OBJECTIVE: Type D personality has been associated with adverse cardiovascular health, with atypical cardiovascular reactions to psychological stress considered a possible mechanism of effect. However, studies examining Type D personality and cardiovascular reactions to acute stress have yielded mixed findings. Here, we conducted a systematic review and meta-analyses to examine if, and under what conditions, Type D personality is associated with cardiovascular reactivity to stress; a particular focus was placed on sex and the social salience of the stressor as potential moderators of effects.
METHODS: Electronic databases (Medline, PsycArticles, PsycInfo, CINAHL, PubMed, Web of Science) were searched for relevant publications. A total of 401 articles were retrieved and screened for eligibility. Inclusion criteria included studies with nonclinical samples employing a resting baseline period followed by a psychological stress task period and measurement of cardiovascular reactivity. Following screening and removal of irrelevant articles, 17 peer-reviewed studies were included in the review.
RESULTS: Type D personality was associated with lower blood pressure reactivity to acute psychological stress. Subgroup analyses revealed an association between Type D personality and lower cardiovascular reactivity among females, but not males. Additionally, Type D personality was primarily associated with lower cardiovascular reactivity in response to nonsocial stressors.
CONCLUSIONS: Type D personality is associated with lower blood pressure reactivity to acute psychological stress, particularly among females and in response to nonsocial stressors. This lower response may be indicative of blunted cardiovascular reactivity and therefore signals an increased risk of adverse health outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Type D personality is characterized by social inhibition and negative affectivity. Poorer outcomes and worse quality of life have been linked to type D personality in patients with a variety of non-dermatological diseases. Despite increasing evidence of the importance of type D personality in skin diseases, there are no reviews on this subject. The aim of this review is to summarize the current evidence regarding type D personality and skin diseases. A systematic search was performed using Medline and Web of Science databases from inception to 11 October 2022. Studies addressing the presence of type D personality, its associated factors, its impact on the outcomes of the disease or the quality of life of the patients were included in the systematic review. A total of 20 studies, including 3,124 participants, met the eligibility criteria and were included in the review. Acne, hidradenitis suppurativa, psoriasis, melanoma, atopic dermatitis, chronic spontaneous urticaria and pruritic disorders were the main diseases assessed. Type D personality was more frequent among patients with skin diseases than among controls. Type D personality was found to be associated with poorer quality of life and higher rates of psychological comorbidities in patients with skin diseases. In conclusion, type D personality appears to be a marker of patients with increased risk of poorer quality of life and higher rates of psychological comorbidities. Screening for type D personality in specialized dermatology units might be beneficial to identify patients who are more psychologically vulnerable to the consequences of chronic skin diseases.

BACKGROUND: Type D personality, operationalized as high scores on negative affectivity (NA) and social inhibition (SI), has been associated with various medical and psychosocial outcomes. The recent failure to replicate several earlier findings could result from the various methods used to assess the Type D effect. Despite recommendations to analyze the continuous NA and SI scores, a popular approach groups people as having Type D personality or not. This method does not adequately detect a Type D effect as it is also sensitive to main effects of NA or SI only, suggesting the literature contains false positive Type D effects. Here, we systematically assess the extent of this problem.
METHODS: We conducted a systematic review including 44 published studies assessing a Type D effect with both a continuous and dichotomous operationalization.
RESULTS: The dichotomous method showed poor agreement with the continuous Type D effect. Of the 89 significant dichotomous method effects, 37 (41.6%) were Type D effects according to the continuous method. The remaining 52 (58.4%) are therefore likely not Type D effects based on the continuous method, as 42 (47.2%) were main effects of NA or SI only.
CONCLUSIONS: Half of the published Type D effect according to the dichotomous method may be false positives, with only NA or SI driving the outcome.

The role of personality as distal risk factor for suicidal thoughts and behavior is still unclear. This review aims to propose two conceptual models that explain the psychological plausibility of Type D personality as distal risk factor and contributor to the transition from general to suicide distress. To support this aim, we performed a systematic review of existing studies on the association between Type D personality and suicidal distress. A systematic search yielded eight studies that reported on Type D personality and suicidal distress. Type D personality was robustly associated with suicidal thoughts and behaviors, across populations and countries. Type D was related to the level/frequency of suicidal ideation in seven studies, and suicide attempt in two studies. Our first theoretical model identifies intra-psychic (depression, alcohol misuse, posttraumatic stress) and interpersonal (low belonging, social isolation, lack of support) vulnerabilities of individuals with Type D that may fuel the development of suicidal thoughts and behaviors. Type D by itself will not account for why people become suicidal, but our second theoretical model suggests that the avoidant-passive tendencies of Type D individuals may result in persistent problem-solving deficits, and, eventually, feelings of entrapment that may contribute to the desire to escape from pain. We conclude that empirical evidence supports the hypothesized link between Type D personality, and suicidal thoughts and behaviors. Our conceptual models - albeit often supported by indirect evidence - further substantiate the plausibility of this link, and offer concrete guidance for future studies. Primarily, more longitudinal research is necessary.

Background Psychological factors are associated with an increased risk of developing ischemic heart disease ( IHD ). Women more often report psychological factors, and sex and gender differences are present in IHD . In this meta-analysis we examine the risks of psychological factors for IHD incidence in women and men. We hypothesize that a broad range of psychological factors are related to a higher risk for incident IHD , with a higher risk for women. Methods and Results PubMed, EMBASE , and Psyc INFO were searched for studies assessing the risk between psychological factors and incident IHD . Psychological factors included depression, anxiety or panic disorder, social support, hostility, anger, personality (type D), type A behavior pattern, posttraumatic stress disorder, and psychological distress. In the primary analyses, 62 studies (77 separate reports) that included 2 145 679 women and 3 119 879 men and reported confounder-adjusted hazard ratios or relative risks were included. Pooled effect confounder-adjusted estimates from random-effects models showed that psychological factors (all combined) were associated with incident IHD in women (hazard ratio: 1.22; 95% CI , 1.14-1.30) and men (hazard ratio: 1.25; 95% CI , 1.19-1.31). No sex and gender differences were found for these pooled effect estimates ( P=0.547). Conclusions Psychological factors are associated with incident IHD in both women and men, but no significant differences were observed between women and men. IHD is predominantly being studied as obstructive coronary artery disease, which is more prevalent in men. Data are needed on psychological predictors and other manifestations of IHD such as coronary microvascular disease, which is more common in women.

This review article synthesizes recent research findings on the psychological context of Type D personality and the mechanisms through which Type D affects disease progression and prognosis among patients with coronary heart disease (CHD).
One in four patients with CHD has a Distressed (Type D) personality, which is characterized by two stable traits: social inhibition and negative affectivity. Type D personality predicts increased mortality and morbidity burden, and poorer health-related quality of life. Type D is part of a family of psychosocial risk factors that affect CHD prognosis. The pattern of co-occurrence of these psychosocial factors and intra-individual differences in psychosocial profiles may affect risk prediction accuracy. Multiple biological and behavioral processes have been associated with Type D personality. Identifying pathways explaining the observed associations between Type D personality and CHD is important to improve etiological and pathophysiological knowledge and to design personalized interventions, and targeting specific risk-associated pathways.

Heart disease is related to the etiology of mental health problems such as depression, anxiety, and posttraumatic stress.
The goal of this scoping review was to determine which factors pose a significant risk for the onset of symptoms of depression, anxiety, and posttraumatic stress in patients with heart disease, as well as to identify what might protect them from these afflictions.
We conducted a thorough search of relevant medical and psychological databases (Scopus, PsycARTICLES, Psychology and Behavioral Sciences Collection, Sage Journals, and MEDLINE) and identified 41 studies that met inclusion criteria, which included all types of heart disease.
The results of our review indicate that mental health history, the tendency to stifle negative emotional experiences (known as \"type D personality\"), and social support in patients with heart disease are related to the onset of or protection from depression, anxiety, and posttraumatic stress. These factors, along with gender and younger age, seem to be relatively consistent predictors of mental health problems in this population.
As per our results, it is important for clinicians to attend to the mental health history, type D personality, and presence and quality of social support in patients with heart disease. More research into prevention and gender differences is necessary to hone the detection and treatment of these problems in people with heart disease.
Attention to their mental health history, their ability to express and regulate affect, their age, and their gender will most likely assist in identifying symptoms of depression, anxiety, and posttraumatic stress in people with cardiac disease. Gender differences, particularly in the manifestation of depression, ought to be taken into account.

Posttraumatic stress disorder (PTSD) is a chronic condition related to severe stress and trauma. There is a mounting evidence about increased prevalence and mortality from cardiovascular diseases (CVD) in patients with PTSD. This review summarizes the current data on possible relations between PTSD and increased risks of CVD, including biological, psychological and behavioral factors. Biological factors refer to increased prevalence of metabolic syndrome (MetS), hypertension, elevation of pro-inflammatory cytokines and homocysteine levels. Peripheral Brain-derived neurotropic factor (BDNF), serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and quantitative electroencephalogram (qEEG) are promising surrogate markers of increased cardiovascular risk. Among psychological factors, some personality traits, such as neuroticism and trait impulsivity/hostility, contribute to the development of PTSD, and are associated with general cardiovascular distress. Recently, type-D (distressed) personality is usually investigated in relation to cardiovascular morbidity, but in populations other than PTSD patients. Behavioral factors refer to unhealthy life-styles, encompassing high smoking rate, drug substances abuse and addiction, physical inactivity and unhealthy diet. The relationships among all these factors are complex and yet incompletely taken into consideration. Because of a high prevalence of CVD in patients with PTSD, there is a strong need for a more intensive focus on this vulnerable population in both primary and secondary cardiovascular prevention as well as in effective treatment possibilities.

Medication non-adherence following acute coronary syndrome (ACS) is associated with poor clinical outcomes. A systematic review and meta-analysis were undertaken to identify psychosocial factors associated with medication adherence in patients with ACS.
A search of electronic databases (Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, International Pharmaceutical Abstracts, CINAHL, ASSIA, OpenGrey, EthOS and WorldCat) was undertaken to identify relevant articles published in English between 2000 and 2014. Articles were screened against our inclusion criteria and data on study design, sample characteristics, predictors, outcomes, analyses, key findings and study limitations were abstracted.
Our search identified 3609 records, of which 17 articles met our inclusion criteria (15 independent studies). Eight out of ten studies found an association between depression and non-adherence. A meta-analysis revealed that depressed patients were twice as likely to be non-adherent compared to patients without depression (OR=2.00, 95% CI 1.57-3.33, p=0.015). Type D personality was found to predict non-adherence in both studies in which it was measured. Three out of three studies reported that treatment beliefs based on the Necessity-Concerns Framework predicted medication non-adherence and there was some evidence that social support was associated with better adherence. There was insufficient data to meta-analyse all other psychosocial factors identified.
There was some evidence that psychosocial factors, particularly depression, were associated with medication adherence following ACS. Targeting depressive symptoms, screening for Type D personality, challenging maladaptive treatment beliefs, and providing better social support for patients may be useful strategies to improve medication adherence.

BACKGROUND: Cardiovasculardisease (CVD) is a major cause of death worldwide. Type D personality, a newly identified risk factor for cardiac outcomes, can deteriorate the health outcomes of CVD patients. Several interventional studies have been conducted on CVD patients with type D personality.
OBJECTIVE: To provide the best available evidence of the effects and characteristics of interventions applied to cardiac patients with type D personality.
METHODS: Experimental studies on the effects of interventions for cardiac patients with type D personality were reviewed. English and Chinese electronic databases were searched from inception to December 2014. The eligibility and quality of each article were reviewed by two independent reviewers. The outcomes of interest included psychological health (anxiety & depression), physical functioning, and quality of life. Data were synthesized in a narrative form rather than meta-analysis because of the heterogeneity of studies and the insufficient data for statistical pooling.
RESULTS: Four studies (one randomized controlled trial and three single-group pre- and posttests) involving 967 cardiac patients were identified. The quality of included studies was moderate, with three studies rated as fair and one study rated as poor. Cardiac rehabilitation programs were the interventions identified in all the included studies, with main components of physical exercise, patient education, psychological intervention, and individual counseling. The findings of this review indicated that cardiac rehabilitation can significantly reduce anxiety and depression, improve physical functioning, and quality of life in cardiac patients with type D personality. The evidence of optimal duration, frequency of interventions, and length of each session was not established.
CONCLUSIONS: This review provides preliminary evidence for the use of cardiac rehabilitation as an effective intervention to improve health outcomes in cardiac patients with type D personality. The optimal delivery format of the intervention for cardiac patients with type D personality needs to be explored.