Association of Type D personality with increased vulnerability to depression: is there a role for inflammation or endothelial dysfunction? - the Maastricht Study

Fleur van Dooren, F.R.J. Verhey, F. Pouwer, C.G. Schalkwijk, S.J.S. Sep, C.D.A. Stehouwer, R.M.A. Henry, P.C. Dagnelie, N.C. Schaper, C.J.H. van der Kallen, A. Koster, M.T. Schram, J. Denollet*

*Corresponding author for this work

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Background: Type D personality - the combination of negative affectivity (NA) and social inhibition (SI) has been associated with depression but little is known about underlying mechanisms. We examined whether (1) Type D is a vulnerability factor for depression in general, (2) Type D is associated with inflammation or endothelial dysfunction, and (3) these biomarkers alter the possible association between Type D and depression.

Methods: In the Maastricht Study, 712 subjects underwent assessment of NA, SI and Type D personality (D514), depressive disorder (Mini-International Neuropsychiatric Interview) and depressive symptoms (Patient Health Questionnaire-9). Plasma biomarkers of inflammation (hsCRP, SAA, sICAM-1, IL-6, IL-8, TNF-alpha) and endothelial dysfunction (5VCAM-1, sICAM-1, E-selectin, vWF) were measured with sandwich immunoassays or ELISA and combined into standardized sumscores.

Results: Regarding personality, 49% of the study population was low in NA and SI, 22% had SI only, 12% NA only and 17% had Type D. Depressive disorder and depressive symptoms were significantly more prevalent in Type D versus the other three personality subgroups. Multivariable regression analyses showed that Type D was associated with inflammation (beta=0.228, p =0.014) and endothelial dysfunction (beta=0.216, p =0.022). After adjustment for these biomarkers, Type D remained independently associated with increased vulnerability to depressive disorder (OR= 13.20, p

Limitations: The cross-sectional design restrained us to draw any conclusions on causality. The relatively low prevalence of depressive disorder restrained us to adjust for more potential confounders.

Conclusions: Type D personality may be a vulnerability factor for depression, irrespective of levels of inflammation or endothelial dysfunction. Future research should examine possible underlying mechanisms. 

Original languageEnglish
Pages (from-to)118-125
Number of pages8
JournalJournal of Affective Disorders
Publication statusPublished - 1 Jan 2016


  • Personality
  • Depression
  • Inflammation
  • Endothelial dysfunction
  • DSM-IV

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