Psychometric properties of the Type D scale (DS14) in Norwegian cardiac patients

Bergvik, S., Sørlie, T., Wynn, R. & Sexton, H. (2010). Psychometric properties of the Type D scale (DS14) in Norwegian cardiac patients. Scandinavian Journal of Psychology. The combination of negative affectivity (NA) and social inhibition (SI) – the Type D Personality – is associated with poor outcomes in coronary artery disease (CAD) patients. A Norwegian translation of the standard instrument measuring Type D (DS14) was tested on 432 CAD patients receiving coronary revascularization treatment. Factor analysis produced two factors with high inter‐item reliability, indicating that the Norwegian DS14 has acceptable psychometric properties. Eighteen percent were classified as Type D, lower than has been reported elsewhere. Type D was associated with anxiety, depression, and passive coping. NA correlated positively with depression, anxiety, and passive coping. SI correlated positively with depression and anxiety, and negatively with active coping. The prevalence of Type D was higher among women, and negatively correlated with time since treatment. The variation in Type D prevalence among studies needs further elucidation as does the predictive power of continuous scoring of the Type D trait.     

Adherence, body mass index, and depression in adults with type 2 diabetes: the mediational role of diabetes symptoms and self-efficacy.

OBJECTIVE: Evidence indicates that depression is linked to the development and worsening of diabetes, but the mechanisms underlying this link are not well understood. The authors examined the hypothesis that diabetes-related symptoms mediate the effect of both behavioral adherence and body mass index (BMI) on depression. In addition, they examined whether a prior finding that self-efficacy mediates the effect of behavioral adherence and BMI on depression would replicate with a larger sample size (W. P. Sacco, K. J. Wells, C. A. Vaughan, A. Friedman, S. Perez, & R. Morales, 2005). Also, the relative contributions of diabetes-related symptoms and self-efficacy to depression were evaluated. DESIGN AND PARTICIPANTS: Cross-sectional design involving adults diagnosed with Type 2 diabetes (N = 99). MAIN OUTCOME MEASURES: The primary outcome measure was depression (Patient Health Questionnaire: Nine Symptom Depression Checklist). Predictors of depression were diet and exercise adherence (Summary of Diabetes Self-Care Activities Questionnaire), diet and exercise self-efficacy (Multidimensional Diabetes Questionnaire), diabetes symptoms (Diabetes Symptom Checklist), and BMI (based on height and weight data from medical records). RESULTS: Path and mediation analyses indicated that adherence and BMI each contributed to depression indirectly, via their effects on self-efficacy and diabetes-related medical symptoms. CONCLUSION: Results provide evidence consistent with two independent pathways by which BMI and adherence could increase depression in people with Type 2 diabetes. The first pathway indicates that the effects of higher BMI and poor adherence on depression are mediated by lower self-efficacy perceptions. The second pathway indicates that the effect of higher BMI on depression is mediated by increased diabetes symptoms.     

Coping, control, and adjustment in Type 2 diabetes.

The relationships of both coping strategies and perceived control to psychological and physiological adjustment were investigated in 115 adults (65 women, 50 men) with Type 2 diabetes. Results showed that (a) emotional preoccupation and palliative coping were positively correlated with depression and state anxiety, whereas perceived control was negatively correlated with depression, state anxiety, and hemoglobin A1c (HbA1c); (b) instrumental coping predicted lower depression; (c) perceived control moderated the relationships between instrumental coping and depression, and emotional preoccupation coping and HbA1c; and (d) emotional preoccupation coping mediated the relationships between perceived control and depression, and perceived control and state anxiety. Results are discussed in terms of the goodness-of-fit hypothesis (V. J. Conway & D. J. Terry, 1992), optimal coping, and the importance of perceived control in psychological and physiological adjustment.     

Effects of Rational Emotive Cognitive Behavioral Coaching on Depression Among Type 2 Diabetic Inpatients

Depression is a human illness that may prevent sustainable goal attainment. People with Type 2 diabetes mellitus have a much higher risk of being depressed than the nonclinical population, which may be due to associations between the neurobiological mechanisms that play a role in the two diseases. The objective of the present study was to investigate the effects of rational emotive cognitive behavioral coaching (RE-CBC) on depressive thinking in a group of inpatients with Type 2 diabetes in Nigeria. A pretest–posttest control group design was used. Eighty participants were randomly allocated to the treatment and control groups. Outcomes were evaluated using Nigerian language (Igbo) versions of the Beck Depression Inventory-II and the Hamilton Rating Scale for Depression, and the intervention was delivered in Igbo. An Igbo version of the Rational Emotive Behavior Therapy Manual for Depression was used as the intervention package. Data were analyzed using mean rank, repeated measures ANOVA, and the Mann–Whitney U test. At the end of the intervention, a significant decline in depression was observed among the participants in the group that received RE-CBC, but not in those that received standard counseling (control group). The effects of RE-CBC were maintained at follow-up. The present results suggest that RE-CBC is an effective and time-efficient intervention for managing depression in inpatients living with Type 2 diabetes. Further evaluations are warranted in other countries.     

Type A behaviour and psychophysiological arousal

The "coronary prone" or Type A behaviour pattern, characterized by e.g., hard-driving competitiveness, impatience and aggressiveness, is associated with elevated systolic blood pressure and catecholamine secretion during challenge. In experiments at our laboratory, elevated psychophysiological arousal was found in Type A subjects during understimulation, but not during active performance on a self-paced reaction time task. Results suggest that differences in cardiovascular and behavioural reactivity between Type A and B persons tend to be related to the pace of the environment to which they are exposed. Studies of antecedents of Type A behaviour in children show that "Type A children" respond to challenge with a greater increase in sympathetic arousal than "non-Type As". This suggests the possibility that genetic dispositions and/or conditioned sympathetic reactivity play an important role in the development of the Type A behaviour pattern.     

Effects of consistent aerobic exercise on the psychological functioning of women

Effects of consistent aerobic exercise on depression, anxiety, and health locus of control for a group of nonclinical inactive women were investigated. Type A and Type H (hard-driving) behavioral styles were evaluated to determine whether these traits were related to exercise improvement. 26 women were randomly assigned to either an exercise group (n = 10) or exercise with cognitive strategy instructions (n = 16). All subjects increased distance run in 12-min. run test from pre- to posttest. Women improved in depression and trait anxiety. Depression was significantly correlated with body mass index at end of program. Posttest state-anxiety was significantly correlated with 6-wk. follow-up of exercise frequency. No significant difference in pre- and posttest health locus of control was found. Type H scores were significantly correlated with number of exercise sessions attended. Consistent aerobic exercise had a positive effect on psychological functioning, and some characteristics may affect exercise improvement.     

The distressed (Type D) personality mediates the relationship between remembered parenting and psychological distress in cardiac patients

Objective: Both the distressed (Type D) personality (i.e. the combination of negative affectivity and social inhibition traits) and dysfunctional parenting styles are associated with anxiety and depression. As parenting styles have been related to personality development, dysfunctional parenting styles may also be associated with Type D personality. We examined whether remembered parenting was associated with anxiety and depression in cardiac patients and whether Type D personality mediated this relationship.

Methods: Our sample comprised 435 patients treated with percutaneous coronary intervention (PCI) and 123 patients with congestive heart failure (CHF). Patients completed the Hospital Anxiety and Depression Scale, Type D Scale (DS14), and Remembered Relationship with Parents (RRP¹⁰) scale.

Results: Remembered parenting was significantly associated with higher anxiety and depression levels and Type D personality. In multivariable linear regression analyses, Type D personality accounted for 25–29% of the variance in anxiety and 23–46% of the variance in depression, while remembered parenting was no longer significantly associated with these domains. Sobel tests and bootstrapping indicated that Type D personality mediated the relationship between remembered parenting and anxiety and depression.

Conclusion: Type D personality mediated the relationship between remembered parenting and anxiety and depression in both PCI and CHF patients.     

Anger in type a women: Implications for coronary heart disease

The present study examines the relationship between Type A behaviour and anger in a sample of managerial women. The Type A behaviour pattern is hard driving, job-devoted lifestyle which is associated with a significantly increased risk of coronary heart disease in men as in women. Anger and hostility have been reported to be critical components of the Type A behaviour pattern which contribute to coronary heart disease. This research also examines the relationship between occupational demands and job anger in managerial women. Occupational demands include demands particularly unique to women in non-traditional occupational roles such as inequity of pay, underutilization of skills, low boss support and perceived sex discrimination. State (job) and Trait Anger were also assessed as were various psychological and behavioural outcomes such as state anxiety, depression, job satisfaction, absenteeism, and “intention to turnover”. Results showed that sex discrimination was a significant occupational stressor in Type As only. Further results of a multiple regression analysis indicated tha for Type As only, sex discrimination was positively associated with job anger when social support from one's boss was low. However, with increasing support, Type As were less likely to report anger when discrimination was high. In conclusion, the results of this study have demonstrated that social support can function as a buffer against anger, thus extending the buffering hypothesis originally put forth to refer to the buffering effects of social support and anxiety.     

Perfectionism,Type A Behavior,and Self-Efficacy in Depression and Health Symptoms among Adolescents

The current study examined the associations among dimensions of perfectionism, Type A behavior, self-efficacy, distress, and health symptoms in high school students. A sample of 73 high school students (34 boys, 39 girls) completed measures of self-oriented perfectionism, socially prescribed perfectionism, Type A behavior, self-efficacy, depressive symptoms, and psychosomatic symptoms. Correlational analyses found that self-oriented perfectionism was marginally related to Type A behavior. Students with elevated levels of depressive symptoms were also characterized by self-oriented perfectionism, Type A behavior, low self-efficacy, and health symptoms. In addition, health symptoms were linked with low self-efficacy. Simultaneous entry of several variables into a regression analysis found that significant unique predictors of depression were low self-efficacy and elevated self-oriented perfectionism. Similarly, a regression analysis found that low self-efficacy and high self-oriented perfectionism were unique predictors of health symptoms. The findings highlight the distinctions between the perfectionism and the Type A constructs, and support self-regulation models of depression and physical symptoms that include an emphasis on excessive perfectionistic standards and low self-efficacy. We discuss the need for preventive interventions designed for perfectionistic adolescents with low self-efficacy.     

A Self-Attribution-Reactance Model of Recovery from Injury in Type A Individuals1

A self-attribution-reactance model of Type A behavior and medical recovery is introduced. The model proposes that Type As' bias to view themselves as causal for all outcomes makes them sensitive to events (illness, injury, or treatment) that reduce their personal control. Consequently, Type As are more likely than Type Bs to respond to such events with reactant behavior (noncompliance with treatment) in order to restore their perceptions of control and freedom. In a test of the model, 32 patients being treated for running-related injuries were assessed for Type A behavior, preference for control over and involvement with treatment, and attributions for and reactions to their injury at the beginning of treatment. The physician's ratings of progress through treatment made at the conclusion of the study served as the measure of recovery. Results supported the model in that extreme Type As were more likely than moderate Type As and Type Bs to be judged as exhibiting poor recovery. Moreover, Type As judged to have made poor progress made more extreme self-attributions and were more angry about their injuries than were Type A and B patients judged to have made good progress. The implications of the findings for promoting compliance are discussed.     

Type A behavior, hardiness, and psychological well-being in Japanese women

The effects of Type A behavior and hardiness on depression and physical symptoms in the face of hassles were examined in 107 Japanese female college students. Analysis of variance indicated that Type A females had less depression under low hassles. There were no hardiness main effects or interactions. Neither Type A behavior nor hardiness moderated the adverse effect of hassles for Japanese women. An implication for research is suggested.     

Clinical events in coronary patients who report low distress: adverse effect of repressive coping

OBJECTIVE: Coronary artery disease (CAD) patients who report low distress are considered to be at low psychological risk for clinical events. However, patients with a repressive coping style may fail to detect and report signals of emotional distress. The authors hypothesized that repressive CAD patients are at risk for clinical events, despite low self-rated distress. DESIGN: This was a prospective 5- to 10-year follow-up study, with a mean follow-up of 6.6 years. At baseline, 731 CAD patients filled out Trait-Anxiety (distress), Marlowe-Crowne (defensiveness), and Type D scales; 159 patients were classified as "repressive," 360 as "nonrepressive," and 212 as "Type D." MAIN OUTCOME MEASURES: The primary endpoint was a composite of total mortality or myocardial infarction (MI); the secondary endpoint was cardiac mortality/MI. RESULTS: No patients were lost to follow-up; 91 patients had a clinical event (including 35 cardiac death and 32 MI). Repressive patients reported low levels of anxiety, anger and depression at baseline, but were at increased risk for death/MI (21/159 = 13%) compared with nonrepressive patients (22/360 = 6%), p = .009. Poor systolic function, poor exercise tolerance, 3-vessel disease, index MI and Type-D personality--but not depression, anxiety or anger--also independently predicted clinical events. After controlling for these variables, repressive patients still had a twofold increased risk of death/MI, OR = 2.17, 95% CI = 1.10-4.08, p = .025). These findings were replicated for cardiac mortality/MI. CONCLUSION: CAD patients who use a repressive coping style are at increased risk for clinical events, despite their claims of low emotional distress. This phenomenon may cause an underestimation of the effect of stress on the heart. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

Type A Personality Characteristics and the Effect on Individual and Team Academic Performance

Type A personality has been conceptualized in part as high need for achievement combined with aggression, hostility, and self-esteem issues. In teams of undergraduate business students, high levels of Type A personality significantly correlated with high levels of depression and high levels of social monitoring; and negatively correlated with social desirability, communality, and individual performance across time. In team settings, the more Type A's were balanced in a team with low Type A's, the more there was team commitment and the more team synergy behaviors; while if teams had a greater number of Type A's, there was more individualistic behavior, and team project scores were lower.     

Therapieresistente Depression – eine differenzialdiagnostische Herausforderung

Background

Diagnosis and treatment of major depression is part of daily routine in psychiatric practice. We therefore rely on the latest ICD-10 and the described symptoms. However, is this decision always obvious, and which differential diagnostic considerations should be made, especially for patients with treatment-resistant depression or in elderly patients?

Method

A clinical case report is described, taking into consideration the results of a literature search and national and international guidelines.

Results

Major depression is usually part of daily routine in the psychiatric hospital. It is one of the most common diagnoses; the estimated lifetime prevalence of unipolar major depression is 12?% and continues to increase. But what should be done, if symptoms continue to deteriorate, despite guideline-based treatment? The following case report shows that in this situation further diagnostic procedures are needed and necessary. An 80-year-old man is transferred to a psychiatric ward because of depressive symptoms. Despite adequate treatment, the psychiatric state deteriorates. Finally, the diagnosis of normal pressure hydrocephalus (NPH) is made with the direct consequence of further treatment options. Especially the possible overlap of symptoms for depression, dementia, and NPH are shown, thus, making the differential diagnosis challenging.

Conclusion

In 80?% of cases, NPH remains unrecognized and untreated. Similarities in the symptoms lead to the difficulty of distinguishing NPH from other neurodegenerative disorders and, as in this case report, also from major depression. In case of NPH, early diagnosis and treatment are important because if the disease is too advanced, clinical improvement is unlikely. Therefore, in cases of treatment-resistant major depression it is advisable to perform additional diagnostic tests and to consult with interdisciplinary neurology and neuroradiology teams.     

Type A behavior pattern and emotion expression in younger and older adults.

Eighty younger (less than 50 years, M = 28 years) and 80 older (more than 50 years, M = 69 years) Type A and Type B Ss were evaluated for Type A behavior pattern using the Structured Interview (SI) and given personality tests for anxiety, depression, anger, aggression, hostility, and anger-in-anger-out. Ss also underwent an emotion induction procedure. Videotapes of the emotion induction procedure (N = 160) and the SI (N = 80) were coded for facial expression of emotion. Type As did not differ from Bs on anxiety or depression but did on anger and aggression. Type As showed anger inhibition and anger bound to shame, as predicted by emotion socialization theory. The greatest number of differential effects were observed between age groups. Older individuals, in general, were more emotionally expressive than younger Ss across a range of emotions. Women appeared more conflicted about anger expression than men, and Type A women more so than Type A men.     

Bortner type A scores and basic emotions: aggression, distrustful, depression, and gregarious

We examined the correlations between scores on Bortner's scale and measures of aggression, distrustful, gregarious, and depression in 1,084 employees. Prospectively over 2 yr. we investigated the relationship of Type A behavior with cardiac mortality. Subjects classified as Type A had higher mean ratings on measures of aggression and distrustful than did persons classified as Type B. Mortality was lower in patients classified as reporting Type A behavior (12%) than in the patients classified as reporting Type B behavior (22%).     

Conceptualizing and measuring personality vulnerability to depression: comment on Coyne and Whiffen (1995)

J. C. Coyne and V. E. Whiffen (1995) reviewed research on personality vulnerability to depression, focusing on S. J. Blatt's (1974, 1990) concepts of dependency and self-criticism and A. T. Beck's (1983) concepts of sociotropy and autonomy. The authors discuss 6 issues raised in that review: (a) the typological or dimensional nature of vulnerability, (b) the theoretical implications of "mixed" vulnerability, (c) the relations of vulnerability to Neuroticism. (d) the potential confounding of vulnerability with concurrent depression, (e) the potential confounding of vulnerability with social context, and (f) the differentiation of dependency from relatedness. The authors conclude that Blatt's and Beck's concepts are continuous, nearly orthogonal dimensions that can be identified and measured independently from Neuroticism, depression, and social context.     

Toward an animal model of type A behavior

Time estimation and dominance tests were used to differentiate the behavior of Mongolian gerbils to be analogous to Type A and Type B human behavior. Preliminary classification of animals as "Type A" or "B" was based upon differential performance on DRL 20-sec and DRL 60-sec reinforcement schedules. To retain their preliminary classification, Type A and Type B animals were required to be dominant and subordinate, respectively, in matches with each of three same-sex animals of opposite behavioral classification. Following classification, breeding pairs were constituted and classification procedures were repeated with two succeeding generations. Animals that exhibited Type A timing "won" significantly more dominance matches than did Type B animals. Incidence rates of Type A and Type B behavior in the two selectively bred generations were significantly greater than frequencies in the original stock generation. The usefulness of the present animal model for investigating the association of Type A behavior with coronary heart disease is discussed.     

Psychological factors associated with poor hypertension control: differences in personality and stress between patients with controlled and uncontrolled hypertension

Only one-third of patients with hypertension under pharmacological treatment achieve the recommended blood pressure goals. Psychological factors could partially account for poor hypertension control through the existence of personality traits related to treatment compliance (e.g., self-discipline, deliberation, impulsiveness), and the fact that stress and some personality traits (e.g., anxiety, depression, anger expression, Type A) are involved in the etiology of some hypertension cases. This study was aimed at examining the differences in personality and stress between patients taking antihypertensive medications with controlled and uncontrolled hypertension. Results revealed that after controlling sex, age, and traditional variables associated with poor hypertension control, the uncontrolled hypertension group showed higher scores on impulsiveness, depression, anger expression-out, and stress, with differences ranging between medium and large (Hedges' g effect size = 0.77 to 1.08). These results support the hypothesized relationship between psychological factors and poor hypertension control.     

Testing for robustness in Monte Carlo studies

Monte Carlo studies provide the information needed to help researchers select appropriate analytical procedures under design conditions in which the underlying assumptions of the procedures are not met. In Monte Carlo studies, the 2 errors that one could commit involve (a) concluding that a statistical procedure is robust when it is not or (b) concluding that it is not robust when it is. In previous attempts to apply standard statistical design principles to Monte Carlo studies, the less severe of these errors has been wrongly designated the Type I error. In this article, a method is presented for controlling the appropriate Type I error rate; the determination of the number of iterations required in a Monte Carlo study to achieve desired power is described; and a confidence interval for a test's true Type I error rate is derived. A robustness criterion is also proposed that is a compromise between W. G. Cochran's (1952) and J. V. Bradley's (1978) criteria.