How are Depression and Type D Personality Associated with Outcomes in Chronic Heart Failure Patients?
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This review aims to summarize the current evidence for the association of depression and Type D personality with clinical and patient-centred outcomes and self-care in chronic heart failure (CHF) patients. Emotional distress is highly prevalent in CHF patients. In contrast to results in coronary artery disease, there is inconsistent evidence for the adverse effects of depression and Type D on prognosis. Type D and depression are important predictors of impaired health status in CHF, and patients characterised by depression or Type D report reduced self-care. Pathophysiological processes associated with depression and Type D are discussed, as they may contribute to disease progression. Future research may benefit from taking inconsistencies in and problems with assessment of depression and Type D into account, as well as focusing on the network of psychophysiological and behavioural factors to elucidate their precise role in CHF patients with depression or Type D. Furthermore, it is advised that clinicians address the observed differences in self-care behaviours to improve health in CHF patients with depression or Type D personality.
KeywordsDepression Type D personality Chronic heart failure Medical outcomes Patient reported outcomes Behavioural Biological Mechanisms Mortality Review Emotional distress Health status Self-care Psychobiological
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Conflict of Interest
Jos Widdershoven is supported by grants from Medtronic, St. Jude Medical, Inc., Boston Scientific, and Sorin, and has been reimbursed for travel/accommodations/meeting expenses for a congressional travel grant.
Dionne Kessing declares that she has no conflict of interest.
Angélique Schiffer declares that she has no conflict of interest.
Johan Denollet declares that he has no conflict of interest.
Nina Kupper is supported by a grant from the Netherlands Organization for Scientific Research (NWO), and has received payment for lectures for the RINO group, an institution for postdoctoral education.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 1.WHO. Global atlas on cardiovascular disease prevention and control, policies, strategies and interventions. 2011.Google Scholar
- 2.Camm AJ, Luscher TF, Serruys PW, editors. The ESC textbook of cardiovascular medicine. 2nd ed. New York: Oxford University Press; 2009.Google Scholar
- 10.Kupper N, Pedersen SS, Hofer S, Saner H, Oldridge N, Denollet J. Cross-cultural analysis of Type D (distressed) personality in 6222 patients with ischemic heart disease: a study from the International HeartQoL Project. Int J Cardiol. 2011. doi: 10.1016/j.ijcard.2011.10.084.
- 14.• Adams J, Kuchibhatla M, Christopher EJ, Alexander JD, Clary GL, Cuffe MS, et al. Association of depression and survival in patients with chronic heart failure over 12 years. Psychosomatics. 2012;53:339–46. This is a large depression and mortality study with one of the longest follow-up durations.PubMedCrossRefGoogle Scholar
- 20.Barlera S, Tavazzi L, Franzosi MG, Marchioli R, Raimondi E, Masson S, et al. Predictors of mortality in 6975 patients with chronic heart failure in the Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure trial: proposal for a nomogram. Circ Heart Fail. 2013;6:31–9.PubMedCrossRefGoogle Scholar
- 25.WHOQOL: measuring quality of life. Programme on mental health. World Health Organization. 1997.Google Scholar
- 30.Heo S, Moser DK, Pressler SJ, Dunbar SB, Kim J, Ounpraseuth S, et al. Dose-dependent relationship of physical and depressive symptoms with health-related quality of life in patients with heart failure. Eur J Cardiovasc Nurs. 2013. doi: 10.1177/1474515112470996.
- 33.Pedersen SS, Herrmann-Lingen C, de Jonge P, Scherer M. Type D personality is a predictor of poor emotional quality of life in primary care heart failure patients independent of depressive symptoms and New York Heart Association functional class. J Behav Med. 2010;33:72–80.PubMedCrossRefGoogle Scholar
- 41.Graven LJ, Grant JS. Coping and health-related quality of life in individuals with heart failure: an integrative review. Heart Lung J Crit Care. 2013. doi: 10.1016/j.hrtlng.2012.12.002.
- 56.Svansdottir E, Denollet J, Thorsson B, Gudnason T, Halldorsdottir S, Gudnason V, et al. Association of Type D personality with unhealthy lifestyle, and estimated risk of coronary events in the general Icelandic population. Eur J Prev Cardiol. 2013;20(2):322–30.Google Scholar
- 62.Graven LJ, Grant J. The impact of social support on depressive symptoms in individuals with heart failure: update and review. J Cardiovasc Nurs. 2012. doi: 10.1097/JCN.0b013e3182578b9d.
- 63.Maeda U, Shen BJ, Schwarz ER, Farrell KA, Mallon S. Self-efficacy mediates the associations of social support and depression with treatment adherence in heart failure patients. Int J Behav Med. 2013;20(1):88–96.Google Scholar
- 68.de Jonge P, Rosmalen JGM, Kema IP, Doornbos B, van Melle JP, Pouwer F, et al. Psychophysiological biomarkers explaining the association between depression and prognosis in coronary artery patients: a critical review of the literature. Neurosci Biobehav Rev. 2010;35:84–90.PubMedCrossRefGoogle Scholar
- 72.Hoogwegt MT, Pedersen SS, Theuns DAMJ, Kupper N. The relation between emotional distress and heart rate variability in patients with an implantable cardioverter-defibrillator Under review.Google Scholar
- 75.Einvik G, Dammen T, Namtvedt SK, Hrubos-Strom H, Randby A, Kristiansen HA, et al. Type D personality is associated with increased prevalence of ventricular arrhythmias in community-residing persons without coronary heart disease. Eur J Prev Cardiol. 2012. doi: 10.1177/2047487312462800.
- 76.Kupper N, Denollet J, Widdershoven J, Kop WJ. Type D personality is associated with low cardiovascular reactivity to acute mental stress in heart failure patients. Int J Psychophysiol. 2013. doi: 10.1016/j.ijpsycho.2013.01.011.
- 82.• Johansson P, Lesman-Leegte I, Svensson E, Voors A, van Veldhuisen DJ, Jaarsma T. Depressive symptoms and inflammation in patients hospitalized for heart failure. Am Heart J. 2011;161:1053–9. This is the largest prospective study into the association between depression and inflammation to date.PubMedCrossRefGoogle Scholar
- 84.• Mommersteeg PM, Pelle AJ, Ramakers C, Szabo BM, Denollet J, Kupper N. Type D personality and course of health status over 18 months in outpatients with heart failure: multiple mediating inflammatory biomarkers. Brain Behav Immun. 2012;26:301–10. In this study, an advanced statistical approach was conducted using a multiple mediation structural equation (SEM) growth model.PubMedCrossRefGoogle Scholar
- 96.•• Lamers F, Vogelzangs N, Merikangas KR, de Jonge P, Beekman AT, Penninx BW. Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. Mol Psychiatry. 2012. doi: 10.1038/mp.2012.144. In this study, different depression profiles are associated with different psychopathological processes, which is very important to take into account in future research.
- 101.Moritz KM, Lim GB, Wintour EM. Developmental regulation of erythropoietin and erythropoiesis. Am J Physiol Regul Integr Comp Physiol. 1997;273:R1829–44.Google Scholar
- 104.Nyklicek I, van Beugen S, Denollet J. Effects of mindfulness-based stress reduction on distressed (Type D) personality traits: a randomized controlled trial. J Behav Med. 2012. doi: 10.1007/s10865-012-9431-3.