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Clustering of Negative Affectivity and Social Inhibition in the Community: Prevalence of Type D Personality as a Cardiovascular Risk Marker

Hausteiner, Constanze MD; Klupsch, Daniela; Emeny, Rebecca PhD; Baumert, Jens PhD; Ladwig, Karl-Heinz MD, PhDfor the KORA Investigators

doi: 10.1097/PSY.0b013e3181cb8bae
Original Articles

Objective: To explore the prevalence of Type D personality—the combination of negative affectivity and social inhibition—in the general population and its relationship to other cardiovascular risk factors, including psychopathological symptoms. Type D personality has been identified as a prognostic risk factor for various cardiovascular disease conditions.

Methods: In a representative sample of 2698 individuals (aged 35–74 years), psychological, lifestyle, and somatic risk factors were investigated with laboratory testing, self-report measures, and a clinical interview. Type D was assessed with the German Type D Scale-14.

Results: The prevalence of Type D was 23.4% (95% confidence interval [CI], 21.2–25.6) in men and 26.9% (95% CI, 23.7–30.1) in women and, thus, in the range of classical risk factors (e.g., hypercholesterolemia). In age-adjusted analysis, Type D was associated with psychopathological symptoms, including depression and somatic symptom burden. With the exception of physical inactivity in both sexes, hypertension in women and hypercholesterolemia in men, Type D was not associated with classical cardiovascular risk factors. Multivariate analysis revealed depression, exhaustion, anxiety, and low self-rated health as associated with Type D in both sexes (odds ratios, 1.97–3.21 in men, 1.52–2.44 in women).

Conclusions: A Type D personality disposition can be found in about a quarter of the general population, which is comparable to the prevalence of classical cardiovascular risk factors. In both sexes, an independent association to Type D appeared mainly in psychopathological symptoms. Type D constitutes a relevant and independent risk marker in the community and should receive attention in clinical practice.

CAD = coronary artery disease; CHD = coronary heart disease; DS14 = Type D Scale-14; NA = negative affectivity; HADS = Hospital Anxiety and Depression Scale; KORA = Cooperative Health Research in the Augsburg Region, Germany; MI = myocardial infarction; PHQ-9 = Patient Health Questionnaire depression module; SI = social inhibition; PTSD = posttraumatic stress disorder; TNF = tumor necrosis factor.

From the Department of Psychosomatic Medicine and Psychotherapy (C.H., K.-H.L.), Technische Universität München, Munich, Germany; and Helmholtz Zentrum München (D.K., R.E., J.B., K.-H.L.), German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany.

Address correspondence and reprint requests to: K. H. Ladwig, Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany. E-mail:

Received for publication June 12, 2008; revision received October 6, 2009.

The KORA research platform was initiated and financed by the Helmholtz Zentrum München, German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research and by the State of Bavaria.

None of the authors has any financial interest in the subject matter or materials discussed in the manuscript.

The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Copyright © 2010 by American Psychosomatic Society
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