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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Available from: Jacob De Voogd, Oct 03, 2015
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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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    • "Poor outcomes may be exacerbated by the presence of cooccurring anxiety, which is independently associated with recurrent cardiac events and mortality [83] and which has been linked with poor response to treatment for depression [84–86]. Other patients who appear to be at particularly high risk for poor outcomes include those with prominent anhedonia (the inability to experience pleasure) [87–89] and those with type D personality (a personality structure characterized by negative affectivity and social inhibition) [19], though the latter association is controversial [90]. "
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    ABSTRACT: In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors-including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities-may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population.
    Cardiovascular Psychiatry and Neurology 04/2013; 2013:695925. DOI:10.1155/2013/695925
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