title: Patients with a congenital heart defect and type D personality feel functionally more impaired, report a poorer health status and quality of life, but use less healthcare.
abstract: BACKGROUND
  Type D personality, characterized by high levels of negative affectivity and social inhibition, is related to mortality, morbidity, poor health status, quality of life (QoL) and less healthcare utilization in various cardiovascular patient groups. To date, studies in patients with congenital heart disease (CHD) are lacking.
  
  
  OBJECTIVE
  (1) To examine the prevalence of type D personality in CHD patients; (2) to compare type D to non-type D patients with regard to disease severity, functional status, health status and QoL; and (3) to examine the extent to which type D personality is independently related to healthcare utilization.
  
  
  METHODS
  A total of 1109 adult CHD patients were included in a questionnaire survey. Due to missing data, 302 patients were excluded.
  
  
  RESULTS
  The prevalence of Type D personality was 20.4%. Type D patients reported a poorer functional status, health status and QoL than non-type D patients (p<0.05). Type D patients reported less healthcare use than non-type D patients (primary and cardiac outpatient healthcare: adjusted OR=0.56, 95% CI=0.35-0.90; inpatient healthcare: adjusted OR=0.38, 95% CI=0.17-0.83). Results of a post-hoc analysis showed a high prevalence of type D personality in patients with a poor functional status who did not consult their cardiologist.
  
  
  CONCLUSIONS
  type D patients report a poorer functional status, health status and QoL, but less healthcare utilization. In clinical practice, patients should be screened for type D personality, since social inhibition may prevent them from contacting a healthcare provider in the event of symptom aggravation.
authors.affiliation: Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands. d.schoormans@amc.uva.nl
authors.forename: Dounya
authors.initials: D
authors.lastname: Schoormans
authors.forename: Barbara Jm
authors.initials: BJ
authors.lastname: Mulder
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.forename: Els G
authors.initials: EG
authors.lastname: Pieper
authors.forename: Arie Pj
authors.initials: AP
authors.lastname: van Dijk
authors.forename: Gert-Jan Tj
authors.initials: GJ
authors.lastname: Sieswerda
authors.forename: Mariët S
authors.initials: MS
authors.lastname: Hulsbergen-Zwarts
authors.forename: Thijs Hwm
authors.initials: TH
authors.lastname: Plokker
authors.forename: Leo Gh
authors.initials: LG
authors.lastname: Brunninkhuis
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Mirjam Ag
authors.initials: MA
authors.lastname: Sprangers
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006330:Heart Defects, Congenital / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010551:Personality; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index