title: Clustering of device-related concerns and type D personality predicts increased distress in ICD patients independent of shocks.
abstract: BACKGROUND
  This study examined the impact of clustering of device-related concerns and Type D personality on anxiety and depressive symptoms during a six-month period and the clinical relevance of shocks, implantable cardioverter defibrillator (ICD) concerns, and Type D.
  
  
  METHODS
  Consecutively implanted ICD patients (n = 176) completed questionnaires at baseline and six months and were divided into four risk groups: (1) No risk factors (neither ICD concerns nor Type D); (2) ICD concerns only; (3) Type D only; (4) Clustering (both ICD concerns and Type D).
  
  
  RESULTS
  The prevalence of Type D and concerns were 21.6% and 34.7%. Analysis of variance for repeated measures showed a reduction in anxiety over time (P < 0.001), with the risk groups exerting a stable (P = 0.14) but differential effect (P < 0.001); the highest level was seen in the clustering group. Similar results were found for depression, although depressive symptoms did not decrease (P = 0.08) and the impact of clustering was less clear. These results were confirmed in adjusted analysis, with shocks (P = 0.024) also being associated with anxiety but not depression. The impact of ICD concerns and Type D personality on anxiety and depression at baseline and six months was large (>or=0.8) compared to negligible to moderate for shocks (0.0-0.6).
  
  
  CONCLUSIONS
  ICD patients with psychosocial risk factor clustering had the highest level of anxiety, whereas the pattern for depression was less consistent. Shocks influenced outcomes, but the impact was smaller compared to ICD concerns and Type D personality. It may be timely to expand the focus beyond shocks when seeking to identify ICD patients at risk for adverse clinical outcome due to their psychological profile.
authors.affiliation: CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands. s.s.pedersen@uvt.nl
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Dominic A M J
authors.initials: DA
authors.lastname: Theuns
authors.forename: Ruud A M
authors.initials: RA
authors.lastname: Erdman
authors.forename: Luc
authors.initials: L
authors.lastname: Jordaens
mesh_terms: D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D017147:Defibrillators, Implantable / Q000523:psychology*; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010551:Personality / Q000145:classification*; D010555:Personality Inventory; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors