International Journal of Behavioral Medicine

, Volume 21, Issue 2, pp 240–247

Decreased Physical Effort, Fatigue, and Mental Distress in Patients with Coronary Artery Disease: Importance of Personality-Related Differences

  • Adomas Bunevicius
  • Julija Brozaitiene
  • Margarita Staniute
  • Vaidute Gelziniene
  • Inga Duoneliene
  • Victor J. M. Pop
  • Robertas Bunevicius
  • Johan Denollet



Identification of cardio-toxic psychological symptoms in coronary artery disease (CAD) patients is important.


We examined the association of negative affectivity (NA), social inhibition (SI), and their combination in the distressed (Type D) personality with functional status, fatigue, and mental distress in CAD patients.


Following acute coronary syndrome, 690 consecutive CAD patients agreed to participate in this cross-sectional study and were evaluated for clinical characteristics, including left ventricular ejection fraction (LVEF), and for NA, SI, and Type D personality (i.e., NA and SI; DS14 scale) when they entered a cardiac rehabilitation program in Lithuania. Patient-centered outcomes included functional status (bicycle ergometer), symptoms of fatigue (Multidimensional Fatigue Inventory-20), and mental distress (Beck Depression Inventory–II and Hospital Anxiety and Depression Scale).


The reference subgroup (neither NA nor SI) included 34 % of patients; 13 % had NA only, 19 % had SI only, and 34 % had Type D profile. Type D patients had worse functional status, and Type D patients and NA-only patients had higher symptom levels of fatigue and mental distress. In multivariate regression models that included LVEF, clinical characteristics, and depressive symptoms, Type D personality was an independent predictor of decreased exercise capacity (OR = 1.77, 95 % CI 1.06–2.95, p = .03) and decreased motivation for activity (OR = 3.14, 95 % CI 1.73–5.73, p < .001). Type D, NA, and SI were also independent predictors of mental distress.


Type D personality traits independently predicted poor functional status and worse patient-centered outcomes independently from LVEF and depression. Further studies exploring personality-related differences in cardiovascular outcomes are needed.


Coronary artery disease Type D personality Outcomes Functional status 


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Copyright information

© International Society of Behavioral Medicine 2013

Authors and Affiliations

  • Adomas Bunevicius
    • 1
    • 2
  • Julija Brozaitiene
    • 1
  • Margarita Staniute
    • 1
  • Vaidute Gelziniene
    • 1
  • Inga Duoneliene
    • 1
  • Victor J. M. Pop
    • 2
  • Robertas Bunevicius
    • 1
  • Johan Denollet
    • 2
  1. 1.Behavioral Medicine InstituteLithuanian University of Health SciencesPalangaLithuania
  2. 2.CoRPS—Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands

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