Lack of prognostic value of type D personality for mortality in a large sample of heart failure patients

Psychosom Med. 2011 Sep;73(7):557-62. doi: 10.1097/PSY.0b013e318227ac75. Epub 2011 Aug 23.

Abstract

Background: Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms.

Methods: We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression.

Results: At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144).

Conclusions: In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Depression / mortality
  • Depression / physiopathology
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / mortality
  • Heart Failure / psychology*
  • Humans
  • Male
  • Natriuretic Peptide, Brain / blood
  • Personality Inventory
  • Personality* / physiology
  • Prognosis
  • Proportional Hazards Models
  • Psychiatric Status Rating Scales

Substances

  • Natriuretic Peptide, Brain