Personality traits and medical outcome of cardiac illness

Abstract

Objective

Our goal was to examine the empirical literature on the effect of personality traits on the medical outcome of cardiac illness.

Method

Pub Med and Psychological Abstracts were searched for the years 1990 to September 2009 using the terms personality, personality traits, personality disorder, health, recovery from illness, cardiac illness and surgical recovery. Articles were then selected that were prospective, had a peer review published measure of personality, a standardized measure of outcome of physical illness and at least one year follow up.

Results

Seven articles were identified that met our criteria. All seven had a significant finding that personality traits predicted medical outcomes. Of these seven articles six had similar enough measures of personality to be included in a meta analysis. (All used Type D personality.) Meta analysis found an odds ratio of 3.76 for Type D personality traits predicting poorer medical outcome. This indicated that patients with Type D personality had a 276% increase in the odds of a poor medical outcome compared to patients without Type D personality.

Conclusions

These findings indicate that personality traits are a strong predictor of medical outcome of cardiac disease.

Introduction

Physicians have always had the feeling that personality traits can affect the outcome of an illness. The feeling is that “fighters” or the more resilient would do better while “quitters” or the less resilient would do worse. Every physician has a memory of a patient who was determined to get well and who did do better than expected. To some extent the literature supports such a possibility. Freidman in two reports examined the effect of childhood personality on physical health decades later and found a link between conscientiousness and longevity (Friedman et al., 1993, Friedman, 2000). Friedman did not find the expected effects for neuroticism and optimism on later physical health. However, Danner (Danner et al., 2001), in another longitudinal report found that optimism at a young age predicted longevity decades later. A five year study by Wilson et al. (2004) of older Catholic clergy used the five factor model of personality. The results indicated that neuroticism predicted higher later life mortality while conscientiousness had a protective effect on mortality.

A cardiac mortality an epidemiologic study by Almada et al. (1991) used the variables of neuroticism and Cynicism. They found a relationship to cardiac mortality and Cynicism although not for neuroticism. However, in a well designed British epidemiological study with a twenty-one year follow up period found a significant relationship between neuroticism and cardiac mortality (Shipley et al., 2007). Christensen et al. (2002) in examining patients ill with renal disease found that low conscientiousness and high neuroticism both predicted patient mortality.

There has also been research on a personality concept called Type D personality. Type D or “distressed” personality is characterized by the tendency to experience negative emotions, to inhibit these emotions and to avoid social contact. It has been hypothesized that this personality type might increase negative emotions and predispose to anxiety and depression and could create stress. The stress could then result in higher cortisol levels. The combined stress and higher cortisol levels might negatively affect the heart. Sher (2005) has reviewed this concept.

Overall the literature gives us the intriguing notion that personality traits might affect health, mortality and cardiac mortality in particular. There does not appear to be in a simple pattern with just one personality trait being responsible. The purpose of this report was to examine empirical data on personality traits and outcome of cardiac illness in those patients who were already ill.