title: Trajectories of perceived emotional and physical distress in patients with an implantable cardioverter defibrillator.
abstract: BACKGROUND
  Little is known about the course of emotional and physical distress in patients with an implantable cardioverter defibrillator (ICD).
  
  
  OBJECTIVE
  We examined (1) trajectories of emotional and physical distress in the first 18 months postimplantation and (2) predictors of these trajectories, including demographical, clinical, and personality factors.
  
  
  METHODS
  Dutch patients with an ICD (N = 645) completed measures on anxiety, depression, somatic symptoms, and perceived disability at the time of implantation, and 2, 12, and 18 months postimplantation. Measures on Type D personality (tendency to inhibit the expression of negative emotions) and anxiety sensitivity (tendency to fear anxiety-related sensations) were also completed at baseline.
  
  
  RESULTS
  Latent class analysis (LatentGOLD) identified six to seven distinct trajectories, varying largely in overall levels of distress, and remaining relatively stable after a small initial decline. Multinomial regression showed that Type D personality and anxiety sensitivity were the most prominent predictors, particularly of trajectories that reflected higher distress levels. Cardiac resynchronization therapy and coronary artery disease also increased the risk for distress, whereas ICD indication and shocks did not.
  
  
  CONCLUSIONS
  The course of emotional and physical distress may be relatively stable after ICD implantation. In clinical practice, identification of patients with high risk of higher levels of emotional and physical distress may be warranted; as such, patients with high levels of anxiety sensitivity or a Type D personality should be identified and offered behavioral support.
authors.affiliation: Department of Medical Psychology, CoRPS - Center of Research on Psychology in Somatic diseases, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands, kristavandenbroek@hotmail.com.
authors.forename: Krista C
authors.initials: KC
authors.lastname: van den Broek
authors.forename: Nina
authors.initials: N
authors.lastname: Kupper
authors.forename: Pepijn H
authors.initials: PH
authors.lastname: van der Voort
authors.forename: Marco
authors.initials: M
authors.lastname: Alings
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.forename: Ivan
authors.initials: I
authors.lastname: Nyklíček
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology*; D003327:Coronary Disease / Q000523:psychology* / Q000628:therapy; D017147:Defibrillators, Implantable / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010465:Perception; D019919:Prosthesis Implantation / Q000523:psychology; D012307:Risk Factors; D013312:Stress, Physiological / Q000502:physiology*; D013315:Stress, Psychological / Q000523:psychology*; D064415:Type D Personality