Study Of Type D-Adverse Cardiac Prognosis In Patients With Coronary Heart Disease

Objective:To examine the validity and reliability of the Type D personality Scale(DS14) in both a coronary heart disease(CHD) sample and a normative sample.To explore the possible mechanisms of the adverse prognosis of CHD induced by Type D personality,and the following studies were included:the clinical and epidemiological characteristics of Type D personality in patients with CHD;the interactions between Type D and,①psychological factors,②classical risk factors for predicting the rate of clustering of CHD risk factors;the hypothesis of Type D personality-adverse prognosis in CHD patients using structural equation modeling(SEM).Methods:The study included 187 patients with CHD and 453 normative subjects,and they all filled out the following scales: Demographics questionnaire,DS14,Affect intensity scale(AIS), Emotional expressivity scale(EES),Symptom checklist-90(SCL-90), Beck Depression Inventory(BDI),and Type A personality scales (TAS-C).CHD patients were administered clinical examination, including family history of CHD,body mass index(BMI),heart rate, blood pressure,serum total cholesterol(TC),triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,fasting glucose,plasma homocysteine,C-reactive protein(CRP),and selective coronary angiography. The reliability analysis of DS14 included the Cronbach's alpha coefficients,the mean inter-item correlations,and the test-retest reliability. The validity analysis of DS14 included construct validity(confirmatory factor analyses are performed for two samples) and concurrent validity. The hierarchical multiple regression analyses were performed to examine the predictability of the DS14 for the rate of clustering of CHD risk factors.The analyses of SEM were used to investigate the possible mechanisms of the adverse prognosis induced by Type D personality in CHD patients.Results:(1) The Cronbach's alpha coefficients of the two subscales of DS 14 ranged from 0.68～0.89,the mean inter-item correlations ranged from 0.28～0.52,the test-retest coefficients was 0.79 for NA and 0.82 for SI in the normative sample.A confirmatory factor analysis provided a good fit for a two-factor model in two samples(with X~2/df＜5;CFI,IFI,GFI≥0.90;RMSEA≤0.08).The correlation coefficients of the two subscales(NA and SI) of DS14 with the total score of DS14 ranged from 0.58～0.95(p＜0.01).NA was significantly correlated with the negative affect intensity of AIS(γ=0.22～0.29,P＜0.01),whereas it was not significantly correlated with the positive affect intensity of AIS(p＞0.01). SI were significantly correlated with the emotional expressivity of EES(γ=-0.26～-0.28,p＜0.01).Both NA and SI were significantly correlated with the factors of SCL-90 as followings:somatization,depression, anxiety,phobic anxiety,and interpersonal relation(γ=0.18～0.46,P＜0.05～0.01);NA were positively correlated with the hostility factor of SCL-90(γ=0.23～0.38,p＜0.05～0.01) whereas SI was not significantly correlated with it(p＞0.05).Both NA and SI were positively correlated with the three factors of BDI(γ=0.25～0.49,P＜0.01).None of the correlation between DS 14(NA and SI) and the Competition and Hostility subscale of the TAS-C showed statistically significance for both samples excepting the moderate correlations between Time Hurry subscale of the TAS-C with SI in CHD sample(γ=0.18,p＜0.05),and with NA in normative sample(γ=0.18,p＜0.05).(2) The percentage of the family history of CHD,smoking,fasting glucose,and CRP in patients with Type D personality was higher than the ones in patients without Type D personality(p＜0.05).None of the two-way interactions between DS14(NA and SI,respectively) and depression,anxiety,anger,affect intensity,and emotional expressivity, showed significant predictive effects for increased rate of clustering of CHD risk factors.The interactions between SI and TC predicted increased the rate of clustering of CHD risk factors(β=1.81,p＜0.05); while the interactions between SI and smoking predicted decreased the rate of clustering of CHD risk factors(β=-1.03,p＜0.05).Elevated levels of SI predicted increased severity of coronary artery lesions in CHD patients(β=0.28,p＜0.05);A comparison among the baseline model and the three competitive models using SEM showed that the model-3 was the optimal model,with better fit indexes than the others (X~2/df=1.682,RMSEA=0.071,CFI=0.909,IFI=0.912,GFI=0.908), and with the most parsimonious path(p＜0.01).Conclusion:(1) The Chinese version of the DS14 demonstrated satisfactory reliability and validity in both CHD sample and normative sample,and can be considered as an appropriate tool for assessing Type D personality in Chinese sample.(2) In CHD patients,the interaction between SI and TC exhibited increased predictive power for the rate of CHD risks clustering while the interaction between SI and smoking exhibited the decreased predictive power;the elevated levels of SI predicted increased severity of coronary artery lesions.(3) Analysis using SEM showed that Type D personality predicted adverse prognosis in CHD patients via the two mediating pathways:one is the negative affects, and the other is the physiological risk factors.Furthermore,the negative affects exert indirect influence on adverse prognosis through the physiological mechanism.