title: Decline in health-related quality of life 6 months after coronary artery bypass graft surgery: the influence of anxiety, depression, and personality traits.
abstract: BACKGROUND
  Although coronary artery bypass graft (CABG) is known to improve health-related quality of life (HRQoL), this improvement does not seem to be realized in all patients who had undergone CABG surgery.
  
  
  OBJECTIVE
  The aim of this study was to test the direct and indirect influence of personality trait Type D on no change-deterioration trajectories HRQoL and the mediating influence of increased symptoms of anxiety and depression.
  
  
  METHODS
  The hypothesized influence of personality trait Type D on the relationship between increased anxiety and depression and no change-deterioration trajectories in HRQoL was tested with path analysis using structural equation modeling.
  
  
  RESULTS
  The results of the current study show that Type D personality comprised a vulnerability factor for poor patient-reported outcomes (ie, HRQoL and distress), and despite significant and clinically relevant benefits also for Type D patients after CABG, their well-being remained poorer than that of non-Type D participants at 6 months. Increased levels of anxiety largely mediated the influence of Type D personality on no change-deterioration trajectories in both physical and mental HRQoL, whereas increased symptoms of depression explained deterioration in physical and mental HRQoL without the influence of Type D personality.
  
  
  CONCLUSIONS
  There is evidence that increased symptoms of psychological distress is a strong predictor of no change-deterioration trajectories in HRQoL and that this relationship is influenced by personality trait Type D. We conclude that mediating factors, especially increased anxiety and depression, should be treated adequately in post-CABG clinical routine.
authors.affiliation: Berrie Middel, PhD Research Methodologist and Statistician, Department of Health Sciences, Division of Care and Nursing Science and Division of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, the Netherlands. Noha El Baz, PhD, RN Assistant Professor, Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands, and Faculty of Nursing, Department of Emergency and Critical Care Nursing, Alexandria University, Egypt. Susanne S. Pedersen, PhD Professor, Department of Medical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, the Netherlands. Jitse P. van Dijk, MD, PhD Associate Professor, Department of Health Sciences, Division of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, the Netherlands. Klaske Wynia, PhD Assistant Professor, Department of Health Sciences, Division of Care and Nursing Science and Division of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, the Netherlands. Sijmen A. Reijneveld, MD, PhD Professor, Department of Health Sciences, Division of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, the Netherlands.
authors.forename: Berrie
authors.initials: B
authors.lastname: Middel
authors.forename: Noha
authors.initials: N
authors.lastname: El Baz
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Jitse P
authors.initials: JP
authors.lastname: van Dijk
authors.forename: Klaske
authors.initials: K
authors.lastname: Wynia
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000523:psychology* / Q000601:surgery; D003863:Depression / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life / Q000523:psychology*; D013315:Stress, Psychological; D013997:Time Factors; D064415:Type D Personality