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

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