title: Type D (distressed) personality in primary care patients with type 2 diabetes: validation and clinical correlates of the DS14 assessment.
abstract: OBJECTIVE
  In cardiovascular research, Type D personality (high negative affectivity and social inhibition) has been associated with a more than 3-fold increased risk of adverse health outcomes. This study examined the validity and clinical correlates of the Type D construct as assessed by the Type D Scale-14 (DS14) in type 2 diabetes patients.
  
  
  METHODS
  1553 primary care patients with type 2 diabetes were assessed for demographic, clinical, lifestyle and psychological characteristics in 2007. A subgroup (n=1012) completed the DS14 again 1 year later.
  
  
  RESULTS
  The two-factor model of the Type D construct was confirmed in exploratory and confirmatory factor analyses; results were stable across gender. The Negative Affectivity (NA) and Social Inhibition (SI) subscales had adequate reliability in both men and women, as measured by Cronbach's alpha (NA=0.87, SI=0.83), lambda2 (NA=0.87/0.88, SI=0.84), corrected item-total correlations (NA 0.47-0.77, SI 0.34-0.72) and mean inter-item correlations (NA=0.50/0.51, SI=0.42). One year test-retest reliability using intraclass correlation coefficients was 0.64/0.63 for NA and 0.73/0.65 for SI. Type D and non-Type D patients did not differ in vascular history or physiological risk factors, but Type D women had a more sedentary lifestyle (p=.003). Type D patients experienced less social support and more stressful life events, loneliness, and more depressed mood, anhedonia and anxiety (p<.001 for most variables). These differences were clinically significant (Cohen's d>0.60 for most variables).
  
  
  CONCLUSIONS
  Type D personality can be reliably assessed in primary care patients with type 2 diabetes, and is associated with increased loneliness, stress and emotional distress in these patients.
authors.affiliation: Center of Research on Psychology in Somatic Diseases-CoRPS, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Giesje
authors.initials: G
authors.lastname: Nefs
authors.forename: François
authors.initials: F
authors.lastname: Pouwer
authors.forename: Victor
authors.initials: V
authors.lastname: Pop
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment / Q000706:statistics & numerical data*; D010553:Personality Development; D011320:Primary Health Care; D011446:Prospective Studies; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012917:Social Adjustment; D012944:Social Support