Association of Type D personality with increased vulnerability to depression: Is there a role for inflammation or endothelial dysfunction? - The Maastricht Study

Fleur E P van Dooren; Frans R J Verhey; Frans Pouwer; Casper G Schalkwijk; Simone J S Sep; Coen D A Stehouwer; Ronald M A Henry; Pieter C Dagnelie; Nicolaas C Schaper; Carla J H van der Kallen; Annemarie Koster; Miranda T Schram; Johan Denollet

doi:10.1016/j.jad.2015.09.028

Association of Type D personality with increased vulnerability to depression: Is there a role for inflammation or endothelial dysfunction? - The Maastricht Study

J Affect Disord. 2016 Jan 1:189:118-25. doi: 10.1016/j.jad.2015.09.028. Epub 2015 Sep 25.

Affiliations

¹ Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; MHeNS - Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
² MHeNS - Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
³ CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
⁴ Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
⁵ CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
⁶ Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
⁷ Department of Social Medicine, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
⁸ CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands. Electronic address: J.Denollet@uvt.nl.

PMID: 26433759
DOI: 10.1016/j.jad.2015.09.028

Abstract

Background: Type D personality - the combination of negative affectivity (NA) and social inhibition (SI) - has been associated with depression but little is known about underlying mechanisms. We examined whether (1) Type D is a vulnerability factor for depression in general, (2) Type D is associated with inflammation or endothelial dysfunction, and (3) these biomarkers alter the possible association between Type D and depression.

Methods: In the Maastricht Study, 712 subjects underwent assessment of NA, SI and Type D personality (DS14), depressive disorder (Mini-International Neuropsychiatric Interview) and depressive symptoms (Patient Health Questionnaire-9). Plasma biomarkers of inflammation (hsCRP, SAA, sICAM-1, IL-6, IL-8, TNF-α) and endothelial dysfunction (sVCAM-1, sICAM-1, E-selectin, vWF) were measured with sandwich immunoassays or ELISA and combined into standardized sumscores.

Results: Regarding personality, 49% of the study population was low in NA and SI, 22% had SI only, 12% NA only and 17% had Type D. Depressive disorder and depressive symptoms were significantly more prevalent in Type D versus the other three personality subgroups. Multivariable regression analyses showed that Type D was associated with inflammation (β=0.228, p=0.014) and endothelial dysfunction (β=0.216, p=0.022). After adjustment for these biomarkers, Type D remained independently associated with increased vulnerability to depressive disorder (OR=13.20, p<0.001) and depressive symptoms (β=3.87, p<0.001).

Limitations: The cross-sectional design restrained us to draw any conclusions on causality. The relatively low prevalence of depressive disorder restrained us to adjust for more potential confounders.

Conclusions: Type D personality may be a vulnerability factor for depression, irrespective of levels of inflammation or endothelial dysfunction. Future research should examine possible underlying mechanisms.

Keywords: Depression; Endothelial dysfunction; Inflammation; Personality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Biomarkers / blood
Cross-Sectional Studies
Depression / pathology*
Depression / psychology*
Endothelial Cells / pathology*
Female
Humans
Inflammation / blood
Inflammation / pathology*
Inflammation Mediators / blood
Male
Middle Aged
Personality Assessment
Prevalence
Type D Personality*

Substances

Biomarkers
Inflammation Mediators