International Journal of Behavioral Medicine

, Volume 20, Issue 3, pp 425-433

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Association of Psychiatric History and Type D Personality with Symptoms of Anxiety, Depression, and Health Status Prior to ICD Implantation

  • Annemieke H. StarrenburgAffiliated withDepartment of Clinical Psychology, Medisch Spectrum Twente Email author 
  • , Karin KraaierAffiliated withDepartment of Cardiology, Thorax Center Twente, Medisch Spectrum Twente
  • , Susanne S. PedersenAffiliated withCoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University
  • , Moniek van HoutAffiliated withDepartment of Clinical Psychology, Medisch Spectrum Twente
  • , Marcoen ScholtenAffiliated withDepartment of Cardiology, Thorax Center Twente, Medisch Spectrum Twente
  • , Job van der PalenAffiliated withDepartment of Research Methodology, Measurement and Data Analysis, University of Twente



Personality factors and psychiatric history may help explain individual differences in risk of psychological morbidity and poor health outcomes in patients with an implantable cardioverter defibrillator (ICD).


We examined associations between previous anxiety and depressive disorder, type D personality, anxiety or depressive symptoms, and health status in ICD patients prior to ICD implantation.


Patients (N = 278; 83 % men; mean age = 62.2 years ±11) receiving a first ICD from September 2007 through April 2010 at the Medisch Spectrum Twente, The Netherlands completed validated questionnaires before implantation assessing type D personality (14-item Type D Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), and health status (36-item Short Form Health Survey). History of anxiety or depressive disorder was assessed with the Mini International Neuropsychiatric Interview structural interview.


Previous anxiety or depressive disorder was prevalent in 8 and 19 % of patients, respectively. Type D personality was present in 21 %, depressive symptoms in 15 %, and anxiety in 24 %. In adjusted analyses, type D personality was a dominant correlate of previous depressive disorder (odds ratio (OR) 6.2, p < 0.001) and previous anxiety disorder (OR 3.9, p = 0.004). Type D personality (OR 4.0, p < 0.001), age (OR 1.03, p = 0.043), and gender (OR 2.5, p = 0.013) were associated with anxiety symptoms at baseline. Type D personality (OR 5.9. p < 0.001) was also associated with increased depressive symptoms at baseline. Heart failure and type D personality were related to poorer health status.


In ICD patients, prior to ICD implantation, a previous anxiety or depressive disorder, type D personality, and anxiety and depressive symptoms were associated with poorer health status. Type D personality was also independently associated with increased anxiety and depression symptoms.


Anxiety Depression Health status ICD Type D personality