Svansdottir et al. BMC Public Health 2012, 12:42 http://www.biomedcentral.com/1471-2458/12/42 R E S E A R C H A R T I C L E Open Access Type D personality is associated with impaired psychological status and unhealthy lifestyle in Icelandic cardiac patients: A cross-sectional study Erla Svansdottir1,2, Krista C van den Broek1, Hrobjartur D Karlsson2,3, Thorarinn Gudnason3 and Johan Denollet1* Abstract Background: Type D (distressed) personality has been associated with adverse cardiac prognosis and poor emotional well-being in cardiac patients, but it is still unclear what mechanisms link Type D personality with poor clinical outcomes in cardiac patients. In the present cohort of Icelandic cardiac patients, we examined potential pathways that may explain this relationship. The objectives were to examine 1) the association between Type D personality and impaired psychological status, and to explore whether this association is independent of disease severity; and 2) the association between Type D personality and an unhealthy lifestyle. Methods: A sample of 268 Icelandic coronary angiography patients (74% males (N = 199); mean age 62.9 years (SD 10.5), range 28-85 years) completed the Type D Scale (DS14), Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS) at hospitalization. Health-related behaviors were assessed 4 months following angiography. Clinical data were collected from medical files. Results: Type D personality was associated with an increased risk of anxiety (OR 2.97, 95% CI:1.55-5.69), depression (OR 4.01, 95% CI:1.42-11.29), and stress (OR 5.99, 95% CI:3.08-11.63), independent of demographic variables and disease severity. Furthermore, fish consumption was lower among Type Ds, as 21% of Type Ds versus 5% of non- Type Ds consumed fish < 1 a week (p < 0.001). Type D patients were also more likely to smoke at follow-up (22% versus 10%, p = 0.024) and to use antidepressants (17% versus 9%, p = 0.049) and sleeping pills (49% versus 33%, p = 0.019) compared to non-Type Ds. Type D personality was not associated with other health-related behaviors, aside from trends towards less fruit and vegetable consumption, and more weight gain. Conclusion: Type D personality was associated with psychological distress and an unhealthy lifestyle in Icelandic cardiac patients. Future studies should further investigate the association between Type D personality and health- related behaviors. Keywords: Coronary heart disease, Health-related behavior, Personality, Psychological, Risk factors Background Evidence linking psychological factors with adverse prognosis in patients suffering from cardiovascular dis- ease (CVD) has accumulated in recent years [1,2]. In this realm of research, one specific personality construct, the Type D (distressed) personality, has shown particu- lar promise as a potential risk factor for poor prognosis in CVD patients. Type D personality refers to high * Correspondence: j.denollet@uvt.nl 1CoRPS–Center of Research on Psychology in Somatic diseases, P.O. Box 90153, Tilburg University, 5000 LE Tilburg, The Netherlands Full list of author information is available at the end of the article scores on two stable personality traits, negative affectiv- ity (NA) and social inhibition (SI), and portrays indivi- duals who frequently experience negative emotions (elevated NA), but tend to inhibit emotional expression due to fear of rejection (elevated SI) [3]. This combina- tion of elevated negative affect and high social inhibition is thought to have a negative impact on clinical out- comes in cardiac patients, rather than one of the two personality traits alone [4]. The Type D personality concept was originally devel- oped to identify cardiac patients at risk of developing emotional and interpersonal difficulties [3,5], and has as © 2012 Svansdottir et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.