Type D personality and cardiovascular disease : Evidence and clinical implications

Despite significant reductions in morbidity andmortality in recent years due to improved treat-ment strategies, cardiovascular disease is the lead-ing cause of death in the Western world.Psychosocial factors, such as depression, havebeen shown to impact adversely on the progno-sis of patients with coronary artery disease, butpersonality factors have to a large extent beenignored since the controversial findings sur-rounding the Type A behaviour pattern. This re-view on Type D personality highlights the im-portance of including personality factors in re-search and clinical practice, as personality may bean important explanatory factor of individualdifferences in multiple clinical outcomes. Type Dpersonality is defined as a high score on nega-tive affectivity (a tendency to experience increasednegative emotions) and social inhibition (a ten-dency not to express these emotions when to-gether with others). Type D has been associatedwith increased depression, fatigue, poor health-related quality of life, and increased risk of cardiacmorbidity and mortality independent of estab-lished biomedical risk factors. Type D personal-ity can be assessed with the Type D 14-item Scale(DS14). The scale is a brief, valid and standardisedinstrument that comprises little burden to pa-tients and to clinical practice. The DS14 has re-cently been validated in Italian cardiac patients.