Type D personality and depressive symptoms are independent predictors of impaired health status following acute myocardial infarction

Objective: In this prospective follow-up study we investigated whether the type D personality construct (the tendency to experience negative emotions and to be socially inhibited) exerts an independent effect on disease-specific health status in post-myocardial infarction (MI) patients, after adjustment for disease severity and depressive symptoms. Methods: Patients (n = 503) were assessed on demographic and clinical variables and completed the type D scale (DS14) and Beck Depression Inventory (BDI) within the first week of hospital admission for acute MI. Two months post-MI, all patients completed the WHO Composite International Diagnostic Interview (CIDI) interview. After 18 months, they filled out the Seattle Angina Questionnaire (SAQ) to assess disease-specific health status. Results: At follow-up, type D patients had significantly lower mean scores on all SAQ subscales, indicating worse disease-specific health status, compared to non-type D patients (all p values <0.01). After adjustment for disease severity and depression in multivariate analysis, type D patients still had more physical limitations (mean SAQ score: 49 versus 54; p = 0.014), less angina stability (62 versus 71; p = 0.002) and a less accurate disease perception (52 versus 61; p <= 0.001) compared with non-type D patients. Depressed patients (BDI >= 10) also reported significantly lower SAQ scores compared to non-depressed patients. Conclusions: The type D construct is an independent predictor of impaired disease-specific health status. Type D personality, in addition to depression, may thus be an important psychological factor that deserves attention during the period of rehabilitation in post-MI patients.