A one-year prospective investigation of Type D personality and self-reported physical health
Summary (3 min read)
Introduction
- Type D personality is characterised by the interaction of negative affectivity (NA) and social inhibition (SI) (Denollet, 2000).
- Existing research has established Type D as a predictor of poorer physical health, including increased somatic symptoms, general health complaints and immune related illnesses (Condén, Leppert, Ekselius, & Åslund, 2013; Stevenson & Williams, 2014; Williams & Wingate, 2012).
- Prospective examination is required to further understand the mechanisms underpinning the now well-documented relationship.
- It has also been criticised for not accurately representing the interactive effect of SI and NA, and typologies generated from two continuous variables in this way, have been criticised (Coyne et al., 2011).
- In light of the current Type D literature it is hypothesised that: i) Type D personality will be linked to increased reporting of physical symptoms ii) Stress, anxiety and depression will play a mediating role in the relationships between Type D and physical symptoms iii).
Participants and Procedure
- An online questionnaire based study was conducted with 535 healthy individuals (18-65 years).
- Participants were recruited online via social media platforms, student participation pools and via email within the researcher’s institution.
- Exclusion criteria stipulated that individuals with a history of psychological health issues, known chronic or immune related illnesses, and diagnosed sleep disorders should refrain from taking part (including those diagnosed in the year between baseline and follow up).
- Informed consent was gained online via a multiple-choice selection and an option to provide an email address (to be contacted for the follow-up) was given at baseline.
Type D scale- 14
- The CHIPS is a list of 33 common physical symptoms (e.g. ‘back pain’; ‘diarrhoea’) rated on a 5-point Likert scale ranging from (0) ‘not been bothered by the problem’ to (4) ‘extremely bothered by the problem’ (during the previous 2 weeks).
- The total score is the sum of the responses on the 33 items (possible score range 0-132).
- Each cluster was considered individually within the current study, with the exception of haemorrhagic symptoms, given the low internal consistency of this factor (Allen et al., 2017).
Perceived Stress Scale
- Subjective stress was measured using the Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983).
- The PSS is a 10-item scale (α= 0.85) that assesses how respondents have experienced and dealt with stressful situations in the past month.
- Response choices are on a 5-point Likert scale and range from (0) “never” to (4) “very often” and a number of items are reverse scored.
- Scores are calculated by summing the 10 item ratings, and range from 0 to 40, with higher scores indicating higher levels of perceived stress.
Hospital Anxiety and Depression Scale
- Levels of anxiety and depression were examined using the Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983).
- The HADS comprises 14 items with answers coded between 0 and 3 (positively worded items are reversed scored).
- 7 items measure anxiety (α= 0.83) and 7 items measure depression (α=0.82), a separate score is derived for each scale with higher scores indicating higher levels of anxiety and depression, respectively.
Social Readjustment Rating Scale
- The Social Readjustment Rating Scale (SRRS; Holmes & Rahe, 1967) assessed the number of stressful life events experienced over the past year.
- The scale comprises 42 items weighted by impact (e.g. 100 points for death of a spouse, 11 points for minor violations of the law).
- The sum of the weighted items is calculated to give a total score for each participant.
Retrospective Health Questions
- A number of retrospective health questions were included in the follow-up.
- Example responses were categorical including scales of frequency (e.g. ‘never’ to ‘often’) and perceptions of quality (e.g. ‘very good’ to ‘very poor’).
Treatment of data
- At baseline, all 535 participants completed the DS14, CHIPS and HADS; however, 11 participants did not complete the PSS.
- The remainder of the participants’ data was included in analyses.
- Mediation analyses using the PROCESS macro for SPSS (Hayes & Preacher, 2013) were then used to examine if perceived stress, anxiety, depression, or stressful life events mediated the relationship between Type D and physical symptoms at follow up.
- The indirect effect shows the indirect relationship between Type D personality and CHIPS scores via each mediator (i.e. path a*b).
Temporal stability
- Pearson’s correlations analyses demonstrated strong correlations between baseline and follow-up scores; (SI; r= .857**, NA; r=.837**, Type D; r=.828**) indicating the DS14 exhibited excellent test-retest reliability, and stability over the year period.
- For the purpose of the current study Type D scores and categorisation determined at baseline were used for the remaining analyses.
- Test-retest correlations of SI, NA, Type D, anxiety, depression, perceived stress and total physical symptoms between baseline and follow up can be observed in table 2. TABLE 2 HERE.
Anxiety, depression and stress
- As shown in Table 3, Type D participants reported significantly greater levels of anxiety, depression, and perceived stress at baseline (N=535) compared with non-Type D participants.
- These findings were supported by Pearson’s correlational analyses, which indicated significant positive correlations between SI, NA, and total Type D (NA × SI) scores with anxiety, depression, and perceived stress at baseline.
Physical symptoms
- Type D participants reported significantly more physical symptoms than non-Type D participants at baseline across all symptom clusters.
- Pearson’s correlational analyses indicated significant positive correlations between SI scores (at baseline) and physical symptoms, with the exception of gastrointestinal symptoms.
Mediating pathways
- All symptom clusters at baseline significantly predicted the respective cluster at follow up (all p values ≤ .001).
- As shown in table 4, Type D personality was found to be a significant predictor of metabolic, cold/flu, and gastrointestinal symptoms (path c) one year later when baseline scores were controlled (total effect).
- The indirect effect (a*b) of Type D on metabolic symptoms (whereby the bootstrapped confidence interval for the indirect effect did not include 0) via both anxiety (BaC CI [.0017, .0070]) and stressful life events (BaC CI [.0001, .0020]) was significant.
- The direct effect (path c’) became nonsignificant when considered through the anxiety pathway (p=.130) indicating full mediation, and remained significant through the stressful life events pathway (p=.015) indicating partial mediation.
- No mediating effects of, depression, anxiety and perceived stress were observed.
Perceived general health
- Ds were more likely to rate their current general health as ‘fair’, their health over the past year as ‘not very good’, and be dissatisfied’ with their current health status.
- Ds were also less likely to provide ratings of ‘very good’ for these questions.
- There were no differences in how participants compared their current health status to one year earlier (X² (4) =7.299, p=.099).
Frequency of illnesses
- Ds were more likely to have felt unwell or run-down ‘frequently’ and were less likely to have ‘never’ suffered a non-serious illness or taken time off work.
- Type D category did not relate to the frequency of participants suffering an illness requiring prescription medication; X² (4) =2.749, p=.65.
Healthcare utilisation
- Type D was significantly associated with seeking medical information (without visiting a medical professional) (X² (4) =15.444, p=.003).
- Type D individuals were more likely to have ‘never’, or ‘once or twice’ sought medical information.
- (See Table S2 for responses to each retrospective health question for Type D and non-Type Ds).
Discussion
- The current study is the largest to date to i) consider the relationship between Type D and physical symptoms in the general population, and ii) investigate differences in aspects of retrospective health and healthcare utilization in relation to Type D status.
- This also indicates that the relationships between Type D and physical symptoms exist across both the dichotomous and dimensional conceptualisations of Type D. However, in the regression models controlling for SI and NA, Type D was only found to be predictive of total symptoms, sympathetic/cardiac, muscular, metabolic, vasovagal, and headache symptoms.
- This should also be considered when interpreting these findings, particularly with respect to the predictive utility of the Type D construct.
- Further, as stress is associated with various health outcomes, it is likely this theory could explain the observed associations with other symptom clusters.
- In summary, the current study has provided evidence that Type D personality may predict particular symptoms which are often associated with heightened stress.
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Cites background or methods from "A one-year prospective investigatio..."
...Instead, they recommend conceptualising Type D as a dimensional construct, an approach that has been used in a number of recent studies (e.g. Allen et al., 2019; Smith et al., 2018b; Stevenson & Williams, 2014)....
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...Recently a study by Allen et al. (2019) also found that the NA SI interaction did predict symptoms after controlling for the influence of the NA and SI components, but that this effect was marginal, suggesting that the effects may be primarily driven by NA....
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...Recently, Allen et al. (2019) identified higher levels of depression, anxiety and stress in Type D individuals, and Smith et al. (2018a) showed that the relationship between Type D and physical symptoms can be explained by subjective stress and anxiety....
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...Levels of anxiety and depression were examined using the Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983)....
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...The Social Readjustment Rating Scale (SRRS; Holmes & Rahe, 1967) assessed the number of stressful life events experienced over the past year....
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"A one-year prospective investigatio..." refers methods in this paper
...…methodology still maintains substantial merit and is regarded as a reliable technique for assessing perceived health and physical symptoms (Cella et al., 2010) Furthermore, with regards to the symptom perception hypothesis (Watson & Pennebaker,1989), it must also be considered that…...
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