Is Type D personality a risk factor for all-cause mortality? A prospective population-based study among 2625 colorectal cancer survivors from the PROFILES registry

Abstract

ObjectiveOur goal was to examine whether Type D personality and its components, negative affectivity (NA) and social inhibition (SI), were associated with all-cause mortality among colorectal cancer (CRC) patients. MethodsCRC patients diagnosed between 2000 and 2009, as registered in the Dutch population-based Eindhoven Cancer Registry, received a questionnaire on Type D (DS14) on average 5.3years after diagnosis. Survival status (31-12-2013) was obtained from the Central Bureau for Genealogy. We used a Cox proportional hazard model to relate personality to all-cause mortality, while adjusting for demographics, clinical characteristics and cardiovascular disease (CVD). ResultsFifty percent was categorized as the ‘reference group’ (n=1281), 17% as ‘SI only’ (n=421), 12% as ‘NA only’ (n=309), and 21% as ‘Type D’ (n=532). After adjustment, CRC patients in the ‘NA only’ and ‘Type D’ groups showed an increased risk (HR=2.0, 95% CI=1.4–2.8, p<0.01, and HR=1.7, 95% CI=1.3–2.4, p<0.01) for all-cause mortality. This adverse effect of NA was limited to men aged >70. There was an additional adverse effect of SI on all-cause mortality in older men without CVD (HR=2.3, 95% CI=1.2–4.4, p=0.01). Personality was not related to mortality in women. Entering personality continuously, showed an increased risk for NA among older survivors, men and patients with comorbid CVD. Neither SI nor the interaction term was predictive in both the un- and adjusted Cox models. ConclusionOur findings suggest that it is the NA component that drives the adverse effect of psychological distress on survival in CRC patients, which is most prominent among older men.