title: Health inequalities in the Netherlands: a cross-sectional study of the role of Type D (distressed) personality.
abstract: BACKGROUND
  In the Netherlands, as in many European countries, inequalities in health exist between people with a high and a low socioeconomic status (SES). From the perspective of the 'indirect selection hypothesis', this study was designed to expand our understanding of the role of Type D personality as an explanation of health inequalities.
  
  
  METHODS
  Data came from two cross-sectional Dutch surveys among the general population (aged between 19 and 64 years, response 53.7%, n = 12,090). We analyzed the relative risks of low SES, assessed using education and income, and Type D personality, assessed using the Type D Scale-14 (DS14), for different outcomes regarding lifestyle-related risk factors and health, using multivariate Generalized Linear Models.
  
  
  RESULTS
  Results showed that Type D personality was significantly associated with low SES (OR = 1.7 for both low education and low income). Moreover, the relative risks of Type D personality and low SES were significantly elevated for most adverse health outcomes, unconditionally as well as conditionally.
  
  
  CONCLUSIONS
  The cross-sectional design hinders the making of definite etiological inferences. Nevertheless, our findings suggest that Type D personality does not explain the socioeconomic health inequalities, but is a risk factor in addition to low SES. Prevention of adverse health outcomes in low SES populations may have more effect when it takes into account that persons with a low SES in combination with a Type D personality are at highest risk.
authors.affiliation: Academic Collaborative Centre Public Health Brabant, Tranzo, Tilburg School of Social and Behavioral Sciences, University of Tilburg, Tilburg, the Netherlands. M.J.H.vanBon@uvt.nl
authors.forename: Marja J H
authors.initials: MJ
authors.lastname: van Bon-Martens
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.forename: Lambertus A L M
authors.initials: LA
authors.lastname: Kiemeney
authors.forename: Mariël
authors.initials: M
authors.lastname: Droomers
authors.forename: Monique J A
authors.initials: MJ
authors.lastname: de Beer
authors.forename: Ien A M
authors.initials: IA
authors.lastname: van de Goor
authors.forename: Hans A M
authors.initials: HA
authors.lastname: van Oers
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010551:Personality / Q000145:classification*; D012309:Risk-Taking; D012923:Social Class; D013315:Stress, Psychological; D055815:Young Adult