Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor

Abstract

Background:

There is a lack of knowledge about factors associated with health-related quality of life in cardiac arrest survivors and their spouses. In addition, survivors and spouses are likely to affect each other’s health-related quality of life.

Aims:

The aim was to investigate if a distressed personality and perceived control among cardiac arrest survivors and their spouses were associated with their own and their partner’s health-related quality of life.

Methods:

This dyadic cross-sectional study used the actor–partner interdependence model to analyse associations between a distressed personality (type D personality), perceived control (control attitudes scale), and health-related quality of life (EQ index and EQ visual analogue scale).

Results:

In total, 126 dyads were included in the study. Type D personality and perceived control in cardiac arrest survivors were associated with their own health-related quality of life. In their spouses, a significant association was found for type D personality but not for perceived control. In addition, type D personality and perceived control in survivors were associated with health-related quality of life in their spouses.

Conclusions:

Type D personality and perceived control are factors that might be considered during post cardiac arrest, because of the associations with health-related quality of life in survivors and spouses. More research is needed to test psychosocial interventions in the cardiac arrest population in order to improve health-related quality of life.

Keywords

Heart arrest survivor partner health quality of life dyads

Introduction

Cardiac arrest (CA) is a significant health problem worldwide, associated with a high risk of mortality.¹ The total number of CAs in Europe is not known, but in Sweden more than 8000 people suffer from CA annually, and receive cardiopulmonary resuscitation. The most common aetiology of CA is coronary artery disease (CAD). In recent decades, major improvements in initial life-saving interventions have contributed to an increased number of survivors.² Surviving a life-threatening condition, such as a CA, will however most likely affect the lives of both survivors and their relatives.^3,4 In qualitative studies, CA survivors have described the event as a trauma suddenly disrupting their normal lives and as a confrontation with death. They often wake up in chaos, with extensive memory loss, and have to struggle to find meaning and to regain control.⁴ Their bodily functions are altered and they often have to adjust their lives to various health problems. In addition, fear of suffering another CA and overestimation of symptom severity are present.⁵ Among spouses, experiences of hopelessness, feelings of inadequacy and lack of control have been reported.³

In healthcare, measures of self-reported health-related quality of life (HRQoL) are often used to evaluate interventions and the impact of a disease on those affected.^6,7 HRQoL can be defined as the parts of an individual’s subjective quality of life that are related to physical, mental and social health.⁸ Although overall HRQoL among the majority of survivors is reported to be acceptable and comparable to general populations,^9,10 emotional problems, cognitive impairment and fatigue are common.^9,11 Therefore, screening patients for health problems and offering evidence-based follow-up is important.^7,12 However, as little is known about factors associated with HRQoL, developing interventions to improve care is difficult.

In a recent study, type D personality and perceived control were identified as predictors of HRQoL among CA survivors treated with an implantable cardioverter defibrillator (ICD).⁹ These results might be important when screening patients during post-CA follow-up, in order to offer targeted support for those who require it. The prevalence of type D personality, also called ‘distressed personality’, has been reported to be 21% in the general population and 28% in patients with CAD. A person with type D personality can be defined as someone perceiving negative emotions (negative affectivity), and not being willing to share these emotions with friends and relatives out of fear of being rejected (social inhibition).¹³ Type D personality is reported to be associated with a higher risk of mortality, morbidity¹⁴ and impaired HRQoL¹⁵ in patients with CAD. Perceived control can be defined as the individual’s perception of being able to control important situations in life, and is associated with psychosocial recovery after a CAD event.¹⁶ Perceived control appears to be important also for CA survivors,⁵ and might be positively targeted in health-supporting interventions.¹⁷

Few studies have investigated HRQoL among spouses and other relatives of CA survivors. However, emotional distress appears to be present.¹⁸ Wachelder et al. reported emotional problems to be even more common among relatives compared to CA survivors.¹⁹ Psychosocial factors associated with HRQoL among relatives have not been investigated.

Survivors and their spouses are likely to affect each other’s health. Such effects have been reported in other cardiovascular diseases, for example, heart failure,²⁰ but have not previously been explored in CA populations. No studies have investigated factors associated with HRQoL post-CA from a dyadic perspective. The aim of this study was therefore to investigate if a distressed personality and perceived control among CA survivors and their spouses were associated with their own and their partner’s HRQoL.

Methods

Study design

This study had an observational cross-sectional design. It is a part of a larger longitudinal study investigating several aspects of health among CA survivors and their relatives. The study conforms with the principles outlined in the Declaration of Helsinki²¹ and was approved by the regional ethical review board in Linköping, Sweden (no. 2013/235-31). The STROBE cross-sectional reporting guidelines were used.²²

Setting and participants

All Swedish CAs in which resuscitation efforts are performed are eligible for inclusion in the Swedish national register for cardiopulmonary resuscitation (https://www.hlrr.se/). The survivors were identified from the registry and invited to the study during a telephone follow-up (for the registry) at 3–6 months post-CA, between November 2013 and August 2018. These follow-up calls are typically performed by a cardiology nurse or a resuscitation coordinator.

All surviving patients 18 years of age or older, who had experienced a CA due to cardiopulmonary aetiology were considered eligible for inclusion. For the main study, the survivors themselves chose which (if any) relatives should be included. Relatives should also be 18 years of age or older. Short expected survival and difficulties in understanding study instructions were criteria for exclusion in both survivors and their relatives. The inclusion was performed at two university hospitals and three county hospitals in the south of Sweden. All participating survivors and their relatives received the study questionnaire, including a consent form, at 6 months post-CA. Those not replying received one reminder. Among 317 patients eligible for inclusion, 66 patients chose not to participate and 39 accepted participation but did not return the questionnaire. This resulted in a total response rate for the main study of 67% (n=212). There were no significant differences in age or sex between participants and non-participants.

For the present study all dyads (n=126), that is, only survivors participating together with their partner, were included. For presenting and discussing the results we use the term ‘spouse’ for husband or wife, or to define a cohabiting partner.

Measurements

The study questionnaire consisted of demographic data including health history, family relationships and level of education. Validated instruments for measuring HRQoL (EuroQol-5D-5 level; EQ-5D-5L), perceived control (control attitude scale; CAS) and type D personality (standard assessment of negative affectivity, social inhibition and type D personality; DS-14) were used. Both survivors and their spouses were sent the same set of questionnaires.

EuroQol-5D-5 level

The EQ-5D is a generic self-rating measure of HRQoL, including a descriptive system based on five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. In the five-level version (EQ-5D-5L), the severity of health problems within these domains is rated on a five-point scale, from ‘no problems’ (0) to ‘severe problems’ (5).²³ These ratings may be used to present a health state profile and to calculate a preference-based index in which higher index values indicate better HRQoL. In the present study a crosswalk procedure using the Danish value set for EQ-5D-3 level version and the crosswalk index value calculator (www.euroqol.org) was used, resulting in possible values from −0.624 (worst possible HRQoL) and 1 (perfect HRQoL). In addition, EQ-5D-5L includes a visual analogue scale (EQ VAS), a one-item measure of HRQoL, ranging from ‘the worst health you can imagine’ (0) to ‘the best health you can imagine’ (100). The EQ-5D-5L is reported to have acceptable measurement properties²² and is recommended for reporting HRQoL in CA survivors.²⁴

Control attitude scale

The CAS measures perceived control and is used for patients with cardiac conditions and their relatives. The measure consists of four items, two for perceived control and two for helplessness. Responses are rated on a scale from 1 (‘not at all’) to 7 (‘very much’) and are summarised to a total score ranging from 4 to 28. A higher score indicates more perceived control. The CAS has been psychometrically evaluated in cardiac patients and their partners showing acceptable properties²⁵ and has previously been used in CA populations.⁹

Instrument for detecting type D personality

The DS-14 measures negative affectivity, social inhibition and type D personality. The measure consists of seven items (statements) for negative affectivity and seven for social inhibition (in total 14 items). Responses are given using a five-point scale from 0 (‘false’) to 4 (‘true’), resulting in total scores ranging from 0 to 28 for negative affectivity and social inhibition. To detect type D personality scores of 10 or greater for both scales are required.¹³ The DS-14 has demonstrated good measurement properties in cardiac patients,¹⁴ and has previously been applied in CA survivors.⁹

Data analyses

Descriptive statistics were used to present characteristics of participants and study variables. In addition, the Mann–Whitney U test was used to compare HRQoL between survivors and spouses.

The actor–partner interdependence model (APIM) was used to investigate if type D personality and perceived control in CA survivors and their spouses (i.e. distinguishable members) were associated with their own and their partner’s HRQoL. The APIM is an interpersonal conceptual model for analysing non-independent dyadic data. By using the APIM, the effect of someone’s explanatory variable on that person’s outcome variable may be investigated, that is, the actor effect. The effect of the same variable on the partner’s outcome is also included in the model, that is, the partner effect.²⁶ For the present study structural equation modelling (path analyses) was used to estimate actor and partner effects in four different models. Perceived control (continuous variable) or type D personality (dichotomised variable) were used as the explanatory variables and HRQoL (EQ index or EQ VAS) as the outcome variable.

P values less than 0.05 were considered statistically significant. Statistical analyses were performed using Stata 14.2 (StataCorp LP, College Station, TX, USA) and Mplus version 8.2 (Muthén and Muthén, Los Angeles, CA, USA).

Results

In total, 126 dyads (survivor and spouse) were included. There were no differences in EQ VAS, EQ index, age or perceived control between the included survivors compared to those not included, that is, those participating in the main study without a spouse. However, survivors without a participating spouse were more likely to be women (χ²(1)=14.90, P<0.001) and have a type D personality (χ²(1)=8.79, P=0.003).

The mean age for included survivors and their spouses was 66.0 (standard deviation (SD) 11.2) and 64.4 (SD 10.9) years, respectively. In the majority of the dyads (n=107, 85%) the survivor was a man and the spouse was a woman. The majority of participants (n=239, 95%) were born in Sweden.

The survivors reported significantly higher levels of perceived control (P=0.001) and less negative affectivity compared to their spouses (P=0.007). There were no differences between survivors and spouses with regard to social inhibition and type D personality. In EQ-5D, the median index value for participants was 0.79 (q1–q3=0.75–0.87), and the EQ VAS was 80 (q1–q3=70–90), with no significant differences between survivors and spouses. The survivors reported significantly more problems in their usual activities (P<0.001). In contrast, spouses reported significantly more problems with anxiety/depression (P=0.020). There were no differences between survivors and spouses in mobility, self-care and pain/discomfort. More details are presented in Table 1.

Table 1.

Characteristics of survivors and spouses.

Variable	All, n=252	Survivors, n=126	Spouses, n=126	P value
Age, m (SD) (range)	65.2 (11.1) (28–89)	66.0 (11.2) (31–89)	64.4 (10.9) (28–82)	0.196¹
Gender, n (%)				<0.001²
Male	127 (50.4)	108 (85.7)	19 (15.1)
Female	125 (49.6)	18 (14.2)	107 (84.9)
Place of cardiac arrest, n (%)				1.000²
IHCA	–	75 (59.5)	–
OHCA	–	51 (40.5)	–
County of birth, n (%)				0.523³
Sweden	239 (94.8)	122 (96.8)	117 (92.9)
Other Nordic country	6 (2.4)	2 (1.6)	4 (3.2)
Other European country	4 (1.6)	1 (0.8)	3 (2.4)
Country outside Europe	3 (1.2)	1 (0.8)	2 (1.6)
Education, n (%)
No primary school	14 (5.6)	7 (5.6)	7 (5.6)	0.837²
Primary school	63 (25.0)	30 (23.8)	33 (26.2)
Upper secondary school	97 (38.5)	52 (41.3)	45 (35.7)
University	78 (31.0)	37 (29.4)	41 (32.5)
Treated with an ICD, n (%)	–	57 (45.2)	–
Treated with PCI and/or CABG, n (%)	–	88 (69.8)	–
Self-rating scales
CAS, md (q1–q3)	19 (16–23)	21 (16–24)	18 (16–21)	0.001¹
DS-14, md (q1–q3)
Negative affectivity	6 (3–11)	5 (2–9)	7 (4–11)	0.007¹
Social inhibition	7 (4–11)	6 (3–10)	8 (4–12)	0.111¹
Type D personality, n (%)	39 (15.5)	16 (12.7)	23 (18.3)	0.223²
EQ-5D-5L, md (q1–q3)
EQ index	0.79 (0.75–0.87)	0.80 (0.74–1.00)	0.79 (0.76–0.86)	0.976¹
EQ mobility	1 (1–2)	1 (1–2)	1 (1–2)	0.427¹
EQ self-care	1 (1–1)	1 (1–1)	1 (1–1)	0.084¹
EQ usual activities⁴	1 (1–2)	1 (1–2)	1 (1–2)	<0.001¹
EQ pain/discomfort	2 (1–2)	2 (1–2)	2 (1–2)	0.238¹
EQ anxiety/depression	1 (1–2)	1 (1–2)	2 (1–2)	0.020¹
EQ VAS	80 (70–90)	80 (70–85)	80 (70–90)	0.171¹

IHCA: in-hospital cardiac arrest; OHCA: out-of-hospital cardiac arrest; ICD: implantable cardioverter defibrillator; PCI: percutaneous coronary intervention; CABG: coronary artery bypass graft; CAS: control attitude scale; DS-14: instrument for detecting type D personality; type D personality: combination of negative affectivity and social inhibition (⩾10 on both scales); EQ-5D-5L: EuroQol-5 dimensions-5 levels; EQ VAS: EuroQoL visual analogue scale.

Mann–Whitney U test.

Chi-square test.

Fishers’ exact test.

Survivors reported significantly more problems in EQ usual activities compared to spouses; however, not reflected by median and quartile values.

Associations between perceived control and HRQoL

Using the APIM, significant actor effects for perceived control on HRQoL were found for the survivors. Higher levels of perceived control were associated with better HRQoL, measured by EQ VAS (β=0.53, P<0.001) and EQ index (β=0.48, P<0.001) among survivors. No significant actor effects were found for perceived control among spouses. A significant positive partner effect for perceived control among survivors on HRQoL of their spouses was found when measured by EQ VAS (β=0.20, P<0.05), that is, a higher level of perceived control in the survivor was associated with better HRQoL in the spouse. In contrast, no such effect was identified for EQ index. No significant partner effects for perceived control in spouses were detected (Figure 1).

Associations between type D personality and HRQoL

Significant actor effects for type D personality on HRQoL were found for the survivors, measured by EQ VAS (β=−0.36, P<0.001) and EQ index (β=−0.34, P<0.001) and for the spouses, measured by EQ VAS (β=−0.18, P<0.05). Having a type D personality was associated with worse HRQoL in both groups. In addition, a significant negative partner effect for type D personality among survivors on HRQoL of their spouses was found for EQ VAS (β=−0.24, P<0.01) but not for EQ index. No significant partner effects for type D personality in spouses were detected (Figure 2).

Discussion

To the best of our knowledge, this is the first study using dyadic analyses to investigate HRQoL and its associations with type D personality and perceived control, in CA survivors and their spouses. Both perceived control and type D personality were significantly associated with HRQoL in the APIM models. Having a type D personality and perceiving less control were associated with lower HRQoL. In the APIM models, actor effects (five of eight possible) were more common than partner effects (two of eight possible).

Type D personality and perceived control displayed significant associations (actor effects) with HRQoL among survivors. Type D personality and perceived control have both previously been reported to be associated with HRQoL in CA survivors implanted with an ICD.⁹ The present study contributes by suggesting that these results are transferable to CA survivors in general. In addition, type D personality displayed a significant actor effect for spouses’ HRQoL. These results might contribute important knowledge for healthcare professionals, involved in post-CA follow-up, to be able to find and support those at risk of experiencing health problems. Cardiac rehabilitation including stress management and social interactions is reported to reduce ‘type D characteristics’ and improve quality of life in CAD patients.²⁷ In addition, psychosocial risk factors such as type D personality might obstruct the effects of CA rehabilitation and the lifestyle changes important for secondary prevention.²⁸ In CAD patients, perceived control is associated with fewer cardiac complications.²⁹ In addition, cardiopulmonary resuscitation training increased the level of perceived control in spouses post-CA.¹⁷ Efforts to increase the perception of control could therefore potentially be a target for nursing interventions and for supporting HRQoL in CA survivors and spouses.

Both type D personality and perceived control among survivors were associated with HRQoL in their spouses, that is, significant partner effects were found. These results are in contrast to other cardiovascular APIM studies, in which partner effects of spouses’ characteristics on patients’ HRQoL are more common.²⁰ In the present study, spouses appear to be sensitive to characteristics of their partners (the survivors), but not vice versa. A systematic review concluded that dyadic psychological interventions had positive effects in patients with CAD and their spouses. The interventions, aimed at facilitating the adjustment to experiencing CAD, contributed to better HRQoL and lower blood pressure among patients, and reduced emotional distress among their spouses.³⁰ Emotional distress in one of the partners, as a reaction to an event, might induce a similar response in the other, while health-related behaviours such as exercise, diet and sleep could be transmitted and shared.³¹ Although previous CA research has not been able to report any positive effects of interventions targeting relatives’ HRQoL,¹² including them in post-CA care is recommended in guidelines.⁷

Actor effects were less common among spouses compared to survivors. In addition, no partner effects in spouses were significantly associated with HRQoL in survivors. The reasons for this are not obvious. A previous randomised controlled study, testing a structured nurse-led follow-up intervention post-CA, reported positive effects on emotional health among survivors, but not among relatives.¹² Perhaps it is more difficult to identify associations and influence outcomes among spouses, when much initial focus after CA is probably put on the survivors. Spouses might consider it necessary to conceal their own problems and needs,³ which might also influence the results of clinical studies. Dyadic studies might contribute to a better understanding of previous research and help to design new studies. Finally, as many survivors are reported to have cognitive problems, they might not be sensitive to reactions in their spouses. The differences could also be a consequence of the measures being more suitable for patients. This ought to be evaluated further.

To summarise, the higher number of actor effects compared to partner effects is consistent with previous studies, using dyadic analyses, in other cardiovascular populations. In previous studies, for example, that by Chung et al.²⁰ and the present study, in which partner effects (in APIM) are present, the actor effects are greater. It is likely that personality factors, such as type D personality and perceived control, strongly influence individual experiences of HRQoL. Therefore, it is likely that the associations are greater for each individual than between individuals. However, the partner effects we identified suggest that including spouses in post-CA care is important, especially in survivors with type D personality and low levels of perceived control.

Limitations

This study has some limitations. No a priori power analysis was conducted for this study, as it is part of a larger project. However, the APIM is a simple model which includes one predictor for analysing dyadic data, and therefore the sample size could be considered sufficient.²³ The cross-sectional design does not allow any firm conclusions regarding cause and effect. In addition, we did not have access to data on participants’ conditions prior to the CA. Moreover, the results may not be fully generalisable to countries culturally different from Sweden. However, the results contribute to a better understanding of dyadic associations and might help designing new interventions.

Although, subjective self-reported measures such as the EQ-5D might be affected by daily stressors, they provide important knowledge from the perspective of patients/spouses. In general, HRQoL among the participants was good. However, difficulties in including those with the poorest functional outcome might lead to overestimating HRQoL among survivors and spouses. In addition, by using generic measures, we cannot be sure if reported health problems are a consequence of the CA. Hence, there is a need for condition-specific measurements in order to evaluate health-promoting interventions better and improve care.

Conclusion

Type D personality and perceived control in CA survivors were associated with their own HRQoL. In their spouses, a significant association was found for type D personality but not for perceived control. In addition, type D personality and perceived control in survivors were associated with HRQoL in their spouses. Therefore, type D personality and perceived control are factors that might be considered during post-CA care, in which spouses should be included. More research is needed to test psychosocial interventions in the CA population in order to improve HRQoL.

Footnotes

Acknowledgements

The authors would like to thank Lillemor Håkansson, Emilie Bertilsson, Gunilla Edholm, Monica Jonsson, Maria Pettersson, Elisabeth Ericsson and Katarina Bång for their help with the data collection, and Jean E Stevenson for reviewing the language. A special thanks to the participating survivors and their spouses.

Implications for practice

Screening for type D personality and assessing the level of perceived control in survivors and their spouses might be important in post-cardiac arrest care to identify those at risk of experiencing health problems.

Including spouses in post-cardiac arrest care is potentially important, especially as their health-related quality of life is associated with characteristics among survivors.

Efforts to reduce stress and support the level of perceived control might be beneficial, but further evaluation is needed.

Declaration of conflicting interests

The authors declare that there is no conflict of interest.

Fundings

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: the Swedish Heart and Lung Association and the Medical Research Council of Southeast Sweden contributed by funding this study.

References

Berdowski

Berg

Tijssen

, et al. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation 2010; 81: 1479–1487.

Herlitz

The Swedish national register for cardiopulmonary resuscitation – Annual report 2017 [Swe: Svenska hjärt-lungräddningsregistrets årsrapport 2017]. Gothenburg: The Swedish national register for cardiopulmonary resuscitation, 2017.

Bremer

Dahlberg

Sandman

Experiencing out-of-hospital cardiac arrest: significant others’ lifeworld perspective. Qual Health Res 2009; 19: 1407–1420.

Haydon

van der Riet

Inder

A systematic review and meta-synthesis of the qualitative literature exploring the experiences and quality of life of survivors of a cardiac arrest. Eur J Cardiovasc Nurs 2017; 16: 475–483.

Haydon

van der Riet

Inder

Long-term survivors of cardiac arrest: a narrative inquiry. Eur J Cardiovasc Nurs. Epub ahead of print 18 April 2019. DOI: 10.1177/1474515119844717.

Marshall

Haywood

Fitzpatrick

Impact of patient-reported outcome measures on routine practice: a structured review. J Eval Clin Pract 2006; 12: 559–568.

Nolan

Soar

Cariou

, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95: 202–222.

Karimi

Brazier

Health, health-related quality of life, and quality of life: what is the difference?

Pharmacoeconomics 2016; 34: 645–649.

Israelsson

Thylen

Stromberg

, et al. Factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter-defibrillator. Resuscitation 2018; 132: 78–84.

10.

Smith

Andrew

Lijovic

, et al. Quality of life and functional outcomes 12 months after out-of-hospital cardiac arrest. Circulation 2015; 131: 174–181.

11.

Moulaert

Verbunt

van Heugten

, et al. Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review. Resuscitation 2009; 80: 297–305.

12.

Moulaert

van Heugten

Winkens

, et al. Early neurologically focused follow-up after cardiac arrest improves quality of life at one year: a randomised controlled trial. Int J Cardiol 2015; 193: 8–16.

13.

Denollet

DS14: standard assessment of negative affectivity, social inhibition, and type D personality. Psychosom Med 2005; 67: 89–97.

14.

Grande

Romppel

Barth

Association between type D personality and prognosis in patients with cardiovascular diseases: a systematic review and meta-analysis. Ann Behav Med 2012; 43: 299–310.

15.

Versteeg

Spek

Pedersen

, et al. Type D personality and health status in cardiovascular disease populations: a meta-analysis of prospective studies. Eur J Prev Cardiol 2012; 19: 1373–1380.

16.

Moser

Dracup

Psychosocial recovery from a cardiac event: the influence of perceived control. Heart Lung 1995; 24: 273–280.

17.

Moser

Dracup

Impact of cardiopulmonary resuscitation training on perceived control in spouses of recovering cardiac patients. Res Nurs Health 2000; 23: 270–278.

18.

Zimmerli

Tisljar

Balestra

, et al. Prevalence and risk factors for post-traumatic stress disorder in relatives of out- of-hospital cardiac arrest patients. Resuscitation 2014; 85: 801–808.

19.

Wachelder

Moulaert

van Heugten

, et al. Life after survival: long-term daily functioning and quality of life after an out-of-hospital cardiac arrest. Resuscitation 2009; 80: 517–522.

20.

Chung

Moser

Lennie

, et al. The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: testing dyadic dynamics using Actor-Partner Interdependence Model. J Psychosom Res 2009; 67: 29–35.

21.

Human Experimentation: Code of Ethics of the World Medical Association (Declaration of Helsinki). Br Med J 1964; 2: 177.

22.

von Elm

Altman

Egger

, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007; 335: 806–808.

23.

Herdman

Gudex

Lloyd

, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011; 20: 1727–1736.

24.

Haywood

Whitehead

Nadkarni

, et al. COSCA (Core Outcome Set for Cardiac Arrest) in adults: an advisory statement from the International Liaison Committee on Resuscitation. Resuscitation. Epub ahead of print 1 May 2018. DOI: 10.1016/j.resuscitation.2018.03.022.

25.

Arestedt

Agren

Flemme

, et al. A psychometric evaluation of the four-item version of the Control Attitudes Scale for patients with cardiac disease and their partners. Eur J Cardiovasc Nurs 2015; 14: 317–325.

26.

Kenny

Cook

Partner effects in relationship research: conceptual issues, analytic difficulties, and illustrations. Pers Relationship 1999; 6: 433–448.

27.

Karlsson

Edstrom-Pluss

Held

, et al. Effects of expanded cardiac rehabilitation on psychosocial status in coronary artery disease with focus on type D characteristics. J Behav Med 2007; 30: 253–261.

28.

Pogosova

Saner

Pedersen

, et al. Psychosocial aspects in cardiac rehabilitation: from theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. Eur J Prev Cardiol 2015; 22: 1290–1306.

29.

McKinley

Fien

Riegel

, et al. Complications after acute coronary syndrome are reduced by perceived control of cardiac illness. J Adv Nurs 2012; 68: 2320–2330.

30.

Reid

Ski

Thompson

DR.

Psychological interventions for patients with coronary heart disease and their partners: a systematic review. PloS One 2013; 8: e73459.

31.

Kiecolt-Glaser

Wilson

SJ.

Lovesick: how couples’ relationships influence health. Annu Rev Clin Psychol 2017; 13: 421–443.

Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor–partner interdependence model

Abstract

Background:

Aims:

Methods:

Results:

Conclusions:

Keywords

Introduction

Methods

Study design

Setting and participants

Measurements

EuroQol-5D-5 level

Control attitude scale

Instrument for detecting type D personality

Data analyses

Results

Associations between perceived control and HRQoL

Associations between type D personality and HRQoL

Discussion

Limitations

Conclusion

Footnotes

Acknowledgements

Declaration of conflicting interests

Fundings

References