The Big Mush: Psychometric Measures are Confounded and Non-Independent in Their Association with Age at Initial Diagnosis of Ischaemic Coronary Heart Disease

Abstract

The present study uses early diagnosis of ischaemic coronary heart disease (ICHD) as a proxy for disease malignancy in testing the statistical strength of association, and uniqueness/confounding, of several psychometric scales that have previously been found to prospectively predict death in cardiac samples (Beck Depression Inventory, Crown–Crisp Phobic Anxiety Scale, Type D Scale & Ketterer Stress Symptom Frequency Checklist). Eighty-three patients (no. of females=35) with documented ICHD were assessed for traditional and psychometric risk factors. The psychometric risk factors were moderately to strongly intercorrelated, and strongly confounded in their relationship to age at initial diagnosis. In a stepwise multiple regression, only the AIAI (aggravation, irritation, anger and impatience) scale of the Ketterer Stress Symptom Frequency Checklist (KSSFC) survived as a predictor of age at initial diagnosis (P=0.016). In a subgroup of the sample for whom the Spouse/Friend Version of the KSSFC was received (n=58, or 70%), spouse/friend reported AIAI survived as the only predictor (P=0.010). While present results need replication in a prospective study of diagnosed ICHD patients for all important clinical outcomes, only one psychometric screening instrument may be necessary to identify patients in need of treatment.

Is Type D Personality Here to Stay? Emerging Evidence Across Cardiovascular Disease Patient Groups

“…By contrast, in the study by Ketterer and colleagues the global Type D construct was not a predictor of age at initial diagnosis of IHD (used as a proxy for the severity of disease) when including other psychological constructs [54]. However, it should be noted that the former study was conducted in a large sample from the general population (n = 822) and the latter in a relatively small group of patients with established CVD (n = 83).…”

“…to test the overlap between Type D personality and other psychological risk factors, such as depression and vital exhaustion [53,54]. This endeavor is important given the abundance of psychological constructs available and given that it is not feasible to assess all in clinical Manifestation often feels unhappy, tends to worry; easily irritated; lacks in self-esteem tends to be closed and reserved; tends to keep others at distance Assessment DS14 negative affectivity subscale (7 items; score 10 as cut-off) DS14 social inhibition subscale (7 items; score 10 as cut-off)…”

Anxiety, independent of depressive symptoms, is associated with in-hospital cardiac complications after acute myocardial infarction

“…Among psychiatric outpatients, comorbid depressive and anxiety disorders are associated with worse functional and treatment outcomes than either disorder alone [38,39]. Furthermore, in cardiac patients, psychological variables as a group (such as anxiety and depression) may be negatively associated with cardiac prognosis [40,41], rather than a single variable or syndrome in isolation being associated with poor cardiac outcomes. This suggests a potential additive effect of anxiety and depression on cardiac outcomes, and future studies of post-MI patients should explore this phenomenon.…”

Are we witnessing the decline effect in the Type D personality literature? What can be learned?

“…Furthermore, claims that prognostic value of Type D personality is independent of depressive symptoms should be greeted with skepticism, given the long-recognized high association among measures of negative affect [40][41][42][43][44]. Seemingly reasonable theoretical and conceptual distinctions often cannot be sustained when attempts are made to demonstrate discriminant validity of measures of specific negative affects.…”

“…Moreover, there is a large literature showing that negative affect, and particularly depressive symptoms can often be found to predict mortality, but this literature also indicates considerable difficulty singling out particular psychological variables as a risk for mortality or that the association is not artifactual. Ketterer and colleagues [40] have referred to the "big mush" of confounded and non-independent negative affect measures. Meehl [46] has applied the label "crud factor" to the broader tendency of self-reported negative factors to be correlated with each other in ways that cannot readily be unambiguously differentiated.…”