replication of the results regarding the prognostic validity of Type D personality in a German sample of cardiac patients. Methods: Cardiac patients (n = 1040) were recruited from cardiac rehabilitation centers (n = 484), an outpatient clinic (n = 249), and a university hospital (n = 307). Main analyses were based on the combined data from these three subsamples. Cardiac health status, medical risk factors, sociodemographic characteristics, psychological symptoms, and Type D personality were assessed at baseline. The primary end point was all-cause mortality. The Cox proportional hazards regression model was used to estimate the relative risk of death. Results: Vital status was known for 977 patients (22.5% women; mean [standard deviation] = 63.3 [10.7] years). Within the follow-up time (mean [standard deviation] = 71.5 [3.6] months), 172 patients died. Type D personality was found in 25.2% of survivors and in 22.2% of nonsurvivors (&khgr;2= 0.78, p =.38). Depressive symptoms (p =.13) and anxiety (p =.27) were also not predictive of mortality. In the multivariate analyses, neither Type D (p =.95) nor negative affectivity (p =.71) and social inhibition (p =.59), as well as their interaction (p =.88), were associated with all-cause mortality. Conclusions: 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.BMI = body mass index; CAD = coronary artery disease; CHF = chronic heart failure; DS14 = Type D scale (14-item version); HADS = Hospital Anxiety and Depression Scale; HD = heart disease; HR = Cox proportional hazard ratio; NA = negative affectivity; SI = social inhibition

Type D personality is independently associated with major psychosocial stressors and increased health care utilization in the general population

BACKGROUND Type D is considered as a non pathological personality trait and propensity for mental distress. Its relationship with mental distress has been mainly studied in cardiovascular patients and with respect to depression. The knowledge about the relationship of Type D with mental disorders, psychosocial stressors and health care utilization in the general population is insufficient. Therefore the present study sought to determine the associations of Type D with mental distress, major psychosocial stressors, health status, and health care utilization in the general population. METHODS Cross-sectional analysis in a representative population based sample of n = 2495 subjects (mean age 49 years, range 14-92 years) of whom 33.1% had Type D personality. RESULTS Individuals with Type D had an increased risk for clinically significant depression, panic disorder, somatization and alcohol abuse. After adjustment for these mental disorders Type D was still robustly associated with all major psychosocial stressors. The strongest associations emerged for feelings of social isolation and for traumatic events. After comprehensive adjustment Type D still remained associated with increased help seeking behavior and utilization of health care, especially of mental health care. LIMITATIONS The main limitation is the reliance on self-report measures and the lack of information about the medical history and clinical diagnosis of the participants. CONCLUSION Type D identifies persons with severely increased risk for mental distress, major psychosocial stressors and increased health care utilization. As a frequent disposition, Type D is assumed to be of high relevance for health care.

A short form of the General Self-Efficacy Scale (GSE-6): Development, psychometric properties and validity in an intercultural non-clinical sample and a sample of patients at risk for heart failure.

Objective: General self-efficacy has been found to be an influential variable related to the adaptation to stress and chronic illness, with the General Self-Efficacy (GSE) Scale by Jerusalem and Schwarzer being a reliable and valid instrument to assess this disposition. The aim of this study was to construct and test a short form of this scale to allow for a more economical assessment of the construct. Methods: The item characteristics of the original scale were assessed using an intercultural non-clinical sample (n=19,719). Six items with the highest coefficient of variation and good discrimination along the range of the trait were selected to build a short form of the instrument (GSE-6). Subsequently, the psychometric properties and the concurrent and predictive validity of the GSE-6 were tested in a longitudinal design with three measurements using a sample of patients with risk factors for heart failure (n=1,460). Results: Cronbach’s alpha for the GSE-6 was between .79 and .88. We found negative associations with symptoms of depression (–.35 and –.45), anxiety (–.35), and vital exhaustion (–.38) and positive associations with social support (.30), and mental health (.36). In addition, the GSE-6 score was positively associated with active problem-focused coping (.26) and distraction/self-encouragement (.25) and negatively associated with depressive coping (–.34). The baseline GSE-6 score predicted mental health and physical health after 28 months, even after controlling for the respective baseline score. The relative stability over twelve and 28 months was r=.50 and r=.60, respectively, while the mean self-efficacy score did not change over time. Conclusions: The six item short form of the GSE scale is a reliable and valid instrument that is useful for the economical assessment of general self-efficacy in large multivariate studies and for screening purposes.

The influence of perceived discrimination on health in migrants

OBJECTIVE The aim of the study was to investigate the influence of racial discrimination on subjective health in migrants. METHODS The sample included 1.844 migrants from the SOEP. Discrimination was assessed by two items. Socioeconomic status, country of origin, and health behavior were included in multivariate regression models to control for effects on health. Differential models with regard to gender and origin were analysed. RESULTS Migrants who experienced discrimination report a worse health status. Discrimination determines mental and physical health of migrants. There are differences in models due to gender and origin. CONCLUSIONS In addition to socioeconomic factors experienced discrimination should be taken into account as a psycho-social stressor of migrants.

The construct validity of social inhibition and the type-D taxonomy

In contrast to the prognostic validity of the type-D personality, there is still little knowledge on the construct validity. In a sample of 102 healthy young adults the construct validity was analysed against the Big-Five dimensions, four of the 16 PF factors, and repressive emotion regulation. Social inhibition was associated with Apprehensiveness, and low scores in social competencies and self-deception. The three non-type-D clusters clearly differed; the restrained cluster emerged as opposite to the type-D cluster in nearly every personality dimension and type of emotion regulation. The article concludes that emotion regulation in socially inhibited persons deserves further investigation.

Obesogenic environments: environmental approaches to obesity prevention

Abstract Childhood obesity is a major concern for public health. There are multiple factors (e.g., genetic, social, and environmental) that contribute to unhealthy weight gain. Drawing from findings on “obesogenic environments” and core principles of preventive strategies to reduce health inequalities, this paper gives an overview of recent childhood prevention programs that target aspects of the physical environment (“environmental changes”). Out of the ten reviews we screened (including more than 300 studies), we identified very few that addressed aspects of the environment. We focus here on 14 programs that follow different approaches to environmental changes (e.g., access to/quality of playgrounds, changes in school cafeterias). Altering the environment offers opportunities for healthier behaviors and seems to be an effective strategy to prevent childhood obesity. However, the evaluation of those (mostly) multidimensional interventions does not allow drawing firm conclusions about the single effect of environmental changes. We conclude that obesity prevention programs should combine person-based and environmental approaches.

Type D personality and persistence of depressive symptoms in a German cohort of cardiac patients

BACKGROUND Depression is associated with a negative prognosis in coronary heart disease and heart failure patients. Type D personality has been shown to predict the persistence of depressive symptoms over 12 months. Data on longer follow-up periods and on the effectiveness of Type D as a screening tool compared to established measures of depressive symptoms are missing. METHODS Type D personality and depressive mood were assessed with the DS14 and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) in 679 consecutive cardiac patients (22.2% female, mean age 62.4±10.2 years) over a period of 6 years. Latent class and growth mixture models with Type D, comorbidity, age, and sex as covariates were used to model individual depression trajectory classes and to predict trajectories and class membership. Estimates of specificity and sensitivity were calculated for Type D and the HADS-D baseline cut-off point. RESULTS In a model with four latent classes (mild symptoms, moderate and increasing symptoms, significant but decreasing symptoms, and significant and increasing symptoms), Type D predicted the membership in the class with significant and increasing symptoms (OR=10.94, 4.93, and 3.15). Sensitivity and specificity were 59% and 78% for Type D and 47% and 80% for the HADS-D. LIMITATIONS Some possible confounders might be missing. With just two measurement points only linear trajectories could be modeled. CONCLUSIONS Type D personality is a stronger predictor for persistent depressive symptoms than the baseline HADS-D score, but the predictive power seems low for clinical practice.

A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial

Background Traditional secondary prevention programs often fail to produce sustainable behavioral changes in everyday life. Peer-modeling interventions and integration of peer experiences in health education are a promising way to improve long-term effects in behavior modification. However, effects of peer support modeling on behavioral change have not been evaluated yet. Therefore, we implemented and evaluated a website featuring patient narratives about successful lifestyle changes. Objective Our aim is to examine the effects of using Web-based patient narratives about successful lifestyle change on improvements in physical activity and eating behavior for patients with coronary heart disease and chronic back pain 3 months after participation in a rehabilitation program. Methods The lebensstil-aendern (“lifestyle-change”) website is a nonrestricted, no-cost, German language website that provides more than 1000 video, audio, and text clips from interviews with people with coronary heart disease and chronic back pain. To test efficacy, we conducted a sequential controlled trial and recruited patients with coronary heart disease and chronic back pain from 7 inpatient rehabilitation centers in Germany. The intervention group attended a presentation on the website; the control group did not. Physical activity and eating behavior were assessed by questionnaire during the rehabilitation program and 12 weeks later. Analyses were conducted based on an intention-to-treat and an as-treated protocol. Results A total of 699 patients were enrolled and 571 cases were included in the analyses (control: n=313, intervention: n=258; female: 51.1%, 292/571; age: mean 53.2, SD 8.6 years; chronic back pain: 62.5%, 357/571). Website usage in the intervention group was 46.1% (119/258). In total, 141 trial participants used the website. Independent t tests based on the intention-to-treat protocol only demonstrated nonsignificant trends in behavioral change related to physical activity and eating behavior. Multivariate regression analyses confirmed belonging to the intervention group was an independent predictor of self-reported improvements in physical activity regularity (β=.09, P=.03) and using less fat for cooking (β=.09, P=.04). In independent t tests based on the as-treated protocol, website use was associated with higher self-reported improvements in integrating physical activity into daily routine (d=0.22, P=.02), in physical activity regularity (d=0.23, P=.02), and in using less fat for cooking (d=0.21, P=.03). Multivariate regression analyses revealed that using the website at least 3 times was the only factor associated with improved lifestyle behaviors. Conclusions Usage of the lebensstil-aendern website corresponds to more positive lifestyle changes. However, as-treated analyses do not allow for differentiating between causal effects and selection bias. Despite these limitations, the trial indicates that more than occasional website usage is necessary to reach dose-response efficacy. Therefore, future studies should concentrate on strategies to improve adherence to Web-based interventions and to encourage more frequent usage of these programs.

Built environment and health: a systematic review of studies in Germany

Objectives Empirical research on the relationship between the built environment and health is increasing at a tremendous pace. However, findings from Anglo-American countries may not apply to the European context. Therefore, we systematically reviewed the existing evidence on the role of the built environment for leading risk factors and health behavior in Germany. Methods Through an extensive search via PubMed and Web of Science, using predefined selection criteria, two independent reviewers identified 25 empirical studies. We described the main study variables (year of publication, study design, data source, sample characteristics), classified the studies according to their respective operationalization of environmental features and health outcomes, and qualitatively summarized the main results. Results The majority of the studies focused on anthropometric measures and physical activity. Access to respective destinations was associated with sports-related physical activity but not with body composition. Also, people living in urban structures tended to show more health-adverse behaviors such as smoking and drinking. Some evidence indicated that higher levels of noise and air pollution were related to higher blood pressure levels. No association was observed between green spaces or street design and health. Conclusions Future research should investigate relationships using a sound theoretical basis and research designs that better account for the complex relationship between the built environment and health.