title: Shocks, personality, and anxiety in patients with an implantable defibrillator.
abstract: BACKGROUND
  Studies have examined the relationship between shocks and anxiety, but little is known about the role of personality. Our aim was to examine the determinants of self-reported and interviewer-rated anxiety following implantable cardioverter defibrillator (ICD) implantation.
  
  
  METHODS
  At baseline, that is, 0-3 weeks following ICD implantation, 308 ICD patients (82% men, mean age = 62.6 years) completed the DS14 (Type D personality) and ASI (anxiety sensitivity). The STAI (self-reported symptoms of state-anxiety) was assessed at baseline and follow-up, which was 2 months following ICD implantation. At this follow-up, the HAM-A interview (interviewer-rated anxiety) was assessed in a subsample (57%); the occurrence of ICD shocks was deduced from medical records.
  
  
  RESULTS
  Analysis of covariance (ANCOVA) for repeated measures showed a significant interaction effect between time and shocks (F = 9.27, P = 0.003) with patients who had experienced a shock experiencing higher levels of self-reported anxiety at follow-up. The main effects of Type D personality (F = 33.42, P < 0.0001) and anxiety sensitivity (F = 66.31, P < 0.0001) were significant, indicating that these patients scored higher on self-reported anxiety across time points. Multivariable linear regression analyses yielded Type D personality (beta= 0.18, P = 0.021) and anxiety sensitivity (beta= 0.19, P = 0.016), but not shocks, as independent predictors of interviewer-rated anxiety. Covariates included gender, marital status, education, age, ICD indication, cardiac history, and comorbidity.
  
  
  CONCLUSIONS
  Type D personality and anxiety sensitivity were independent predictors of both self-reported and interviewer-rated anxiety outcomes while ICD shocks were related to an increase in levels of self-reported anxiety only. Identification and support of ICD patients with Type D personality, increased anxiety sensitivity, or shocks is important.
authors.affiliation: CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands.
authors.forename: Krista C
authors.initials: KC
authors.lastname: Van den Broek
authors.forename: Ivan
authors.initials: I
authors.lastname: Nyklícek
authors.forename: Pepijn H
authors.initials: PH
authors.lastname: Van der Voort
authors.forename: Marco
authors.initials: M
authors.lastname: Alings
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology*; D017147:Defibrillators, Implantable / Q000523:psychology* / Q000706:statistics & numerical data*; D004597:Electroshock / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010552:Personality Assessment / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors