Type D personality,physical symptoms and subjective stress: The mediating effects of coping and social support

Coping style and social support may represent mechanisms to explain the relationship between Type D personality and ill-health. This study investigated whether Type D is associated with physical symptoms and perceived stress in a non-cardiac population, and if these relationships are mediated by coping and social support. In a cross-sectional study, 304 participants (110 males, mean age 22.1 years) completed measures of Type D, physical symptoms, coping, perceived stress and social support. Results showed that Type D, the interaction of negative affectivity and social inhibition (NA?×?SI), was positively correlated with physical symptoms, perceived stress, and avoidant coping, and negatively correlated with social support, problem-focused coping and emotion-focused coping. A series of bootstrapped multiple mediator tests showed that social support and avoidant coping fully mediated the relationship between Type D and physical symptoms. Furthermore, social support and emotion-focused coping partially mediated the relationship between Type D and perceived stress. These findings demonstrate for the first time that Type D personality is associated with physical symptoms in a non-cardiac population. Social support and coping style represent mechanisms that can, in part, explain the relationship between Type D and physical symptoms, and Type D and perceived stress.     

Type D personality, physical symptoms and subjective stress: the mediating effects of coping and social support

Coping style and social support may represent mechanisms to explain the relationship between Type D personality and ill-health. This study investigated whether Type D is associated with physical symptoms and perceived stress in a non-cardiac population, and if these relationships are mediated by coping and social support. In a cross-sectional study, 304 participants (110 males, mean age 22.1 years) completed measures of Type D, physical symptoms, coping, perceived stress and social support. Results showed that Type D, the interaction of negative affectivity and social inhibition (NA × SI), was positively correlated with physical symptoms, perceived stress, and avoidant coping, and negatively correlated with social support, problem-focused coping and emotion-focused coping. A series of bootstrapped multiple mediator tests showed that social support and avoidant coping fully mediated the relationship between Type D and physical symptoms. Furthermore, social support and emotion-focused coping partially mediated the relationship between Type D and perceived stress. These findings demonstrate for the first time that Type D personality is associated with physical symptoms in a non-cardiac population. Social support and coping style represent mechanisms that can, in part, explain the relationship between Type D and physical symptoms, and Type D and perceived stress.     

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.     

Type D personality and social relations in adults with diabetes: results from diabetes MILES – The Netherlands

Abstract

Objective: To examine whether individual differences in Type D personality (combination of negative affectivity (NA) and social inhibition (SI)) could explain heterogeneity in perceived social support and relationship adjustment (intimate partner relationship) among people living with diabetes.

Design: In the Diabetes MILES—The Netherlands survey, 621 adults with type 1 or type 2 diabetes (54% female, age: 56?±?14 years) completed measures of Type D personality (DS14), perceived social support and relationship adjustment. We used established DS14 cut-off scores to indicate Type D personality, high NA only, high SI only and reference groups.

Results: Participants from the Type D and NA only groups perceived lower levels of social support (Welch[3,259]?=?37.27, p?<?0.001), and relationship adjustment (Welch[3,191]?=?14.74; p?<?0.01) than those from the SI only and reference groups. Type D was associated with lower social support (lowest quartile; adjusted OR?=?8.73; 95%CI?=?5.05?～?15.09; p?<?0.001) and lower relationship adjustment (lowest quartile; adjusted OR?=?3.70; 95%CI?=?2.10?～?6.53; p?<?0.001). Type D was also associated with increased levels of loneliness.

Conclusion: Participants with Type D and participants with high NA only tend to experience less social support and less relationship adjustment. Type D personality was also associated with more loneliness. Experiencing lower social support and relationship adjustment may complicate coping and self-management in people with diabetes.     

DS14 is more likely to measure depression rather than a personality disposition in patients with acute coronary syndrome

It has been suggested that Type D Personality is a risk factor for acute coronary syndrome (ACS) and the DS14 has been developed for its assessment. However, some of the items on the DS14 seem to evaluate depressive symptoms rather than personality features. Therefore, the present study aims to verify whether an overlap exists between the constructs of Type D Personality and depression. Three‐hundred‐and‐four consecutive patients who were both presenting their first ACS and had no history of major depression completed the Hospital Anxiety and Depression Scale (HADS) and the DS14 to assess Type D personality at baseline and have been re‐evaluated at 1, 2, 4, 6, 9 and 12‐month follow‐ups. Out of 304 subjects (80.6% males), 40 were diagnosed as depressed. An exploratory factor analysis of HADS and the DS14 in the second month revealed that four out of seven items on the depressive subscale of HADS (HADS‐D) and six out of seven items on the Negative Affectivity (NA) subscale of the DS14 segregated on the same factor. Results were verified by a Partial Confirmatory Factor Analysis performed at the twelfth month when most of the patients achieved complete remission from the depressive episode. Temporal stability was poor for NA and Type D Personality and these construct co‐vary with HADS‐D over time. Our data suggests that NA and depression are overlapping constructs, supporting the idea that the DS14 measures depressed features, rather than a personality disposition.     

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.     

Modeling Interactions Between Latent Variables in Research on Type D Personality: A Monte Carlo Simulation and Clinical Study of Depression and Anxiety

Several approaches exist to model interactions between latent variables. However, it is unclear how these perform when item scores are skewed and ordinal. Research on Type D personality serves as a good case study for that matter. In Study 1, we fitted a multivariate interaction model to predict depression and anxiety with Type D personality, operationalized as an interaction between its two subcomponents negative affectivity (NA) and social inhibition (SI). We constructed this interaction according to four approaches: (1) sum score product; (2) single product indicator; (3) matched product indicators; and (4) latent moderated structural equations (LMS). In Study 2, we compared these interaction models in a simulation study by assessing for each method the bias and precision of the estimated interaction effect under varying conditions. In Study 1, all methods showed a significant Type D effect on both depression and anxiety, although this effect diminished after including the NA and SI quadratic effects. Study 2 showed that the LMS approach performed best with respect to minimizing bias and maximizing power, even when item scores were ordinal and skewed. However, when latent traits were skewed LMS resulted in more false-positive conclusions, while the Matched PI approach adequately controlled the false-positive rate.     

The distressed (Type D) and Five-Factor Models of personality in young,healthy adults and their association with emotional inhibition and distress

The distressed (Type D) personality (the combination of negative affectivity and social inhibition traits) has been associated with adverse health outcomes. This study investigated the validity of the Type D construct against the Five-Factor Model (FFM) of personality, and its association with emotional control and distress. In total 498 university students (mean age 28.9 ± 8.4 years) completed the Type D scale (DS14), and measurements for the FFM of personality, emotional control, anxiety, depression and stress. The construct validity of the Icelandic DS14 was confirmed. The Type D components negative affectivity and social inhibition were strongly associated with neuroticism and extraversion of the FFM (r = 0.82 and r = −0.67, respectively). Negative affectivity also correlated with rehearsal/rumination (r = 0.58) and social inhibition with emotional inhibition (r = 0.54), indicative of emotional control. Type D personality (40% of sample) was associated with higher levels of anxiety, depression and stress. The Type D personality components were associated with the FFM of personality, emotional control and emotional distress. Importantly, social and emotional inhibition were closely related, providing novel information about the presence of emotional inhibition within the social inhibition trait.     

Type D Personality: A Five-Factor Model Perspective

This study investigated the position of Type D (high Negative Affectivity and high Social Inhibition) within the Five-Factor Model (FFM) of personality. A sample of 155 healthy subjects were administered the Type D Scale and the NEO-FFI, assessing the FFM traits. Subjects also filled out the General Health Questionnaire and the Job Stress Survey. Negative Affectivity was positively correlated with Neuroticism (0.74) and negatively with Conscientiousness ( m 0.38), Agreeableness ( m 0.37), and Extraversion ( m 0.35). Social Inhibition was negatively correlated with Extraversion ( m 0.61) and Conscientiousness ( m 0.40) and positively with Neuroticism (0.50). Type D subjects reported more somatic distress ( p <0.0001), anxiety ( p <0.0001) and depression ( p <0.01) than non-Type D subjects. An alternative one-dimensional representation of the D-traits was suggested, conceptualized as a dimension ranging from neurotic introversion with relatively low conscientiousness to stable extraversion with relatively high conscientiousness. These findings are discussed in the light of the renewed interest in psychology for type versus dimensional representations of individual differences.     

Physiological and nonverbal correlates of extraversion, neuroticism, and psychoticism during active and passive coping

Correlations of extraversion, neuroticism, and psychoticism with state anxiety, physiological arousal, and facial expressivity were assessed in 45 adolescents during a passive task (venipuncture) and an active coping task (speech). Task was a major determiner of the relationship between these variables. During venipuncture heart-rate increase was positively correlated with state anxiety, neuroticism, and anxiety expression and negatively correlated with extraversion. However, during the speech, HR change was negatively correlated with state anxiety and nonverbal indices of anxiety, but was positively correlated with extraversion and positive nonverbal expression. Skin conductance change findings were weaker but, when occurring, were in the same direction as the HR findings. Extraversion was highly associated with all nonverbal expressivity measures: inversely correlating with venipuncture and speech anxiety expression and positively correlating with venipuncture and speech positive expression. Neuroticism was positively correlated with nonverbal expression of anxiety during venipuncture but not speech. Psychoticism correlated positively with nonverbal positive expression during both venipuncture and speech.     

Adolescent stress: Evaluation of the factor structure of the Adolescent Stress Questionnaire (ASQ‐N)

Moksnes, U. K., Byrne, D. G., Mazanov, J. & Espnes, G. A. (2010). Adolescent stress: Evaluation of the factor structure of the Adolescent Stress Questionnaire (ASQ‐N). Scandinavian Journal of Psychology, 51, 203–209. The present study reports an evaluation of the factor structure of the Norwegian version of the Adolescent Stress Questionnaire (ASQ‐N) among 723 students. Principal components analysis (PCA) revealed nine internally consistent dimensions of adolescent stress. Scales constructed from this PCA correlated positively with measures of depression and anxiety and negatively with self‐esteem. Girls reported higher stress levels than boys in seven of the nine scales and age was also positively correlated with the scale scores of adolescent stress. The results revealed that the instrument has potential for measuring adolescent stress. The stability of the ASQ‐N needs to be tested repeatedly, across cohorts and over time, to establish the adequacy for use in Norwegian adolescent studies.     

Coping with human immunodeficiency virus: Do optimists fare better?

Individuals who test positive for human immunodeficiency virus (HIV) face a difficult adjustment task. It was hypothesized that those who were more optimistic would cope more effectively and experience less distress. Both general and health-specific measures of coping were used. Optimism and distraction were negatively related to state anxiety, whereas emotional preoccupation was positively related to state anxiety. Optimism was not a predictor of depression. Rather, distraction was negatively related to depression, whereas palliative coping, emotional preoccupation, and the interaction of palliative coping and optimism were positively related to depression. The mediation of optimism by coping variables indicated that emotion-oriented coping was a negative mediator of optimism on both state anxiety and depression. Distraction (which includes some social diversion content) was a mediator of the impact of optimism on depression.     

Coping with human immunodeficiency virus: Do optimists fare better?

Individuals who test positive for human immunodeficiency virus (HIV) face a difficult adjustment task. It was hypothesized that those who were more optimistic would cope more effectively and experience less distress. Both general and health-specific measures of coping were used. Optimism and distraction were negatively related to state anxiety, whereas emotional preoccupation was positively related to state anxiety. Optimism was not a predictor of depression. Rather, distraction was negatively related to depression, whereas palliative coping, emotional preoccupation, and the interaction of palliative coping and optimism were positively related to depression. The mediation of optimism by coping variables indicated that emotion-oriented coping was a negative mediator of optimism on both state anxiety and depression. Distraction (which includes some social diversion content) was a mediator of the impact of optimism on depression.     

Good and Bad Sides of Self-Compassion: A Face Validity Check of the Self-Compassion Scale and an Investigation of its Relations to Coping and Emotional Symptoms in Non-Clinical Adolescents

To demonstrate that the positive and negative subscales of Self-Compassion Scale (SCS) are very different in nature, we conducted a series of face validity checks on the items of this questionnaire among psychologists and psychology students (Study 1). Furthermore, a survey was administered to a convenience sample of non-clinical adolescents to examine the relations between various SCS subscales and symptoms of anxiety and depression as well as coping styles (Study 2). The results of the face validity checks revealed that the positive subscales seem to be well in line with the protective nature of self-compassion as they were mainly associated with cognitive coping and healthy functioning, whereas the negative subscales were chiefly associated with psychopathological symptoms and mental illness. The survey data demonstrated that the positive SCS subscales were positively correlated with adaptive coping (r’s between .22 and .50) and negatively correlated with symptoms of anxiety and depression (r’s between ?.19 and ?.53), while the negative subscales were positively correlated with symptoms (r’s between .49 and .61) and maladaptive coping strategies such as passive reacting (r’s between .53 and .56). Additional analyses indicated the negative subscales of the SCS accounted for a significant proportion of the variance in symptoms, whereas the unique contribution of the positive SCS subscales was fairly marginal. We caution to employ the total SCS score that includes the reversed negative subscales as such a procedure clearly inflates the relation between self-compassion and psychopathology.     

Balanced states of mind in psychopathology and psychological well-being

The balanced states of mind (BSOM) model proposes that coping with stress and psychological well-being is a function of the BSOM ratio of positive thoughts to the sum of positive and negative thoughts. Based on different BSOM ratios, different BSOM categories are constructed to quantitatively differentiate levels of coping with stress and psychological well-being. The cognitive content-specificity hypothesis states that there are unique themes of semantic content in self-reported automatic thoughts particular to depression or anxiety. This study investigated the BSOM model and its cognitive content-specificity for depression, anxiety, anger, stress, life satisfaction, and happiness, based on negative and positive automatic thoughts. Three hundred and ninety-eight college students from Singapore participated in this study. First, BSOM ratio and positive automatic thoughts were positively correlated with life satisfaction and happiness, and negatively correlated with stress, anxiety, depression, and anger. In contrast, negative automatic thoughts were positively correlated with stress, anxiety, depression, and anger, and negatively correlated with life satisfaction and happiness. Second, levels of psychopathology and psychological well-being were statistically differentiable among the BSOM categories for depression, happiness, perceived stress, and life satisfaction; and less statistically differentiable among the BSOM categories for anxiety and anger, as expected based on the BSOM model and cognitive content-specificity hypothesis. Third, the results were more supportive of the BSOM model for depression, followed by happiness, perceived stress, life satisfaction, anxiety, and anger in terms of percentage of variance accounted for by BSOM categories, as expected based on the cognitive content-specificity hypothesis. Taken together, the results suggested that the more moderately positive thoughts one has (balanced by negative thoughts), the better mental health outcomes one has. Implications and limitations of these findings are discussed.     

Cardiac morbidity risk and depression and anxiety: a disorder, symptom and trait analysis among cardiac surgery patients

The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.     

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).     

新冠肺炎疫情下的评估、应对与抑郁和焦虑的关系：多元多重中介模型

作为全球性公共卫生事件,新型冠状病毒肺炎疫情成为潜在心理应激事件。本研究以线上问卷调研形式在疫情爆发上升期考察了民众对此疫情的可控性评估及应对方式对抑郁焦虑的影响。结果表明：（1）自控性显著负向预测抑郁焦虑,他控性对抑郁焦虑无显著预测作用;（2）前行应对显著负向预测抑郁焦虑,创伤应对显著正向预测抑郁焦虑;（3）前行应对在自控性与抑郁焦虑之间起中介作用,即自控性通过正向预测前行应对进而负向预测抑郁焦虑;（4）前行应对在他控性与抑郁焦虑之间起中介作用,即他控性通过正向预测前行应对进而对抑郁焦虑产生积极影响;（5）然而,创伤应对也在他控性与抑郁焦虑之间起中介作用,即他控性通过正向预测创伤应对对抑郁焦虑产生消极影响。本研究对可控性评估和应对方式对抑郁焦虑的影响以及应对方式的中介作用进行了探究与讨论。     

Type D assessment in patients with chronic heart failure and peripheral arterial disease: evaluation of the experimental DS(3) scale using item response theory

Type D personality refers to a clustering of 2 stable personality traits, namely negative affectivity and social inhibition. Currently Type D is standardly assessed using the DS14. An experimental Type D personality scale, the DS((3)), was developed to examine an avenue for assessing Type D more efficiently. The DS((3)) differs from the DS14 in its use of a 3-point Likert scale to rate responses, use of all negatively worded items, and a rearranged presentation of items. This article examines the psychometric properties of this questionnaire by examining its dimensionality, item and scale properties, and cutoff scores to screen for Type D personality. Data from 2 clinical samples were analyzed using item response theory. The results suggest that the DS((3)) is a potentially suitable instrument for Type D assessment. It has high reliability, and Type D personality classification based on this scale corresponds well with the current standard Type D assessment based on the DS14.     

A Normative Study of TAT Ambiguity

Type D personality refers to a clustering of 2 stable personality traits, namely negative affectivity and social inhibition. Currently Type D is standardly assessed using the DS14. An experimental Type D personality scale, the DS⁽³⁾, was developed to examine an avenue for assessing Type D more efficiently. The DS⁽³⁾ differs from the DS14 in its use of a 3-point Likert scale to rate responses, use of all negatively worded items, and a rearranged presentation of items. This article examines the psychometric properties of this questionnaire by examining its dimensionality, item and scale properties, and cutoff scores to screen for Type D personality. Data from 2 clinical samples were analyzed using item response theory. The results suggest that the DS⁽³⁾ is a potentially suitable instrument for Type D assessment. It has high reliability, and Type D personality classification based on this scale corresponds well with the current standard Type D assessment based on the DS14.