A general propensity to psychological distress affects cardiovascular outcomes: evidence from research on the type D (distressed) personality profile.

Specific negative emotions have been related to adverse cardiac events, but a general propensity to psychological distress may also affect cardiovascular outcomes. In this summary article, we provide a reliable estimate of the prognostic risk associated with Type D (distressed) personality, a general propensity to distress that is defined by high scores on the “negative affectivity” and “social inhibition” traits. Quantitative analyses of prospective studies that included a total of 6121 patients with a cardiovascular condition indicated that Type D personality was associated with a more than 3-fold increased risk of adverse events (9 studies) and long-term psychological distress (11 studies). In addition, a narrative review of 29 studies showed that Type D personality and depression are distinct manifestations of psychological distress, with different and independent cardiovascular effects. There are also plausible biological and behavioral pathways that may explain this adverse effect of Type D personality. The findings reported in this summary article support the simultaneous use of specific and general measures of distress in cardiovascular research and practice.