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Clustering of Negative Affectivity and Social Inhibition in the Community: Prevalence of Type D Personality as a Cardiovascular Risk Marker

From the Department of Psychosomatic Medicine and Psychotherapy (C.H., K.-H.L.), Technische Universität München, Munich, Germany; and Helmholtz Zentrum München (D.K., R.E., J.B., K.-H.L.), German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany.

Address correspondence and reprint requests to: K. H. Ladwig, Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany. E-mail: ladwig{at}helmholtz-muenchen.de

Objective: To explore the prevalence of Type D personality—the combination of negative affectivity and social inhibition—in the general population and its relationship to other cardiovascular risk factors, including psychopathological symptoms. Type D personality has been identified as a prognostic risk factor for various cardiovascular disease conditions.

Methods: In a representative sample of 2698 individuals (aged 35–74 years), psychological, lifestyle, and somatic risk factors were investigated with laboratory testing, self-report measures, and a clinical interview. Type D was assessed with the German Type D Scale-14.

Results: The prevalence of Type D was 23.4% (95% confidence interval [CI], 21.2–25.6) in men and 26.9% (95% CI, 23.7–30.1) in women and, thus, in the range of classical risk factors (e.g., hypercholesterolemia). In age-adjusted analysis, Type D was associated with psychopathological symptoms, including depression and somatic symptom burden. With the exception of physical inactivity in both sexes, hypertension in women and hypercholesterolemia in men, Type D was not associated with classical cardiovascular risk factors. Multivariate analysis revealed depression, exhaustion, anxiety, and low self-rated health as associated with Type D in both sexes (odds ratios, 1.97–3.21 in men, 1.52–2.44 in women).

Conclusions: A Type D personality disposition can be found in about a quarter of the general population, which is comparable to the prevalence of classical cardiovascular risk factors. In both sexes, an independent association to Type D appeared mainly in psychopathological symptoms. Type D constitutes a relevant and independent risk marker in the community and should receive attention in clinical practice.

Key Words: Type D • negative affectivity • social inhibition • risk marker • cardiovascular disease • prevalence • comorbidity

Abbreviations: CAD = coronary artery disease; CHD = coronary heart disease; DS14 = Type D Scale-14; NA = negative affectivity; HADS = Hospital Anxiety and Depression Scale; KORA = Cooperative Health Research in the Augsburg Region, Germany; MI = myocardial infarction; PHQ-9 = Patient Health Questionnaire depression module; SI = social inhibition; PTSD = posttraumatic stress disorder; TNF = tumor necrosis factor.