title: Cross-cultural analysis of type D (distressed) personality in 6222 patients with ischemic heart disease: a study from the International HeartQoL Project.
abstract: BACKGROUND
  Type D (distressed) personality, the conjoint effect of negative affectivity (NA) and social inhibition (SI), predicts adverse cardiovascular outcomes, and is assessed with the 14-item Type D Scale (DS14). However, potential cross-cultural differences in Type D have not been examined yet in a direct comparison of countries.
  
  
  OBJECTIVE
  To examine the cross-cultural validity of the Type D construct and its relation with cardiovascular risk factors, cardiac symptom severity, and depression/anxiety.
  
  
  METHODS
  In 22 countries, 6222 patients with ischemic heart disease (angina, 33%; myocardial infarction, 37%; or heart failure, 30%) completed the DS14 as part of the International HeartQoL Project.
  
  
  RESULTS
  Type D personality was assessed reliably across countries (αNA>.80; αSI>.74; except Russia, which was excluded from further analysis). Cross-cultural measurement equivalence was established for Type D personality at all measurement levels, as the factor-item configuration, factor loadings, and error structure were not different across countries (fit: CFI=.91; NFI=.88; RMSEA=.018), as well as across gender and diagnostic subgroups. Type D personality was more prevalent in Southern (37%) and Eastern (35%) European countries compared to Northern (24%) and Western European and English-speaking (both 27%) countries (p<.001). Type D was not confounded by cardiac symptom severity, but was associated with a higher prevalence of hypertension, smoking, sedentary lifestyle, and depression.
  
  
  CONCLUSIONS
  Cross-cultural measurement equivalence was demonstrated for the Type D scale in 21 countries. There is a pan-cultural relationship between Type D personality and some cardiovascular risk factors, supporting the role of Type D personality across countries and cardiac conditions.
authors.affiliation: Tilburg University, Tilburg, The Netherlands. h.m.kupper@tilburguniversity.edu
authors.forename: Nina
authors.initials: N
authors.lastname: Kupper
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Stefan
authors.initials: S
authors.lastname: Höfer
authors.forename: Hugo
authors.initials: H
authors.lastname: Saner
authors.forename: Neil
authors.initials: N
authors.lastname: Oldridge
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D000368:Aged; D002170:Canada / Q000208:ethnology; D003431:Cross-Cultural Comparison; D005060:Europe / Q000208:ethnology; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D064415:Type D Personality; D014481:United States / Q000208:ethnology