Objective:

Type D personality—a joint tendency toward negative affectivity (NA) and social inhibition (SI)—is related to poor cardiac prognosis, but there is no standard for assessing Type D. This study reports on the Type D Scale-14 (DS14) as a standard measure of NA, SI, and Type D.

Methods:

The study included 3813 participants (2508 from the general population, 573 cardiac patients, 732 hypertension patients). They all filled out the DS14, containing 7-item NA and SI subscales; 275 subjects also completed the NEO-FFI, and 121 patients filled out the DS14 twice.

Results:

Factor analysis of the DS14 yielded 2 dominant traits; all of the NA and SI items loaded between 0.62 to 0.82 on their corresponding factor (N= 3678). The NA scale covered dysphoria, worry, and irritability; the SI scale covered discomfort in social interactions, reticence, and lack of social poise. The NA and SI scales were internally consistent (α= 0.88/0.86; N= 3678), stable over a 3-month period (test–retest r= 0.72/0.82) and not dependent on mood and health status (N= 121). NA correlated positively with neuroticism (r= 0.68); SI correlated negatively with extraversion (r=− 0.59/− 0.65). Scale-level factor analysis confirmed the construct validity of the DS14 against the NEO-FFI. Using a cutoff of 10 (NA≥ 10 and SI≥ 10), 1027 subjects (28%) were classified as Type D, 21% in the general population versus 28% in coronary heart disease and 53% in hypertension (p≤. 001). Age, sex, and Type D (odds ratio, 3.98; 95% confidence interval, 3.2–4.6; p<. 0001) were independently associated with cardiovascular morbidity.

Conclusion:

The DS14 is a brief, psychometrically sound measure of negative affectivity and social inhibition that could readily be incorporated in epidemiologic and clinical research.