Psychosocial issues and type D personality: effects on rehabilitation 

The distressed (Type D) personality is a risk marker for emotional distress, poor quality of life and health status, and adverse prognosis in patients with established heart disease. Type D patients are at a 2-fold increased risk of dying prematurely, independent of demographic and clinical characteristics, including disease severity, and mood states, such as anxiety and depression, and optimal medical treatment.

Patients with this personality disposition are characterized by increased negative emotions (e.g. feeling down in the dumps, worrying) paired with a tendency not to share these emotions with others. The prevalence of Type D varies between 25-33%, with 1 in 4 or 1 in 3 patients having this personality disposition.

Evidence suggests that this subset of high-risk patients derives benefit from cardiac rehabilitation (CR), with gains in quality of life and health status and reductions in emotional distress. Despite these benefits, Type D patients report poorer quality of life than non-Type D patients and have a higher risk of mortality also in CR cohorts. This suggests that adjunctive intervention, e.g. anti-depressant treatment and/or psychological counselling, is warranted in these patients in order to improve their quality of life and to enhance secondary prevention.

In clinical practice:

• Refer Type D patients to CR – they benefit
• Know who they are – screen with the Type D Scale (DS14)
• Establish a good rapport with patients and partners
• Look at body language and non-verbal cues
• Check if their medication and general treatment can be optimized further
• Referral to mental health professional if available

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