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Type D personality, suboptimal health behaviors and emotional distress in adults with diabetes: Results from Diabetes MILES–The Netherlands

  • G. Nefs
    Correspondence
    Corresponding author. Tel.: +31 13 466 3290; fax: +31 13 466 2067.
    Affiliations
    Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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  • J. Speight
    Affiliations
    The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia—Vic, 570 Elizabeth Street, Melbourne 3000, VIC, Australia

    Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia

    AHP Research, 16 Walden Way, Hornchurch, UK
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  • F. Pouwer
    Affiliations
    Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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  • V. Pop
    Affiliations
    Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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  • M. Bot
    Affiliations
    Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands

    Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, and GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
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  • J. Denollet
    Affiliations
    Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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Published:January 20, 2015DOI:https://doi.org/10.1016/j.diabres.2015.01.015

      Abstract

      Aims

      Type D personality – defined as high negative affectivity (NA) and high social inhibition (SI) – has been associated with adverse cardiovascular prognosis. We explored the differential associations of Type D personality and its constituent components with health behaviors, emotional distress and standard biomedical risk factors as potential risk mechanisms in adults with diabetes.

      Methods

      3314 Dutch adults with self-reported type 1 or 2 diabetes completed an online survey, including the DS14 Type D Scale. AN(C)OVAs and X2 tests were used to compare participants scoring (i) low on NA and SI; (ii) high on SI only; (iii) high on NA only; (iv) high on NA and SI (Type D).

      Results

      Participants with Type D personality (29%) were less likely to follow a healthy diet or to consult healthcare professionals in case of problems with diabetes management than those scoring high on neither or only one component. They also reported more barriers surrounding medication use, diabetes-specific social anxiety, loneliness and symptoms of depression and anxiety. There were no differences in standard biomedical risk factors (body mass index, blood pressure, cholesterol, HbA1c). After adjustment for demographics, clinical characteristics, NA, and SI in multivariable logistic regression analyses, Type D personality was independently associated with 2 to 3-fold increased odds of suboptimal health behaviors and over 15-fold increased odds of general emotional distress.

      Conclusions

      Type D personality was not related to standard biomedical risk factors, but was associated with unhealthy behaviors and negative emotions that are likely to have adverse impact on adults with diabetes.

      Keywords

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      References

        • Van der Kooy K.
        • van Hout H.
        • Marwijk H.
        • Marten H.
        • Stehouwer C.
        • Beekman A.
        Depression and the risk for cardiovascular diseases: systematic review and meta analysis.
        Int J Geriatr Psychiatry. 2007; 22: 613-626
        • Roest A.M.
        • Martens E.J.
        • de Jonge P.
        • Denollet J.
        Anxiety and risk of incident coronary heart disease: a meta-analysis.
        J Am Coll Cardiol. 2010; 56: 38-46
        • van Melle J.P.
        • de Jonge P.
        • Spijkerman T.A.
        • Tijssen J.G.
        • Ormel J.
        • van Veldhuisen D.J.
        • et al.
        Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis.
        Psychosom Med. 2004; 66: 814-822
        • Roest A.M.
        • Martens E.J.
        • Denollet J.
        • de Jonge P.
        Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis.
        Psychosom Med. 2010; 72: 563-569
        • Kinder L.S.
        • Kamarck T.W.
        • Baum A.
        • Orchard T.J.
        Depressive symptomatology and coronary heart disease in Type I diabetes mellitus: a study of possible mechanisms.
        Health Psychol. 2002; 21: 542-552
        • Pouwer F.
        • Nefs G.
        • Nouwen A.
        Adverse effects of depression on glycemic control and health outcomes in people with diabetes: a review.
        Endocrinol Metab Clin North Am. 2013; 42: 529-544
        • Kubzansky L.D.
        • Cole S.R.
        • Kawachi I.
        • Vokonas P.
        • Sparrow D.
        Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: a prospective study in the normative aging study.
        Ann Behav Med. 2006; 31: 21-29
        • Denollet J.
        • Pedersen S.S.
        • Ong A.T.
        • Erdman R.A.
        • Serruys P.W.
        • van Domburg R.T.
        Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era.
        Eur Heart J. 2006; 27: 171-177
        • Denollet J.
        DS14: standard assessment of negative affectivity, social inhibition, and Type D personality.
        Psychosom Med. 2005; 67: 89-97
        • Denollet J.
        • Schiffer A.A.
        • Spek V.
        A general propensity to psychological distress affects cardiovascular outcomes: evidence from research on the type D (distressed) personality profile.
        Circ Cardiovasc Qual Outcomes. 2010; 3: 546-557
        • Grande G.
        • Romppel M.
        • Barth J.
        Association between type D personality and prognosis in patients with cardiovascular diseases: a systematic review and meta-analysis.
        Ann Behav Med. 2012; 43: 299-310
        • Pelle A.J.
        • Pedersen S.S.
        • Schiffer A.A.
        • Szabo B.
        • Widdershoven J.W.
        • Denollet J.
        Psychological distress and mortality in systolic heart failure.
        Circ Heart Fail. 2010; 3: 261-267
        • Grande G.
        • Romppel M.
        • Vesper J.M.
        • Schubmann R.
        • Glaesmer H.
        • Herrmann-Lingen C.
        Type D personality and all-cause mortality in cardiac patients—data from a German cohort study.
        Psychosom Med. 2011; 73: 548-556
        • Marshall S.M.
        • Flyvbjerg A.
        Prevention and early detection of vascular complications of diabetes.
        BMJ. 2006; 333: 475-480
        • Williams L.
        • O’Connor R.C.
        • Howard S.
        • Hughes B.M.
        • Johnston D.W.
        • Hay J.L.
        • et al.
        Type-D personality mechanisms of effect: the role of health-related behavior and social support.
        J Psychosom Res. 2008; 64: 63-69
        • Borkoles E.
        • Polman R.
        • Levy A.
        Type-D personality and body image in men: the role of exercise status.
        Body Image. 2010; 7: 39-45
        • Hausteiner C.
        • Klupsch D.
        • Emeny R.
        • Baumert J.
        • Ladwig K.H.
        Clustering of negative affectivity and social inhibition in the community: prevalence of type D personality as a cardiovascular risk marker.
        Psychosom Med. 2010; 72: 163-171
        • Mommersteeg P.M.
        • Kupper N.
        • Denollet J.
        Type D personality is associated with increased metabolic syndrome prevalence and an unhealthy lifestyle in a cross-sectional Dutch community sample.
        BMC Public Health. 2010; 10: 714
        • Williams L.
        • O’Connor R.
        • Grubb N.
        • O’Carroll R.
        Type D personality predicts poor medication adherence in myocardial infarction patients.
        Psychol Health. 2011; 26: 703-712
        • Einvik G.
        • Dammen T.
        • Hrubos-Strom H.
        • Namtvedt S.K.
        • Randby A.
        • Kristiansen H.A.
        • et al.
        Prevalence of cardiovascular risk factors and concentration of C-reactive protein in Type D personality persons without cardiovascular disease.
        Eur J Cardiovasc Prev Rehabil. 2011; 18: 504-509
        • Gilmour J.
        • Williams L.
        Type D personality is associated with maladaptive health-related behaviours.
        J Health Psychol. 2012; 17: 471-478
        • Pelle A.J.
        • Schiffer A.A.
        • Smith O.R.
        • Widdershoven J.W.
        • Denollet J.
        Inadequate consultation behavior modulates the relationship between Type D personality and impaired health status in chronic heart failure.
        Int J Cardiol. 2010; 142: 65-71
        • Nefs G.
        • Pouwer F.
        • Pop V.
        • Denollet J.
        Type D (distressed) personality in primary care patients with type 2 diabetes: validation and clinical correlates of the DS14 assessment.
        J Psychosom Res. 2012; 72: 251-257
        • Mols F.
        • Denollet J.
        Type D personality among noncardiovascular patient populations: a systematic review.
        Gen Hosp Psychiatry. 2010; 32: 66-72
        • Mols F.
        • Denollet J.
        Type D personality in the general population: a systematic review of health status, mechanisms of disease, and work-related problems.
        Health Qual Life Outcomes. 2010; 8: 9
        • Simson U.
        • Nawarotzky U.
        • Porck W.
        • Friese G.
        • Schottenfeld-Naor Y.
        • Hahn S.
        • et al.
        [Depression, anxiety, quality of life and type D pattern among inpatients suffering from diabetic foot syndrome].
        Psychother Psychosom Med Psychol. 2008; 58: 44-50
        • Martens E.J.
        • Kupper N.
        • Pedersen S.S.
        • Aquarius A.E.
        • Denollet J.
        Type D personality is a stable taxonomy in post-MI patients over an 18-month period.
        J Psychosom Res. 2007; 63: 545-550
        • Pedersen S.S.
        • Denollet J.
        • Ong A.T.
        • Sonnenschein K.
        • Erdman R.A.
        • Serruys P.W.
        • et al.
        Adverse clinical events in patients treated with sirolimus-eluting stents: the impact of Type D personality.
        Eur J Cardiovasc Prev Rehabil. 2007; 14: 135-140
        • Nefs G.
        • Bot M.
        • Browne J.L.
        • Speight J.
        • Pouwer F.
        Diabetes MILES—The Netherlands: rationale, design and sample characteristics of a national survey examining the psychosocial aspects of living with diabetes in Dutch adults.
        BMC Public Health. 2012; 12: 925
        • Speight J.
        • Browne J.L.
        • Holmes-Truscott E.
        • Hendrieckx C.
        • Pouwer F.
        Diabetes MILES—Australia (Management and Impact for Long-term Empowerment and Success): methods and sample characteristics of a national survey of the psychological aspects of living with type 1 or type 2 diabetes in Australian adults.
        BMC Public Health. 2012; 12: 120
        • Matza L.S.
        • Park J.
        • Coyne K.S.
        • Skinner E.P.
        • Malley K.G.
        • Wolever R.Q.
        Derivation and validation of the ASK-12 adherence barrier survey.
        Ann Pharmacother. 2009; 43: 1621-1630
        • Craig C.L.
        • Marshall A.L.
        • Sjostrom M.
        • Bauman A.E.
        • Booth M.L.
        • Ainsworth B.E.
        • et al.
        International physical activity questionnaire: 12-country reliability and validity.
        Med Sci Sports Exerc. 2003; 35: 1381-1395
        • Wardle J.
        Eating style: a validation study of the Dutch Eating Behaviour Questionnaire in normal subjects and women with eating disorders.
        J Psychosom Res. 1987; 31: 161-169
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.
        • Lowe B.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Welch G.W.
        • Jacobson A.M.
        • Polonsky W.H.
        The problem areas in diabetes scale. An evaluation of its clinical utility.
        Diabetes Care. 1997; 20: 760-766
        • Broadbent E.
        • Petrie K.J.
        • Main J.
        • Weinman J.
        The brief illness perception questionnaire.
        J Psychosom Res. 2006; 60: 631-637
        • MacNicol S.A.M.
        • Murray S.M.
        • Austin E.J.
        Relationships between personality, attitudes and dietary behaviour in a group of Scottish adolescents.
        Pers Individ Dif. 2003; 35: 1753-1764
        • Svansdottir E.
        • van den Broek K.C.
        • Karlsson H.D.
        • Gudnason T.
        • Denollet J.
        Type D personality is associated with impaired psychological status and unhealthy lifestyle in Icelandic cardiac patients: a cross-sectional study.
        BMC Public Health. 2012; 12: 42
        • Courneya K.S.
        • Helsten L.A.M.
        Personality correlates of exercise behavior, motives, barriers and preferences: an application of the five-factor model.
        Pers Individ Dif. 1998; 24: 625-633
        • Rhodes R.E.
        • Smith N.E.
        Personality correlates of physical activity: a review and meta-analysis.
        Br J Sports Med. 2006; 40: 958-965
        • Bunevicius A.
        • Brozaitiene J.
        • Staniute M.
        • Gelziniene V.
        • Duoneliene I.
        • Pop V.J.
        • et al.
        Decreased physical effort, fatigue, and mental distress in patients with coronary artery disease: importance of personality-related differences.
        Int J Behav Med. 2014; 21: 240-247
        • Molloy G.J.
        • Randall G.
        • Wikman A.
        • Perkins-Porras L.
        • Messerli-Burgy N.
        • Steptoe A.
        Type D personality, self-efficacy, and medication adherence following an acute coronary syndrome.
        Psychosom Med. 2012; 74: 100-106
        • Brostrom A.
        • Stromberg A.
        • Martensson J.
        • Ulander M.
        • Harder L.
        • Svanborg E.
        Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS.
        J Sleep Res. 2007; 16: 439-447
        • Schiffer A.A.
        • Denollet J.
        • Widdershoven J.W.
        • Hendriks E.H.
        • Smith O.R.
        Failure to consult for symptoms of heart failure in patients with a type-D personality.
        Heart. 2007; 93: 814-818
        • Polman R.
        • Borkoles E.
        • Nicholls A.R.
        Type D personality, stress, and symptoms of burnout: the influence of avoidance coping and social support.
        Br J Health Psychol. 2010; 15: 681-696
        • Michal M.
        • Wiltink J.
        • Grande G.
        • Beutel M.E.
        • Brahler E.
        Type D personality is independently associated with major psychosocial stressors and increased health care utilization in the general population.
        J Affect Disord. 2011; 134: 396-403
        • Watson D.
        • Clark L.A.
        Negative affectivity: the disposition to experience aversive emotional states.
        Psychol Bull. 1984; 96: 465-490
        • Williams L.
        • O’Connor R.C.
        • Grubb N.R.
        • O’Carroll R.E.
        Type D personality and illness perceptions in myocardial infarction patients.
        J Psychosom Res. 2011; 70: 141-144
        • Mols F.
        • Denollet J.
        • Kaptein A.A.
        • Reemst P.H.
        • Thong M.S.
        The association between Type D personality and illness perceptions in colorectal cancer survivors: a study from the population-based PROFILES registry.
        J Psychosom Res. 2012; 73: 232-239
        • Kupper N.
        • Pedersen S.S.
        • Hofer S.
        • Saner H.
        • Oldridge N.
        • Denollet J.
        Cross-cultural analysis of type D (distressed) personality in 6222 patients with ischemic heart disease: a study from the International HeartQoL Project.
        Int J Cardiol. 2013; 166: 327-333
        • Speight J.
        • Browne J.
        • Holmes-Truscott E.
        • Hendriecks C.
        • Pouwer F.
        Diabetes MILES—Australia 2011 survey report.
        Diabetes Australia, 2011