title: Type D personality and course of health status over 18 months in outpatients with heart failure: multiple mediating inflammatory biomarkers.
abstract: BACKGROUND
  The distressed (Type D) personality is associated with poor health status (HS) and increased inflammatory activation in heart failure (HF). We tested whether multiple inflammatory biomarkers mediated the association between Type D personality and the course of self-reported HS over 18 months.
  
  
  METHODS
  HF outpatients (n=228, 80% male, mean age 67.0±8.7 years), filled out the Type D questionnaire (DS14) at inclusion and the Short Form-12 (SF12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 0, 6, 12, and 18 months. Blood samples at inclusion were analyzed for high sensitive C-reactive protein (hsCRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and its soluble receptors (sTNFr1, sTNFr2). A multiple mediation latent growth model was tested using structural equation modeling.
  
  
  RESULTS
  Type D personality (prevalence=21%) was associated with poorer HS (all scales p<0.001), deterioration of mental HS (p<0.001), and higher TNF-α and sTNFr2 levels in the full mediation model. A higher inflammatory burden was associated with a poorer baseline level and a deterioration of generic physical, mental and disease-specific HS. No mediating effects were found for the multiple inflammatory biomarkers on the association between Type D and baseline self-reported HS, whereas change in physical HS was significantly mediated by the group of five inflammatory biomarkers (p=0.026).
  
  
  CONCLUSIONS
  Only the association between Type D personality and change in self-reported physical health status was significantly mediated by inflammatory biomarkers. Future research should investigate whether the association between Type D personality and poor health status may be explained by other biological or behavioral factors.
authors: Center of Research on Psychology in Somatic diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands. P.M.C.Mommersteeg@uvt.nl
authors: Paula M C
authors: PM
authors: Mommersteeg
authors: Aline J
authors: AJ
authors: Pelle
authors: Christian
authors: C
authors: Ramakers
authors: Balázs M
authors: BM
authors: Szabó
authors: Johan
authors: J
authors: Denollet
authors: Nina
authors: N
authors: Kupper
mesh_terms: D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000097:blood / Q000523:psychology*; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000503:physiopathology / Q000523:psychology; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D010551:Personality / Q000502:physiology*; D010555:Personality Inventory; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D013315:Stress, Psychological / Q000097:blood* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein