Type D personality as a predictor of poor health outcomes in patients with cardiovascular disease

With great interest we have read the study by Al-Qezweny et al. [1]. In this prospective study the association between Type D personality and depression was investigated in patients who have been treated with percutaneous coronary intervention (PCI). The researchers found an increased risk for depression and anxiety in PCI patients with a Type D personality compared with PCI patients with a non-Type D personality. This interesting study sheds more light on the complex relationship between depression and Type D personality. Type D personality is a multifaceted construct which consists of two components: negative affectivity and social inhibition [2]. Negative affectivity is composed of three facets: dysphoria, anxious apprehension, and irritability [2]. In other words, dysphoria is one of the constituting facets of negative affectivity, and the association between Type D personality and depression also validates the negative affectivity component of Type D. This partial overlap was found in several studies which, however, also supported the psychometric distinctiveness of the Type D personality as compared with depression [2, 3]. Overall, research indicates that Type D personality is a predictor or vulnerability factor of depression [3], which is also supported by the findings reported by Al-Qezweny et al. As stressed above, Type D personality not only focuses on negative affectivity but also on social inhibition. To explore the relationship between social inhibition and depres-