title: Clustering of poor device acceptance and Type D personality is associated with increased distress in Danish cardioverter-defibrillator patients.
abstract: BACKGROUND
  Psychosocial risk factors tend to cluster together within individuals, likely enhancing the risk of adverse health outcomes. We examined (1) the influence of clustering of poor device acceptance and Type D personality on anxiety and depressive symptoms, and (2) the demographic and clinical determinants of patients with clustering, in a large cohort of Danish implantable cardioverter defibrillator (ICD) patients.
  
  
  METHODS
  Patients (N = 557; 81.9% male; mean age = 61.9 +/- 14.3 years) implanted with an ICD between 1989 and 2006 were asked to complete a set of standardized and validated questionnaires and were divided into four risk groups: (1) No risk factors (neither poor device acceptance nor Type D), (2) Poor device acceptance only, (3) Type D only, (4) Clustering (both poor device acceptance and Type D).
  
  
  RESULTS
  The prevalence of anxiety was significantly higher in patients with clustering of risk factors (54.2%) compared to patients with poor device acceptance (30.0%), Type D personality (26.5%), or no risk factors (7.6%) (chi(2)= 88.472; df = 3; P < 0.001). Similarly, the prevalence of depression was higher in the clustering group (47.2%) compared to patients with poor device acceptance (19.1%), Type D personality (23.5%), or no risk factors (1.8%) (Fisher's exact = 112.874; df = 3; P < 0.001). Patients with the clustering of poor device acceptance and Type D had the highest mean scores of anxiety (P < 0.001) and depression (<0.001), also when adjusting for demographic and clinical baseline characteristics including shocks. Shocks (P = 0.006) were associated with increased anxiety but not with depression (P = 0.31).
  
  
  CONCLUSIONS
  Patients with poor device acceptance and Type D personality should be identified and monitored in clinical practice, as they may benefit from adjunctive intervention in order to experience the same quality of life benefits following implantation as other patients. Given the cross-sectional nature of the study, these findings should be confirmed using a prospective study design.
authors.affiliation: CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, The Netherlands. s.s.pedersen@uvt.nl
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Helle
authors.initials: H
authors.lastname: Spindler
authors.forename: Jens B
authors.initials: JB
authors.lastname: Johansen
authors.forename: Peter T
authors.initials: PT
authors.lastname: Mortensen
mesh_terms: D017147:Defibrillators, Implantable / Q000523:psychology* / Q000706:statistics & numerical data*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D010551:Personality / Q000145:classification; D010552:Personality Assessment / Q000706:statistics & numerical data; D011584:Psychology / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*