Clustering of Poor Device Acceptance and Type D Personality is Associated with Increased Distress in Danish Cardioverter‐Defibrillator Patients

Abstract

Psychosocial risk factors tend to cluster together within individuals, likely enhancing the risk of adverse health outcomes. We examined (1) the influence of clustering of poor device acceptance and Type D personality on anxiety and depressive symptoms, and (2) the demographic and clinical determinants of patients with clustering, in a large cohort of Danish implantable cardioverter defibrillator (ICD) patients. Patients (N = 557; 81.9% male; mean age = 61.9 +/- 14.3 years) implanted with an ICD between 1989 and 2006 were asked to complete a set of standardized and validated questionnaires and were divided into four risk groups: (1) No risk factors (neither poor device acceptance nor Type D), (2) Poor device acceptance only, (3) Type D only, (4) Clustering (both poor device acceptance and Type D). The prevalence of anxiety was significantly higher in patients with clustering of risk factors (54.2%) compared to patients with poor device acceptance (30.0%), Type D personality (26.5%), or no risk factors (7.6%) (chi(2)= 88.472; df = 3; P < 0.001). Similarly, the prevalence of depression was higher in the clustering group (47.2%) compared to patients with poor device acceptance (19.1%), Type D personality (23.5%), or no risk factors (1.8%) (Fisher's exact = 112.874; df = 3; P < 0.001). Patients with the clustering of poor device acceptance and Type D had the highest mean scores of anxiety (P < 0.001) and depression (<0.001), also when adjusting for demographic and clinical baseline characteristics including shocks. Shocks (P = 0.006) were associated with increased anxiety but not with depression (P = 0.31). Patients with poor device acceptance and Type D personality should be identified and monitored in clinical practice, as they may benefit from adjunctive intervention in order to experience the same quality of life benefits following implantation as other patients. Given the cross-sectional nature of the study, these findings should be confirmed using a prospective study design.