BACKGROUND: Type-D personality, defined as a combination of high negative affect and high social isolation, has been associated with poor health outcomes. However, pathways underlying this association are largely unknown. We investigated the relationship between Type-D personality and several biological and behavioral pathways including the autonomic nervous system, the immune system, glucose regulation and sleep in a large, apparently healthy sample. METHODS: Data from a total of 646 respondents (age 41.6±11.5, 12,2% women) were available for analysis. Persons with Type-D (negative affect and social isolation score ≥10) were contrasted with those without Type-D. Measures of plasma fibrinogen levels, white blood cell count, high sensitivity C-reactive protein, fasting plasma glucose (FPG), cholesterol, high-density and low-density lipoprotein, glycated hemoglobin (HbA1c), creatinine, triglycerides, and albumin were derived from fasting blood samples. Urine norepinephrine and free cortisol were determined by high-performance liquid chromatography. Time-domain heart rate variability (HRV) measures were calculated for the 24hr recording period and for nighttime separately. RESULTS: Persons with Type-D had higher HbA1c, FPG, and fibrinogen, and lower nighttime HRV than those without Type-D, suggesting worse glycemic control, systemic inflammation and poorer autonomic nervous system modulation in Type-D persons. In addition, those with Type-D reported less social support and greater sleep difficulties while no group differences were observed for alcohol and cigarette consumption, physical activity and body mass index. CONCLUSIONS: Findings provide some of the first evidence for multiple possible biological and behavioral pathways between Type-D personality and increased morbidity and mortality.

Department of Internal Medicine Faculty of Medicine University of Ostrava Ostrava Czech Republic Department of Human Movement Studies Human Motion Diagnostic Centre University of Ostrava Ostrava Czech Republic

Department of Psychology The Ohio State University Columbus Ohio United States of America

Department of Psychology The Ohio State University Columbus Ohio United States of America Section for Translational Psychobiology in Child and Adolescent Psychiatry Department of Child and Adolescent Psychiatry Centre for Psychosocial Medicine University of Heidelberg Heidelberg Germany

Institute of Medical Psychology Center for Psychosocial Medicine University Hospital Heidelberg Heidelberg Germany Mannheim Institute of Public Health Social and Preventive Medicine Mannheim Medical Faculty Heidelberg University Mannheim Germany

Mannheim Institute of Public Health Social and Preventive Medicine Mannheim Medical Faculty Heidelberg University Mannheim Germany

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