Are we witnessing the decline effect in the Type D personality literature? What can be learned?

Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, USA. Electronic address: .
Journal of psychosomatic research (Impact Factor: 2.74). 12/2012; 73(6):401-407. DOI: 10.1016/j.jpsychores.2012.09.016
Source: PubMed


After an unbroken series of positive, but underpowered studies seemed to demonstrate Type D personality predicting mortality in cardiovascular disease patients, initial claims now appear at least exaggerated and probably false. Larger studies with consistently null findings are accumulating. Conceptual, methodological, and statistical issues can be raised concerning the construction of Type D personality as a categorical variable, whether Type D is sufficiently distinct from other negative affect variables, and if it could be plausibly assumed to predict mortality independent of depressive symptoms and known biomedical factors, including disease severity. The existing literature concerning negative affect and health suggests a low likelihood of discovering a new negative affect variable that independently predicts mortality better than its many rivals. The apparent decline effect in the Type D literature is discussed in terms of the need to reduce the persistence of false positive findings in the psychosomatic medicine literature, even while preserving a context allowing risk-taking and discovery. Recommendations include greater transparency concerning research design and analytic strategy; insistence on replication with larger samples before accepting "discoveries" from small samples; reduced confirmatory bias; and availability of all relevant data. Such changes would take time to implement, face practical difficulties, and run counter to established practices. An interim solution is for readers to maintain a sense of pre-discovery probabilities, to be sensitized to the pervasiveness of the decline effect, and to be skeptical of claims based on findings reaching significance in small-scale studies that have not been independently replicated.

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    • "Type D Personality seems to increase the risk of Coronary Artery Disease (CAD) (Beutel, Wiltink, Till et al., 2012) and to worsen cardiac outcome (Denollet & Conraads, 2011). However, the initial enthusiasm about the impact of Type D Personality on the CAD prognosis declined in more recent years (Coyne & de Voogd, 2012), and the debate on a possible overlap between Type D Personality and depression is still open. Indeed, though some studies underline how " Type D Personality refers to a chronic, more covert form of distress that is distinct from depression " (Denollet & Conraads, 2011; Denollet & Pedersen, 2008; Denollet, de Jonge, Kuyper et al., 2009; Denollet, Schiffer & Spek, 2010; Pelle, Denollet, Zwisler & Pedersen, 2009), others point out that Type D Personality, particularly the NA dimension, has been associated with a history of depressive disorder (Starrenburg, Kraaier, Pedersen, van Hout, Scholten & van der Palen, 2013) or presence of depressive symptoms (Bergvik, "
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    ABSTRACT: It has been suggested that Type D Personality is a risk factor for acute coronary syndrome (ACS) and the DS14 has been developed for its assessment. However, some of the items on the DS14 seem to evaluate depressive symptoms rather than personality features. Therefore, the present study aims to verify whether an overlap exists between the constructs of Type D Personality and depression. Three-hundred-and-four consecutive patients who were both presenting their first ACS and had no history of major depression completed the Hospital Anxiety and Depression Scale (HADS) and the DS14 to assess Type D personality at baseline and have been re-evaluated at 1, 2, 4, 6, 9 and 12-month follow-ups. Out of 304 subjects (80.6% males), 40 were diagnosed as depressed. An exploratory factor analysis of HADS and the DS14 in the second month revealed that four out of seven items on the depressive subscale of HADS (HADS-D) and six out of seven items on the Negative Affectivity (NA) subscale of the DS14 segregated on the same factor. Results were verified by a Partial Confirmatory Factor Analysis performed at the twelfth month when most of the patients achieved complete remission from the depressive episode. Temporal stability was poor for NA and Type D Personality and these construct co-vary with HADS-D over time. Our data suggests that NA and depression are overlapping constructs, supporting the idea that the DS14 measures depressed features, rather than a personality disposition. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd.
    Scandinavian Journal of Psychology 09/2015; DOI:10.1111/sjop.12244 · 1.29 Impact Factor
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    • "In addition, several studies reported on the prognostic value of depressive symptoms on mortality in HF patients [14] [15]. Coyne and de Voogd [11] questioned whether type D personality is sufficiently distinct from other negative affect variables, especially since depressive symptoms highly correlate with the NA component of type D personality . Smith [12] reported problems on partialing depression in type D personality analyses. "
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    ABSTRACT: Given the debate around limitations and controversies in type D personality studies, we aimed to evaluate the prognostic value of 'synergistically' analyzed type D personality (interaction z-scores negative affectivity NA, and social inhibition SI) on 10-year mortality and on 10-year subjective health status in percutaneous coronary intervention (PCI) patients. This prospective study comprised a cohort of 1190 consecutive patients who underwent PCI between October 2001 and September 2002 (73% male, mean age: 62years, range [27-90]years). At baseline, type D personality (DS14), and depression/anxiety (HADS) were assessed. Primary endpoint was 10year all-cause mortality; secondary endpoint was 10-year subjective health status (SF-36). After a median follow-up of 10.3years (IQR 9.8-10.8), 293 deaths of any cause (24.6%) were recorded. After adjustment for significant baseline characteristics, personality categories approached and dichotomously approached type D personality were associated with 10-year mortality, p<.05. Synergistically approached type D personality was not associated with all-cause mortality or subjective health status at 10years. In survivors, higher NA was associated with lower subjective health status. Type D was not associated with mortality after adjusting for continuous depression and anxiety in all approaches. Synergistically analyzed type D was not associated with 10-year all-cause mortality in PCI patients whereas dichotomous type D was. However, after adjustment for depression most of the findings had disappeared. Depression played an important role in this. Type D was not associated with 10-year subjective health status. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of psychosomatic research 06/2015; 79(3). DOI:10.1016/j.jpsychores.2015.05.014 · 2.74 Impact Factor
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    • "It is possible that patients who refused participation were more likely to be depressed and anxious, and more likely to have a Type D personality [29]. Furthermore, the Type D construct as a prognostic indicator for cardiovascular outcomes is the subject of some debate [30]. Initially published studies have reported higher odds ratios for Type D personality as a predictor of mortality and cardiovascular outcomes compared with more recent studies in which more events were reported, which could possibly imply an overestimation of the effect of Type D personality on mortality or cardiovascular events [5]. "
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    ABSTRACT: Recent guidelines on cardiovascular disease prevention advocate the importance of psychological risk factors, as they contribute to the risk of developing cardiovascular disease. However, most previous research on psychological distress and cardiovascular factors has focused on selected populations with cardiovascular disease. The primary aim was to determine the prevalence of depression, anxiety, and Type D personality in elderly primary care patients with hypertension. Secondary aim was to examine the relation between elevated systolic blood pressure and depression, anxiety, and Type D personality. A cross-sectional study in primary care practices located in the south of the Netherlands. Primary care hypertension patients (N = 605), between 60 and 85 years (45 % men, mean age = 70 ± 6.6), were recruited for this study. All patients underwent a structured interview including validated self-report questionnaires to assess depression (PHQ-9), anxiety (GAD-7), and Type D personality (DS14) as well as blood pressure assessment. Depression was prevalent in 5 %, anxiety in 5 %, and Type D personality in 8 %. None of the distress measures were associated with elevated systolic blood pressure of >160 mmHg (all p-values >0.05). This study showed no relation between psychological distress and elevated systolic blood pressure in elderly primary care patients with hypertension.
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 12/2013; 22(2). DOI:10.1007/s12471-013-0502-z · 1.84 Impact Factor
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