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Type D Personality Is Associated With Increased Anxiety and Depressive Symptoms in Patients With an Implantable Cardioverter Defibrillator and Their Partners

From the Department of Psychology and Health (S.S.P.), Tilburg University, The Netherlands; Department of Cardiology (S.S.P., R.T.V.D., D.A.M.J.T., L.J., R.A.M.E.), Thoraxcenter, Erasmus Medical Center Rotterdam, The Netherlands; and Department of Medical Psychology and Psychotherapy (R.A.M.E.), Erasmus Medical Center Rotterdam, The Netherlands.

Address correspondence and reprint requests to Dr. Susanne S. Pedersen, Department of Psychology and Health, Room P503a, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands. E-mail: S.S.Pedersen{at}uvt.nl

OBJECTIVE: We investigated the prevalence of anxiety and depressive symptoms in patients with an implantable cardioverter defibrillator (ICD) and their partners, and the role of personality factors and social support as determinants of distress.

METHODS: Of all surviving patients (n = 221) having had an ICD implanted between October 1998 and January 2003, 182 patients and 144 partners completed the Hospital Anxiety and Depression Scale, the Type D Personality Scale, and the Perceived Social Support Scale. Type D personality defines those who tend to experience increased negative distress and who do not express these negative emotions in social interactions. Clinical variables for the patients were obtained from medical records.

RESULTS: Thirty-one percent of patients versus 42% of partners suffered from symptoms of anxiety (p = .048); symptoms of anxiety were particularly prevalent in male partners. Twenty-eight vs. 29% suffered from depressive symptoms (p = .901). In patients, Type D personality was independently related to anxiety (OR: 7.03; 95% CI: 2.32–21.32) and depressive symptoms (OR: 7.40; 95% CI: 2.49–21.94) adjusting for all other variables. Underlying cardiac disease pathology did not explain differences in patient distress. In partners, Type D personality was independently associated with increased symptoms of anxiety (OR: 8.77; 95% CI: 3.19–24.14) and depression (OR: 4.40; 95% CI: 1.76–11.01).

CONCLUSION: Partners experienced similar levels of depression but higher levels of anxiety compared with ICD patients. Personality was an important explanatory factor of distress in both ICD patients and their partners. Research is now warranted to investigate the implications of this finding for the clinical course of ICD patients, as Type D personality has been associated with adverse prognosis in patients with coronary artery disease.

Key Words: anxiety, • coronary artery disease, • depressive symptoms, • implantable cardioverter defibrillator, • Type D personality.

Abbreviations: CAD = coronary artery disease;; ICD = implantable cardioverter defibrillator;; MI = myocardial infarction.

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