Type D personality impairs Quality of Life, coping and short-term psychological outcome in patients attending an outpatient intensive program of cardiac rehabilitation

Elena Sogaro, Francesca Schininà, Costanza Burgisser, Francesco Orso, Rachele Pallante, Teresa Aloi, Duccio Vanni, Adolfo Pazzagli, Francesco Fattirolli
  • Elena Sogaro
    Department of Neurological and Psychiatric Sciences, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy | elesogar@tin.it
  • Francesca Schininà
    Department of Neurological and Psychiatric Sciences, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
  • Costanza Burgisser
    Department of Critical Care Medicine and Surgery, Cardiac Rehabilitation Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
  • Francesco Orso
    Department of Critical Care Medicine and Surgery, Cardiac Rehabilitation Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
  • Rachele Pallante
    Department of Critical Care Medicine and Surgery, Cardiac Rehabilitation Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
  • Teresa Aloi
    Department of Neurological and Psychiatric Sciences, Clinical Psychology Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
  • Duccio Vanni
    Department of Neurological and Psychiatric Sciences, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
  • Adolfo Pazzagli
    Department of Neurological and Psychiatric Sciences, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
  • Francesco Fattirolli
    Department of Critical Care Medicine and Surgery, Cardiac Rehabilitation Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy

Abstract

Background: Type D personality represents a risk factor for adverse outcome and impaired Quality of Life (QoL) in CHD patients. Only few studies investigated Type D patients following cardiac rehabilitation (CR). No study investigated Type D personality in Italian patients attending a CR program of 4 weeks. The aims of the study were a) to verify the presence of Type D personality among patients attending an Italian CR program; b) to investigate psychological health status, QoL and coping style of CR patients and c) to test the influence of Type D personality on CR patients outcome. Methods: Data from 59 patients attending an outpatient intensive program of 4 weeks of CR were collected at admission, and 1 month after discharge, using a set of self-report questionnaires. Variables were measured using CBAH, DS-14, Q-LES-Q and Brief COPE Scale. Results: The percentage of Type D personality found in the study sample was 39%. At admission Type D patients showed a significant lower level of psychological health status and QoL satisfaction compared to non Type D patients (p<0.05). After CR a significant percentage of Type D patients, despite an overall improvement, continued to show a clinically relevant psychological impairment in terms of anxiety (p=0.003), depressive mood (p=0.001), impairment in psychophysical well-being (p=0.002), perceived psychophysical stress (p=0.002), interpersonal difficulties (p<0.001), and social anxiety (p=0.045). Type D personality was also found to be associated with a significant greater use of maladaptive coping strategies (p<0.05). Conclusions: Type D personality played a significant clinically relevant role on psychological health outcome in CR. Type D personality patients reported a significant higher level of psychological impairment, in terms of anxiety, depressive mood, impairment in psychophysical wellbeing, perceived psychophysical stress, interpersonal difficulties, social anxiety, and a significant lower QoL, prior and after CR. Type D personality seemed also to be associated with maladaptive coping strategies. Importance of assessment for Type D personality is warranted in CR setting, as additional interventions seem required to enhance the outcome of these patients defined in letterature at high-risk.