| BackgroundCoronary heart disease (CHD) is a kind of psychosomatic disease,which is a result of the integrated effects of biological, psychological and social factors. The potentially deleterious effects of type d Personality on the etiology and prognosis of CHD are well recognized. Type D patients are at increased risk for mortality and repeat MI, even after invasive treatment with a drug-eluting stent. Several issues need to be solved, however. Although research shows that the incidence of anxiety and depression is significantly increased in patients with CHD, it is unclear whether type d Personality has any prognostic value in CHD patients on anxiety and depression. CHD patients with anxiety, depression and type d personality have a poor quality of life, but little is known about its interactions of anxiety, depression and type d personality.PurposeTo explore the relationship among type d personality and coronary heart disease; to explore the effect of the type d personality on CHD patients with anxiety and depression.To evaluate the impact of type d personality, anxiety and depression on quality of life in CHD patients and its interaction of anxiety, depression and type d personality on quality of life in CHD patients.Which would provide theoretical basis of psychological behavior intervention for CHD patients.Materials and Methods1. According to the inclusion and exclusion criteria, a total of370inpatients with CHD and normal coronary angiogram that had undergone coronary angiography from October2010to March2012in our hospital were enrolled in this study. There were296subjects in CHD group (including103subjects of stable angina pectoris,122subjects of unstable angina pectoris and71subjects of acute myocardial infarction) and74subjects without CHD as the control group. The296CHD patients were divided into two groups according to the results of DS14:type d personality group and non type d personality group.2. All subjects were administered a standardized questionnaire that provided information about their sex, age, occupation, educational level, smoking and drinking history, history of hypertension and diabetes, et al. And type d personality scale were used to assess the type of personality of all the participants. In addition to the above survey, all the CHD patients were administered Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and the Short Form36Questionnaire (SF-36) to text the anxiety, depression and quality of life.3. Gensini scores of coronary artery lesionsThe severity of coronary stenosis was evaluated on coronary angiography findings by Gensini score.4. All data were analyzed by SPSS (version13.0) using chi-square for categorical variables and independent t text for continuous variables. Continuous variables were expressed as mean±standard deviation. Categorial variables were presented as ratio or constituent ratio. Logistic regression was conducted to assess the predicted values of type d personality to anxiety and depression (OR and95%CI).Spearman correlation was used to determine the correlative relationship between type d personality and quality of life of patients with CHD. Multiple stepwise regression analysis was performed to investigate the impact of personality factors, risk factors of quality of life of CHD patients. A P value of＜0.05was used for all tests to indicate statistical significance.Results1. We eventually selected valid questionnaires370subjects, the mean age (59.40±9.38)year, and207/370subjects were male. The subjects were divided into two groups:CHD patients groups and the control groups. There were significant differences between two groups in educational level and occupation. And other demographic and clinical characteristics were no significant difference.2. Prevalence of type d personality in different groupsOf370subjects,110/296(37.2%) were classified as type d personality, which was higher than the control group(12/74). The proportion of type D personality among four groups:stable angina pectoris(38/103), unstable angina pectoris(46/122), acute myocardial infarction(26/71) and control group(12/74), has a statistically significant difference (P=0.008)3. The scores of Gensini between296CHD patients with and without type D personality had statistically significant differences (46.36±40.54VS31.56±28.27, t=16.65,P＜0.01)(P＜0.002)4. The role of type d personality in the prediction of anxiety and depressionUnivariate logistic regression analysis of each variable for prediction of the CHD patients with anxiety showed:OR=0.248(95%CI:0.136-0.452) for sex; OR=0.521(95%CI:0.360-0.756) for educational level; OR=0.286(95%CI:0.147-0.554) for smoking history; OR=0.248(95%CI:0.086-0.716) for drinking history; OR=1.785(95%CI:1.001-3.183) for hypertension history; OR=3.119(95%CI:1.759-5.531) for type d personality. And univariate logistic regression analysis of each variable for prediction of the CHD patients with depression showed:OR=0.546(95%CI:0.334-0.892) for sex; OR=0.609(95%CI:0.445-0.832) for educational level; OR=3.207(95%CI:1.934-5.318) for type d personality. Multivariate logistic regression analysis showed only type d personality had the role in the prediction of the CHD patients with anxiety and depression[OR:2.900(95%CI:1.570～5.359),OR:2.894(95%CI:1.724～4.856), P＜0.01, separately].5. The influence of type d personality on the quality of life in patients with CHDThe scores of role-physical(RP), bodily pain(BP), general health(GH), vitality(VT). social functioning(SF), role-emotional(RE), mental health(MH), Physical Component Summary(MCS), Mental Component Summary(MCS) and SF-36in patients with type D personality [(32.73±42.52),(57.68±26.93), (42.14±18.23),(47.15±22.60),(59.43±26.67),(45.91±46.22),(49.25±22.21),(53.14±19.59),(50.43±23.74),(51.78±19.85),separately] were lower than the patients with non-type D personality [(56.00±46.61),(64.62±22.27),(48.27±19.19),(61.56±20.17),(69.70±24.35),(70.79±44.53),(70.52±18.91),(63.03±18.73),(68.14±21.17),(65.59±19.00), separately](p＜0.05or0.01). Type d personality, Gensini score, anxiety and depression had negative correlation with the quality of life of patients with coronary heart disease(r=-0.322,-0.236,-0.373,-0.498, separately, p＜0.01), but educational level and sex had positive correlation with the quality of life of patients with coronary heart disease(r=0.240,0.162, separately, p＜0.01). Multiple stepwise regression analysis showed that depression, anxiety, type D personality, education level and Gensini score were entered QOL regression equation (B=-16.30,-8.00,-5.73,2.96,-0.08,p＜0.05or0.01)6. The interaction of anxiety, depression and type d personality on quality of life in CHD patients.There were no interactions among type d personality, anxiety and depression (F=0.35, p=0.79). In the group without anxiety and depression, CHD patients with type d personality had poorer quality of life than that without type d personality, but there were no significant differences in only anxiety group, only depression group and comorbidity anxiety-depression group(t=1.22,1.74,1.39, separately, p＞0.05).The total points of SF-36in only anxiety group and only depression group were significantly lower than that in the group without anxiety and depression, were significantly higher than that in comorbidity anxiety-depression group, but there were no significant differences between two groups.Conclusion1. Type D personality is associated with coronary heart disease (stable angina pectoris, unstable angina pectoris and acute myocardial infarction).2. Type D personality had impact on the extent of coronary lesion in coronary heart disease.3. Type D personality is a risk factor for patients with coronary heart disease accompanied with anxiety and depression. Type D personality increased risk of anxiety and depression in patients with coronary heart disease-2.90times and2.89times than Non-type D personality.4. Type D personality had negative correlation with the quality of life of patients with coronary heart disease, but higher levels of quality of life compared with anxiety and depression patients. Anxiety and depression may mediate the association between type D personality and poor prognosis in patients with coronary heart disease.5. Identifying type D personality and corresponding psychological behavior intervention is important in clinical practice, especially cardiovascular disease, in Chinese. |
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