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Invited Critique
August 14, 2009

Type D Personality and Mortality in Peripheral Arterial Disease—Invited Critique

Arch Surg. 2009;144(8):733. doi:10.1001/archsurg.2009.76

We are all (hopefully) scientists, and we live our lives based on objective, repeatable data. Having said this, it also must be conceded that subjective, difficult-to-quantify psychological factors seem to affect clinical outcomes. We have all had the experience of looking at a patient who has “lost the will to live” and being sure, albeit without any hard data at all, that this patient will not do well.

Aquarius and colleagues, in this relatively straightforward study, provide us with a bit of objectivity regarding this concept. Even after controlling for age, diabetes mellitus, and renal and pulmonary disease, patients with vascular disease whose premorbid answers on a personality questionnaire put them into the type-D (“distressed”) category had a 3-fold higher risk of death when observed for 4 years.