Explaining heterogeneity in the predictive value of Type D personality for cardiac events and mortality

AbstractBackgroundType D personality has been associated with adverse outcomes in patients with coronary artery disease (CAD). However, large heterogeneity exists between Type D studies, including some studies reporting null-findings.ObjectivesThe aim of this study was to examine i) choice of endpoint and ii) age as two study characteristics that may partly explain this large heterogeneity in the Type D associated prognostic effect.MethodsWe used four existing data cohorts of 1503 CAD patients (89% male, mean age=57.2±9.1) with baseline measures of Type D and endpoints >5years follow-up: major adverse cardiac events (MACE), cardiac death/MI, and non-cardiac death. Patients were classified in 4 age categories: <50y, 50–59y, 60–69y and ≥70y. Multiple logistic regression models included age, sex, and clinical covariates.ResultsAt follow-up, there were 295 events, including 116 cardiac death/MI, and 37 non-cardiac deaths. Both continuous and categorical measures of Type D predicted adverse events. Type D was independently associated with MACE (OR=1.82; 95%CI 1.33–2.50) and cardiac death/MI (OR=2.49; 95%CI 1.55–3.99). However, Type D was not associated with non-cardiac death (OR=1.23; 95%CI 0.57–2.69). Regarding age, Type D consistently predicted MACE in the lower age groups (all ORs≥2.20, all ps≤.004), but not in patients aged ≥70y (OR=1.43, p=.57).ConclusionsChoice of endpoint and age modulated the risk conferred by Type D personality. Type D was associated with an increased risk of cardiac events, but not with non-cardiac death, or with events in patients aged ≥70y. Research on psychosocial risk in CAD should account for different sources of heterogeneity in study characteristics

A review and conceptual model of the association of Type D personality with suicide risk

The role of personality as distal risk factor for suicidal thoughts and behavior is still unclear. This review aims to propose two conceptual models that explain the psychological plausibility of Type D personality as distal risk factor and contributor to the transition from general to suicide distress. To support this aim, we performed a systematic review of existing studies on the association between Type D personality and suicidal distress. A systematic search yielded eight studies that reported on Type D personality and suicidal distress. Type D personality was robustly associated with suicidal thoughts and behaviors, across populations and countries. Type D was related to the level/frequency of suicidal ideation in seven studies, and suicide attempt in two studies. Our first theoretical model identifies intra-psychic (depression, alcohol misuse, posttraumatic stress) and interpersonal (low belonging, social isolation, lack of support) vulnerabilities of individuals with Type D that may fuel the development of suicidal thoughts and behaviors. Type D by itself will not account for why people become suicidal, but our second theoretical model suggests that the avoidant-passive tendencies of Type D individuals may result in persistent problem-solving deficits, and, eventually, feelings of entrapment that may contribute to the desire to escape from pain. We conclude that empirical evidence supports the hypothesized link between Type D personality, and suicidal thoughts and behaviors. Our conceptual models – albeit often supported by indirect evidence - further substantiate the plausibility of this link, and offer concrete guidance for future studies. Primarily, more longitudinal research is necessary

The association of positive psychological factors with work ability one year after myocardial infarction

Background Positive psychological factors like optimism, resilience and self-efficacy may facilitate successful adjustment after hospitalization for myocardial infarction (MI) and treatment with percutaneous coronary intervention (PCI), including return to work. Objective To examine whether positive psychological factors (optimism, resilience, and self-efficacy) predict work ability one year after PCI for MI. Methods Patients treated with PCI and with paid employment were included and completed questionnaires at 1 and 12 months post PCI discharge. Patients filled out the LOT-R optimism scale, the dispositional resilience scale (DRS-15), and the Cardiac Self-efficacy Scale (CSE) at 1-month, and the work ability index (WAI) at 1-year follow-up. Hierarchical linear regression models were used. Sensitivity analysis was performed for the acuteness of the PCI treatment. Results In total, 323 patients (14% women; mean age 59.5 ± 6.8y; 74% acute PCI) completed both surveys. At 1-year follow-up, resilience (β = 0.152, p = 0.009) and cardiac self-efficacy (β = 0.273, p < 0.001), but not optimism (β = 0.044, p = 0.432), were associated with work ability at 1 year, irrespective of cardiac history, or sex. Age (β = −0.158, p = 0.002) and comorbidity index (β = −0.104, p = 0.044) were significant covariates. Sensitivity analysis revealed that in patients receiving an elective Conclusion Resilience and cardiac self-efficacy were independently associated with work ability 1 year post PCI, whereas optimism was not. Identification and support of patients low in cardiac self-efficacy and resilience may contribute to improved restoration of work ability post PCI

Investigating a TELEmedicine solution to improve MEDication adherence in chronic Heart Failure (TELEMED-HF):Study protocol for a randomized controlled trial

BACKGROUND: Frequent rehospitalisations and poorer survival chances in heart failure (HF) patients may partly be explained by poor medication adherence. There are multiple medication-related reasons for suboptimal adherence, but psychological reasons may also be important. A novel TELEmonitoring device may improve MEDication adherence in HF patients (TELEMED-HF). TELEMED-HF is a randomized, controlled clinical intervention trial designed to examine (1) the efficacy and cost-efficiency of an electronic medication adherence support system in improving and monitoring HF patients' medication adherence; (2) the effect of medication adherence on hospitalizations and health care consumption; as well as on (3) clinical characteristics, and Quality of Life (QoL); and (4) clinical, sociodemographic, and psychological determinants of medication adherence. METHODS/DESIGN: Consecutive patients with chronic, systolic HF presenting to the outpatient clinic of the TweeSteden Hospital, The Netherlands, will be approached for study participation and randomly assigned (1:1) following blocked randomization procedures to the intervention (n = 200) or usual care arm (n = 200). Patients in the intervention arm use the medication support device for six months in addition to usual care. Post-intervention, patients return to usual care only and all patients participate in four follow-up occasions over 12 months. Primary endpoints comprise objective and subjective medication adherence, healthcare consumption, number of hospitalizations, and cost-effectiveness. Secondary endpoints include disease severity, physical functioning, and QoL. DISCUSSION: The TELEMED-HF study will provide us a comprehensive understanding of medication adherence in HF patients, and will show whether telemonitoring is effective and cost-efficient in improving adherence and preventing hospitalization in HF patients. TRIAL REGISTRATION NUMBER: NCT01347528

Social inhibition and approach-avoidance tendencies towards facial expressions

This study examined how different manifestations of social inhibition (behavioral inhibition, interpersonal sensitivity, and social withdrawal) are related to automatic approach/avoidance behaviors in a social context. A sample of 115 undergraduate students and 20 adults from the general population (Mage = 24.8, SD = 11.4; 75% women) were assessed with the 15-item Social Inhibition Questionnaire (SIQ15). During a facial expression version of the Approach-Avoidance Task (AAT), participants reacted to images of emotional facial expressions (angry, happy, and neutral) or to control images (neutral objects) in portrait or landscape formats by pulling a joystick towards themselves (approach) or pushing it away from themselves (avoidance). The superordinate social inhibition construct was not associated with approach/avoidance tendencies. However, individuals high in the interpersonal sensitivity domain of social inhibition showed stronger approach tendencies for happy and neutral facial expressions compared to neutral objects, which may relate to their focus on seeking the approval of others

Patient and healthcare professionals’ perceived barriers and facilitators to the implementation of psychosocial screening in cardiac practice:A delphi study

BackgroundPsychosocial risk factors contribute to the incidence and progression of coronary heart disease (CHD). Psychosocial screening may identify individuals who are at risk and aid them with getting appropriate care. To successfully implement psychosocial screening in the cardiology practice, the current study aims to identify key barriers and facilitators to its implementation and evaluate their perceived importance among health care professionals (HCPs) and patients.MethodsWe took a modified 3-round Delphi study approach to gain insight into key determinants that could either impede or ease implementation. Round 1 gathered data from HCPs (n = 9; cardiologists, medical psychologists, cardiac nurses) and CHD patients (n = 21), which we transcribed verbatim, coded, and processed into unique determinants. In rounds 2 and 3, participants were asked to select the most relevant determinants and rank them based on importance. Subsequently, determinants were classified by implementation level.ResultsPatients were generally more positive towards screening. HCP barriers included time-constraints, disruption of primary activities, and limited knowledge on psychosocial risk and screening, while patient barriers were commonly related to accessibility and patient characteristics (e.g., health literacy, motivation). Facilitators of both groups mainly pertained to the use of the screener and follow-up care, such as increasing the accessibility and the benefits of the screener.ConclusionBarriers may be targeted by enhancing the effects of the facilitators. Increasing the accessibility to the screener and interventions, improving information provision, and appointing a contact person to oversee the screening process may ease the screening and care process for both patients and HCPs.<br/