title: Type D personality impairs quality of life, coping and short-term psychological outcome in patients attending an outpatient intensive program of cardiac rehabilitation.
abstract: BACKGROUND
  Type D personality represents a risk factor for adverse outcome and impaired Quality of Life (QoL) in CHD patients. Only few studies investigated Type D patients following cardiac rehabilitation (CR). No study investigated Type D personality in Italian patients attending a CR program of 4 weeks. The aims of the study were a) to verify the presence of Type D personality among patients attending an Italian CR program; b) to investigate psychological health status, QoL and coping style of CR patients and c) to test the influence of Type D personality on CR patients outcome.
  
  
  METHODS
  Data from 59 patients attending an outpatient intensive program of 4 weeks of CR were collected at admission, and 1 month after discharge, using a set of self-report questionnaires. Variables were measured using CBA-H, DS-14, Q-LES-Q and Brief COPE Scale.
  
  
  RESULTS
  The percentage of Type D personality found in the study sample was 39%. At admission Type D patients showed a significant lower level of psychological health status and QoL satisfaction compared to non Type D patients (p<0.05). After CR a significant percentage of Type D patients, despite an overall improvement, continued to show a clinically relevant psychological impairment in terms of anxiety (p=0.003), depressive mood (p=0.001), impairment in psychophysical well-being (p=0.002), perceived psychophysical stress (p=0.002), interpersonal difficulties (p<0.001), and social anxiety (p=0.045). Type D personality was also found to be associated with a significant greater use of maladaptive coping strategies (p<0.05).
  
  
  CONCLUSIONS
  Type D personality played a significant clinically relevant role on psychological health outcome in CR. Type D personality patients reported a significant higher level of psychological impairment, in terms of anxiety, depressive mood, impairment in psychophysical wellbeing, perceived psychophysical stress, interpersonal difficulties, social anxiety, and a significant lower QoL, prior and after CR. Type D personality seemed also to be associated with maladaptive coping strategies. Importance of assessment for Type D personality is warranted in CR setting, as additional interventions seem required to enhance the outcome of these patients defined in letterature at high-risk.
authors.affiliation: Department of Neurological and Psychiatric Sciences, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy. elesogar@tin.it
authors.forename: Elena
authors.initials: E
authors.lastname: Sogaro
authors.forename: Francesca
authors.initials: F
authors.lastname: Schinina
authors.forename: Costanza
authors.initials: C
authors.lastname: Burgisser
authors.forename: Francesco
authors.initials: F
authors.lastname: Orso
authors.forename: Rachele
authors.initials: R
authors.lastname: Pallante
authors.forename: Teresa
authors.initials: T
authors.lastname: Aloi
authors.forename: Duccio
authors.initials: D
authors.lastname: Vanni
authors.forename: Adolfo
authors.initials: A
authors.lastname: Pazzagli
authors.forename: Francesco
authors.initials: F
authors.lastname: Fattirolli
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000465:Algorithms; D000553:Ambulatory Care / Q000523:psychology*; D001007:Anxiety / Q000523:psychology; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010353:Patient Education as Topic; D010551:Personality / Q000145:classification; D010552:Personality Assessment; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome