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Titletype d personality across general population and coronary patient samples in iceland
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The studies presented in this thesis were funded by a grant from Rannís– the Icelandic

Centre for Research (grant number 080423021).

ISBN: 978-90-5335-608-1

Layout: Erla Svansdóttir

Cover designed by Erla Svansdóttir and Robert Kanters

Printed by Ridderprint offset-drukkerij B.V., Ridderkerk

Copyrights © 2012 by Erla Svansdóttir, Tilburg, The Netherlands

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that is easy to administer (2-3 minutes) and score

, and that could be used by health

professionals to identify Type D patients that may benefit from more tailored intervention

in clinical care.

Little is known about the population attributable risk Type D poses for CVD

incidence in the community, as the main emphasizes in Type D research has not been to

assert causal connection with CVD incidence, but rather to examine the association

between general distress and prognosis in cardiovascular populations

. As a

consequence, most studies on Type D personality and coronary heart disease have been

conducted in cardiovascular samples. Yet, a number of general population studies on

Type D personality have exposed Type D personality as a vulnerability factor for worse

self-reported health status, more somatic health complaints and disease-promoting


, and unhealthier lifestyle behaviors


Finally, the current findings support the cross-cultural validity for the association

of Type D personality with psychological distress, and are consistent with recent findings

from Denmark

, Germany

and the United States

. Thus, the effect of Type D

personality is not limited to Dutch and Belgian populations

The results of the current study should be interpreted with some caution due to

the following limitations. The participant sample consisted of a heterogeneous group of

cardiac patients undergoing coronary angiography, and thus measurements of disease

severity employed in this study may not portray effectively worse disease status for a

small proportion of the sample (for instance in arrhythmia patients). In addition, the

current findings regarding Type D and psychological status might be susceptible for

reverse causation, due to the cross-sectional origin, but previous longitudinal reports

demonstrating that Type D predicts onset, prevalence and severity of psychological

distress after adjustments for baseline depression

diminish such a risk. Furthermore,

health-related behaviors were assessed with self-report and not by extensive and

psychometrically examined measurement devices. Yet, the current sample represented a

broad group of cardiac patients undergoing a coronary angiography in the only hospital in

Iceland that performs angiographies, and thus the sample portrays effectively the

population of cardiac patients of a whole nation as non-selectively as possible.

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In summary, the results of the present study indicate that Type D personality is associated

with more psychological distress and unhealthy lifestyle behaviors in Icelandic cardiac

patients, and support the cross-cultural validity of the Type D personality construct.

Further studies should be implemented to investigate, in more detail, the association

between Type D personality and health-related behavior, for such investigations could

generate intervention strategies to improve the prognostic outlook for cardiac patients

with Type D personality.


The present research was supported by Rannís, The Icelandic Centre for Research

(Reykjavík, Iceland) with a grant to Dr. Hróbjartur Darri Karlsson, a grant from the

Landspítali-Hospital Research Found (Reykjavík, Iceland) to the project, and by the

Netherlands Organization for Scientific Research (The Hague, The Netherlands) with a VICI

grant (453-04-004) to Dr. Johan Denollet. Our thanks to Axel F. Sigurðsson and Kristján

Eyjólfsson for assistance with acquisition of funding. Special thanks to Unnur

Sigtryggsdóttir, Anne Mette Pedersen, Sigurlaug Magnúsdóttir and their staff at

Landspítali-University Hospital for their generous support with acquisition of data.

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������ ������, van den Broek KC, Thorsson B, Gudnason T, Halldorsdottir S, Gudnason V,

Denollet J, Karlsson HD. Association of Type D personality with unhealthy lifestyle, and

estimated risk of coronary events in the general Icelandic population. Eur J Cardiovasc

Prev Rehabil 2012, (in press).

������ ������, van den Broek KC, Karlsson HD, Gudnason T, Denollet J. Type D personality

is associated with impaired psychological status and unhealthy lifestyle in Icelandic

cardiac patients: A cross sectional study. BMC Public Health 2012; 12:42.

������ ������B Karlsson HD, Gudnason T, Olason DT, Thorgilsson H, Sigtryggsdottir U,

Sijbrands EJ, Pedersen SS, Denollet, J. Validity of Type D personality in Iceland:

Association with disease severity and risk markers in cardiac patients. J Behav Med 2011;


������ ������, Karlsson, HD. [Mind sets half the victory: The association between

personality and health in cardiac patients]. Velferð, 2010: 22 (1); 4-5.


������ ������, van den Broek KC, Denollet J, Gudnason T, Karlsson HD. Type D personality

and gender-related differences in the clinical profile of patients with coronary artery

disease. Submitted.

������ ������, Helgadottir F, van den Broek KC, Olason, DT, Karlsson HD, Denollet J. Type

D personality and emotional distress: The mediating role of coping style. Submitted.

������ ������B van den Broek KC, Karlsson HD, Olason TD, Thorgilsson H, Denollet J. The

Distressed (Type D) and Five-Factor Models of personality in young healthy adults and

their association with emotional inhibition and distress. Submitted.

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Erla Svansdóttir was born in Reykjavik, Iceland, on the 5

of December 1979. She

completed her pre-university education at Menntaskólinn í Kópavogi in 2001. In 2002, she

started studying psychology at the University of Iceland, and completed a Bachelor’s

degree (BA) in psychology in 2004, and a cand.psych degree in 2006. Subsequently, she

developed her cand.psych thesis into a full-scale PhD research project in collaboration

with Landspitali-University Hospital, the Icelandic Heart Association, and Tilburg

University. She has published scientific papers in the Journal of Behavioral Medicine, BMC

Public Health, and European Journal of Preventive Cardiology, and presented her

scientific work at international congresses in San-Antonio (Texas), Geneva, Reykjavik, and

in the Netherlands.

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