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 Human Movement Studies Human Motion Diagnostic Centre University of Ostrava Ostrava Czech Republic

Department of Internal Medicine Faculty of Medicine University of Ostrava Ostrava Czech Republic

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

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

Section for Translational Psychobiology in Child and Adolescent Psychiatry Department of Child and Adolescent Psychiatry Centre for Psychosocial Medicine University of Heidelberg Heidelberg Germany

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Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosom Med.; 2005;67(1):89–97. doi: 10.1097/01.psy.0000149256.81953.49 PubMed DOI

Denollet J, Pedersen SS, Ong ATL, Erdman RAM, Serruys PW, van Domburg RT. Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era. Eur Heart J. 2006; 27(2):171–7. doi: 10.1093/eurheartj/ehi616 PubMed DOI

Mols F, Denollet J. Type D personality among noncardiovascular patient populations: a systematic review. Gen Hosp Psychiatry . Elsevier Inc.; 2010;32(1):66–72. PubMed

Dulfer K, Hazemeijer BAF, Van Dijk MR, Van Geuns RJM, Daemen J, Van Domburg RT, et al. Prognostic value of type D personality for 10-year mortality and subjective health status in patients treated with percutaneous coronary intervention. J Psychosom Res. 2015; 79(3):214–21. doi: 10.1016/j.jpsychores.2015.05.014 PubMed DOI

Grande G, Romppel M, Barth J. Association between type D personality and prognosis in patients with cardiovascular diseases: a systematic review and meta-analysis. Ann Behav Med. 2012; 43(3):299–310. doi: 10.1007/s12160-011-9339-0 PubMed DOI

Mommersteeg PMC, Pelle AJ, Ramakers C, Szabó 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(2):301–10. doi: 10.1016/j.bbi.2011.09.010 PubMed DOI

Kupper N, Pelle AJ, Szabó BM, Denollet J. The relationship between Type D personality, affective symptoms and hemoglobin levels in chronic heart failure. PLoS One. 2013;8(3):e58370 doi: 10.1371/journal.pone.0058370 PubMed DOI PMC

Mommersteeg PMC, Herr R, Bosch J, Fischer JE, Loerbroks A. Type D personality and metabolic syndrome in a 7-year prospective occupational cohort. J Psychosom Res. 2011; 71(5):357–63. doi: 10.1016/j.jpsychores.2011.05.004 PubMed DOI

Tziallas D, Kostapanos MS, Skapinakis P, Milionis HJ, Athanasiou T, S Elisaf M, et al. The association between Type D personality and the metabolic syndrome: a cross-sectional study in a University-based outpatient lipid clinic. BMC Res Notes. 2011;4(1):105. PubMed PMC

Armon G. Type D personality and job burnout: The moderating role of physical activity. Pers Individ Dif. 2014;58:112–5.

Condén E, Ekselius L, Aslund C. Type D personality is associated with sleep problems in adolescents. Results from a population-based cohort study of Swedish adolescents. J Psychosom Res. 2013; 74(4):290–5. doi: 10.1016/j.jpsychores.2012.11.011 PubMed DOI

Mommersteeg PMC, Kupper N, Denollet J. Type D personality is associated with increased metabolic syndrome prevalence and an unhealthy lifestyle in a cross-sectional Dutch community sample. BMC Public Health. 2010;10(1):714. PubMed PMC

Kupper N, Pelle A, Denollet J. Association of Type D personality with the autonomic and hemodynamic response to the cold pressor test. Psychophysiology. 2013; 50(12):1194–201. doi: 10.1111/psyp.12133 PubMed DOI

Task Force of the European Society of Cardiology and The North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996; 17:354–81. PubMed

Schuster AK, Fischer JE, Thayer JF, Mauss D, Jarczok MN. Decreased heart rate variability correlates to increased cardiovascular risk. Int J Cardiol.2016;203:728–30. doi: 10.1016/j.ijcard.2015.11.027 PubMed DOI

Jandackova VK, Scholes S, Britton A, Steptoe A. Are Changes in Heart Rate Variability in Middle-Aged and Older People Normative or Caused by Pathological Conditions? Findings From a Large Population-Based Longitudinal Cohort Study. J Am Heart Assoc. 2016;5(2):e002365 doi: 10.1161/JAHA.115.002365 PubMed DOI PMC

Thayer JF, Fischer JE. Heart rate variability, overnight urinary norepinephrine and C-reactive protein: evidence for the cholinergic anti-inflammatory pathway in healthy human adults. J Intern Med. 2009;265(4):439–47. doi: 10.1111/j.1365-2796.2008.02023.x PubMed DOI

Thayer JF, Fischer JE. Heart rate variability, overnight urinary norepinephrine, and plasma cholesterol in apparently healthy human adults. Int J Cardiol. 2013, 3;162:240–4. doi: 10.1016/j.ijcard.2011.05.058 PubMed DOI

Werner GG, Ford BQ, Mauss IB, Schabus M, Blechert J, Wilhelm FH. High cardiac vagal control is related to better subjective and objective sleep quality. Biol Psychol. 2015;106:79–85. doi: 10.1016/j.biopsycho.2015.02.004 PubMed DOI PMC

Jandackova VK, Britton A, Malik M, Steptoe A. Heart rate variability and depressive symptoms: a cross-lagged analysis over a 10-year period in the Whitehall II study. Psychol Med. 2016;46(10):2121–31. doi: 10.1017/S003329171600060X PubMed DOI

Jarczok MN, Kleber ME, Koenig J, Loerbroks A, Herr RM, Hoffmann K, et al. Investigating the associations of self-rated health: heart rate variability is more strongly associated than inflammatory and other frequently used biomarkers in a cross sectional occupational sample. PLoS One. 2015; 10(2):e0117196 doi: 10.1371/journal.pone.0117196 PubMed DOI PMC

Jarczok MN, Koenig J, Schuster AK, Thayer JF, Fischer JE. Nighttime heart rate variability, overnight urinary norepinephrine, and glycemic status in apparently healthy human adults. Int J Cardiol. 2013. 3;168(3):3025–6. doi: 10.1016/j.ijcard.2013.04.147 PubMed DOI

Martin L a, Doster J a, Critelli JW, Lambert PL, Purdum M, Powers C, et al. Ethnicity and Type D personality as predictors of heart rate variability. Int J Psychophysiol. 2010;76(2):118–21. doi: 10.1016/j.ijpsycho.2010.03.001 PubMed DOI

Hoogwegt MT, Pedersen SS, Theuns D a MJ, Kupper N. Relation between emotional distress and heart rate variability in patients with an implantable cardioverter-defibrillator. Psychophysiology. 2014; 51(2):187–96. doi: 10.1111/psyp.12158 PubMed DOI

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. 2014;21(5):592–600. doi: 10.1177/2047487312462800 PubMed DOI

Kopp WJ, Stein PK, Tracy RP, Barzilay JI, Schulz R, Gottdiener JS. Autonomic nervous system dysfunction and inflammation contribute to the increased cardiovascular mortality risk associated with depression. Psychosom Med. 2010; 72(7):626–35. doi: 10.1097/PSY.0b013e3181eadd2b PubMed DOI PMC

Emons WHM, Meijer RR, Denollet J. Negative affectivity and social inhibition in cardiovascular disease: Evaluating type-D personality and its assessment using item response theory. J Psychosom Res. 2007;63(1):27–39. doi: 10.1016/j.jpsychores.2007.03.010 PubMed DOI

Denollet J, Kupper N. Stress and the heart: the role of type D personality in personalized care. Eur Heart J. 2015;36(28):1783–5. PubMed

Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 health survey: manual and interpretation guide. Boston, MA: The Health Institute, New England Medical Centre; 1993.

Bullinger M. German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med. 1995; 41(10):1359–66. PubMed

Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: An updated literature review. J Psychosom Res. 2002;52(2):69–77. PubMed

Jenkins CD, Stanton BA, Niemcryk SJ, Rose RM. A scale for the estimation of sleep problems in clinical research. J Clin Epidemiol. 1988;41(4):313–21. PubMed

Mackie IJ, Kitchen S, Machin SJ, Lowe GDO. Guidelines on fibrinogen assays. Br J Haematol. 2003;121(3):396–404. PubMed

NIH: U.S. National Library of Medicine [Internet]. Medical encyclopedia. 2016. Available from: https://medlineplus.gov/ency

Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1(1):43–6. PubMed

Rothman KJ. Six persistent research misconceptions. J Gen Intern Med. 2014;29(7):1060–4. doi: 10.1007/s11606-013-2755-z PubMed DOI PMC

Saville D. Multiple Comparison Procedures: The Practical Solution. 1990;44:174–80.

Khaw K-T, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med. 2004;141(6):413–20. PubMed

Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, Pankow J et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med. 2010;362(9):800–11. doi: 10.1056/NEJMoa0908359 PubMed DOI PMC

Sacks DB. A1C versus glucose testing: a comparison. Diabetes Care. 2011;34(2):518–23. doi: 10.2337/dc10-1546 PubMed DOI PMC

Graham MR, Evans P, Thomas N-E, Davies B, Baker JS. Changes in endothelial dysfunction and associated cardiovascular disease morbidity markers in GH-IGF axis pathology. Am J Cardiovasc Drugs. New Zealand. 2009;9(6):371–81. doi: 10.2165/11312100-000000000-00000 PubMed DOI

Kaptoge S, White IR, Thompson SG, Wood AM, Lewington S, Lowe GDO, et al. Associations of plasma fibrinogen levels with established cardiovascular disease risk factors, inflammatory markers, and other characteristics: individual participant meta-analysis of 154,211 adults in 31 prospective studies: the fibrinogen studies colla. Am J Epidemiol. United States; 2007;166(8):867–79. doi: 10.1093/aje/kwm191 PubMed DOI

Steptoe A, Brydon L. Emotional triggering of cardiac events. Neurosci Biobehav Rev. 2009. February;33(2):63–70. doi: 10.1016/j.neubiorev.2008.04.010 PubMed DOI

Einvik G, Dammen T, Hrubos-Strom H, Namtvedt SK, Randby A, Kristiansen HA et al. Prevalence of cardiovascular risk factors and concentration of C-reactive protein in Type D personality persons without cardiovascular disease. Eur J Cardiovasc Prev Rehabil. 2011;18(3):504–9. doi: 10.1177/1741826710389383 PubMed DOI

Kanel R Von, Thayer JF, Fischer JE. Nighttime Vagal Cardiac Control and Plasma Fibrinogen Levels in a Population of Working Men and Women. Ann Noninvasive Electrocardiol. 2009;14(2):176–84. doi: 10.1111/j.1542-474X.2009.00293.x PubMed DOI PMC

Tracey KJ. The inflammatory reflex. Nature. England; 2002. December;420(6917):853–9. doi: 10.1038/nature01321 PubMed DOI

Pocai A, Lam TKT, Gutierrez-Juarez R, Obici S, Schwartz GJ, Bryan J et al. Hypothalamic K(ATP) channels control hepatic glucose production. Nature.2005;434(7036):1026–31. doi: 10.1038/nature03439 PubMed DOI

Thayer JF, Brosschot JF. Psychosomatics and psychopathology: looking up and down from the brain. Psychoneuroendocrinology. 2005;30(10):1050–8. doi: 10.1016/j.psyneuen.2005.04.014 PubMed DOI

Arch JJ, Brown KW, Dean DJ, Landy LN, Brown KD, Laudenslager ML. Self-compassion training modulates alpha-amylase, heart rate variability, and subjective responses to social evaluative threat in women. Psychoneuroendocrinology. 2014;42:49–58. doi: 10.1016/j.psyneuen.2013.12.018 PubMed DOI PMC

Thayer JF, Ahs F, Fredrikson M, Sollers JJ, Wager TD. A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev. 2012;36(2):747–56. doi: 10.1016/j.neubiorev.2011.11.009 PubMed DOI

Ohman A, Mineka S. Fears, phobias, and preparedness: toward an evolved module of fear and fear learning. Psychol Rev. 2001;108(3):483–522. PubMed

Elsenbruch S, Schmid J, Kullmann JS, Kattoor J, Theysohn N, Forsting M et al. Visceral sensitivity correlates with decreased regional gray matter volume in healthy volunteers: a voxel-based morphometry study. Pain. 2014;155(2):244–9. doi: 10.1016/j.pain.2013.09.027 PubMed DOI

Page KA, Seo D, Belfort-DeAguiar R, Lacadie C, Dzuira J, Naik S et al. Circulating glucose levels modulate neural control of desire for high-calorie foods in humans. J Clin Invest. 2011;121(10):4161–9. doi: 10.1172/JCI57873 PubMed DOI PMC

Soares-Miranda L, Sattelmair J, Chaves P, Duncan GE, Siscovick DS, Stein PK et al. Physical activity and heart rate variability in older adults: the Cardiovascular Health Study. Circulation. 2014. 27;129(21):2100–10. doi: 10.1161/CIRCULATIONAHA.113.005361 PubMed DOI PMC

Vonck K, Raedt R, Naulaerts J, De Vogelaere F, Thiery E, Van Roost D et al. Vagus nerve stimulation…25 years later! What do we know about the effects on cognition? Neurosci Biobehav Rev. 2014. September;45:63–71. doi: 10.1016/j.neubiorev.2014.05.005 PubMed DOI

Gremigni P, Sommaruga M. Type D personality, a relevant construct in cardiology Preliminary validation study of the Italian questionnaire. Psicot Cogn Comport. 2005;11:7–18.

Williams L, O’Connor RC, Howard S, Hughes BM, Johnston DW, Hay JL et al. Type-D personality mechanisms of effect: the role of health-related behavior and social support. J Psychosom Res. 2008; 64(1):63–9. doi: 10.1016/j.jpsychores.2007.06.008 PubMed DOI

Beutel ME, Wiltink J, Till Y, Wild PS, Münzel T, Ojeda FM et al. Type D personality as a cardiovascular risk marker in the general population: Results from the gutenberg health study. Psychother Psychosom. 2012;81(2):108–17. doi: 10.1159/000331776 PubMed DOI