Skip to main content
Log in

Personality and coronary heart disease: The type-D scale-16 (DS16)

  • Published:
Annals of Behavioral Medicine

Abstract

Clinical diagnoses of depression, self-reported negative emotions, and personality traits have been associated with both the development and progression of coronary heart disease (CHD). This article focusses on negative affectivity (the tendency to experience negative emotions) and social inhibition (the tendency to inhibit self-expression in social interaction) in CHD patients. Two independent samples of patients with CHD were included in this study. Both empirical and internal-structural criteria were used to devise a brief self-report measure comprising an eight-item negative affectivity and an eight-item social inhibition scale in Sample 1 (N=400). These scales were internally consistent (α=.89 and .82), stable over time (three-month test-retest reliability=.78 and .87) and were validated against standard personality scales. CHD patients with a “distressed” personality (Type-D) report high levels of negative affectivity and social inhibition; accordingly, this self-report measure was termed Type-D Scale-16 (DS16). Previous research showed that Type-D was associated with cardiac events and incidence of cancer in patients with CHD. Type-D as measured by the DS16 was associated with depressive affect and symptoms, stress, poor self-esteem, dissatisfaction with life, and low positive affect in Sample 2 (N=100) of the present article. It is concluded that research on CHD should focus on affective disorder, specific negative emotions, and global personality traits, and that the DS16 is a practical, sound research tool that can be used to assess Type-D.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Friedman HS (ed):Hostility, Coping, and Health. Washington, DC: American Psychological Association, 1992.

    Google Scholar 

  2. Friedman HS, Tucker JS, Reise SP: Personality dimensions and measures potentially relevant to health: A focus on hostility.Annals of Behavioral Medicine. 1995,17: 245–253.

    Article  Google Scholar 

  3. Adler N, Matthews K: Health psychology: Why do some people get sick and some stay well?Annual Review of Psychology. 1994,45:: 229–259.

    Article  PubMed  CAS  Google Scholar 

  4. Dimsdale JE: A perspective on Type A behavior and coronary disease.New England Journal of Medicine. 1988,318: 110–112.

    PubMed  CAS  Google Scholar 

  5. Moser DK, Dracup K: Is anxiety early after myocardial infarction associated with subsequent ischemic and arrhythmic events?Psychosomatic Medicine. 1996,58: 395–401.

    PubMed  CAS  Google Scholar 

  6. Kawachi I, Sparrow D, Vokonas P, Weiss ST: Symptoms of anxiety and risk of coronary heart disease: The Normative Aging Study.Circulation. 1994,90: 2225–2229.

    PubMed  CAS  Google Scholar 

  7. Mittleman MA, Maclure M, Sherwood JB, et al: Triggering of acute myocardial infarction onset by episodes of anger.Circulation. 1995,92: 1720–1725.

    PubMed  CAS  Google Scholar 

  8. Kawachi I, Sparrow D, Spiro III A, Vokonas P, Weiss ST: A prospective study of anger and coronary heart disease: The Normative Aging Study.Circulation. 1996,94: 2090–2095.

    PubMed  CAS  Google Scholar 

  9. Barefoot JC, Schroll M: Symptoms of depression, acute myocardial infarction, and total mortality in a community sample.Circulation. 1996,93: 1976–1980.

    PubMed  CAS  Google Scholar 

  10. Kubzansky LD, Kawachi I, Spiro III A, et al: Is worrying bad for your heart? A prospective study of worry and coronary heart disease in the Normative Aging Study.Circulation. 1997,95: 818–824.

    PubMed  CAS  Google Scholar 

  11. Frasure-Smith N: In-hospital symptoms of psychological stress as predictors of long-term outcome after myocardial infarction in men.American Journal of Cardiology. 1991,67: 121–127.

    Article  PubMed  CAS  Google Scholar 

  12. Kop WJ, Appels AP, Mendes de Leon CF, de Swart HB, Bär FW: Vital exhaustion predicts new cardiac events after successful coronary angioplasty.Psychosomatic Medicine. 1994,56: 281–287.

    PubMed  CAS  Google Scholar 

  13. Everson SA, Goldberg DE, Kaplan GA, et al: Hopelessness and risk of mortality and incidence of myocardial infarction and cancer.Psychosomatic Medicine. 1996,58: 113–121.

    PubMed  CAS  Google Scholar 

  14. Murphy JM, Monson RR, Oliver DC, Sobol AM, Leighton AH: Affective disorders and mortality: A general population study.Archives of General Psychiatry. 1987,44: 473–480.

    PubMed  CAS  Google Scholar 

  15. Carney RM, Rich MW, Freedland KE, et al: Major depressive disorder predicts cardiac events in patients with coronary artery disease.Psychosomatic Medicine. 1988,50: 627–633.

    PubMed  CAS  Google Scholar 

  16. Watson D, Clark LA, Harkness AR: Structures of personality and their relevance to psychopathology.Journal of Abnormal Psychology. 1994,103: 18–31.

    Article  PubMed  CAS  Google Scholar 

  17. Clark LA, Watson D, Mineka S: Temperament, personality, and the mood and anxiety disorders.Journal of Abnormal Psychology. 1994,103: 103–116.

    Article  PubMed  CAS  Google Scholar 

  18. Watson D, Clark LA: Negative affectivity: The disposition to experience aversive emotional states.Psychological Bulletin. 1984,96: 465–490.

    Article  PubMed  CAS  Google Scholar 

  19. Amirkhan JH, Risinger RT, Swickert RJ: Extraversion: A “hidden” personality factor in coping?Journal of Personality. 1995,63: 189–212.

    Article  PubMed  CAS  Google Scholar 

  20. Berry DS, Hansen JS: Positive affect, negative affect, and social interaction.Journal of Personality and Social Psychology. 1996,71: 796–809.

    Article  Google Scholar 

  21. McFatter RM: Interactions in predicting mood from extraversion and neuroticism.Journal of Personality and Social Psychology. 1994,66: 570–578.

    Article  PubMed  CAS  Google Scholar 

  22. Stemberger RT, Turner SM, Beidel DC, Calhoun KS: Social phobia: An analysis of possible developmental factors.Journal of Abnormal Psychology. 1995,104: 526–531.

    Article  PubMed  CAS  Google Scholar 

  23. Denollet J, De Potter B: Coping subtypes for men with coronary heart disease: Relationship to well-being, stress, and Type-A behavior.Psychological Medicine. 1992,22: 667–684.

    PubMed  CAS  Google Scholar 

  24. Denollet J: Biobehavioral research on coronary heart disease: Where is the person?Journal of Behavioral Medicine. 1993,16: 115–141.

    Article  PubMed  CAS  Google Scholar 

  25. Asendorpf JB: Social inhibition: A general-developmental perspective. In Traue HC, Pennebaker JW (eds),Emotion, Inhibition, and Health. Seattle, WA: Hogrefe & Huber Publishers, 1993, 80–99.

    Google Scholar 

  26. Denollet J, Sys SU, Brutsaert DL: Personality and mortality after myocardial infarction.Psychosomatic Medicine. 1995,57: 582–591.

    PubMed  CAS  Google Scholar 

  27. Denollet J, Sys SU, Stroobant N, et al: Personality as independent predictor of long-term mortality in patients with coronary heart disease.Lancet. 1996,347: 417–421.

    Article  PubMed  CAS  Google Scholar 

  28. Denollet J, Brutsaert DL: Personality, disease severity, and the risk of long-term cardiac events in patients with a decreased ejection fraction after myocardial infarction.Circulation. 1998,97: 167–173.

    PubMed  CAS  Google Scholar 

  29. Erdman RA, Duivenvoorden HJ, Verhage F, Kazemier M, Hugenholtz PG: Predictability of beneficial effects in cardiac rehabilitation: A randomized clinical trial of psychosocial variables.Journal of Cardiopulmonary Rehabilitation. 1986,6: 206–213.

    Article  Google Scholar 

  30. Johnson JH, Null C, Butcher JN, Johnson KN: Replicated item level factor analysis of the full MMPI.Journal of Personality and Social Psychology. 1984,47: 105–114.

    Article  PubMed  CAS  Google Scholar 

  31. Van Der Ploeg HM, Defares PB, Spielberger CD:ZBV. A Dutch-Language Adaptation of the Spielberger State-Trait Anxiety Inventory. Lisse, The Netherlands: Swets & Zeitlinger, 1980.

    Google Scholar 

  32. Comrey AL: Factor-analytic methods of scale development in personality and clinical psychology.Journal of Consulting and Clinical Psychology. 1988,56: 754–761.

    Article  PubMed  CAS  Google Scholar 

  33. Taylor JA: A personality scale of manifest anxiety.Journal of Abnormal and Social Psychology. 1953,48: 285–290.

    Article  CAS  Google Scholar 

  34. Eysenck SB, Eysenck HJ, Barrett P: A revised version of the psychoticism scale.Personality and Individual Differences. 1985,6: 21–29.

    Article  Google Scholar 

  35. Crowne DP, Marlowe D: A new scale of social desirability independent of psychopathology.Journal of Consulting Psychology. 1960,24: 349–354.

    Article  PubMed  CAS  Google Scholar 

  36. Tellegen A: Structures of mood and personality and their relevance to assessing anxiety, with an emphasis on self-report. In Tuma AH, Maser J (eds),Anxiety and the Anxiety Disorders. Hillsdale, NJ: Erlbaum, 1985, 681–706.

    Google Scholar 

  37. Beck AT, Beck RW: Screening depressed patients in family practice: A rapid technic.Postgraduate Medicine. 1972,52: 81–85.

    PubMed  CAS  Google Scholar 

  38. Koeter MW, Ormel J:General Health Questionnaire, Dutch-Language Adaptation. Lisse, The Netherlands: Swets & Zeitlinger BV, 1991.

    Google Scholar 

  39. Denollet J: Emotional distress and fatigue in coronary heart disease: The Global Mood Scale (GMS).Psychological Medicine. 1993,23: 111–121.

    PubMed  CAS  Google Scholar 

  40. Ahern DK, Gorkin L, Anderson JL, et al: Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS).American Journal of Cardiology. 1990,66: 59–62.

    Article  PubMed  CAS  Google Scholar 

  41. Frasure-Smith N, Lespérance F, Talajic M: Depression and 18-month prognosis after myocardial infarction.Circulation. 1995,91: 999–1005.

    PubMed  CAS  Google Scholar 

  42. Rosenberg M:Society and Adolescent Self-Image. Princeton, NJ: Princeton University Press, 1965.

    Google Scholar 

  43. Wood V, Wylie ML, Sheafor B: An analysis of a short self-report measure of life satisfaction: Correlation with rater judgements.Journal of Gerontology. 1969,24: 465–469.

    PubMed  CAS  Google Scholar 

  44. Barefoot JC, Helms MJ, Blumenthal JA, et al: Subgroups of depressive symptoms and the survival of CAD patients (abstract).Psychosomatic Medicine. 1997,59: 108.

    Google Scholar 

  45. Clark LA, Watson D: Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications.Journal of Abnormal Psychology. 1991,100: 316–336.

    Article  PubMed  CAS  Google Scholar 

  46. Watson D, Pennebaker JW: Health complaints, stress, and distress: Exploring the central role of negative affectivity.Psychological Review. 1989,96: 234–254.

    Article  PubMed  CAS  Google Scholar 

  47. Denollet J: Negative affectivity and repressive coping: Pervasive influence on self-reported mood, health, and coronary-prone behavior.Psychosomatic Medicine. 1991,53: 538–556.

    PubMed  CAS  Google Scholar 

  48. Costa PT, McCrae RR: Neuroticism, somatic complaints, and disease: Is the bark worse than the bite?Journal of Personality. 1987,55: 299–316.

    Article  PubMed  Google Scholar 

  49. Friedman HS: Where is the disease-prone personality? Conclusion and future directions. In Friedman HS (ed),Personality and Disease. New York: Wiley & Sons, 1990, 283–292.

    Google Scholar 

  50. Amelang M: Using personality variables to predict cancer and heart disease.European Journal of Personality. 1997,11: 319–342.

    Article  Google Scholar 

  51. Sanderman R, Ranchor A: The predictor status of personality variables: Etiological significance and their role in the course of disease.European Journal of Personality. 1997,11: 359–382.

    Article  Google Scholar 

  52. Suls J, Green P, Rose G, Lounsbury P, Gordon E: Hiding worries from one’s spouse: Associations between coping via protective buffering and distress in male post-myocardial infarction patients and their wives.Journal of Behavioral Medicine. 1997,20: 333–349.

    Article  PubMed  CAS  Google Scholar 

  53. Friedman HS, Booth-Kewley S: Personality, Type A behavior, and coronary heart disease: The role of emotional expression.Journal of Personality and Social Psychology. 1987,53: 783–792.

    Article  PubMed  CAS  Google Scholar 

  54. Pennebaker JW:Emotion, Disclosure, & Health. Washington, DC: American Psychological Association, 1995.

    Google Scholar 

  55. Gross JJ, Levenson RW: Hiding feelings: The acute effects of inhibiting negative and positive emotion.Journal of Abnormal Psychology. 1997,106: 95–103.

    Article  PubMed  CAS  Google Scholar 

  56. Jorgensen RS, Johnson BT, Kolodziej ME, Schreer GE: Elevated blood pressure and personality: A meta-analytic review.Psychological Bulletin. 1996,120: 293–320.

    Article  PubMed  CAS  Google Scholar 

  57. Haynes SG, Feinleib M, Kannel WB: The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart disease.American Journal of Epidemiology. 1980,111: 37–58.

    PubMed  CAS  Google Scholar 

  58. Graves PL, Mead LA, Wang NY, Liang K, Klag MJ: Temperament as a potential predictor of mortality: Evidence from a 41-year prospective study.Journal of Behavioral Medicine. 1994,17: 111–126.

    Article  PubMed  CAS  Google Scholar 

  59. Von Dras DD, Siegler IC: Stability in extraversion and aspects of social support at middlife.Journal of Personality and Social Psychology. 1997,72: 233–241.

    Article  Google Scholar 

  60. Berkman LF, Leo-Summers L, Horwitz RI: Emotional support and survival after myocardial infarction. A prospective, population-based study of the elderly.Annals of Internal Medicine. 1992,117: 1003–1009.

    PubMed  CAS  Google Scholar 

  61. Weinberger DA, Schwartz GE, Davidson RJ: Low-anxious high-anxious, and repressive coping styles: Psychometric patterns and behavioral and physiological responses to stress.Journal of Abnormal Psychology. 1979,88: 369–380.

    Article  PubMed  CAS  Google Scholar 

  62. Schwartz GE, Kline JP: Repression, emotional disclosure, and health: Theoretical, empirical, and clinical considerations. In Pennebaker JW (ed),Emotion, Disclosure, & Health, Washington, DC: American Psychological Association, 1995, 177–193.

    Chapter  Google Scholar 

  63. King AC, Taylor CB, Albright CA, Haskell WL: The relationship between repressive and defensive coping styles and blood pressure responses in healthy, middle-aged men and women.Journal of Psychosomatic Research. 1990,34: 461–471.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

About this article

Cite this article

Denollet, J. Personality and coronary heart disease: The type-D scale-16 (DS16). ann. behav. med. 20, 209–215 (1998). https://doi.org/10.1007/BF02884962

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02884962

Keywords

Navigation