Type d personality in cardiovascular psychosomatics: association with type a behavior, demoralization and depression.

Introduction: Some authors pointed out that there is the need to include personality assessment in the early identification of patients at greater risk for distress-related cardiac events. Furthermore, despite the well-known role of depression in the clinical course of cardiovascular diseases, an increasing body of literature highlights that also sub-clinical depression should be considered. Objectives of this study were: 1) to assess specific configuration of personalities (type A/D) and clinical and subclinical depression (major/minor depression, dysthymia and demoralization) among patients in cardiac rehabilitation (CR); 2) to detect overlaps among syndromes. Methods: 246 patients (72.8% males), most of whom undergone angioplasty (38.6%) or valve surgery (30.9%), were enrolled in the study. Assessment included Structured Clinical Interview for DSM–IV (SCID), Interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) and 14-item Type D scale (DS14). Results: Within the sample, DSM diagnoses occurred in 33.3% of cases, DCPR in 41.5% (demoralization=24.8%, type A=28%), and type D personality in 17.9%. Among type D patients, only 18.2% did not show other comorbid diagnoses: 63.6% also presented demoralization, 45.5% type A behavior and 50% DSM depression. On the contrary, 45.9% of demoralized, 29% of type A and 27.2% of depressed patients showed type D traits. Discussion/conclusion: The use of psychosomatic and personality assessments may contribute to a better understanding of patients’ psychological distress than traditional psychiatric nosography. Moreover, it may help to identify early specific subgroups of patients who might be at greater risk for further psychological and cardiac problems.